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Nutrition

Key Points

Adequate dietary consumption is important in maintaining bone health.

Age and gender, but not level of injury, predict total caloric intake in individuals with SCI.

Individuals with SCI are at a significant risk for malnutrition.

VFSS, BSE and FEES are all appropriate screening tools for diagnosing dysphagia in individuals with SCI.

Several risk factors for dysphagia in individuals with SCI exist, the most common being presence of a tracheostomy, ventilator use, increasing age, and presence of a nasogastric tube.

Individuals with tetraplegia have higher rates of altered glucose metabolism.

Impaired gallbladder emptying is seen in diabetic and obese SCI individuals.

Strict guidelines for diet and exercise interventions are important for patients with SCI due to the inconsistent nature of their energy balance causing weight gain leading to obesity.

A combined diet and exercise program can help patients reduce weight following SCI without compromising total lean mass and overall health.

A diet intervention focusing on anti-inflammatory foods and supplements can reduce inflammation serum markers, but may not show improvement in motor nerve conduction.

Participation in a holistic wellness program is positively associated with improved eating and weight-related behaviours in persons with SCI.

A combined nutrition, exercise and behaviour modification program can help persons with SCI increase metabolically active lean tissue, work efficiency, resting oxygen uptake and strength.

Having a high social participation is positively associated with better self-rated health, and receiving sufficient social support is positively associated with a greater dietary satisfaction, in persons with SCI.

Having a positive perceived food environment is associated with higher physical and mental scores of health-related quality of life, and higher diet satisfaction in persons with SCI.

Dietary counseling alone does significantly improve results in lipid profile; consultation with a registered dietitian should be obtained as individualized diets may enhance compliance.

Blood concentrations of DHA and EPA increased as a result of supplementation; however, no significant changes in lipid profile were identified.

DHA and EPA supplementation increase upper body strength and endurance in persons with SCI.

Vitamin D deficiency is highly prevalent in individuals with chronic SCI.

Individuals with SCI should be screened for vitamin D deficiency according to guideline practices and, if when necessary, replacement therapy should be initiated.

Clinicians should conduct early screening for and treatment of vitamin B12 deficiency.

Creatine supplementation does not result in improvements in muscle strength, endurance or function in weak upper limb muscles.

Creatine supplementation enhances exercise capacity in persons with complete tetraplegia and may promote greater exercise training benefits.

Consumption of a standard liquid meal does not change blood pressure, heart rate or noradrenalin levels in individuals with tetraplegia and postural hypotension.

The consumption of a whey protein plus carbohydrate supplement following fatiguing ambulation improves subsequent ambulation by increasing distance, time to fatigue and caloric expenditure in persons with incomplete SCI.

Nutrient-induced thermogenesis is not decreased in tetraplegic individuals with low sympathoadrenal activity; efferent sympathoadrenal stimulation from the brain is not necessary for nutrient-induced thermogenesis.

Impairment of sympathetic control of the kidney secondary to SCI resulting in tetraplegia does not impact renal sodium conservation in response to dietary salt restriction.

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