Long Term Nutritional Considerations with Spinal Cord Injury

1. Long Term Nutritional Considerations with Spinal Cord Injury Presented by: Sarah Feasel, MEd, RD, LD Clinical Nutrition Manager National Rehabilitation Hospital Washington, DC

2. Objectives • 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

3. Changing 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)

4. Putting 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 don’t use it you lose it!”

5. What 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.

6. Much 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

8. Balancing 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!

9. Why 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.

10. What are Secondary Conditions Related to SCI and Nutrition? • Metabolic Syndrome • Bowel Problems • Kidney Stones • Pressure Ulcers • Urinary Tract Infections • Overweight and Obesity

11. Explaining 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) < 40 mg/dL in men and <50 mg/dL in women • Blood pressure > 130/85 mmHg • Blood sugar > 110 mg/dL

12. Overweight 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 • BMI<18.5- Underweight • BMI 18.5-24.9- Normal Weight • BMI 25-29.9- Overweight • BMI 30-39.9- Obese • BMI >40- 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!

13. Overweight 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.

14. Dietary 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

15. Dietary 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

16. Dietary 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

17. Dietary 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

18. Dietary 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

19. Nutrition 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

21. THANK YOU