Nutritional and immune status following spinal cord injury: a case controlled study.

ABSTRACT

STUDY DESIGN: Case controlled study. OBJECTIVE: To compare nutritional status and immune response in a group of spinal cord injured (SCI) patients with age and gender matched non SCI control subjects. METHOD: Thirty past patients of the Burwood Hospital Spinal Injuries Unit living locally were enrolled in the study. Age and gender matched non SCI control subjects were selected volunteers from hospital staff. Nutritional status was assessed by generating a Nutritional Risk Score (NRS, Appendix 1) and drawing blood for full blood count, iron studies, red blood cell folate, vitamin B12, ferritin, magnesium, and zinc. Immune status was assessed by vaccination response index (VRI) to Pneumovax 23 vaccine. RESULTS: Full blood count, iron studies, and testing for red blood cell folate, albumin, prealbumin, vitamin B12, ferritin, magnesium and zinc were normal range for both groups. The SCI group had significantly different median values than controls (P < 0.01) for haemoglobin concentration, white blood cell count, albumin, prealbumin, serum iron and % saturation. Body Mass Index (weight kg/(height cm(2)) was 22.2 (range 15-30) for the SCI group, significantly less than the paired control group index of 26 (range 20-32, P = 0.0004). Median NRS for SCI patients was 2 (range 0-6), compared to 0 (range 2-4) for paired controls (P < 0.0001). Scores ranged from 0 to 2 for each of the five NRS components for the SCI patients and 0 to 3 for the control group. There was no significant difference in the pre- and post-vaccination ratio for IgG, IgA, and IgM response to Pneumovax 23 vaccine. CONCLUSION: We have not identified any nutritional or immune status abnormality in SCI patients, however the SCI patients have a lower value for certain nutritional parameters and BMI. SCI patients however are at only slight risk of nutritional problems given their NRS and their lower normal values for certain nutritional factors.