Nutrition, metabolic syndrome, and obesity: Guidelines for the care of people with spina bifida.
Amy C McPherson, Lorry Chen, Joseph O'Neil and 1 others
PMID 33325412WHAT IT FOUND
Expert consensus guidelines for nutrition in spina bifida advise against using standard BMI charts due to altered body composition.
Clinicians should monitor growth trajectories instead and focus on bowel health and strengths-based weight conversations rather than weight loss alone.
Key findings
01Standard BMI calculations are inaccurate for individuals with spina bifida due to short stature and altered body composition, so growth trajectories should be monitored instead of comparing to typical development norms.
02Guidelines recommend a strengths-based approach that avoids focusing solely on weight loss, which may encourage disordered eating, and instead emphasizes broad benefits of healthy nutrition and bowel management.
03Specific dietary guidance includes increasing fiber slowly to manage constipation and limiting sugary drinks often used for hydration, while acknowledging barriers like food insecurity and texture aversions.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
These are expert consensus guidelines, not results from a controlled clinical trial. There is a lack of high-quality data on metabolic syndrome and weight management specifically for adults with spina bifida. No evidence-based algorithm exists for determining energy needs in this population, so recommendations rely on general population data and expert opinion. BMI is acknowledged as an imperfect measure for this population, but no validated alternative is universally available in clinical settings.
Declared interests
The paper lists publication types including 'Research Support, U.S. Gov't, P.H.S.' but does not explicitly detail individual author financial conflicts of interest in the provided text. The guidelines were developed by the Spina Bifida Association.
The easy way to misread this
Do not use standard BMI-for-age or BMI-for-adult charts to diagnose obesity or health risk in patients with spina bifida. These metrics are skewed by short stature and low muscle mass, potentially leading to incorrect clinical judgments.