SCI: Caloric and Protein Needs in Acute and Rehabilitation Phases (2007)
Chin DE, Kearns P. Nutrition in the Spinal-Injured Patient. NCP. 1991; 6(6):213-222.
R - Click here for explanation of classification scheme.
- 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.
- Article inclusion criteria not described.
- 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:
Location: Worldwide studies
Summary of Results:
- 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.
- 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.
|Government:||US Dept. of Education|
- 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
|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|
|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|