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SCI: Role of the Registered Dietitian (2007)

Citation:

Barber D, Foster D, and Rogers S. The importance of nutrition in the care of persons with spinal cord injury. The Journal of Spinal Cord Medicine, 26:2; Summer 2003. Commentary.

PubMed ID: 12828287
 
Study Design:
Narrative Review
Class:
X - Click here for explanation of classification scheme.
Quality Rating:
Negative NEGATIVE: See Quality Criteria Checklist below.
Research Purpose:

The purpose was to provide expert comment on two research articles:

Petchkrua W, Little JW, Burns SP, Steins SA, James JL. Vitamin B12 deficiency in spinal cord injury: A retrospective study. Journal of Spinal Cord Medicine; 2003: 26: 116-121.

Harrow JJ, Nolan RJ, Morgan MB, Lezama JL. Diagnostic pitfalls: Case report of scurvy in a man with spinal cord injury. Journal of Spinal Cord Medicine; 2003: 26: 168-172.

Inclusion Criteria:

This narrative commentary about two studies did not specify inclusion criteria.

Exclusion Criteria:

No exclusion criteria was specified. Author did not indicate why or how the two articles were selected and others excluded.

Description of Study Protocol:

No study protocol specified.

Data Collection Summary:

No data collection (for the two included articles) was summarized.

Description of Actual Data Sample:

Two research articles (Petchkrua et al, 2003 and Harrow et al, 2003) were selected to discuss the issue of Spinal Cord Injury and vitamin deficiency, particularly vitamin B12 and vitamin C.

Summary of Results:

Two studies were summarized to illustrate that persons with SCI are at risk for nutritional deficiencies.

Petchkura W, Little JW, Burns SP, Stiens SA, and James JL (2003)

  • Persons with Spinal Cord Injury with symptoms including anemia, depression, malaise, pain and weakness were found to be deficient in vitamin B12
  • 12 of 16 persons benefited clinically from vitamin B12 replacement therapy. 

Harrow JJ, Nolan RJ, Morgan MB, and Lezama JL (2003)

  • Case study of person with Spinal Cord Injury illustrates the problems that occur if vitamin deficiency is not considered in diagnosis
  • Vitamin C deficiency and scurvy is uncommon in developed countries but a case is presented. Persons with SCI who live in relative isolation, poverty and poor psychosocial situations are at-risk.
Author Conclusion:

The authors concluded that persons with SCI are at risk for nutritional deficiencies and that the causes are multifactorial. Nutrition assessments by registered dietitians may uncover psychosocial factors contributing to nutrition problems. The authors list a number of issues that may contribute directly or indirectly to poor nutrient intake in spinal cord-injured patients, and that may be addressed by a registered dietitian: 

Lack of education regarding basic nutrient needs:

  • Disordered eating related to poor body image
  • Embarrassment and depression regarding eating skills
  • Social isolation
  • Lack of assistance to buy or prepare groceries
  • Substance abuse displacing nutrients
  • Avoidance of food groups which may impair bowel and bladder programs
  • Irritable bowel syndrome
  • Gluten enteropathy
  • Lactose intolerance
  • Gastroesophageal reflux
  • Glucose intolerance
  • Obesity and overweight
  • Exposure to unreliable nutrition information and changes in taste acuity. 

The authors recommend that all advocates for persons with SCI should recognize the importance of nutrition assessment, education and counseling. The authors conclude their commentary by stating that evaluation by a registered dietitian should be part of every SCI patient's annual medical examination.

Funding Source:
University/Hospital: University of Texas Health Science Center at San Antonio
Reviewer Comments:
  • The authors include an M.D., an R.D. and a PharmD
  • This review article primarily contains expert opinion.
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? No
  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? No
  9. Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed? No
  10. Was bias due to the review's funding or sponsorship unlikely? No