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

Citation:

Chin DE, Kearns P. Nutrition in the Spinal-Injured Patient. NCP. 1991; 6(6):213-222. 

 
Study Design:
Narrative Review
Class:
R - Click here for explanation of classification scheme.
Quality Rating:
Neutral NEUTRAL: See Quality Criteria Checklist below.
Research Purpose:
  • To summarize the unique nutritional problems that patients with SCI present and guidelines for nutritionally supporting the patient in both the acute and chronic phases.

 

Inclusion Criteria:
  • Article inclusion criteria not described.
Exclusion Criteria:
  • Not mentioned.
Description of Study Protocol:

Recruitment:  article selection methods not described

Design:  Narrative Review

Blinding Used (if applicable):  not applicable

Intervention (if applicable):  not applicable

Statistical Analysis:  not performed

Data Collection Summary:

Timing of Measurements:  not applicable

Dependent Variables:  not applicable

Independent Variables:  not applicable

Control Variables:  not applicable

Description of Actual Data Sample:

Initial N:  81 references cited.

Attrition (Final N):  81

Age:  not mentioned

Ethnicity:  not mentioned

Other relevant demographics:

Anthropometrics:

Location:  Worldwide studies

Summary of Results:

Other Findings

  • As many as 50% of SCI hospitalized patients are malnourished (protein-calorie malnutrition PCM).
  • Traditional standards for monitoring the effects of nutrition support are inadequate in SCI due to physiological response to injury and use of steroids.
  • Progressive weight loss common in the acute phase after injury (5.3 kg in paraplegics to 9.1 kg in quadriplegics 18 days after injury); with concomitant muscle atrophy and nitrogen losses, which peaks three weeks after injury and decreases after two months.
  • A decrease in the metabolic rate persists and standard caloric recommendations cannot be used. The Harris-Benedict equation is unreliable and results in overestimation of caloric needs.
  • Tendency toward increased body weight and fat in rehabilitation phase.
Author Conclusion:
  • Because SCI patients are susceptible to the ill effects of overfeeding (respiratory compromise, fatty liver, and obesity), metabolic rate measurements should be a frequent assessment tool. If not available use Cox’s estimate of 22.7 kcal/kg for quadriplegia and 27.9 kcal/kg in paraplegia.
  • Ideal body weight after one month post-injury: (Adjusted New York Metropolitan Life Insurance Co) subtract 5-10% (4.5-7 kg) for paraplegia, and 10-15% (7-9 kg) for quadriplegia.
  • Nutritional support has a prominent role in management of patients with SCI in the acute phase to prevent PCM, maintain lean muscle mass, and to prevent secondary illness in the rehabilitation and chronic phases.
Funding Source:
Government: US Dept. of Education
Reviewer Comments:
  • Comprehensive coverage of topic with emphasis on the dietitian’s role in SCI
  • “Traditional” review without specifics regarding search, selection, or critique of sources.
Quality Criteria Checklist: Review Articles
Relevance Questions
  1. Will the answer if true, have a direct bearing on the health of patients? Yes
  2. Is the outcome or topic something that patients/clients/population groups would care about? Yes
  3. Is the problem addressed in the review one that is relevant to dietetics practice? Yes
  4. Will the information, if true, require a change in practice? Yes
 
Validity Questions
  1. Was the question for the review clearly focused and appropriate? Yes
  2. Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described? No
  3. Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased? No
  4. Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible? No
  5. Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined? Yes
  6. Was the outcome of interest clearly indicated? Were other potential harms and benefits considered? Yes
  7. Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described? No
  8. Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included? Yes
  9. Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed? Yes
  10. Was bias due to the review's funding or sponsorship unlikely? Yes