Nutrition Education to Reduce Metabolic Dysfunction for Spinal Cord Injury: A Module-Based Nutrition Education Guide for Healthcare Providers and Consumers
Abstract
:1. Introduction
2. Pathophysiology of SCI
3. Energy Balance
4. Neurogenic Obesity
5. Weight/Adipose Tissue Management in SCI
6. SCI-Specific Nutritional Guidelines
7. Overview of the Recent SCI-Specific Nutritional Recommendations
8. Nutrition Education Modules
8.1. Module 1—MyPlate: A Guide to Healthy Eating
8.2. Modules 2 and 3—The Fruit and Vegetable Groups
8.2.1. The Fruit Group
8.2.2. The Vegetable Group
8.2.3. Current Fruit and Vegetable Intake
8.2.4. Health Benefits of Fruits and Vegetables
8.3. Module 4—The Grains Group
8.3.1. Current Grain Intake
8.3.2. Health Benefits of Whole Grain
8.4. Modules 5 and 6—The Protein Group
8.4.1. Amino Acids
8.4.2. Protein Needs
8.4.3. Current Protein Intake
8.5. Module 7—The Dairy Group
8.5.1. Current Dairy Intake
8.5.2. Dairy and Cardiovascular Disease
8.5.3. Dairy and Osteoporosis
8.6. Module 8–Fat
8.6.1. Current Fat Intake
8.6.2. Health Benefits of Unsaturated Fats
8.7. Module 9—Essential Fatty Acids
8.7.1. N-3 and N-6 Essential Fatty Acid Intakes
8.7.2. Health Benefits of N-3 Essential Fatty Acids
8.7.3. N-6 Fatty Acid and its Influence on Cardiovascular Disease Risk
8.8. Module 10—Ways to Eat Less Fat and Fewer Calories
8.8.1. Eat High-Fat, Energy-Dense Foods Less Often
8.8.2. Eat Smaller Portions of High-Fat, Energy-Dense Foods
8.8.3. Substitute with Lower-Fat, Lower-Energy Foods
8.9. Module 11—Carbohydrates
8.9.1. Current Carbohydrate Intake
8.9.2. Health Benefits of Complex Carbohydrates
8.10. Module 12—Fiber
8.10.1. Fiber Recommendations
8.10.2. Current Fiber Intake
8.10.3. Fiber and Neurogenic Bowel
8.10.4. Proposed Fiber Requirements in SCI
8.11. Module 13—Planning a Healthy Breakfast
8.12. Module 14—Building a “Light” Meal
8.13. Module 15—Satisfying Snacks
8.14. Module 16—Reading the Nutrition Facts Label
9. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Nutrient | Recommendations | Function | Sources |
---|---|---|---|
Macronutrients (energy content) | |||
Carbohydrates (4 kcal/g) | 45–65% ∀,Δ | Primary source of energy for cells; brain’s preferred fuel source [14]. | |
Simple Carbohydrates | Limit | Refined sugars, candy, syrups, soft drinks, etc. | |
Monosaccharide | |||
Glucose | |||
Fructose | |||
Galactose | |||
Disaccharide | |||
Sucrose | |||
Lactose | |||
Maltose | |||
Complex Carbohydrates | At least 50% of total grain intake should be whole grain.Δ | Grains (whole, refined), vegetables, beans, peas, etc. | |
Polysaccharide | |||
Starch | |||
Cellulose | |||
Protein (4 kcal/g) | 10–35% ∀,Δ | Supplies amino acids which are the major structural components of cells. Needed to serve as enzymes, hormones, membrane receptors, and transporters of nutrients [14]. | Meats, poultry, fish, eggs, dairy, beans, etc. |
Essential amino acids | |||
Histidine | ≥19 y: 14 mg/kg/d ^ | Helps with histamine production, immunity, digestion, sleep, and sexual function [15]. | Meat, fish, poultry, nuts, seeds, whole grains, etc. |
Isoleucine | ≥19 y: 19 mg/kg/d ^ | Involved in muscle metabolism, immune function, produces hemoglobin, and regulates energy [15]. | Meat, fish, poultry, eggs, cheese, lentils, nuts, seeds, etc. |
Leucine | ≥19 y: 42 mg/kg/d ^ | Essential for protein synthesis and growth hormones, grows and repairs muscle tissue, heals wounds and regulates blood sugar [15]. | Dairy, soy, beans, legumes, etc. |
Lysine | ≥19 y: 38 mg/kg/d ^ | Hormone production, cell division, fat metabolism, and wound healing [15]. | Meat, eggs, soy, black beans, quinoa, pumpkin seeds, etc. |
Methionine | ≥19 y: 19 mg/kg/d ^ | Metabolism, detoxification, tissue growth, absorption of zinc and calcium [15]. | Eggs, grains, nuts, seeds, etc. |
Phenylalanine | ≥19 y: 33 mg/kg/d ^ | Production of dopamine, epinephrine, norepinephrine, and other amino acids [15]. | Dairy, meat, poultry, soy, fish, beans, nuts, etc. |
Threonine | ≥19 y: 20 mg/kg/d^ | Needed for collagen and elastin synthesis, clot formation, fat metabolism, and immune function [15]. | Cottage cheese, wheat germ, etc. |
Tryptophan | ≥19 y: 5 mg/kg/d^ | Nitrogen balance, serotonin production [15]. | Wheat germ, cottage cheese, chicken, turkey, etc. |
Valine | ≥19 y: 24 mg/kg/d^ | Muscle growth, tissue regeneration, and providing energy [15]. | Soy, cheese, peanuts, mushrooms, whole grains, vegetables, etc. |
Non-essential amino acids | |||
Alanine | N/A | Nervous system function, tryptophan synthesis [16]. | Meat, poultry, fish, eggs, dairy, etc. |
Asparagine | N/A | Glycoprotein synthesis, liver health; central nervous system signaling and development; Energy levels [16]. | Dairy, beef, poultry, eggs, fish, seafood, potatoes, legumes, nuts, seeds, soy, whole grains, etc. |
Aspartic Acid | N/A | Precursor to other amino acids in the citric acid and urea cycles; serves as an excitatory spinal cord neurotransmitter [16]. | Oysters, sprouting seeds, oat flakes, avocado, asparagus, etc. |
Glutamic Acid | N/A | Precursor to gamma-aminobutyric acid; Excitatory neurotransmitter [16]. | Meat, poultry, fish, eggs, dairy, high-protein vegetables, etc. |
Conditionally essential amino acids | |||
Arginine | N/A | Increases T-cell production; release of insulin and human growth hormones, neutralize hepatic ammonia, and ameliorate skin/connective tissue quality and healing [16]. | Meat, fish, nuts, seeds, legumes, whole grains, dairy, etc. |
Cysteine | N/A | Protein and coenzyme A synthesis, glutathione production [16]. | Chickpeas, couscous, eggs, lentils, oats, turkey, walnuts, etc. |
Glutamine | N/A | Nervous system, increase energy supply [16]. | Chicken, fish, cabbage, spinach, dairy, tofu, lentils, beans, etc. |
Tyrosine | N/A | Dopamine and noradrenaline precursor; protein synthesis [16]. | Soy, chicken, turkey, fish, peanuts, almonds, avocados, bananas, milk, cheese, yogurt, cottage cheese, lima beans, pumpkin seeds, sesame seeds, etc. |
Glycine | N/A | Collagen, sleep, central nervous system [16]. | Red meat, seeds, turkey, chicken, pork, peanuts, granola, etc. |
Proline | N/A | Collagen synthesis; provides energy through collagen degradation under stress [16]. | Bone broth, chicken wings (with skin), pork rinds, gelatin, etc. |
Serine | N/A | Neuromodulatory role; creatine, epinephrine, DNA, and RNA production [16]. | Soybeans, nuts, eggs, chickpeas, lentils, meat, fish, etc. |
Fats (9 kcal/g) | 20–35% ∀,Δ | Provides energy, supports cell function, absorption of fat-soluble nutrients, hormone synthesis [14]. | |
Unsaturated Fat | 27 g of oil Δ; Replace saturated fat with unsaturated fat. Δ,α | ||
Monounsaturated fat | Avocado, nuts, seeds, oils (e.g., olive oil), etc. | ||
Polyunsaturated fat | |||
Linolenic acid (Omega-3 essential fatty acid) | Females: ≥19 y: 1.1 g ^ Males: ≥19 y: 1.6 g ^; 0.6–1.2% ∀ | Eicosapentaenoic acid and docosahexanoic acid and n-3 eicosanoids precursor [14] | Salmon, mackerel, chia, flax, walnuts, etc. |
Linoleic acid (Omega-6 essential fatty acid) | Females: 19–50 y: 12 g ^,Δ ≥51 y: 11 g ^,Δ Males: 19–50 y: 17 g ^,Δ ≥51 y: 14 g ^,Δ; 5–10% ∀ | Arachidonic acid precursor, membrane structural lipid component, cell-signaling pathways [14]. | Corn oil, soybean oil, safflower oil sunflower oil, nuts, etc. |
Saturated Fat | <10% Δ; 5–6% α,ϑ | Milk, cheese, red meat, butter, coconut oil, etc. | |
Trans-Fat | Minimal as possible | ||
Natural trans-fat | Limit | Animal products | |
Artificial trans-fat | Avoid | Fully or partially hydrogenated oil | |
Alcohol (7 kcal/g) [17] | Do not start drinking, limit, or drink in moderation (Females: ≤1 drink/d; Males: ≤2 drinks/d) | Not an essential macronutrient; adults of legal drinking age can choose to not drink alcohol [18]. | Beer, wine, liquor |
Water (0 kcal/g) | Females: ≥19 y: 9 cups/d η Males: ≥19 y: 13 cups/d η | Carries nutrients and oxygen to cells; lubricates joints; lessens burden on kidneys and liver by removing waste products; helps dissolve minerals and nutrients to make them accessible | Soup, milk, tea, coffee, juice, and drinking water |
Nutrient | Recommendations | Function | Sources |
---|---|---|---|
Vitamins | |||
Water-soluble vitamins | |||
Vitamin B1 (Thiamin) | Females: ≥19 y: 1.1 mg Δ,^ Males: ≥19 y: 1.2 mg Δ,^ | Helps cells convert carbohydrates into energy [19]. | Watermelon, acorn squash, etc. |
Vitamin B2 (Riboflavin) | Females: ≥19 y: 1.1 mg Δ,^ Males: ≥19 y: 1.3 mg Δ,^ | Works with other B vitamins, red blood cell growth and production [19] | Milk, yogurt, cheese, whole and enriched grains, etc. |
Vitamin B3 (Niacin) | Females: ≥19 y: 14 mg Δ,^ Males: ≥19 y: 16 mg Δ,^ | Maintain healthy skin and nerves [19]. | Meat, poultry, fish, fortified/whole grains, mushrooms, potatoes, etc. |
Vitamin B5 (Pantothenic acid) | ≥19 y: 5 mg ^ | Food metabolism, hormone and cholesterol production [19]. | Chicken, whole grains, broccoli, avocados, mushrooms, etc. |
Vitamin B6 (Pyridoxine) | Females: 19–50 y: 1.3 mg Δ,^; ≥ 51 y: 1.5 mg Δ,^ Males: 19–50 y: 1.3 mg Δ,^; ≥51 y: 1.7 mg Δ,^ | Red blood cell formation, maintains brain function [19]. | Meat, fish, poultry, legumes, soy, bananas, etc. |
Vitamin B7 (Biotin) | ≥19 y: 30 mcg Γ | Protein and carbohydrate metabolism, hormone and cholesterol production [19]. | Whole grains, eggs, soybeans, fish, etc. |
Vitamin B9 (Folate/folic acid) | ≥19 y: 400 mg Δ,^ | Forms red blood cells with vitamin B12; DNA synthesis [19]. | Fortified grains and cereals, asparagus, spinach, broccoli, black-eyed peas, chickpeas, etc. |
Vitamin B12 (Cobalamin) | ≥19 y: 2.4 mcg Δ,^ | Involved with metabolism, red blood cell formation, maintenance of central nervous system [19]. | Meat, poultry, fish, milk, cheese, fortified soymilk, and cereals, etc. |
Vitamin C (Ascorbic acid) | Females: ≥19 y: 75 mg Δ,^ Males: ≥19 y: 90 mg Δ,^ | Antioxidant, healthy teeth and gums, iron absorption, maintains healthy tissue, wound healing [19]. | Citrus fruits, potatoes, broccoli, bell peppers, spinach, strawberries, tomatoes, Brussel sprouts, etc. |
Fat-soluble vitamins | |||
Vitamin A | Females:≥19 y: 700 mcg RAE Δ,^ Males: ≥19 y: 900 mcg RAE Δ,^ | Forms/maintains healthy teeth, bones, soft tissue, mucous membranes, and skin [19]. | Beef, liver, eggs, shrimp, fish, fortified milk, sweet potatoes, carrots, pumpkin, spinach, mangoes, etc. |
Vitamin D | Females and Males: 19–70 y: 600 IU ≥71 y: 800 IU Δ,^ | Calcium absorption, maintains blood calcium and phosphorus levels [19]. | Fortified milk and cereals, fatty fish, etc. |
Vitamin E | Females and Males: ≥19 y: 15 mg AT Δ,^ | Antioxidant, red blood cells formation, vitamin K usage [19]. | Vegetable oils, leafy green vegetables, whole grains, nuts, etc. |
Vitamin K | Females: ≥ 19 y: 90 mcg Δ,Γ Males: ≥19 y: 120 mcg Δ,Γ | Assists with blood coagulation [19]. | Cabbage, eggs, milk, spinach, broccoli, kale, etc. |
Minerals | |||
Macrominerals (Major) | |||
Calcium | Females: 19–50 y: 1000 mg Δ,^; ≥51 y: 1200 mg Δ,^ Males: 19–71 y: 1000 mg Δ,^; ≥71 y: 1200 mg Δ,^ | Bone and teeth health, muscle and nerve function, blood clotting, blood pressure regulation, immune system health [20]. | Yogurt, cheese, milk, salmon, leafy green vegetables, etc. |
Chloride | Females and Males: 19–50 y: 2300 mg ^ 50–70 y: 2000 mg ^ ≥70 y: 1800 mg ^ | Fluid balance, stomach acid [20]. | Salt |
Magnesium | Females: 19–30 y: 310 mg Δ,^; ≥31 y: 320 mg Δ,^ Males: 19–30 y: 400 mg Δ,^; ≥31 y: 420 mg Δ,^ | Bone health, protein metabolism, muscle contraction, nerve transmission, immune system health [20]. | Spinach, broccoli, legumes, seeds, whole-wheat bread, etc. |
Potassium | Females: ≥19 y: 2300 mg Δ,Γ Males: ≥3400 mg Δ,Γ | Fluid balance, nerve transmission, and muscle contraction [20]. | Meat, milk, fruits, vegetables, grains, legumes, etc. |
Sodium | ≥19 y: ≤2300 mg Δ,δ Persons with SCI and HTN: ≤2400 mg ϑ Ideal: ≤1500 mg α | Fluid balance, nerve transmission, and muscle contraction [20]. | Salt, soy sauce, vegetables, canned food, etc. |
Phosphorus | Females and Males: ≥19 y: 700 mg Δ,^ | Bone and teeth health; acid-base balance [20]. | Meat, fish, poultry, eggs, milk, etc. |
Microminerals (Trace) | |||
Chromium | Females: 19–50 y: 25 mcg Γ; ≥51 y: 20 mcg Γ Males: 19–50 y: 35 mcg Γ; ≥51y: 30 mcg Γ | Works with insulin to regulate blood glucose [20]. | Meat, poultry, fish, nuts, cheese, etc. |
Copper | ≥19 y: 900 mcg ^ | Enzymes, iron metabolism [20]. | Shellfish, nuts, seeds, whole-grain products, beans, prunes, etc. |
Fluoride | Females: ≥19 y: 3mg Γ Males: ≥19 y: 4 mg Γ | Bone and teeth formation; prevents tooth decay [20]. | Fish, teas, etc. |
Iodine | ≥19 y: 150 mcg ^ | Part of thyroid hormone. [20] | Iodized salt, seafood, etc. |
Iron | Females: 19–50 y:18 mg Δ,^; ≥51y: 8 mg Δ,^ Males: ≥19 y: 8 mg Δ,^ | Part of hemoglobin; energy metabolism [20]. | Red meat, poultry, eggs, fruits, green vegetables, fortified bread, etc. |
Manganese | Females: ≥19 y: 1.8 mg Γ Males: ≥19 y: 2.3 mg Γ | Part of several enzymes [20]. | Nuts, legumes, whole grains, tea, etc. |
Selenium | ≥19 y: 55 mcg ^ | Serves as an antioxidant [20]. | Organ meat, seafood, walnuts, etc. |
Zinc | Females: ≥19 y: 8 mg Δ,^ Males: ≥19 y: 11 mg Δ,^ | Enzymes; protein and genetic material synthesis; taste perception, wound healing, normal fetal development, production of sperm, normal growth and sexual maturation, immune system health. [20] | Meat, shellfish, legumes, whole grains, etc. |
Fruit Form | Cup Equivalent | Examples |
---|---|---|
Fresh | 1 piece of whole fruit or 1 cup of cut fruit | Apples, grapes, clementine, banana, or any type of berry (blackberries, blueberries, raspberries, strawberries), etc. |
Frozen | ½ cup of thawed fruit or 1 cup of frozen fruit | Bananas, apples, pineapple, berries, sapote, soursop, papaya, etc. |
Canned | 1 cup of canned fruit | Peaches, pears, apricots, pineapples, etc. |
Dried | ½ cup of dried fruit | Cranberries, raisins, apples, mango, pineapple, blueberries, dates, prunes, apricots, etc. |
Vegetable Subgroup | USDA’s Recommended Intake | Examples |
---|---|---|
Dark green vegetables | 1.5 cup equivalent/week | Broccoli, bok choy, chard, collards, kale, romaine lettuce, spinach, turnip greens and watercress, etc. |
Red and orange vegetables | 5.5 cup equivalents/week | Carrots, red/orange bell peppers, sweet potatoes, tomatoes, and winter squash, etc. |
Beans, peas, and lentils | 1.5 cup equivalents/week | Black beans, black-eyed peas, chickpeas (garbanzo beans), edamame, kidney beans, lentils, lima beans, pinto beans, split peas, etc. |
Starchy vegetables | 5 cup equivalents/week | Corn, cassava, green peas, white potato, taro root, water chestnuts, yam, yucca, etc. |
Other vegetables | 4 cup equivalents/week | Asparagus, avocado, beets, Brussels sprouts, cabbage, cauliflower, celery, cucumber, eggplant, green/string beans, iceberg lettuce, mushrooms, okra, onions, radish, seaweed, etc. |
Grains | Examples | Recommended Intake |
---|---|---|
Whole-Grains | Whole wheat flour, bulgur wheat (cracked wheat), oatmeal, amaranth, barley, millet, popcorn, brown rice, quinoa, dark rye, wild rice, etc. | At least 3-ounce equivalents per day (maximum 6-ounce equivalents of grains per day) |
Refined-Grains | White flour, corn grits, white bread, white pasta, white rice, cream of rice, cream of wheat, etc. | Less than 3-ounce equivalents per day (maximum 6-ounce equivalents of grains per day) |
Protein Source | Recommended Intake | Examples |
---|---|---|
Meats/Poultry/Eggs | 26-ounce equivalents/week | Meats: Beef, goat, lamb, pork and game meat (e.g., moose, elk, deer, etc.) Poultry: Chicken, Cornish hen, duck, goose, turkey, game birds (e.g., ostrich, pheasant, quail, etc.) Eggs: Chicken eggs or any other birds’ eggs |
Seafood | 8-ounce equivalents/week | Salmon, sardines, tuna, shrimp, tilapia, anchovy, black sea bass, catfish, clams, cod, crab, flounder, haddock, oyster, squid, etc. |
Nuts/Seeds/Soy Products | 5-ounce equivalents/week | Nuts and seeds: All nuts (tree nuts and peanuts), nut butters, seeds (e.g., chia, flax, pumpkin, sesame and sunflower, etc.). Soy products: Tofu, tempeh, and products made from soy flour, soy protein isolate, soy concentrate, etc. |
Type | Form | Cup-Equivalent | Examples |
---|---|---|---|
Milk | Fluid | 1 cup | Dairy milk, lactose-free or reduced milk, fortified soy milk, buttermilk, dairy desserts |
Dry | 1 cup (reconstituted in water) | ||
Evaporated | ½ cup | ||
Yogurt | Yogurt | 1 cup | Yogurt, Greek yogurt, kefir, frozen yogurt |
Fortified soy-yogurt | 1 cup | Soy-yogurt, soy desserts | |
Cheese | Natural cheese | 1½ ounces | Brie, cheddar, cottage cheese, Colby, edam, feta, fontina, goat, gouda, gruyere, mozzarella, muenster, parmesan, provolone, ricotta, Swiss, etc. |
Processed cheese | 2 ounces | American cheese |
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Sneij, A.; Farkas, G.J.; Carino Mason, M.R.; Gater, D.R. Nutrition Education to Reduce Metabolic Dysfunction for Spinal Cord Injury: A Module-Based Nutrition Education Guide for Healthcare Providers and Consumers. J. Pers. Med. 2022, 12, 2029. https://doi.org/10.3390/jpm12122029
Sneij A, Farkas GJ, Carino Mason MR, Gater DR. Nutrition Education to Reduce Metabolic Dysfunction for Spinal Cord Injury: A Module-Based Nutrition Education Guide for Healthcare Providers and Consumers. Journal of Personalized Medicine. 2022; 12(12):2029. https://doi.org/10.3390/jpm12122029
Chicago/Turabian StyleSneij, Alicia, Gary J. Farkas, Marisa Renee Carino Mason, and David R. Gater. 2022. "Nutrition Education to Reduce Metabolic Dysfunction for Spinal Cord Injury: A Module-Based Nutrition Education Guide for Healthcare Providers and Consumers" Journal of Personalized Medicine 12, no. 12: 2029. https://doi.org/10.3390/jpm12122029