{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T10:12:44Z","timestamp":1792663964755,"version":"4.5.0"},"reference-count":146,"publisher":"American Spinal Injury Association","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021]]},"abstract":"Individuals with a spinal cord injury (SCI) have a unique physiology characterized by sarcopenia, neurogenic osteoporosis, neurogenic anabolic deficiency, sympathetic dysfunction, and blunted satiety associated with their SCI, all of which alter energy balance and subsequently body composition. The distinct properties of \u201cneurogenic obesity\u201d place this population at great risk for metabolic dysfunction, including systemic inflammation, hyperglycemia, dyslipidemia, and hypertension. The purpose of this article is to demonstrate the relationship between neurogenic obesity and the metabolic syndrome after SCI, highlighting the mechanisms associated with adipose tissue pathology and those respective comorbidities. Additionally, representative studies of persons with SCI will be provided to elucidate the severity of the problem and to prompt greater vigilance among SCI specialists as well as primary care providers in order to better manage the epidemic from a public health perspective.<\/jats:p>","DOI":"10.46292\/sci20-00067","type":"journal-article","created":{"date-parts":[[2021,3,19]],"date-time":"2021-03-19T13:48:42Z","timestamp":1616161722000},"page":"1-10","source":"Crossref","is-referenced-by-count":57,"title":["Pathophysiology of Neurogenic Obesity After Spinal Cord Injury"],"prefix":"10.46292","volume":"27","author":[{"given":"David R.","family":"Gater","sequence":"first","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida"},{"name":"The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary J.","family":"Farkas","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduard","family":"Tiozzo","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"25425","reference":[{"issue":"7","key":"i1082-0744-27-1-1-b1","series-title":"Obes Rev","first-page":"715","article-title":"Obesity: A chronic relapsing progressive disease process. 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hypertension and associated risk factors in people with long-term spinal cord injury living in the Netherlands.\n\t\t\t\t\tDisabil Rehabil.\n\t\t\t\t\t2017;\n\t\t\t\t\t39(\n\t\t\t\t\t9):\n\t\t\t\t\t919\u2013\n\t\t\t\t\t927."},{"issue":"2","key":"i1082-0744-27-1-1-b68","series-title":"Spinal Cord","first-page":"109","article-title":"Hypertension and antihypertensive treatment in veterans with spinal cord injury and disorders","volume":"51","year":"2013","unstructured":"Barry\n W,\n \n \n St Andre\n JR,\n \n \n Evans\n CT,\n \n \n .\n\t\t\t\t\tHypertension and antihypertensive treatment in veterans with spinal cord injury and disorders.\n\t\t\t\t\tSpinal Cord.\n\t\t\t\t\t2013;\n\t\t\t\t\t51(\n\t\t\t\t\t2):\n\t\t\t\t\t109\u2013\n\t\t\t\t\t115."},{"issue":"7","key":"i1082-0744-27-1-1-b69","series-title":"Spinal Cord","first-page":"494","article-title":"Serum leptin, abdominal obesity and the metabolic syndrome in individuals with chronic spinal cord 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A critical update","volume":"432","year":"2016","unstructured":"Laurent\n MR,\n \n \n Dubois\n V,\n \n \n Claessens\n F,\n \n \n .\n\t\t\t\t\tMuscle-bone interactions: from experimental models to the clinic? A critical update.\n\t\t\t\t\tMol Cell Endocrinol.\n\t\t\t\t\t2016;\n\t\t\t\t\t432:\n\t\t\t\t\t14\u2013\n\t\t\t\t\t36."},{"issue":"5","key":"i1082-0744-27-1-1-b12","series-title":"Spinal Cord","first-page":"343","article-title":"Bone mineral and hormone status in paraplegics","volume":"30","year":"1992","unstructured":"Finsen\n V,\n \n \n Indredavik\n B,\n \n \n Fougner\n KJ.\n \n \n Bone mineral and hormone status in paraplegics.\n\t\t\t\t\tSpinal Cord.\n\t\t\t\t\t1992;\n\t\t\t\t\t30(\n\t\t\t\t\t5):\n\t\t\t\t\t343\u2013\n\t\t\t\t\t347."},{"issue":"3","key":"i1082-0744-27-1-1-b13","series-title":"J Orthop Res","first-page":"371","article-title":"Osteoporosis after spinal-cord injury","volume":"10","year":"1992","unstructured":"Garland\n DE,\n \n \n Stewart\n CA,\n \n \n Adkins\n RH,\n \n \n .\n\t\t\t\t\tOsteoporosis after spinal-cord injury.\n\t\t\t\t\tJ Orthop Res.\n\t\t\t\t\t1992;\n\t\t\t\t\t10(\n\t\t\t\t\t3):\n\t\t\t\t\t371\u2013\n\t\t\t\t\t378."},{"issue":"1","key":"i1082-0744-27-1-1-b14","series-title":"J Spinal Cord Med","first-page":"32","article-title":"Age-related prevalence of low testosterone in men with spinal cord injury","volume":"37","year":"2014","unstructured":"Bauman\n WA,\n \n \n La Fountaine\n MF,\n \n \n Spungen\n AM.\n \n \n Age-related prevalence of low testosterone in men with spinal cord injury.\n\t\t\t\t\tJ Spinal Cord Med.\n\t\t\t\t\t2014;\n\t\t\t\t\t37(\n\t\t\t\t\t1):\n\t\t\t\t\t32\u2013\n\t\t\t\t\t39."},{"issue":"9","key":"i1082-0744-27-1-1-b15","series-title":"Am J Phys Med Rehabil","first-page":"758","article-title":"Testosterone levels among men with spinal cord injury \u2013 Relationship between time since injury and laboratory values","volume":"87","year":"2008","unstructured":"Clark\n MJ,\n \n \n Schopp\n LH,\n \n \n Mazurek\n MO,\n \n \n .\n\t\t\t\t\tTestosterone levels among men with spinal cord injury \u2013 Relationship between time since injury and laboratory values.\n\t\t\t\t\tAm J Phys Med Rehabil.\n\t\t\t\t\t2008;\n\t\t\t\t\t87(\n\t\t\t\t\t9):\n\t\t\t\t\t758\u2013\n\t\t\t\t\t764."},{"issue":"6","key":"i1082-0744-27-1-1-b16","series-title":"Horm Metab Res","first-page":"287","article-title":"Serum testosterone and growth-hormone insulin-like growth-factor-I in adults with spinal-cord injury","volume":"27","year":"1995","unstructured":"Tsitouras\n PD,\n \n \n Zhong\n YG,\n \n \n Spungen\n AM,\n \n \n .\n\t\t\t\t\tSerum testosterone and growth-hormone insulin-like growth-factor-I in adults with spinal-cord injury.\n\t\t\t\t\tHorm Metab Res.\n\t\t\t\t\t1995;\n\t\t\t\t\t27(\n\t\t\t\t\t6):\n\t\t\t\t\t287\u2013\n\t\t\t\t\t292."},{"issue":"12","key":"i1082-0744-27-1-1-b17","series-title":"Am J Phys Med Rehabil","first-page":"934","article-title":"Testosterone screening among men admitted to acute inpatient rehabilitation","volume":"83","year":"2004","unstructured":"Acuff\n ME,\n \n \n Clark\n M,\n \n \n Hagglund\n KJ,\n \n \n .\n\t\t\t\t\tTestosterone screening among men admitted to acute inpatient rehabilitation.\n\t\t\t\t\tAm J Phys Med Rehabil.\n\t\t\t\t\t2004;\n\t\t\t\t\t83(\n\t\t\t\t\t12):\n\t\t\t\t\t934\u2013\n\t\t\t\t\t935."},{"issue":"05","key":"i1082-0744-27-1-1-b18","series-title":"Sem Neurol","first-page":"550","article-title":"Cardiovascular autonomic dysfunction in spinal cord injury: epidemiology, diagnosis, and management","volume":"40","year":"2020","unstructured":"Wecht\n JM,\n \n \n Harel\n NY,\n \n \n Guest\n J,\n \n \n .\n\t\t\t\t\tCardiovascular autonomic dysfunction in spinal cord injury: epidemiology, diagnosis, and management.\n\t\t\t\t\tSem Neurol.\n\t\t\t\t\t2020;\n\t\t\t\t\t40(\n\t\t\t\t\t05):\n\t\t\t\t\t550\u2013\n\t\t\t\t\t559."},{"issue":"5","key":"i1082-0744-27-1-1-b19","series-title":"J Clin Endocrinol Metab","article-title":"Recharacterizing the metabolic state of energy balance in thrifty and spendthrift phenotypes","volume":"105","year":"2020","unstructured":"Hollstein\n T,\n \n \n Basolo\n A,\n \n \n Ando\n T,\n \n \n .\n\t\t\t\t\tRecharacterizing the metabolic state of energy balance in thrifty and spendthrift phenotypes.\n\t\t\t\t\tJ Clin Endocrinol Metab.\n\t\t\t\t\t2020;\n\t\t\t\t\t105(\n\t\t\t\t\t5)."},{"issue":"5","key":"i1082-0744-27-1-1-b20","series-title":"Sports Med","first-page":"393","article-title":"Interactions of metabolic hormones, adipose tissue and exercise","volume":"35","year":"2005","unstructured":"McMurray\n RG,\n \n \n Hackney\n AC.\n \n \n Interactions of metabolic hormones, adipose tissue and exercise.\n\t\t\t\t\tSports Med.\n\t\t\t\t\t2005;\n\t\t\t\t\t35(\n\t\t\t\t\t5):\n\t\t\t\t\t393\u2013\n\t\t\t\t\t412."},{"key":"i1082-0744-27-1-1-b21","series-title":"Front Physiol.","article-title":"Upper gastrointestinal dysmotility after spinal cord injury: Is diminished vagal sensory processing one culprit?","volume":"3","year":"2012","unstructured":"Holmes\n GM.\n \n 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the mitigating role of exercise.\n\t\t\t\t\tIn:TaylorJ,\n\t\t\t\t\ted.The Physiology of Exercise in Spinal Cord Injury.New York:\n\t\t\t\t\tSpringer Nature;\n\t\t\t\t\t2016:\n\t\t\t\t\t175\u2013\n\t\t\t\t\t198."},{"issue":"6","key":"i1082-0744-27-1-1-b24","series-title":"J Appl Physiol","first-page":"2398","article-title":"Factors influencing body composition in persons with spinal cord injury: a cross-sectional study","volume":"95","year":"2003","unstructured":"Spungen\n AM,\n \n \n Adkins\n RH,\n \n \n Stewart\n CA,\n \n \n .\n\t\t\t\t\tFactors influencing body composition in persons with spinal cord injury: a cross-sectional study.\n\t\t\t\t\tJ Appl Physiol.\n\t\t\t\t\t2003;\n\t\t\t\t\t95(\n\t\t\t\t\t6):\n\t\t\t\t\t2398\u2013\n\t\t\t\t\t2407."},{"issue":"6","key":"i1082-0744-27-1-1-b25","series-title":"Obesity (Silver Spring)","first-page":"1223","article-title":"Body mass index underestimates adiposity in women with spinal cord 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Gater\n DR.\n \n \n Cardiometabolic disease and dysfunction following spinal cord injury origins and guideline-based countermeasures.\n\t\t\t\t\tPhys Med Rehabil Clin North Am.\n\t\t\t\t\t2020;\n\t\t\t\t\t31(\n\t\t\t\t\t3):\n\t\t\t\t\t415\u2013+."},{"issue":"5","key":"i1082-0744-27-1-1-b33","series-title":"J Spinal Cord Med","first-page":"643","article-title":"Identification and management of cardiometabolic risk after spinal cord injury clinical practice guideline for health care providers","volume":"42","year":"2019","unstructured":"Nash\n MS,\n \n \n Groah\n SL,\n \n \n Gater\n DR,\n \n \n .\n\t\t\t\t\tIdentification and management of cardiometabolic risk after spinal cord injury clinical practice guideline for health care providers.\n\t\t\t\t\tJ Spinal Cord Med.\n\t\t\t\t\t2019;\n\t\t\t\t\t42(\n\t\t\t\t\t5):\n\t\t\t\t\t643\u2013\n\t\t\t\t\t677."},{"issue":"3","key":"i1082-0744-27-1-1-b34","series-title":"Am J Clin Nutr","first-page":"694","article-title":"Healthy percentage body 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hypertension and associated risk factors in people with long-term spinal cord injury living in the Netherlands.\n\t\t\t\t\tDisabil Rehabil.\n\t\t\t\t\t2017;\n\t\t\t\t\t39(\n\t\t\t\t\t9):\n\t\t\t\t\t919\u2013\n\t\t\t\t\t927."},{"issue":"2","key":"i1082-0744-27-1-1-b68","series-title":"Spinal Cord","first-page":"109","article-title":"Hypertension and antihypertensive treatment in veterans with spinal cord injury and disorders","volume":"51","year":"2013","unstructured":"Barry\n W,\n \n \n St Andre\n JR,\n \n \n Evans\n CT,\n \n \n .\n\t\t\t\t\tHypertension and antihypertensive treatment in veterans with spinal cord injury and disorders.\n\t\t\t\t\tSpinal Cord.\n\t\t\t\t\t2013;\n\t\t\t\t\t51(\n\t\t\t\t\t2):\n\t\t\t\t\t109\u2013\n\t\t\t\t\t115."},{"issue":"7","key":"i1082-0744-27-1-1-b69","series-title":"Spinal Cord","first-page":"494","article-title":"Serum leptin, abdominal obesity and the metabolic syndrome in individuals with chronic spinal cord injury","volume":"46","year":"2008","unstructured":"Maruyama\n Y,\n \n \n Mizuguchi\n M,\n \n \n Yaginuma\n T,\n \n \n .\n\t\t\t\t\tSerum leptin, abdominal obesity and the metabolic syndrome in individuals with chronic spinal cord injury.\n\t\t\t\t\tSpinal Cord.\n\t\t\t\t\t2008;\n\t\t\t\t\t46(\n\t\t\t\t\t7):\n\t\t\t\t\t494\u2013\n\t\t\t\t\t499."},{"issue":"4","key":"i1082-0744-27-1-1-b70","series-title":"J Spinal Cord Med","first-page":"485","article-title":"Classification of obesity, cardiometabolic risk, and metabolic syndrome in adults with spinal cord injury","volume":"43","year":"2020","unstructured":"Yahiro\n AM,\n \n \n Wingo\n BC,\n \n \n Kunwor\n S,\n \n \n .\n\t\t\t\t\tClassification of obesity, cardiometabolic risk, and metabolic syndrome in adults with spinal cord injury.\n\t\t\t\t\tJ Spinal Cord Med.\n\t\t\t\t\t2020;\n\t\t\t\t\t43(\n\t\t\t\t\t4):\n\t\t\t\t\t485\u2013\n\t\t\t\t\t496."},{"issue":"9","key":"i1082-0744-27-1-1-b71","series-title":"Spinal 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Rehabil.\n\t\t\t\t\t2021;\n\t\t\t\t\t27(\n\t\t\t\t\t1):\n\t\t\t\t\t109\u2013\n\t\t\t\t\t120.\n\t\t\t\t\tdoi:10.46292\/sci20-00058."},{"issue":"1","key":"i1082-0744-27-1-1-b73","series-title":"Top Spinal Cord Inj Rehabil","doi-asserted-by":"publisher","first-page":"100","DOI":"10.46292\/sci20-00031","article-title":"Dietetics after spinal cord injury: Current evidence and future perspectives","volume":"27","year":"2021","unstructured":"Farkas\n GJ,\n \n \n Sneij\n A,\n \n \n Gater\n DR.\n \n \n Dietetics after spinal cord injury: Current evidence and future perspectives.\n\t\t\t\t\tTop Spinal Cord Inj Rehabil.\n\t\t\t\t\t2021;\n\t\t\t\t\t27(\n\t\t\t\t\t1):\n\t\t\t\t\t100\u2013\n\t\t\t\t\t108.\n\t\t\t\t\tdoi:10.46292\/sci20-00031."}],"container-title":["Topics in Spinal Cord Injury 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