Feeding disorders and nutritional needs in patients with spinal cord injuries

  • E. Maliori
  • I. Vlamis
  • S.G. Pneumaticos
Keywords: Nutritional needs, Spinal Cord Injuries


Poor nutrition in spinal cord injury (SCI) patients can lead to medical complications such as skin ulcers, osteoporosis, obesity, diabetes, dyslipidemia, neurogenic problems of the intestine and bladder and fitness issues that can affect mobility and functional independence. The aim of this study was to review feeding disorders and nutritional needs in patients with SCI. For this reason, a review of the current literature was performed by using the online PUBMED database and the following keywords: “spinal cord injuries” AND (“diet” OR “nutrition” OR “malnutrition” OR “feeding” OR “eating disorders” OR “nutritional needs”). The search retrieved a total of 509 papers. After screening of titles and abstracts, 426 articles were rejected as irrelevant with the topic. Of the 83 remaining publications evaluated, 43 were rejected for various reasons. After reviewing the reference lists of the remaining studies, 6 more studies were identified. Finally, 46 studies were included in the present review. Patients with SCI are disabled for life and must change their lifestyle greatly. Injuries in cervical spine may compromise the process of swallowing, causing dysphagia and respiratory complications. The risk of under-nutrition and malnutrition in SCI patients is high. Poor diet negatively affects overall health leading to obesity, cardiovascular disease, diabetes mellitus and metabolic syndromes. Patients with SCI must follow a proper diet to ensure that the right amount of nutrients is delivered for sustaining the appropriate physiological mechanisms.



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Author Biographies

E. Maliori

Postgraduate training program: “Rehabilitation following Spinal Cord lesions. Spinal Pain Management”, 3rd Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, KAT Hospital.

I. Vlamis

Department of Orthopaedic Surgery, 3rd Department of Orthopaedic Surgery National and Kapodistrian University of Athens, KAT Hospital.

S.G. Pneumaticos

Department of Orthopaedic Surgery, 3rd Department of Orthopaedic Surgery National and Kapodistrian University of Athens, KAT Hospital.


1. Witiw CD, Fehlings MG. Acute Spinal Cord Injury. J Spinal Disord Tech 2015;28(6): 202-10.
2. Sekhon LH, Fehlings MG. Epidemiology, demographics, and pathophysiology of acute spinal cord injury. Spine (Phila Pa 1976) 2001;26(24 Suppl): S2-12.
3. Devivo MJ. Epidemiology of traumatic spinal cord injury: trends and future implications. Spinal Cord 2012; 50(5):365-72.
4. Bigford G, Nash MS. Nutritional Health Considerations for Persons with Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2017;23(3):188-206.
5. Shojaei MH, Alavinia SM, Craven BC. Management of obesity after spinal cord injury: a systematic review. J Spinal Cord Med 2017;40(6):783-94.
6. Farkas GJ, Pitot MA, Berg AS, et al. Nutritional status in chronic spinal cord injury: a systematic review and meta-analysis. Spinal Cord 2019; 57(1):3-17.
7. Thibault-Halman G, Casha S, Singer S, et al. Acute management of nutritional demands after spinal cord injury. J Neurotrauma 2011; 28(8):1497-507.
8. Gater DR, Bauman C, Cowan R. A Primary Care Provider’s Guide to Diet and Nutrition After Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2020;26(3):197-202.
9. Wong S, Kenssous N, Hillier C, et al. Detecting malnutrition risk and obesity after spinal cord injury: a quality improvement project and systematic review. Eur J Clin Nutr 2018; 72(11):1555-60.
10. Powell D, Affuso O, Chen Y. Weight change after spinal cord injury. J Spinal Cord Med 2017;40(2):130-37.
11. Kirshblum S, Johnston MV, Brown J, et al. Predictors of dysphagia after spinal cord injury. Arch Phys Med Rehabil 1999;80(9):1101-05.
12. Shem K, Castillo K, Wong S, et al. Dysphagia in individuals with tetraplegia: incidence and risk factors. J Spinal Cord Med 2011;34(1):85-92.
13. Chaw E, Shem K, Castillo K, et al. Dysphagia and associated respiratory considerations in cervical spinal cord injury. Top Spinal Cord Inj Rehabil 2012; 18(4):291-99.
14. Smith-Hammond CA, New KC, Pietrobon R, et al. Prospective analysis of incidence and risk factors of dysphagia in spine surgery patients: comparison of anterior cervical, posterior cervical, and lumbar procedures. Spine (Phila Pa 1976) 2004;29(13):1441-46.
15. Stewart M, Johnston RA, Stewart I, et al. Swallowing performance following anterior cervical spine surgery. British Journal of Neurosurgery 1995;9(5):605-10.
16. Winslow CP, Winslow TJ, Wax MK. Dysphonia and Dysphagia Following the Anterior Approach to the Cervical Spine. Archives of Otolaryngology–Head & Neck Surgery 2001;127(1):51-55.
17. Bazaz R, Lee MJ, Yoo JU. Incidence of dysphagia after anterior cervical spine surgery: a prospective study. Spine (Phila Pa 1976) 2002;27(22):2453-38.
18. Ebraheim NA, Lu J, Skie M, et al. Vulnerability of the recurrent laryngeal nerve in the anterior approach to the lower cervical spine. Spine (Phila Pa 1976) 1997; 22(22):2664-47.
19. Ihalainen T, Luoto TM, Rinta-Kiikka I, et al. Traumatic cervical spinal cord injury: recovery of penetration/aspiration and functional feeding outcome. Spinal Cord 2018;56(10):1000-07.
20. Shin JC, Chang SH, Hwang SW, et al. The Nutritional Status and the Clinical Outcomes of Patients With a Spinal Cord Injury Using Nutritional Screening Tools. Ann Rehabil Med 2018;42(4):591-600.
21. Wong S, Derry F, Jamous A, et al. Validation of the spinal nutrition screening tool (SNST) in patients with spinal cord injuries (SCI): result from a multicentre study. Eur J Clin Nutr 2012;66(3):382-87.
22. Knight KH, Buchholz AC, Martin Ginis KA, et al. Leisure-time physical activity and diet quality are not associated in people with chronic spinal cord injury. Spinal Cord 2011;49(3):381-85.
23. Lieberman J, Goff D, Jr., Hammond F, et al. Dietary intake and adherence to the 2010 Dietary Guidelines for Americans among individuals with chronic spinal cord injury: a pilot study. J Spinal Cord Med 2014;37(6):751-57.
24. Krempien JL, Barr SI. Risk of nutrient inadequacies in elite Canadian athletes with spinal cord injury. Int J Sport Nutr Exerc Metab 2011;21(5):417-25.
25. Wong S, Derry F, Graham A, et al. An audit to assess awareness and knowledge of nutrition in a UK spinal cord injuries centre. Spinal Cord 2012;50(6): 446-51.
26. Steensgaard R, Bonne S, Wojke P, et al. SCI-SCREEN: A More Targeted Nutrition Screening Model to Detect Spinal Cord-Injured Patients at Risk of Malnutrition. Rehabil Nurs 2019;44(1):11-19.
27. Rowan C, Kazemi A. An observational study of feeding practice in ventilated patients with spinal cord injury. Clin Nutr ESPEN 2020;37:107-13.
28. Wong S, Derry F, Jamous A, et al. The prevalence of malnutrition in spinal cord injuries patients: a UK multicentre study. Br J Nutr 2012;108(5):918-23.
29. Chen X, Liu Z, Sun T, et al. Relationship between nutritional status and mortality during the first 2 weeks following treatment for cervical spinal cord injury. J Spinal Cord Med 2014;37(1):72-78.
30. Wong S, Derry F, Grimble G, et al. How do spinal cord injury centres manage malnutrition? A cross-sectional survey of 12 regional centres in the United Kingdom and Ireland. Spinal Cord 2012;50(2):132-35.
31. Farkas GJ, Gorgey AS, Dolbow DR, et al. Caloric Intake Relative to Total Daily Energy Expenditure Using a Spinal Cord Injury-Specific Correction Factor: An Analysis by Level of Injury. Am J Phys Med Rehabil 2019;98(11):947-52.
32. Pellicane AJ, Millis SR, Zimmerman SE, et al. Calorie and protein intake in acute rehabilitation inpatients with traumatic spinal cord injury versus other diagnoses. Top Spinal Cord Inj Rehabil 2013;19(3):229-35.
33. Dvorak MF, Noonan VK, Bélanger L, et al. Early versus late enteral feeding in patients with acute cervical spinal cord injury: a pilot study. Spine (Phila Pa 1976) 2004;29(9):E175-80.
34. Rowan CJ, Gillanders LK, Paice RL, et al. Is early enteral feeding safe in patients who have suffered spinal cord injury? Injury 2004;35(3):238-42.
35. Tanaka M, Momosaki R, Wakabayashi H, et al. Relationship between nutritional status and improved ADL in individuals with cervical spinal cord injury in a convalescent rehabilitation ward. Spinal Cord 2019;57(6):501-08.
36. Locatelli SM, LaVela SL. Documentation of weight management practices for individuals with spinal cord injuries and disorders. Spinal Cord 2016;54(12):1176-82.
37. Yahiro AM, Wingo BC, Kunwor S, et al. Classification of obesity, cardiometabolic risk, and metabolic syndrome in adults with spinal cord injury. J Spinal Cord Med 2020;43(4):485-96.
38. Sabour H, Javidan AN, Vafa MR, et al. Calorie and macronutrients intake in people with spinal cord injuries: an analysis by sex and injury-related variables. Nutrition 2012;28(2):143-47.
39. de Groot S, Post MW, Postma K, et al. Prospective analysis of body mass index during and up to 5 years after discharge from inpatient spinal cord injury rehabilitation. J Rehabil Med 2010;42(10):922-28.
40. Perret C, Stoffel-Kurt N. Comparison of nutritional intake between individuals with acute and chronic spinal cord injury. J Spinal Cord Med 2011;34(6):569-75.
41. Wong S, Graham A, Green D, et al. Nutritional supplement usage in patients admitted to a spinal cord injury center. J Spinal Cord Med 2013;36(6):645-51.
42. Silveira SL, Winter LL, Clark R, et al. Baseline Dietary Intake of Individuals with Spinal Cord Injury Who Are Overweight or Obese. J Acad Nutr Diet 2019;119(2):301-09.
43. Gorgey AS, Caudill C, Sistrun S, et al. Frequency of Dietary Recalls, Nutritional Assessment, and Body Composition Assessment in Men With Chronic Spinal Cord Injury. Arch Phys Med Rehabil 2015;96(9):1646-53.
44. Sabour H, Soltani Z, Latifi S, et al. Dietary pattern as identified by factorial analysis and its association with lipid profile and fasting plasma glucose among Iranian individuals with spinal cord injury. J Spinal Cord Med 2016;39(4):433-42.
45. Li J, Polston KFL, Eraslan M, et al. A high-protein diet or combination exercise training to improve metabolic health in individuals with long-standing spinal cord injury: a pilot randomized study. Physiol Rep 2018; 6(16): e13813.
46. Sabour H, Nazari M, Latifi S, et al. The Relationship Between Dietary Intakes of Amino Acids and Bone Mineral Density Among Individuals with Spinal Cord Injury. Oman Med J 2016;31(1):22-28.
47. Bailey KA, Lenz K, Allison DJ, et al. Barriers and facilitators to adhering to an anti-inflammatory diet for individuals with spinal cord injuries. Health Psychol Open 2018; 5(2): 2055102918798732.
48. Allison DJ, Beaudry KM, Thomas AM, et al. Changes in nutrient intake and inflammation following an anti-inflammatory diet in spinal cord injury. J Spinal Cord Med 2019;42(6):768-77.
49. Cameron KJ, Nyulasi IB, Collier GR, et al. Assessment of the effect of increased dietary fibre intake on bowel function in patients with spinal cord injury. Spinal Cord 1996;34(5):277-83.
50. Yeung HY, Iyer P, Pryor J, et al. Dietary management of neurogenic bowel in adults with spinal cord injury: an integrative review of literature. Disabil Rehabil 2019:1-12.
51. Lussi C, Frotzler A, Jenny A, et al. Nutritional blood parameters and nutritional risk screening in patients with spinal cord injury and deep pressure ulcer-a retrospective chart analysis. Spinal Cord 2018;56(2):168-75.
52. Ho CH, Powell HL, Collins JF, et al. Poor nutrition is a relative contraindication to negative pressure wound therapy for pressure ulcers: preliminary observations in patients with spinal cord injury. Adv Skin Wound Care 2010;23(11): 508-16.
53. Clinical practice guidelines: Neurogenic bowel management in adults with spinal cord injury. Spinal Cord Medicine Consortium. J Spinal Cord Med 1998; 21(3):248-93.
54. Salameh A, Mohajer MA, Daroucihe RO. Prevention of urinary tract infections in patients with spinal cord injury. CMAJ 2015;187(11):807-11.
55. Szlachcic Y, Adkins RH, Adal T, et al. The effect of dietary intervention on lipid profiles in individuals with spinal cord injury. J Spinal Cord Med 2001;24(1): 26-29.
56. Opperman EA, Buchholz AC, Darlington GA, et al. Dietary supplement use in the spinal cord injury population. Spinal Cord 2010;48(1):60-64.
57. Javierre C, Vidal J, Segura R, et al. Continual supplementation with n-3 fatty acids does not modify plasma lipid profile in spinal cord injury patients. Spinal Cord 2005;43(9):527-30.
58. Koutrakis NE, Goldstein RL, Walia P, et al. Vitamin D, diet, and lifestyle in a chronic SCI population. Spinal Cord 2019;57(2):117-27.
59. Pritchett K, Pritchett RC, Stark L, et al. Effect of Vitamin D Supplementation on 25(OH)D Status in Elite Athletes With Spinal Cord Injury. Int J Sport Nutr Exerc Metab 2019;29(1):18-23.
60. Flueck JL, Schlaepfer MW, Perret C. Effect of 12-Week Vitamin D Supplementation on 25[OH]D Status and Performance in Athletes with a Spinal Cord Injury. Nutrients 2016;8(10).
61. Holla JFM, van den Akker LE, Dadema T, et al. Determinants of dietary behaviour in wheelchair users with spinal cord injury or lower limb amputation: Perspectives of rehabilitation professionals and wheelchair users. PLoS One 2020; 15(1):e0228465.
62. Gale K. Healthy Eating with Spinal Cord Injury (SCI). In: Dietetics DoN, editor.: Buckinghamshire Healthcare NHS Trust; 2018.
63. Nutrition for Adults with Spinal Cord Injury. In: Service NSSCI, editor.: Agency for Clinical Innovation 2019.