By Carleton Rivers, MS, RD, LD
In February 2013, Khalil et al published a review article in Aging and Disease summarizing the available evidence on how carbohydrate, fat and protein impact an individual’s health status after a spinal cord injury (SCI). Because specific nutrients are needed for growth, repair and maintenance of the body, it is imperative that healthcare professionals understand the physiological changes occurring after an SCI that can result in obesity, as well as different types of disease.
Researchers have found that the risk of developing carbohydrate disorders is three times greater in individuals with an SCI compared to their able-bodied counterparts. Reasons for this amplified risk include increased plasma glucose due to the release of glycogen during muscle atrophy; increased adipose tissue resulting from unused glucose stored as fat due to decreased physical activity; and glucose intolerance due to increased intramuscular fat following an SCI. When studying fiber consumption, researchers found that high dietary fiber in clients with SCI does not have the same effect on bowel movements as in able-bodied individuals. Recommended levels of dietary fiber should be individualized to accomplish desired bowel function.
During the first few weeks after an SCI, individuals have persistent negative nitrogen balance, which leads to significant skeletal muscle atrophy. The recommended protein amount needed to offset the rapid decline in lean mass after injury is unclear; however, evidence shows that protein needs for individuals with pressure ulcers can exceed 1.2 grams/kg of body weight and may even reach 2 gram/kg for grades III and IV pressure ulcers. To maintain protein stores, individuals with an SCI should consume 0.8 to 1.0 grams of protein/kg of body weight. Albumin and pre-albumin levels are commonly used to assess a person’s nutritional status specific to protein consumption. It is important to understand that albumin/pre-albumin levels can be influenced by factors other than nutritional intake. For example, traumatic events or acute illness can lower albumin/pre-albumin levels despite sufficient dietary intake. Inflammation in the body has been shown to deplete nutrients, making a nutrition intervention necessary for preventing nutritional deficiencies in individuals with an SCI.
High-fat diets have been shown to be common in individuals with an SCI. When too much fat is consumed, excess fat is stored in adipose tissue, leading to obesity. Obese individuals with SCI have a greater chance of developing cardiovascular disease, diabetes, altered lipid profiles and metabolic syndrome. Consuming monounsaturated fatty acids in place of saturated fat has been shown to be beneficial for those individuals with lipid and carbohydrate disorders. Physical activity has also been shown to improve lipid profiles in individuals with an SCI.
After reviewing the current literature on physiological adaptations affecting macronutrient requirements in individuals with an SCI, Khalil et al were able to conclude that assessing nutritional status and goal setting is strongly recommended during acute, sub-acute and chronic phases of rehabilitation after SCI. Dietary modifications should be made for carbohydrates, proteins and fats, as well as total energy intake, to reduce the risk of obesity, cardiovascular disease, diabetes and metabolic syndrome. To ensure greater compliance with lifestyle changes, SCI clients should receive nutrition counseling that emphasizes the risks that accompany poor nutrition.
Source
Khalil RE, Gorgey AS, Janisko M, Dolbow DR, Moore JR, Gater DR. The Role of Nutrition in Health Status after Spinal Cord Injury. Aging and Disease, 2013;4(1):14-22.