HANA SCI

Dietary Management
pinal Cord Injury
Colonel Hana K. Mudabber
Head of Clinical Nutrition Department
S of

Coordination of Care
 Optimal care of SCI patient requires a
multidisciplinary approach in all aspects
of patient care including nutrition

SCI : Interdisciplinary Team
Others

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)

Nutrition Management
in the Acute Phase

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

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.

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

SCIInflammation
Malnutrition
Loss of muscle
mass
Loss of activity
Acute Illness & Nutritional Status
After injury: weight loss due to loss of muscle
or lean body tissue

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

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.

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

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)

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

Parenteral Nutrition
Benefits
Fewer interruptions in feeding
Nutrition goals reached quickly
Least desirable
Increased risk of infection
Increased cost
Increased risk of mortality

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

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

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.

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

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

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

Nutrition Management
in the Rehabilitation Setting

SCI: Goals of Nutrition Assessment in
the Rehabilitation Setting
Implementing an individualized
therapeutic nutrition plan for the patient
Improving transition into the community
setting

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

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

Community Setting
After Discharge

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

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

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

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

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

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

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

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.

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

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

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
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N
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H
T
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A
B
L
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S

S
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W
O
M
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N
W
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H
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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

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

(BIA)
Bioelectric impedance Analysis
(DEXA)
Dual-Energy X-Ray Absorptiometry

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

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%

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

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.

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.

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.

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

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

Physical Activity for SCI Patients
Swimming
Electrical stimulation exercise
Body weight supported
Treadmill training

3. Lipid Abnormalities
SCI patients are at higher risk of cardiovascular
conditions.
Cardioprotective diet should be
provided if total cholesterol
levels > 200mg/dL

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

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)

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

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.

Nutritional Assessment
The Clinical Dietitian should assess for:
 Anthropometrics
Skin integrity
Dietary intake
Lifestyle factors
Biochemical indices

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.

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

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

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).

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)

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

Side effects
L-Arginine supplementation can cause diarrhea.
Gradual increase of daily dose may help
tolerance.

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.

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

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

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

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

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

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.

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.

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

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

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.

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

Recent Researches
A search of PubMed on the
internet reveals some 58
scientific and technical
papers referenced to
curcumin and wound healing

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

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

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

Constipation
Juices, especially those high in sorbitol,
can help relieve constipation.

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

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

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

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

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

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

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

SCI: Fluid & Neurogenic Bowel:

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

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

HANA SCI

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