Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Clinical nutrition

Detecting malnutrition risk and obesity after spinal cord injury: a quality improvement project and systematic review

European Journal of Clinical Nutrition volume 72, pages 1555–1560 (2018)Cite this article

Subjects

Abstract

Background/objectives

Malnutrition and overweight are a major concern after spinal cord injury (SCI). There is limited information available for prevalence of malnutrition, overweight and nutrition screening compliance. The aim of this study is to (1) determine whether the quality improvement initiative is successful in improving nutrition screening and to (2) systematic review the literature on prevalence of malnutrition and overweight after SCI.

Subjects/methods

The quality improvement project was conducted during November 2013 to October 2017. Nutrition screening data (presence of a correctly completed Spinal Nutrition Screening Tool (SNST) within 24 h of admission) were collected weekly. Literatures on disease-related malnutrition prevalence in adult SCI patients published from inception to 17 March 2017 were included in the systematic review.

Results

Two thousand four hundred and sixty-two SCI (49.3% tetraplegia; 47.6% complete SCI) patients (mean age: 76.7 ± 16.2 years, 70.6% men) were included. Nutrition screening compliance increased significantly overtime (2013–2014: 49.3%; 2014–2015: 69.7%; 2015–2016: 80.7%; 2016–207: 76.7%, p < 0.01). Eighty-four articles were identified from the systematic review, of these nine studies with 9265 SCI patients were included. There was considerable variability in methodology and prevalence of malnutrition risk (three nutrition screening tools were reported: body mass index (BMI); Malnutrition Universal Screening Tool; SNST). The prevalence of undernutrition was in the range of 40–50%. Three different BMI cutoffs were reported as overweight’s cut-off (>22, >23 and >25 kg/m2). The prevalence of overweight was in the range of 45–69.2%.

Conclusions

Malnutrition and overweight is a highly prevalent condition after SCI. Further research is warranted to characterise screening practices and identify evidence-based interventions to this ongoing and costly clinical and public health issue.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1

Similar content being viewed by others

References

  1. National Institute for Health and Clinical Excellence (NICE). Guideline on the prevention, identification, assessment and management of overweight and obesity in adults and children. London: NICE; 2006. http://guidance.nice.org.uk/CG43/NICEGuidance/pdf/English. Accessed 2 Jan 2018.

  2. Wong S, Derry F, Jamous A, Hirani SP, Grimble G, Forbes A. The prevalence of malnutrition in spinal cord injured patients—a UK multicentre study. Br J Nutr. 2012;108:918–923.

    Article  CAS  Google Scholar 

  3. Wong S, Derry F, Jamous A, Hirani SP, Grimble G, Forbes A. Is undernutrition risk associated with an adverse clinical outcome in spinal cord-injured patients admitted to a spinal centre? Eur J Clin Nutr. 2014;68:125–130.

    Article  CAS  Google Scholar 

  4. Consortium for Spinal Cord Medicine. Pressure ulcer prevention and treatment following spinal cord injury: a clinical practice guideline for healthcare professionals. 2nd ed. Paralyzed Veterans of America; Washington, DC., 2014.

  5. National Institute for Health and Clinical Excellence (NICE). Guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children. London: NICE; 2006.

  6. Gerasimidis K, Drongitis P, Murray L, Young D, McKee RF. A local nutritional screening tool compared to malnutrition universal screening tool. Eur J Clin Nutr. 2007;61:916–921.

    Article  CAS  Google Scholar 

  7. Tammam JD, Gardner L, Hickson M. Validity, reliability and acceptability of the Imperial Nutrition Screening System (INSYST): a tool that does not require the body mass index. J Hum Nutr Diet. 2009;22:536–544.

    Article  CAS  Google Scholar 

  8. Elia M. Screening for malnutrition: a multidisciplinary responsibility. Development and use of the Malnutrition Universal Screening Tool (MUST) for adults. Redditch, Worcestershire: BAPEN. http://www.bapen.org.uk/pdfs/must/must_full.pdf. Accessed 3 Apr 2018.

  9. Wong S, Derry F, Jamous A, Hirani SP, Grimble G, Forbes A. Validation of the Spinal Nutrition Screening Tool (SNST) in patients with spinal cord injuries (SCI)—result form a multicentre study. Eur J Clin Nutr. 2012;66:382–387.

    Article  CAS  Google Scholar 

  10. Russell CA, Elia M. Nutrition screening surveys in UK hospitals, 2007–2011: a report based on the amalgamated data from the four nutrition screening week surveys undertaken by BAPEN in 2007, 2008, 2010 and 2011. 2014. www.bapen.org.uk

  11. Schindler K, Pernicka E, Laviano A, Howard P, Schutz T, Bauer P, et al. How nutritional risk is assessed and managed in European hospitals: a survey of 21,007 patients findings from the 2007–2008 cross-sectional nutrition day survey. Clin Nutr. 2010;29:552–559.

    Article  Google Scholar 

  12. Wahman K, Nash MS, Lewis JE, Seiger A, Levi R. Cardiovascular disease risk and the need for the prevention after paraplegia determined by conventional multifactorial risk models: the Stockholm spinal cord injury study. J Rehabil Med. 2011;43:237–242.

    Article  Google Scholar 

  13. Weaver FM, Collins EG, Kurichi J, Miskevics S, Smith B, Rajan S, Gater D. Prevalence of obesity and high blood pressure in veterans with spinal cord injuries and disorders: a retrospective review. Am J Phys Med Rehabil. 2007;86:22–29.

    Article  Google Scholar 

  14. Gupta N, White KT, Sanford PR. Body mass index in spinal cord injury—a retrospective study. Spinal Cord. 2006;44:92–94.

    Article  CAS  Google Scholar 

  15. Park P, Upadhyaya C, Garton HJ, Foley KT. The impact of minimally invasive spine surgery on perioperative complications in overweight or obese patients. Neurosurgery. 2008;62:693–699.

    Article  Google Scholar 

  16. Buchholz AC, Pencharz PB. Energy expenditure in chronic spinal cord injury. Curr Opin Clin Nutr Metab Care. 2004;7:635–639.

    Article  Google Scholar 

  17. Laughton GE, Buchholz AC, Martin Ginis KA, Goy RE, SHAPE SCI Research Group. Lowering body mass index cutoffs better identifies obese persons with spinal cord injury. Spinal Cord. 2009;47:757–762.

    Article  CAS  Google Scholar 

  18. Jones LM, Legge M, Goulding A. Healthy body mass index values often underestimate body fat in men with spinal cord injury. Arch Phys Med Rehabil. 2003;84:1068–1071.

    Article  Google Scholar 

  19. Kearns PJ, Thompson JD, Werner PC, Pipp TL, Wilmot CB. Nutritional and metabolic response to acute spinal-cord injury. J Parenter Enteral Nutr. 1992;16:11–15.

    Article  CAS  Google Scholar 

  20. Cree MG, Wolfe RR. Postburn trauma insulin resistance and fat metabolism. Am J Physiol Endocrinol Metab. 2008;294:E1–E9.

    Article  CAS  Google Scholar 

  21. Cederholm T, Bosaeus I, Barazzoni R, Bauer J, Van Gossum A, Klek S, et al. Diagnostic criteria for malnutrition—an ESPEN consensus statement. Clin Nutr. 2015;34:335e40.

    Article  Google Scholar 

  22. Wong S, Graham A, Hirani SP, Charlton D, Coalwood S, Mckeown E, Taylor C, Saif M. Review of dietetic service provision and activity in spinal cord injury centres: a multicentre survey in the UK and Republic of Ireland. Spinal Cord. 2015;53:855–859.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We are grateful to all the medical and nursing staff facilitating the NS, and Janine Turner and Steven Cameron for proof-reading the manuscript.

Author contributions

All authors contributed to the report. SW—protocol development, data collection, data analysis and manuscript preparation. NK—data collection, data analysis and manuscript revision. CH—data collection, data analysis and manuscript revision. SP—data collection, data analysis and manuscript revision. PJ—data analysis and manuscript revision. SL—data collection and manuscript revision. MS—data analysis and manuscript revision.

Author information

Authors and Affiliations

  1. National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK

    Samford Wong, Noureddine Kenssous, Clare Hillier, Sharon Pollmer, Penny Jackson, Sarah Lewis & Mofid Saif

  2. School of Health Sciences, City, University of London, London, UK

    Samford Wong

Authors
  1. Samford Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Noureddine Kenssous
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Clare Hillier
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sharon Pollmer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Penny Jackson
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sarah Lewis
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mofid Saif
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Samford Wong.

Additional information

Parts of the study data were submitted to present at the International Spinal Cord Society/American Spinal Injury Association joint meeting in May 2018.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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 72, 1555–1560 (2018). https://doi.org/10.1038/s41430-018-0194-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41430-018-0194-y

Search

Advanced search

Quick links