What We Do and What We Should Do Against Malnutrition in Spinal Cord Injury: A Position Paper From Italian Spinal Cord Injury Network Rehabilitation Centers

J Clin Med Res, 2024 · DOI: https://doi.org/10.14740/jocmr5015 · Published: April 30, 2024

Spinal Cord Injury Nutrition & Dietetics Rehabilitation

Simple Explanation

Spinal cord injury (SCI) significantly impacts body composition and alters energy and nutritional needs, placing patients at a high risk of malnutrition. Malnutrition can hinder optimal functional recovery, prolong hospital stays, increase hospital admissions, and contribute to the development of obesity and cardiovascular and metabolic ailments in chronic patients. Clear guidance is needed to support clinicians in managing the nutritional needs of patients with SCI at different stages of the disease: acute, post-acute, and post-discharge phases.

Study Duration

Not specified

Participants

Eight clinicians (five physiatrists, two internists, and one urologist) and one nurse

Evidence Level

Not specified

Key Findings

1
Patients with acute SCI typically exhibit an energy expenditure up to 54% lower than those without.
2
BMI is an unreliable method to assess nutritional status in SCI patients, especially in the acute and initial post-acute phases, because of changes in body composition.
3
A standardized dietary protocol for individuals with SCI can comprise carbohydrates for 45% of the total daily calories, fats for 30% and proteins for 25%.

Research Summary

Patients with SCI face a significant risk of malnutrition, necessitating adequate monitoring of their nutritional status over time and consideration of TDEE changes across different disease phases. Further research is needed to understand the impact of gender on the nutritional status of SCI patients, as current studies predominantly focus on males. A comprehensive healthcare team, including an RD, is essential to regularly assess nutritional status, implement lifestyle and dietary modifications, and prevent complications affecting prognosis and quality of life.

Practical Implications

Nutritional Guidelines

Establish and implement clear nutritional guidelines for SCI patients at different stages of the disease (acute, post-acute, post-discharge).

Standardized Assessment

Use standardized tools and protocols for nutritional assessment in SCI patients to ensure consistent and accurate monitoring across different spinal units.

Personalized Nutrition Plans

Develop personalized nutrition plans that consider individual energy needs, body composition, and potential complications to optimize patient outcomes.

Study Limitations

1
Lack of SCI-specific recommendations for differentiating between cachexia, age-related sarcopenia, and malnutrition.
2
Limited access to specialized equipment like DXA, BIA, CT, and MRI for body composition assessments.
3
Challenges in accurately measuring volitional food intake of inpatients due to reliance on external food sources.

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