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

Gary J Farkas, Alicia Sneij, David W McMillan, Eduard Tiozzo, Mark S Nash, David R Gater Jr, Gary J Farkas, Alicia Sneij, David W McMillan, Eduard Tiozzo, Mark S Nash, David R Gater Jr

Abstract

Many persons with spinal cord injury (SCI) have one or more preventable chronic diseases related to excessive energetic 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 non-disabled 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 these data with several established nutritional guidelines from American Heart Association, Australian Dietary Guidelines, Dietary Guidelines for Americans, Institute of Medicine Dietary Reference Intake, Public Health England Government Dietary Recommendations, WHO 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 multicentre 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.

Keywords: Alcohol; Carbohydrates; Diet; Energy expenditure; Energy intake; Fat; Fiber; Macronutrients; Micronutrients; Minerals; Nutrition; Protein; Spinal cord injury; Vitamins; energetic intake.

Conflict of interest statement

The authors attest that they have no financial or other conflicts of interest.

Figures

Fig. 1.
Fig. 1.
The neuroendocrine components involved in the regulation of energy balance relevant to spinal cord injury. Organs and systemic signaling pathways are represented with green lines (circulating hormonal signals), red (voluntary neurological signals) and blue (autonomic neurological signals). The pop-out shows the action of these signals on regions in the hypothalamus and brainstem. Legend: 3V, third ventricle; ARC, arcuate nucleus; Carbs, carbohydrates, CCK, cholecystokinin; DMH, dorsomedial hypothalamic nucleus; FGF, fibroblast growth factors; FFA, free fatty acids; GLP-1, glucagon-like peptide 1; lat, lateral nucleus; n., nerve; PVN, paraventricular nucleus; P-YY-3–36, peptide YY3–36; SN, substantia nigra; and VMH, ventromedial hypothalamic nucleus. , Humoral; , Autonomic; , Voluntary
Fig. 2.
Fig. 2.
Sequential dietary recommendations for persons with a spinal cord injury (SCI). First, BMR or RMR should be annually measured with indirect calorimetry or estimated using SCI-specific predictions equations (Nightingale and Gorgey(116), Chun et al.(105) or Buchholz et al.(79)) when indirect calorimetry is unavailable. Second, total daily energy expenditure should be estimated as the product of BMR or RMR and 1·15 for persons with SCI using the Farkas et al.(9) equation. Third, a registered dietician should oversee a healthy dietary pattern following the Clinical Practice Guidelines on Identification and Management of Cardiometabolic Risk after SCI and additional recommendations provided in this review(10).

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