Cardiovascular disease appears prematurely in persons with SCI. It is the most frequent cause of death among persons surviving more than 30 years following injury and accounts for 45% of all SCI deaths (Devivo et al. 1999). Abnormalities in lipid metabolism develop shortly after injury and tend to progress over time (Bauman et al. 1992; Brenes et al. 1986; Kocina 1997; Szlachcic et al. 2001). Despite the high risk for CVD morbidity and mortality in individuals with SCI, few studies have addressed the benefits of risk reduction interventions aimed at modifiable factors and those that exist have been limited to exercise interventions. This section discusses what is known about the value of nutrition counseling in improving dyslipidemia in persons with SCI.
Szlachcic et al. (2001) evaluated the effects of dietary education for individuals with SCI at least two years post-injury who had moderately elevated total cholesterol levels (>5.2mmol/L) and reported significant decreases in total and low-density lipoprotein cholesterol (LDLC). Individuals who were assessed at baseline as having total cholesterol (TC) values >5.2 mmol/L (200 mg/dL) were referred to the staff registered dietitian for counseling. Specifically, individuals were advised to limit daily fat intake to<30% of total daily calories (kcal), daily saturated fat intake to<10%, dailycholesterol intake to<300 mg and to consume 60% of total daily calories as carbohydrate. Subjects in the treatment group were seen by a dietitian at least twice to assess their dietary compliance. The remaining 136 subjects (control group) did not receive nutrition consultation. Subjects in the treatment group were significantly older and were a greater number of years post injury than those in the control group; therefore, changes in lipid profile were analyzed controlling for differences in age and duration post-injury. A greater number of individuals in the treatment group demonstrated a significant decrease in TC (69%) compared to the control group (43%). These declines were also demonstrated for LDL in the treatment and control group (67% versus 47%, respectively). There were no significant changes in HDL for either group although one third of all subjects in both groups had HDLC values below the recommended range at baseline. Finally, 60% of the treatment group and 45% of control group had declines in triglycerides levels.
There is level 2 evidence from one prospective controlled trial (Szlachic et al., 2001) that standard dietary counseling (total fat <30% of kcal, saturated fat <10% of kcal, cholesterol <300 mg, carbohydrate 60% of kcal) can reduce total and LDL cholesterol among individuals with SCI who have total cholesterol >5.2 mmol/L.
- Dietary counseling results in improved lipid profile; consultation with a registered dietitian should be obtained, because individualized diets may enhance compliance.