Clinical Decisionmaking

Poor diets of urban men with paraplegia underscore the importance of screening these patients for chronic diseases

More than 200,000 people in the United States live with spinal cord injury (SCI), and about 10,000 more of these injuries occur each year. The numerous physiologic and metabolic changes that accompany SCI increase the risk of affected individuals for developing cardiovascular disease (CVD), type 2 diabetes, insulin resistance, and hypertension. Diet is a cornerstone of prevention and treatment of both CVD and diabetes, but city-dwelling males with paraplegia often do not get recommended levels of several key nutrients in their diets. Many of these individuals have a body mass index (BMI) and waist circumference outside recommended ranges, according to a recent study.

The researchers examined findings from a survey of 95 healthy urban men aged 20 to 59 with paraplegia. They found that these men had diets that included too much total and saturated fat and lacked adequate fiber, calcium, fruit, and dairy intake. Most participants met calorie and protein recommendations, but only 12 percent of participants met the recommendations for fiber intake.

By using standard BMI and waist circumference cut-points for the able-bodied, about half of the men were overweight, 19 percent were obese, 7.5 percent were underweight, and more than one-third had a large waist circumference. Men at significantly higher risk for lower quality diets were those who lived alone, smoked, had low family incomes, little nutritional knowledge, and high BMI. Black men had the poorest diets of all.

Such poor diets among men with SCI are particularly problematic, given their increased risks for cardiac disease and insulin resistance and their difficulty in losing weight due to activity limitations. In addition, these men have fewer energy requirements than others due to a loss of lean body mass. Clinicians should provide nutritional guidance to individuals in this at-risk group, conclude the researchers who conducted the study, which was supported by the Agency for Healthcare Research and Quality (HS11277).

More details are in "Dietary intake and nutritional status of urban community-dwelling men with paraplegia," by Kristin M. Tomey, M.S., David M. Chen, M.D., Xin Wang, Ph.D., and Carol L. Braunschweig, Ph.D., in the April 2005 Archives of Physical Medicine and Rehabilitation 86, pp. 664-671.

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