"People with spinal cord injuries have unique nutrition issues," said Vickeri Barton, associate director of nutrition at Harborview Medical Center. "Partly this is due to changes in body composition and metabolism, partly to changes in activity level, and partly to the barriers to preparing meals, shopping, and so on." All these factors may make it harder to maintain good nutrition after SCI.
Barton is well-versed in the nutritional needs of SCI patients. She worked in Harborview''s Trauma and Rehab Medicine units for 20 years, where she saw patients with acute SCI and helped with early nutritional issues such as swallowing problems, tube feedings, and weight loss. In the last five years she has been working in outpatient care, helping patients with long-term nutrition issues, including weight gain. Barton is part of the multidisciplinary team approach to comprehensive SCI care.
Why are nutrition and weight management important after SCI?
There is an increased risk for diabetes, elevated cholesterol and obesity . A 2005 study 1 of 22 men with paraplegia found that subjects with lower physical activity levels had lower levels of HDL (high-density lipoproteins, known as the "good" cholesterol), higher fasting glucose, larger abdominal girth, higher triglycerides, and higher chronic inflammation-together these factors contribute to the "metabolic syndrome profile, which puts you at greater risk for heart disease and diabetes," Barton explained. "There''s a tendency to gain weight in around the middle for a variety of reasons-partly the loss of abdominal muscle, partly inactivity-but whether that means that you''re set up automatically for metabolic syndrome is not well understood yet." What is clear, however, is the need to focus on minimizing or reversing these tendencies; nutrition plays an important role in this.
Weight gain affects mobility and independence. "Weight gain makes it harder to push your wheelchair and puts you at greater risk for skin breakdown because you have more weight on your bottom."
Weight gain can increase expenses. "You may need to buy a larger wheelchair or hire attendants to help with transfers."
There is a risk of getting pressure ulcers. Nutrition is important in maintaining healthy skin and in healing wounds if pressure sores have already occurred.
There is an increased risk for osteoporosis . Again, nutrition can help keep bones stronger and prevent fractures.
What is a desirable weight?
Right after injury, people lose a significant amount of weight. "It''s not uncommon for a young man to lose 40 lbs. while in the hospital," Barton reported. "And a lot of that is the initial loss of muscle mass due to inactivity. But before going home, weight starts to go up again." While there are no weight guidelines specifically for people with SCI, weight charts for the general public, such as those from life insurance companies, can be adjusted for use with the SCI population. To compensate for a reduction in muscle mass, the general rule is to subtract 5-10% for paraplegia and 10-15% for tetraplegia (quadriplegia). For example, if the desirable weight for a medium-build, 5-foot 11-inch man is around 160 lbs., the recommendation of a similar-size man with paraplegia would be 5%-10% less, or 144 lbs. to 152 lbs. For a man with tetraplegia, desirable weight would be even lower-136 lbs. to 144 lbs.
Weight is only one factor, however. More important is the amount of fat a person is carrying around. This is often determined using the body mass index (BMI), calculated by dividing your weight by your height. But Barton doesn''t use this on SCI patients, "because of the research evidence that BMI often underestimates body fat in SCI." A recent study compared 19 males with SCI to 19 non-injured males matched for age, height and weight. While the groups had similar BMIs, subjects with SCI averaged 8.9 kg less lean (muscle) mass, 7.1 kg more fat mass, 9.4% more body fat, and 3.7 kg more fat in the trunk than the non-injured controls. Fat mass refers to an actual measurement of the quantity of fat described by weight of the mass, whereas percent body fat refers to that amount of fat mass in comparison with the percent lean muscle mass and percent water the human body contains.
Estimating Calorie Needs
"People with SCI often ask me how many calories they need," Barton said. A formula to calculate calorie needs in SCI was developed in a 1985 study 3 that is still quoted widely today:
Persons with paraplegia: 27.9 calories times body weight in kg. (1 kg. = 2.2 lbs)