Energy expenditure and nutrient intake after spinal cord injury: a comprehensive review and practical recommendations

Br J Nutr, 2022 · DOI: 10.1017/S0007114521003822 · Published: September 14, 2022

Spinal Cord Injury Nutrition & Dietetics Rehabilitation

Simple Explanation

Spinal cord injury (SCI) can lead to changes in the body that affect how energy is used and how nutrients are processed. This can result in chronic diseases if energy intake is too high and eating patterns are poor. Because evidence-based dietary reference intake values for SCI do not exist, ensuring appropriate consumption of macronutrient and micronutrients for their energy requirements becomes a challenge. This review evaluates energy balance, appetite control, energy expenditure, and nutrient intake in individuals with SCI, comparing this data with nutritional guidelines and providing practical assessment and nutritional recommendations to facilitate a healthy dietary pattern after SCI.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Not specified

Key Findings

1
Individuals with SCI often have an increased risk of neurogenic obesity, which results from dysfunction of energy metabolism, physical deconditioning, and altered hormonal homeostasis.
2
Energy expenditure is reduced in persons with chronic SCI. TDEE is reduced in persons with chronic SCI by as much as 54 % in persons with tetraplegia and nearly 20 % in individuals with paraplegia
3
Existing dietary guidelines are primarily designed for the non-disabled population and may not adequately address the unique nutritional needs of individuals with SCI.

Research Summary

This review highlights the importance of considering the unique metabolic and physiological changes that occur after SCI when developing nutritional recommendations. The authors emphasize the need for individualized assessment of energy needs through indirect calorimetry and the importance of adopting a healthy dietary pattern that focuses on whole foods and limits processed foods, saturated fats, and sodium. Future research should focus on developing comprehensive, evidence-based dietary reference values specific for persons with SCI to reduce secondary complications.

Practical Implications

Individualized Nutritional Assessment

Healthcare professionals should perform comprehensive nutritional assessments, including indirect calorimetry, to accurately determine energy needs for individuals with SCI.

Adherence to SCI-Specific Guidelines

Persons with SCI and their healthcare team should follow the PVA guidelines, and it is the strongest evidence-based dietary guidelines for the population with SCI.

Focus on Dietary Patterns

Encourage a shift towards whole food-based diets with emphasis on reducing refined carbohydrates, sodium and saturated fats, and improving intake of unsaturated fats and fibre.

Study Limitations

1
Limited dietary recommendations outside of the PVA guidelines that capture the unique nutrient needs after SCI.
2
Small sample sizes in SCI literature relative to non-disabled research restricts the depth of conclusions.
3
Reliance on self-reported dietary intake, which can be subject to underreporting, especially in individuals with higher levels of injury.

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