Title: Long Term Nutritional Considerations with Spinal Cord Injury
1Long Term Nutritional Considerations with Spinal
Cord Injury
- Presented by
- Sarah Feasel, MEd, RD, LD
- Clinical Nutrition Manager
- National Rehabilitation Hospital
- Washington, DC
2Objectives
- Nutritional needs following SCI
- Calories and Metabolism
- Using food labels
- Secondary conditions of SCI related to diet
- Metabolic syndrome
- Overweight and Obesity
- Dietary Recommendations
- Conclusions
3Changing Nutritional Needs
- Nutritional needs change a great deal after SCI
- Calorie needs change the most
- Calorie needs decrease because of decreased
activity - Calorie needs also decrease because there is less
lean body tissue or muscle which promotes a
faster metabolism (how fast your body burns
calories)
4Putting it in Perspective
- After injury we see weight loss in our patients.
This is mainly due to loss of muscle or lean body
tissue. - If you dont use it you lose it!
5What are calories anyway?!?!
- Quick Calorie Lesson
- A calorie is a unit of measurement - but it
doesn't measure weight - A calorie is a unit of energy. When you hear
something contains 100 calories, it's a way of
describing how much energy your body could get
from eating or drinking it.
6Much more about calories
- Calories aren't bad for you. Your body needs
calories for energy. - But eating TOO MANY calories - and not burning
enough of them off through activity - can lead to
weight gain - Most foods and drinks contain calories.
- Some foods, such as an apple, contain few
calories - Other foods, such as ice cream, contain more
calories - Calories can come from 4 different areas in our
foods - Carbohydrates have 4 calories per gram
- Protein has 4 calories per gram
- Fat has 9 calories per gram
- Alcohol has 7 calories per gram
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8Balancing Act
- To maintain a healthy weight range, it is
important to balance calories from foods and
beverages with the calories that we use - Think of the calories you consume and the
calories you burn as your calorie budget for the
day. You need to decide how you want to spend
those calories - To lose weight Consume fewer calories than you
burn each day. - To do this either cut back on your calories or
exercise more!
9Why do we care about diet with SCI?
- The doctors, nurses, therapists, and dietitians
who have treated you are concerned about your
diet for several reasons. - Poor diet can lead to many problems that can make
your job and the job of your care givers harder.
10What are Secondary Conditions Related to SCI and
Nutrition?
- Metabolic Syndrome
- Bowel Problems
- Kidney Stones
- Pressure Ulcers
- Urinary Tract Infections
- Overweight and Obesity
11Explaining Metabolic Syndrome
- Metabolic Syndrome is not a single disease but a
group of health problems that is believed to
arise due to a combination of genetic factors and
lifestyle factors including overeating and lack
of physical activity. - If 3 of these categories are met you would could
have metabolic syndrome - Symptoms of Metabolic Syndrome
- Waist Circumference greater than 40 inches for
men and 35 inches for women (in SCI population it
is likely a different estimation) - Triglyceride level 150 mg/dL
- HDL (good cholesterol) lt 40 mg/dL in men and lt50
mg/dL in women - Blood pressure gt 130/85 mmHg
- Blood sugar gt 110 mg/dL
12Overweight and Obesity
- For the general population overweight and obesity
can be categorized by using a measurement called
BMI (Body Mass Index) - This index uses your weight and height to then
calculate a number which will categorize you into
one of 5 categories - BMIlt18.5- Underweight
- BMI 18.5-24.9- Normal Weight
- BMI 25-29.9- Overweight
- BMI 30-39.9- Obese
- BMI gt40- Extreme Obese
- In SCI patients we use BMI but the numbers do not
truly mean the same thing as in the general
population. SCI patients need to watch out for
being OVERFAT!
13Overweight and Obesity
Example Patient 1 Young male BMI 17.9,
Underweight Average fat in 3 areas assessed
28.2 fat This would make this patient obese
because the in this age group the amount of fat
that is considered acceptable is 18-25, making
this seemingly underweight patient obese.
14Dietary Recommendations to Prevent Metabolic
Syndrome and Overweight/Obesity
- Complications of Metabolic Syndrome can be
prevented through diet. - Early Intervention is key!
- 1.) Limit your Fat Intake
- Try to increase your fruit and vegetable intake
- Go vegetarian every now and again
- Choose fat free or low fat dairy products
- Choose lean meats and skinless poultry and fish
15Dietary Recommendations to Prevent Metabolic
Syndrome and Overweight/Obesity
- Complications of Metabolic Syndrome can be
prevented through diet. - Early Intervention is key!
- 2.) Reduce your use of Saturated Fat and Trans
Fat - These are the fats that are solid at room
temperature - Animal fats/Lard
- Shortening
- Tropical oils like palm and coconut oil
16Dietary Recommendations to Prevent Metabolic
Syndrome and Overweight/Obesity
- Complications of Metabolic Syndrome can be
prevented through diet. - Early Intervention is key!
- 3.) Eat less cholesterol
- Cholesterol is in foods from animal origin
- If you reduce the amount of animal fat in your
diet, you will reduce your cholesterol intake
17Dietary Recommendations to Prevent Metabolic
Syndrome and Overweight/Obesity
- Complications of Metabolic Syndrome can be
prevented through diet. - Early Intervention is key!
- 4.) Limit the empty calories
- Choose water or diet beverages over regular soda
or juices - Try not to add extra sugar to anything
- Think when eating convenience foods
- Think about condiments
18Dietary Recommendations to Prevent Metabolic
Syndrome and Overweight/Obesity
- Complications of Metabolic Syndrome can be
prevented through diet. - Early Intervention is key!
- 5.) Remember the difference between sometimes and
everyday foods - Sometimes foods are foods that we might call
bad or unhealthy - Everyday foods are things like fruits,
vegetables, lean meat, low-fat dairy, healthy
oils, beans
19Nutrition and SCI Conclusions
- This is a tremendously large topic and I hope
that I was able to give an overview of the topic
with some helpful recommendations - Changing the way you eat is a complex task and
not something that will magically happen
overnight, it takes time - You may experience difficulties but take it one
meal at a time?
20- References
- 1.) The American Dietetic Association,
www.eatright.org - 2.) Steps to Your Health, Morrison Management
Specialists publication 2007 - 3.) Photo used from www.umm.edu
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