4. Role of the Clinical Dietitian
Participate in the interdisciplinary team by
providing care for Neurotrauma patients in all
aspects of patient care:
1. Acute phase
2. Rehabilitation phase
3. Community setting (After Discharge)
6. Nutritional needs change frequently after SCI
Stress response
Sepsis
Fever
Infection
Surgery
Nutritional assessments need to be frequent,
with ongoing diet alterations made to keep up
with the patients' changing needs
Caloric and protein needs
in the acute phase
7. Management of Hypermetabolism
Algorithm content developed by John Anderson, PhD, and Sanford C. Garner, PhD, 2000. Updated by Maion F. Winkler and Ainsley Malone, 2002.
8. SCI: Nutrition Assessment in the
Acute Care Setting
Nutrition assessment should be conducted within
the first 48 hours post-injury to determine
Nutrient needs
Provide nutrition support recommendations
Early nutrition support is associated with improved patient
outcomes
Identify conditions that may predispose the patient to
nutrition-related complications
10. Complications with Loss
of Lean Body Mass
% Loss Total LBM Complications Associated Mortality
%
10 Decreased immunity,
Increased infections
10
20 Decreased healing,
weakness, infection
30
30 Too weak to sit,
pressure ulcers,
pneumonia, no
healing
50
40 Death, usually from
pneumonia
100
11. What is the best route of delivery:
Enteral vs. Parenteral
Enteral Nutrition (EN):
Enteral nutrition is a treatment
option when oral nutrition is
unsafe
due to aspiration risk
or when the
patient can no
longer meet nutritional needs
with an oral diet.
12. Enteral Nutritional Support
Continuous EN
Better tolerated than
bolus/intermittent EN in ICU
setting
Limit interruptions!
Unnecessary for certain
procedures—NPO at midnight
should not be automatic
Low rate of gastric residuals
13. Benefits - EN
Supports gut integrity
Modulate stress and immune response
Lower risk of infection than Parenteral
Nutrition (PN)
Reduction in hospital LOS
catabolism
Improve the nutritional status (meet protein,
energy and micronutrient requirements)
Infection
Lower cost
Quicker return of cognitive function
(Taylor, et. al)
14. Risks of EN
Feeding when gut perfusion poor can lead to
gut ischemia
Feeding intolerance in critical illness
May not reach nutritional goals as quickly as
PN
16. SCI: Energy Needs in the Acute Phase
Indirect calorimetry is considered to be the 'gold
standard' and the only accurate and clinically feasible
method of measuring energy expenditure in critically ill
hypermetabolic patients
It is called “indirect” because the caloric burn rate is
calculated from a measurement of oxygen uptake.
Used in both mechanically ventilated
and spontaneously breathing patients
(ventilated patients most accurate)
Equipment is expensive and not readily
available in the medical facilities
17. SCI: Assessment: Energy Needs in the
Acute Phase using Predictive Equations
If Indirect Calorimetry is not available, the
clinical dietitian may estimate energy
needs with the Harris-Benedict formula
using admission weight
an injury factor of 1.2
an activity factor of 1.1
18. Harris-Benedict Formula
Basal Energy Expenditure
Male: BEE = 66.67 + 13.75W + 5H - 6.76A
Female: BEE = 665.1 + 9.56W +1.85H -4.68A
H= height in centimeters
W= weight in kg
A= age in years.
19. SCI: Calculations of Energy Needs
Harris-Benedict Formula
Energy Needs = [BEE]) X (activity factor) X (injury factor)
an injury factor of 1.2
an activity factor of 1.1
20. SCI: Protein Needs in Acute Phase
2.0 g/kg of ideal body weight/day to minimize -ve
nitrogen balance that occurs during the acute
phase
Status Estimated Requirements
Normal (RDA) 0.8-1.0 g/kg/day
Moderately stress 1.0-2.0 g/kg/day
Severely stressed 2.0-3.0 g/kg/day
Blackburn's General Guide for Protein Needs Based on Stress level
21. SCI: Monitoring and Evaluation of
Protein Intake in Acute Care Setting:
Overfeeding
0 – 4 weeks post-injury : the clinical dietitian
should monitor the patient's protein intake to
ensure that the patient does not consume more
than 2.0g/kg of body weight/day to achieve +ve
nitrogen balance without any excessive nutrition
support that may result in overload and
metabolic complications
23. SCI: Goals of Nutrition Assessment in
the Rehabilitation Setting
Implementing an individualized
therapeutic nutrition plan for the patient
Improving transition into the community
setting
24. SCI: Energy Needs
Patients with SCI have reduced metabolic activity due to
denervated muscle
Actual energy needs are at least 10% below predicted
needs
22.7 kcal/ kg body weight for patients with quadriplegia
27.9 kcal/ kg for those with paraplegia
Example:
Patient weight 70 kg x 22.7 ≅ 1600 kcal/day energy needs for
patient with quadriplegia
25. SCI: Protein Needs
in the Rehabilitation Setting
(0.8 to 1.0) g/kg/day for maintenance of
protein status in the absence of
pressure ulcers or infection
Example:
Patient weight 70 kg x1 = 70 /day protein
needs for patient with SCI
27. SCI: Nutrition Assessment
in the Community Setting
Should be conducted as part of the annual
medical exam
Developing and implementing an individualized
therapeutic nutrition plan necessary to identify
secondary SCI conditions related to nutrition
28. Secondary SCI Conditions
Related to Nutrition
1. Metabolic Syndrome
2. Overweight and Obesity
3. Lipid Abnormalities
4. Pressure Ulcers
5. Bowel Problems
6. Urinary Tract Infections
29. 1. Metabolic Syndrome
Metabolic Syndrome is not a single disease
but a group of health problems that is
believed to arise due to a combination of
1. Genetic factors
2. Lifestyle factors including overeating
3. Lack of physical activity
30. Symptoms of Metabolic Syndrome
1. Waist Circumference greater than
102 cm for men and 88 cm for
women (in SCI population it is likely
a different estimation)
2. Triglyceride level ≥150 mg/dL
3. HDL < 40 mg/dL in men
and <50 mg/dL in women
4. Blood pressure > 130/85 mmHg
5. Blood sugar > 110 mg/dL
31. Dietary Recommendations to Prevent
Metabolic Syndrome & Overweight/Obesity
Limiting Fat Intake
Choosing fat free or low fat dairy products
Choosing lean meats and skinless poultry and fish
Reducing Saturated Fat and Trans Fat
These are the fats that are solid at room temp
Animal fats
Shortening
Palm and coconut oil
32. Dietary Recommendations to Prevent
Metabolic Syndrome & Overweight/Obesity
Eating less cholesterol
Cholesterol is in foods from animal origin
reducing the amount of saturated (animal fat)
Increasing fruit and vegetable intake
Limiting empty calories
Choosing water or diet beverages over regular soda &
reducing the amount of sweets & sugars & alcohol
33. For the general population overweight and
obesity can be categorized by using BMI
BMI<18.5- Underweight
BMI 18.5-24.9- Normal Weight
BMI 25-29.9- Overweight
BMI 30-39.9- Obese
BMI >40- Extreme Obese
2. Overweight and Obesity
34. SCI: Assessment of Body Composition: BMI
and skinfold measurements
The clinical dietitian should not use
the following to measure
body composition in
persons with SCI:
body mass index (BMI)
Skinfold measurements
These methods may not provide
reliable results since they
were developed based
on able-
bodied persons.
35.
36. SCI: Estimation of Ideal Body Weight
Quadraplegia or (Tetraplagia):
Reduction of 10% to 15% (7-9) kg
lower than table weight
Paraplegia:
Reduction of 5% to 10%
(4.5-7) kg lower than table weight
37. Estimation of Ideal Body Weight
The clinical dietitian should estimate ideal
body weight for persons with SCI by
adjusting the Metropolitan Life Insurance
tables for individuals of equivalent height
and weight
38. Height (m)
Frame Size
Medium Large
Para Tetra Para Tetra
1.57 49 46.5 54.5 52
1.60 51 49 57 55
1.62 54.5 52 60 58
1.65 57 55 63.5 61
1.67 60 58 66 64
1.70 62 60 69 67
1.72 65 63 72 69
1.75 68.5 66 75 73
1.77 75 68 78.5 76
1.80 73.5 71 81 78.5
1.83 76 74 85 82
1.86 79 77 87 85
1.88 81 79 90 88
1.91 84 82 93.5 91
1.93 86.5 85 96 94
1.96 90 88 99 97
1.98 92 90 102 99.5
S
C
I
M
E
N
W
E
I
G
H
T
T
A
B
L
E
S
39. S
C
I
W
O
M
E
N
W
E
I
G
H
T
T
A
B
L
E
S
Height (m)
Frame Size
Medium Large
Para Tetra Para Tetra
1.47 36 34 40 38
1.5 38.5 36 43.5 41
1.52 41 39 45 43
1.55 43.5 41 48.5 46
1.57 45 43 46 48
1.60 47 45 53.5 51
1.62 50 48 55.5 53
1.65 52 49 57.5 55
1.67 54.5 52 60.5 58
1.70 56 54 63 61
1.72 59.5 57 65 63
1.75 61 59 68 66
1.77 63.5 61 70 68
1.78 66 64 73.5 71
1.83 68.5 66 75 73
40. SCI: Assessment of Body Composition:
BIA and DEXA
Assessment of body composition for medically
stable SCI patients by using
Bio-electric Impedance Analysis (BIA)
Dual-Energy X-Ray Absorptiometry (DEXA)
Persons with SCI have significantly higher fat
mass and lower lean mass than persons without
SCI
42. What’s the difference between weight &
body fat in terms of health risks?
Weight measurement alone cannot accurately
determine a person’s body fat % and the
resulting health risks
New evidence indicates that fat loss, not weight
loss can extend lifespan
43. Level of Body Fat % for General Health
Adult Male Adult Female
Age Excellent Good Average Poor Age Excellent Good Average Poor
19-24 10.8% 14.9% 19.0% 23.3% 19-24 18.9% 22.1% 25.0% 29.6%
25-29 12.8% 16.5% 20.3% 24.4% 25-29 18.9% 22.0% 25.4% 29.8%
30-34 14.5% 18.0% 21.5% 25.2% 30-34 19.7% 22.7% 26.4% 30.5%
35-39 16.1% 19.4% 22.6% 26.1% 35-39 21.0% 24.0% 27.7% 31.5%
40-44 17.5% 20.5% 23.6% 26.9% 40-44 22.6% 25.6% 29.3% 32.8%
45-49 18.6% 21.5% 24.5% 27.6% 45-49 24.3% 27.3% 30.9% 34.1%
50-54 19.4% 22.7% 25.6% 28.7% 50-54 26.6% 29.7% 33.1% 36.2%
54-59 20.2% 23.2% 26.2% 29.3% 54-59 27.4% 30.7% 34.0% 37.3%
60 20.3% 23.5% 26.7% 29.8% 60 27.6% 31.0% 34.4% 38.0%
44. Example
Patient: 30 years old male
BMI= 17.9 Underweight
Average % fat assessed: 28.2%
This would make this patient obese because in
this age group the amount of fat that is
considered acceptable is 18-25%, making this
seemingly underweight patient obese
45. SCI: Risks Associated Overweight & Obesity
The SCI patients is at a higher risk of associated
comorbidities
Diabetes
Metabolic syndrome
Cardiovascular disease
Lower levels of spontaneous physical activity and a
lower thermic effect of food result in decreased energy
expenditure and energy needs.
46. What is the Thermic Effect of Food?
It is a reference to the increase in metabolic rate (i.e. the
rate at which your body burns calories) that occurs after
ingestion of food.
Energy expenditure (i.e. calories) to digest, absorb, and
store the nutrients; accounts for 5 to 10 % of the energy
content of the food ingested.
Example
500 calorie meal, 50 calories (or 10%) would be expected
to be burned due to the thermic effect of food, a net
calorie consumption of 500 - 50 = 450 calories.
47. Influence of Body Composition on the
Thermic Effect of Food
Lean people have a thermic effect of food
2 to 3 X greater than obese or people with
higher body fat %, during rest, after
exercise, and during exercise.
Segal KR, Gutin B, Albu J, Pi-Sunyer FX. Thermic effects of food and exercise in lean and obese men of similar lean
body mass. Am J Physiol. 1987 Jan;252(1 Pt 1):E110-7.
48. SCI: Wheel Chairs & Energy Needs
Compared to ultralight wheelchairs and pushrim-
activated, power-assisted wheelchairs; The use of
a manual standard wheelchair increases:
Energy needs
heart rate
Oxygen consumption and ventilation, especially as
speed and resistance levels increase
49. SCI: Nutrition Education
Regarding Physical Activity
physical activity should be encouraged as part
of a comprehensive weight management
program for overweight or obese SCI patients
50. Physical Activity for SCI Patients
Swimming
Electrical stimulation exercise
Body weight supported
Treadmill training
51. 3. Lipid Abnormalities
SCI patients are at higher risk of cardiovascular
conditions.
Cardioprotective diet should be
provided if total cholesterol
levels > 200mg/dL
52. SCI: Factors Related to Lipid Abnormalities
Age
Ethnicity
Gender
Time since injury
Level of injury
Activity level
Dietary habits
Smoking behavior
Alcohol intake
Overweight or obese status
ModifiableNon-Modifiable
53. SCI: Nutrition Screening for Lipid
Abnormalities
Screening for lipid abnormalities is recommended for all
persons with SCI in order to reduce morbidity and
mortality.
Up to 30% deaths from CHD
due to an unhealthy diet
36% due to inactivity
NHF (2006)
Up to 30% deaths from CHD
due to an unhealthy diet
36% due to inactivity
NHF (2006)
54. 4. Pressure Ulcers
Patients who are at the
greatest risk of developing
pressure ulcers
Nonambulatory
Compromised nutritional
status
Pressure ulcers are
secondary to the decrease
in oxygen supplied to at-
risk areas (eg, coccyx,
elbows, heels)
Modifiable
55. SCI: Nutrition Prescription for SCI
Persons with Pressure Ulcers
A nutrition prescription should be formulated as part of
the nutrition intervention for persons with (SCI) and
pressure ulcers
Energy
Protein
Fluid
Micronutrient requirements
Additional energy and protein is needed for optimal
healing of pressure ulcers
Fluid and micronutrient needs will vary depending on the
person's status.
56. Nutritional Assessment
The Clinical Dietitian should assess for:
Anthropometrics
Skin integrity
Dietary intake
Lifestyle factors
Biochemical indices
57. SCI: Biochemical Parameters Associated
with Prevention of Pressure Ulcers
laboratory indices associated with the risk of
pressure ulcers
albumin, Prealbumin, Zinc, vitamin A and vitamin C
Biochemical parameters as close to normal as
possible or within the normal range are
associated with reduced risk of pressure ulcers.
58. Serum Albumin
Hypoalbuminemia, has been associated with the
development and progression of pressure ulcers.
Nutritional intervention needs to include adequate
protein and adequate calories to spare protein for
wound healing.
The goal is a serum albumin of greater than 3.5 g/dL
The amount of protein and number of calories need
to increase as the stage of the ulcer increases
59. SCI: Assessment: Energy Needs with
Pressure Ulcers
SCI patients with pressure ulcers have higher
energy needs
Additional energy is needed for optimal healing
30 – 40 kcal/kg of body weight/day
Harris-Benedict x Stress Factor
1.2 for stage II ulcer
1.5 for stage III and IV ulcers
60. SCI: Assessment: Protein Needs with
Pressure Ulcers
The clinical dietitian should calculate
protein needs as follows:
(1.2 - 1.5)g of protein/kg body weight/day
(Stage II pressure ulcers)
(1.5 - 2.0)g of protein/kg body weight/day
(Stage III and IV pressure ulcers).
61. Arginine
Dietary supplementation with arginine has been shown
to enhance protein metabolism, helping to decrease
muscle loss, and collagen synthesis, which helps to
increase the strength of the wound
Increased protein demand for normally nonessential amino
acids, becomes essential (conditionally essential)
Increases IGF-1 (Insulin Like Growth Factor) level
hormone that promotes wound healing
Studies suggest +ve outcomes in post-op surgical
wounds.
L-Arginine is also effective in healing chronic ulcers in
people with diabetes (ultimately helping to reduce leg
amputations)
62. When and How to Use Arginine
Should NOT be first line of defense
Consider for non-healing wounds after calorie
and protein needs met
Therapeutic dose to promote healing is ~9
grams/day
64. Glutamine
Functions
Regulates amino acid homeostasis
Preferred energy source for rapidly
multiplying cells of intestinal mucosa and
immune system
May stabilize the intestinal barrier, reducing
risk of bacterial translocation and systemic
inflammatory response [Neu 2002]
Clinical trials of supplementation suggest benefit
but remain inconclusive.
65. How and When to Use Glutamine
This is NOT first line of defense
Indications are for patients with GI
impairment and Immune deficiencies
Provide 15-30g/day or 0.57 gm/kg wt
66. ß-Hydroxy-ß-methyl-butyrate (HMB)
Substance derived from breakdown of amino
acid leucine
Function
Anti-catablic agent
Used for reduction of muscle tissue
breakdown
Lack of clinical trials available
Some Products are marketed for wound healing
Contains 7 gm arginine, 7 gm glutamine, 1.5
g HMB per packet
67. SCI: Fluid Needs with Pressure Ulcers
The clinical dietitian should assess hydration
status to determine fluid needs.
evaluation of parameters such as input and output
urine color
skin turgor
BUN
serum sodium
68. Fluid Needs with Pressure Ulcers
Normal requirement: (30 – 40)ml/kg
Minimum of 1 ml/kcal/day
(10 – 15) ml per kg additional fluids
may be required with the use of air
fluidized beds set at a high temp.
(more than 31º to 34ºC
Fluid loss also includes evaporation
from open wounds, wound drainage
and fever
69. SCI: Nutrition Support & Pressure Ulcers
Implementing aggressive nutrition support
measures for SCI patients at risk of
pressure ulcer development may include
(Enteral and Parenteral Nutrition)
Improved nutrition intake, body weight and
biochemical parameters are associated with
reduced risk of pressure ulcer development
70. SCI: Micronutrients & Wound Healing
Daily vitamin and mineral supplement
should not be more than 100% of the
RDA.
When supplementing greater than the Tolerable
Upper Intake Level (UL); the dietitian should re-
evaluate the need for micronutrient
supplementation every 7 to 10 days.
71. Vitamin A
Stimulates differentiation in fibroblasts and
collagen synthesis to quicken healing
Vitamin A deficiency results in impaired wound
healing and alteration in immune function that
may increase wound infections.
Recommendations for amount of Vitamin A is
(10,000 IU to 50,000 IU /day)
10,000 IU IV for moderate-severely injured patients
or malnourished patients for a limit of 10 days.
72. Vitamin A & Steroids
For patients receiving steroids, 10,000 IU
to 15,000 IU for one week has been
recommended to counteract the anti-
inflammatory effects of steroids
Steroids adversely affect all phases of
wound healing and increase risk of
infection[Ross 2002]
Vitamin A supplementation should be
implemented cautiously because of
potential toxicity
73. Vitamin C
Necessary for collagen synthesis
Enhances immune function
Depressed levels found in elderly, smokers,
and certain cancers [Ross 2002]
Vitamin C deficiency has been associated with
delayed wound healing
High doses of Vitamin C for healing chronic
wounds is recommended
(100 to 200)mg/day of Vitamin C for Stage I and II
pressure ulcers
(1,000 to 2,000) mg/day of Vitamin C for Stage III
and IV pressure ulcers
74. Zinc
Zinc deficiency is associated with delayed wound healing
due to a decrease in collagen protein synthesis and
impaired immune competence.
(50mg elemental Zinc) twice/day is recommended as a
standard adult oral replacement (minimal daily
requirements is 15 mg/d)
High-dose supplementation of zinc
should be limited to (2-3) weeks
Dosage should be individualized
according to zinc status and metabolic
demands.
75. Iron
Anemia assessed by hemoglobin and
hematocrit levels
If low hemoglobin concentration is due
to iron deficiency anemia, it may be a
factor in tissue hypoxia and impaired
wound healing.
Supplementation should be provided
as indicated to correct iron deficiency
anemia.
There are 58 studies about curcumin &
wound healing in the PubMed until this
date 30/6/2011
76. Recent Researches
A search of PubMed on the
internet reveals some 58
scientific and technical
papers referenced to
curcumin and wound healing
77. Curcumin & Wound-healing
Dermal wound healing processes with curcumin incorporated collagen films
Gopinath D.etal Biomaterials. 2004 May;25(10):1911-7
Protective effects of curcumin against oxidative damage on skin cells in
vitro: its implication for wound healing
Phan TTetal J Trauma. 2001 Nov;51(5):927-31
Enhancement of wound healing by curcumin in animals
Sidhu G Setal , Wound Repair Regen. 1998 Mar-Apr;6(2):167-77
Inhibitory effect o fcurcuminon PMA-induced increase in ODC m RNA in
mouse epidermis Lu
YP…Conney AH, Carcinogenesis. 1993 Feb;14(2):293-7
Inhibitory effect of dietary curcuminon skin carcinogenesisin mice
LimtrakulP., CancerLett. 1997 Jun 24;116(2):197-203
Turmeric and curcuminas topical agents in cancer therapy
KuttanR.,Tumori. 1987 Feb 28;73(1):29-31
78. 5. Neurogenic Bowel
The Clinical Dietitian should prescribe for SCI
patient with neurogenic bowel an initial fiber
intake of 15g/day, with gradual increases
up to 30g/day of fiber, as tolerated from a
variety of sources.
Excessive fiber may result in unacceptable
Flatulence
Significant increase in stool volume
Painful abdominal distension
79. 5. Neurogenic Bowel
Fiber intake > 20g/day may be
associated with undesirable
prolonged intestinal transit times
resulting in excessive fluid
reabsorption and the formation
of hardened stools
Transit TimeTransit Time
83. Juices that are Good for Chronic
Constipation
Sorbitol is a natural fruit sugar that is
poorly absorbed by the intestines, so
it stays in the intestinal tract and
makes the stools more liquid
84. Prune juice
Prune juice contains 6.1 g of
sorbitol /100-g serving
Prune juice and other prune
products have long been used to
relieve constipation due to their
laxative effect
An added benefit of prune juice
over many other fruit juices is that
it does not cause a spike in blood
sugar, which can be dangerous for
diabetics.
Baylor College of Medicine
85. Pear Juice
One 8-oz glass of pear juice
can contain as much as 7 g of
sorbitol.
As few as 10 g of sorbitol can
cause diarrhea in children
(it is best to offer a child
only a small amount to assist
in chronic constipation relief)
Baylor College of Medicine
86. Apple Juice
Apple juice is naturally high in
sorbitol
It is a mild juice that can cause
gas in some individuals
it is often one of the first
juices given to babies who have constipation
It is suggested to give babies 2 oz of apple juice
twice per day for constipation
87. Constipation
Foods (such as dairy products, white potatoes,
white bread and bananas) can contribute to
constipation
Foods (such as excess amounts of fruit, caffeine,
or spicy foods and warm fluids with lemon juice)
may soften the stool or cause diarrhea
88. Constipation
Drinking water and eating high-fiber foods such as
fruits, vegetables, whole grains and legumes may
help to soften and make the stool bulkier, which
stimulates movement of the bowel
Peristalsis can be stimulated with vegetables, fruits
(especially dried fruits)
Dried fruits are the ideal substitute for candies
89. SCI: Fluid & Neurogenic Bowel:
Estimating Fluid Needs to Promote Optimal Stool Consistency
1 ml fluid/kcal estimated energy needs + 500 ml
Example
1500 fluid/kcal estimated energy needs+ 500 ml= 2000
ml fluid Needs/day
30-40ml/kg body weight + 500 ml
Example
40 x 55 kg body weight + 500 ml = 2700 ml fluid
needs/day
91. 6. Urinary Tract Infections
The Clinical Dietitian may recommend
that cranberry juice be included in the
diet to reduce urinary tract infections
Consumption of one cup (250ml)
cranberry juice, 3 times/day, may be
associated with a reduced urinary tract
biofilm load
Cranberry juice contains hippuric acid
and another substances that seems to
prevent adherence of bacteria to
urinary tract epithelial
92. SCI: Cranberry Extract Supplements
The Clinical Dietitian should not
recommend cranberry extract
supplements to promote urologic
health (prevention of urinary tract
infections, urologic stones, etc.) with
SCI patients
Cranberry extract supplements,
ingested in tablet or capsule form, are
not effective in prolonging the UTI-free
period or decreasing bacteriuria or
WBC count in persons with SCI
patients
How much nutritional needs change has not been well studied in SCI patients but we do know that they change. Today, specifically I am going to focus on calories because for the most part protein and fluid needs stay about the same. However, I will mention that if you are increasing protein in your diet you need to increase fluid (water) at the same time because of the damage that high protein diets can do to your kidneys.
Metabolism is a complicated chemical process so I am going to explain it in simple terms that all of us will remember. The amount of calories that a person burns in a day is affected by how active that person is, the amount of fat and muscle in their body, and their basal metabolic rate, which is how many calories we are burning while we are at rest.
Indirect calorimetry relies on the fact that burning 1 calorie (Kilocalorie) requires 208.06
milliliters of oxygen.
Because of this very direct relationship between caloric burn and oxygen consumed,
measurements of oxygen uptake (VO2) and caloric burn rate are virtually
interchangeable.
Oxygen uptake requires a precise measurement of the volume of expired air and of the
concentration of oxygen in the expired air.
These are some of the problems that I mentioned on the last slide that we are particularly concerned about. I am not going to go into great detail about any of the secondary conditions related to SCI and nutrition. However, I am going to highlight the words listed in red related to the metabolic syndrome because this is something many of you may be unfamiliar with.
Metabolic syndrome which puts you at greater risk for cardiovascular disease, other heart disease, diabetes and other complications.
Metabolic syndrome which puts you at greater risk for cardiovascular disease, other heart disease, diabetes and other complications.
Removing the skin cuts the amount of fat in half!!
Removing the skin cuts the amount of fat in half!!
to 10 % of the energy content of the food ingested.
This would mean, for example, that if you eat a 400 calorie meal, you can reasonably expect somewhere between 20 to 40 calories to be burned in the process of digesting, absorbing, and storing the nutrients from the meal.
Or, as another example, if you eat 2000 calories per day, roughly 100 to 200 calories will be burned each day as a result of the thermic effect of food.
to 10 % of the energy content of the food ingested.
This would mean, for example, that if you eat a 400 calorie meal, you can reasonably expect somewhere between 20 to 40 calories to be burned in the process of digesting, absorbing, and storing the nutrients from the meal.
Or, as another example, if you eat 2000 calories per day, roughly 100 to 200 calories will be burned each day as a result of the thermic effect of food.
to 10 % of the energy content of the food ingested.
This would mean, for example, that if you eat a 400 calorie meal, you can reasonably expect somewhere between 20 to 40 calories to be burned in the process of digesting, absorbing, and storing the nutrients from the meal.
Or, as another example, if you eat 2000 calories per day, roughly 100 to 200 calories will be burned each day as a result of the thermic effect of food.