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

Abstract

Many persons with spinal cord injury (SCI) have one or more preventable chronic diseases related to excessive caloric intake, and poor eating patterns. Appropriate nutrient consumption relative to need becomes a concern despite authoritative dietary recommendations from around the world. These recommendations were developed for the nondisabled population and do not account for the injury-induced changes in body composition, hypometabolic rate, hormonal dysregulation, and nutrition status after SCI. 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. In this compressive review, we briefly evaluate aspects of energy balance and appetite control relative to SCI. We report on the evidence regarding energy expenditure, nutrient intake, and their relationship after SCI. We compare this data to several established nutritional guidelines from American Heart Association, Australian Dietary Guidelines, Dietary Guidelines for Americans, Institute of Medicine Dietary Reference Intake, Public Health England Guidelines Government Dietary Recommendations, World Health Organization Healthy Diet, and the Paralyzed Veterans of America (PVA) Clinical Practice Guidelines. We also provide practical assessment and nutritional recommendations to facilitate a healthy dietary pattern after SCI. Because of a lack of strong SCI research, there are currently limited dietary recommendations outside of the PVA guidelines that capture the unique nutrient needs after SCI. Future multicenter clinical trials are needed to develop comprehensive, evidence-based dietary reference values specific for persons with SCI across the care continuum that rely on accurate, individual assessment of energy need.

Comparison of Various Indices in Identifying Insulin Resistance and Diabetes in Chronic Spinal Cord Injury

“…All participants completed informed consent that was approved by the Institutional Review Board at the host institution. Inclusion criteria included (1) men and women from 18 to 65 years old, with maximum age chosen to avoid any confounding influences of age on body composition; (2) C4-L2 motor complete (American Spinal Injury A & B [ 48 ]) individuals; and (3) at least one year post-SCI, as by this time body composition changes stabilize [ 49 ]. Only individuals with complete SCI were studied to ensure a homogeneous study sample and to limit the potential influence of incomplete versus complete SCI on body composition [ 50 , 51 ].…”

The Diagnosis and Management of Cardiometabolic Risk and Cardiometabolic Syndrome after Spinal Cord Injury

“…CMS and its component risk factors are strongly attributed to obesity [13]. Obesity develops from a positive energy balance where total daily energy intake exceeds total daily energy expenditure (Figure 3) [27][28][29][30][31][32][33][34], thus making people with SCI susceptible to this risk factor and CMS [35]. In this narrative review, we provide the latest evidence on and the etiopathogenesis of cardiometabolic risk after SCI.…”

“…Suboptimal diet [ 161 ] and sedentary behavior/physical inactivity [ 8 , 9 ] are also among the leading modifiable risk factors for cardiovascular disease and all-cause mortality worldwide. For people with SCI, a sedentary lifestyle is either involuntarily or voluntarily adopted [ 139 , 140 , 141 , 142 ], and poor dietary patterns are often observed [ 29 , 30 , 32 , 34 ]. Although algorithms for mitigating CMS have not been designed using SCI-specific thresholds for each risk factor, current strategies can be generally used to guide risk reduction.…”

“…Lifestyle modifications after SCI focus on mitigating cardiometabolic risk by increasing energy expenditure through physical activity or exercise [ 49 ] and reducing energy intake via a heart-healthy dietary pattern [ 27 , 29 , 30 , 31 , 32 , 33 , 34 ]. Clinical trials investigating the impact of exercise plus dietary intervention on cardiometabolic risk have been limited to date [ 170 , 171 ].…”

“…CMS and its component risk factors are strongly attributed to obesity [ 13 ]. Obesity develops from a positive energy balance where total daily energy intake exceeds total daily energy expenditure ( Figure 3 ) [ 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ], thus making people with SCI susceptible to this risk factor and CMS [ 35 ].…”