Assessment of nutritional status of active handicapped individuals

Micronutrient deficiency in the diets of para-athletes participating in a sports scholarship program

OBJECTIVES

The aim of this study was to determine the usual energy and micronutrient intake distributions and compare the prevalence of insufficient/excessive micronutrient intake in Brazilian para-athletes with and without scholarship support.

METHODS

The study was conducted between September 2018 and August 2019 and included 101 athletes with a disability from 13 Paralympic disciplines living in Brasília, the Federal District. Food intake was estimated from two or four non-consecutive 24-h food recalls in which para-athletes reported all food, beverages, and supplements consumed in the previous 24-h. Dietary intake analysis was performed by implementing the National Cancer Institute method. Comparisons between scholarship and non-scholarship athletes were performed using Student's t tests for parametric variables and Wilcoxon signed-rank tests for nonparametric variables.

RESULTS

Mean usual energy intake was significantly lower in scholarship para-athletes (2128 ± 125 kcal/d) than in non-scholarship para-athletes (2239 ± 116 kcal/d; P < 0.001). The prevalence of inadequacy for vitamin D, calcium, vitamin A, thiamine, riboflavin, and zinc was significantly higher in scholarship than in non-scholarship para-athletes (P < 0.001). The prevalence of risk for iron deficiency was 29.5% in female para-athletes. The prevalence of micronutrient inadequacy was >10% for eight (60%) and seven (54%) micronutrients among scholarship and non-scholarship para-athletes, respectively.

CONCLUSIONS

The Brazilian Federal sport scholarship assistance program in its current format is insufficient to protect athletes from micronutrient inadequacies.

Low Appendicular Lean Mass Index and Associations with Metabolic and Demographic Parameters in Wheelchair Athletes with Spinal Cord Injury

BACKGROUND

People suffering from spinal cord injury (SCI) undergo metabolic and physical disturbances that target the skeletal muscle, causing a progressive loss of muscle mass.

OBJECTIVE

To estimate the appendicular lean mass index (ALMI) in athletes with traumatic (T-group) and non-traumatic (NT-group) SCI, and its association with metabolic and demographic parameters.

METHODS

Wheelchair athletes with SCI aged 18 to 52 years old were included (n = 62). From DEXA assessment, we estimated the ALM index (ALMI = appendicular lean mass/height2) and classified participants according to the degree of muscle loss (ALMI < 2 SD from the reference populations). Fasting blood was assayed for glycaemia, insulin, cortisol, and IGF-1 serum levels. Data were compared by T-test and Fisher's Exact Test; predictors of ALMI were investigated by linear regression models.

RESULTS

The frequency of low ALMI was 63% in overall sample, 55% T-group and 71% NT-group. Low ALMI had no significant association with the origin of injury (X2 = 1.1, p = 0.29). Linear regression analyses showed significant association, in the whole sample, between ALMI and serum levels of IGF-1 (Beta = 0.69; p < 0.001), age (Beta=-5.8; p < 0.001), percentage fat mass (Beta=-0.26; p = 0.001), and energy intake (Beta = 0.32; p = 0.02). These significances were not maintained in the NT-group sub-analyses.

CONCLUSIONS

Low ALMI was very frequent in our SCI participants, despite exercising and independently of the type of injury. Metabolic and demographic variables associated with low ALMI were different according to the origin of injury, which possibly relies on physiopathology particularities. More studies are necessary to clarify our findings.

Management of obesity after spinal cord injury: a systematic review

CONTEXT

Individuals with chronic spinal cord injury (SCI) are susceptible to central and visceral obesity and it's metabolic consequences; consensus based guidelines for obesity management after SCI have not yet been stablished.

OBJECTIVES

To identify and compare effective means of obesity management among SCI individuals.

METHODS

This systematic review included English and non-English articles, published prior to April 2017 found in the PubMed/Medline, Embase, CINAHL Psychinfo and Cochrane databases. Studies evaluating any obesity management strategy, alone or in combination, including: diet therapy, voluntary and involuntary exercise such as neuro-muscular electric stimulation (NMES), pharmacotherapy, and surgery, among individuals with chronic SCI were included. Outcomes of interest were reductions in waist circumference, body weight (BW), body mass index (BMI) and total fat mass (TFM) and increases in total lean body mass (TLBM) from baseline. From 3,553 retrieved titles and abstracts, 34 articles underwent full text review and 23 articles were selected for data abstraction. Articles describing weight loss due to inflammation, cancer or B12 deficiency were excluded. The Downs and Black reported poor to moderate quality of the studies.

RESULTS

Bariatric surgery produced the greatest permanent weight reduction and BMI correction followed by combinations of physical exercise and diet therapy. Generally, NMES and pharmacotherapy improved TLBM and reduced TFM but not weight.

CONCLUSIONS

The greatest weight reduction and BMI correction was produced by bariatric surgery, followed by a combination of physical exercise and diet therapy. NMES and pharmacologic treatment did not reduce weight or TFM but increased in TLBM.

Eating attitudes and behaviours in elite Canadian athletes with a spinal cord injury

Athletes with a spinal cord injury (SCI) appear to have relatively modest energy requirements despite demanding training regimes. Virtually nothing is known about the factors which influence the energy intake of those with a SCI including food related attitudes and behaviours. Using a cross-sectional observational design, three aspects of eating attitudes were measured using the Three-Factor Eating Questionnaire (TFEQ) along with six days of self-reported dietary intake and anthropometrics. Between March 2007 and May 2009, a total of 32 Canadian athletes with a SCI (n=24 men, n=8 women) completed the study. The TFEQ scales showed a cognitive dietary restraint score of 10.8±4.7, disinhibition score of 2.8±1.8 and hunger score of 3.1±2.2. When the group was split into high and low restraint groups using a median of 11.5, no differences were detected in any of the absolute parameters of reported dietary intake although the higher restraint group had protein intakes account for a greater proportion of total energy. Those with higher restraint scores also had a relatively higher disinhibition score. While the cognitive dietary restraint scores for the women were similar to other able-bodied populations, the scores for men were higher than population norms from other studies. The scores for disinhibition and hunger were lower than reported ranges from able-bodied subjects. These athletes may be actively monitoring or limiting dietary intake to avoid the high prevalence of obesity associated with a SCI or perhaps to maintain an ideal body composition for their sport performance.