22 ABSTRACT 23 Study design Experimental study 24 Objectives To compare lipid metabolism in individuals with a cervical spinal cord injury (SCIC) 25 and able-bodied (AB) persons in response to mild cold stress. 26 Settings Laboratory of Wakayama Medical University, Japan. 27 Methods Nine males with SCIC and 11 AB wore a water-perfusion suit in a supine position. 28 Following 30-min rest thermoneutrality, the whole body was cooled by perfusing 25°C water 29 through the suit for 15-20 minutes (CS). Blood samples were collected before, immediately, and 60 30 (post-CS60) and 120 minutes after CS (post-CS120). Concentrations of serum free fatty acid 31 ([FFA]s), total ketone bodies ([tKB]s), insulin ([Ins]s) and plasma adrenaline ([Ad]p), noradrenaline 32 ([NA]p) and glucose ([Glc]p) were assessed. 33 Results [Ad]p in SCIC were lower than AB throughout the study (p=0.0002) and remained largely 34 unchanged in both groups. [NA]p increased after cold stress in AB only (p<0.0001; GxT p=0.006). 35 [FFA]s increased by 62% immediately after cold stress in SCIC (p=0.0028), without a difference 36 between groups (p=0.65). [tKB]s increased by 69% at post-CS60 and 132% at post-CS120 from the 37 start in SCIC with no differences between groups (p=0.54). [Glc]p and [Ins]s were reduced in SCIc 38 only (GxT p=0.003 and p=0.001, respectively). 39 Conclusion These data indicate that mild cold stress acutely elevates lipid and ketone body 40 metabolism in persons with SCIc, despite the presence of sympathetic dysfunction.