Malnutrition in Spinal Cord Injury: More Than Nutritional Deficiency

Abstract

Denervation of the spinal cord below the level of injury leads to complications producing malnutrition. Nutritional status affects mortality and pathology of injured subjects and it has been reported that two thirds of individuals enrolled in rehabilitation units are malnourished. Therefore, the aim should be either to maintain an optimal nutritional status, or supplement these subjects in order to overcome deficiencies in nutrients or prevent obesity. This paper reviews methods of nutritional assessment and describes the physiopathological mechanisms of malnutrition based on the assumption that spinal cord injured subjects need to receive adequate nutrition to promote optimal recovery, placing nutrition as a first line treatment and not an afterthought in the rehabilitation of spinal cord injury.

Investigation of measured and predicted resting energy needs in adults after spinal cord injury: a systematic review

“…SCI is initially associated with catabolic conditions of trauma such as spinal shock and patients may be at risk of weight loss, malnutrition and pressure injuries. 1 In the long term, SCI results in marked body composition changes, specifically muscle atrophy below the level of injury and higher relative fat mass compared with people without SCI, [1][2][3] which may contribute to decreases in resting energy expenditure (REE). In an environment of reduced mobility, energy needs are further reduced, and there is an increased risk of weight gain and obesity-related chronic diseases.…”

Métodos de avaliação da composição corporal de adultos com lesão medular: uma revisão

“…Dentro dessa magnitude de métodos e instrumentos constatou-se algumas normativas acerca dos parâmetros de avaliação: os profissionais da saúde que utilizam esses métodos o fazem para obterem estratégias e/ou intervenções mais adequadas para essa população; os mesmos estão atentos a precisão dos instrumentos e os possíveis equívocos ligados a estimação de componentes corporais de indivíduos com lesão medular; a falta de fidedignidade dos resultados das avaliações antropométricas, indicando que o IMC, pregas cutâneas, circunferência de cintura, não servem como uma variável a fim de diagnosticar excesso de gordura corporal, tendo em vista a falta de parâmetros específicos para essa população (BUCHHOLZ; BUGARESTI, 2005;GATER, 2005;ERIKS-HOOGLAND et al, 2011;GATER, 2007;GORGEY et al, 2010a;DIONYSSIOTIS, 2012).…”

“…Considerando-se a relação entre a lesão medular e a modificação da CC, enfatizase a importância da avaliação da CC em pessoas imobilizadas (EDWARDS et al, 2008;GORGEY et al, 2010;CRANE et al, 2011;DOLBOW et al, 2012), principalmente para averiguar a taxa de redução da massa magra corporal, que é uma variável relacionada ao risco nutricional (GRIFFIN et al, 2009;GATER, 2012;DIONYSSIOTIS, 2012) e, por ser considerado a principal reserva de proteínas corporais, é responsável pelo direcionamento da produção de anticorpos, a cicatrização de feridas e a produção de células brancas do sangue, tanto em lesões agudas como crônicas (RIBEIRO et al, 2011;DIONYSSIOTIS, 2012). Logo, se ocorre uma depleção abrupta do músculo esquelético, isto significa menor quantidade de proteínas que garantem um estado nutricional adequado e a saúde do sistema imunológico.…”

Analysis of the dietary habits and nutritional status of patients with spinal cord injury after nutritional intervention

“…5 It is noteworthy that the reduction in physical activity may lead to a reduction of muscle mass by atrophy, in addition to reducing bone mass (especially below the injury location) and increasing fat mass. 7,8 Physiological, pathological, psychological, dietary, and environmental factors may influence the nutritional status of individuals with SCI, 9 with pressure ulcers and osteoporosis as the frequent complications that can affect the nutritional profile of these patients even more. [10][11][12] Pressure ulcers are present in approximately 35% of these individuals, resulting in serious medical and psychosocial complications, as well as in the increase of health costs, interfering in the quality of life.…”