Spinal Cord Injury

SCI: Caloric and Protein Needs in Acute and Rehabilitation Phases (2007)

Assessment
What are the caloric needs for patients during the acute and rehabilitation phases following spinal cord injury?
- Conclusion
  People with spinal cord injury tend to have reduced metabolic activity due to denervated muscle. Measured energy expenditure is at least 10% below predicted; therefore, caloric needs of spinal cord injured patients should be based on measured energy expenditure. If indirect calorimetry is not available during the acute phase (0 - 4 weeks post-injury), one small longitudinal study indicated that caloric needs can be estimated by using the Harris-Benedict formula using admission weight, an activity factor of 1.1 and an injury/stress factor of 1.2. One study reports that during the rehabilitation phase, initial caloric needs can be estimated using 22.7 kcal/kg body weight for individuals with tetraplegia and 27.9 kcal/kg for those with paraplegia. When estimating caloric needs of individuals with spinal cord injury, acuteness of injury, level of injury, gender, and physical activity level should be taken into consideration.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What are the caloric needs during the acute and rehabilitation phases following spinal cord injury?
- Search Plan and Results: Caloric Needs 2006
What are the protein needs for patients during the acute and rehabilitation phases following spinal cord injury?
- Conclusion
  The acute phase of spinal cord injury results in an obligatory negative nitrogen balance that may persist for 7 weeks or more, as nitrogen excretion increases with changes in body weight and loss of lean body mass. Efforts to achieve positive nitrogen balance with aggressive nutrition support is generally unsuccessful and may result in overfeeding. Although a protein intake of 2.4 grams/kg IBW/day may lessen the negative nitrogen balance, 2 g protein/kg IBW/day may be more appropriate given potential concerns of substrate overload. Acute phase hypoalbuminemia may not be indicative of malnutrition, but a rising albumin level within 3 weeks of injury generally indicates adequate nutritional intake. For a person with spinal cord injury, 0.8 - 1.0 g protein/kg body weight/day may be required for maintenance, with an increase to 1.0 - 1.5 g protein/kg body weight/day if pressure ulcers or infection are present.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What are the protein needs during the acute and rehabilitation phases following spinal cord injury?
- Search Plan and Results: Protein Needs 2006