Individuals with spinal cord injuries (SCI) commonly present with component risk factors for cardiometabolic risk and combined risk factors for cardiometabolic syndrome (CMS). These primary risk factors include obesity, dyslipidemia, dysglycemia/insulin resistance, and hypertension. Commonly referred to as “silent killers”, cardiometabolic risk and CMS increase the threat of cardiovascular disease, a leading cause of death after SCI. This narrative review will examine current data and the etiopathogenesis of cardiometabolic risk, CMS, and cardiovascular disease associated with SCI, focusing on pivotal research on cardiometabolic sequelae from the last five years. The review will also provide current diagnosis and surveillance criteria for cardiometabolic disorders after SCI, a novel obesity classification system based on percent total body fat, and lifestyle management strategies to improve cardiometabolic health.

Spinal cord injury (SCI) results in a high prevalence of neurogenic obesity and metabolic dysfunction. The increased risk for neurogenic obesity and metabolic dysfunction is mainly due to the loss of energy balance because of significantly reduced energy expenditure following SCI. Consequently, excessive energy intake (positive energy balance) leads to adipose tissue accumulation at a rapid rate, resulting in neurogenic obesity, systemic inflammation, and metabolic dysfunction. The purpose of this article is to review the existing literature on nutrition, dietary intake, and nutrition education in persons with SCI as it relates to metabolic dysfunction. The review will highlight the poor dietary intakes of persons with SCI according to authoritative guidelines and the need for nutrition education for health care professionals and consumers. Nutrition education topics are presented in a module-based format with supporting literature. The authors emphasize the role of a diet consisting of low-energy, nutrient-dense, anti-inflammatory foods consistent with the Dietary Guidelines for Americans’ MyPlate to effectively achieve energy balance and reduce the risk for neurogenic obesity and metabolic dysfunction in individuals with SCI.

To describe health consequences associated with poor diet in persons with spinal cord injuries and disorders (SCI/D). Descriptive qualitative design using in-depth interviews with SCI/D health providers. Audio-recorded and transcribed verbatim transcripts were coded and analyzed using thematic analysis. Participants (n = 12) were from 11 nationwide VA hospitals. Participants were male (75%), white (67%), 26-49 years of age, and most were dietitians (75%) and physiatrists (17%). Seven key themes identified consequences associated with poor diet in persons with SCI/D, including (1) Weight gain and body composition changes, (2) cardiometabolic conditions, (3) bowel dysfunction, (4) pressure injuries/wounds, (5) other SCI/D secondary conditions/complications (renal/kidney; immune function/susceptibility to infections; autonomic dysreflexia; bone health/osteoporosis; pain), (6) physical fatigue, and (7) poor mental health. Excess weight, cardiometabolic conditions, SCI/D secondary conditions/complications (e.g., bowel dysfunction, pressure injuries), and poor mental health were identified as health consequences of inadequate nutrition. Health providers should make individuals with SCI/D aware of the risks and health consequences to incentivize healthier dietary behaviors. Efforts to identify nutrition shortcomings and to develop interventions and tailored care plans are needed to improve a myriad of health consequences due to poor diet and nutrition in persons with SCI/D.

The prevalence of prediabetes in people living with human immunodeficiency virus (HIV) is two to three times higher than that of the general population. The aim of this study was to assess the effectiveness of an intervention in guiding low-income people living with HIV (PLWH) and prediabetes through the stages of change and promote self-efficacy of positive health behavior. Methods: A 6- month randomized, controlled intervention was conducted where participants (N = 38) were randomized into the intervention group (n = 20) or the control group (n = 18). The participants’ stages of change, nutrition knowledge, and self-efficacy were assessed using questionnaires. Participants were recruited in August 2017–December 2018, were HIV seropositive, had undetectable viral load, were prediabetic, and not currently receiving glucose-altering medications. Participants randomized into the intervention group received medical nutrition therapy/counseling and nutrition education; participants randomized into the control group received educational material related to nutrition, HIV, and prediabetes at baseline. Primary outcome measures were progression through the stages of change as measured by the transtheoretical (“stages of change”) model, improvements in nutrition knowledge, and self-efficacy of the participants. Results: Significant improvement in stage of behavioral change was observed in the intervention group for physical activity, fruit/vegetable intake, fiber intake as well as nutrition knowledge and self-efficacy; however, no significant changes were observed in the control group. Conclusions: A nutrition intervention was effective in promoting positive health behavior by progressing participants through the stages of behavioral change in low-income people living with HIV and prediabetes.