{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T01:57:44Z","timestamp":1784944664562,"version":"3.55.0"},"reference-count":41,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2022,8,24]],"date-time":"2022-08-24T00:00:00Z","timestamp":1661299200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT; Ministry of Science&amp; ICT)","award":["2020R1G1A110314811"],"award-info":[{"award-number":["2020R1G1A110314811"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Cachexia and low muscle mass in motor-complete tetraplegia are associated with poor outcomes. This study aimed to document anthropometric, body composition, and nutritional indices in patients and to assess the effect of a comprehensive rehabilitation nutrition program in cachexia and low muscle mass. For 34 motor-complete tetraplegia in the subacute phase, a comprehensive rehabilitation nutrition program was provided for 8 to 9 weeks. Risk of malnutrition, anthropometric and body composition indices, as well as laboratory tests were assessed upon admission and at discharge. A body mass index of less than 20.2 kg\/m2 was used as the cut-off value for obesity. Upon admission, 73.5% of patients were classified as obese, half were at risk of malnutrition, and 29.4% were compatible with cachexia. Compared to the premorbid state, the non-obese group showed greater weight reduction (p &lt; 0.01) and higher prevalence of low muscle mass (p = 0.004) than the obese group. Disease duration was different between groups (p &lt; 0.01). After rehabilitation, malnutrition risk, protein levels, and hemodynamic results improved in both groups (p &lt; 0.05). A significant time \u00d7 group interaction was observed for muscle mass, skeletal muscle mass, and appendicular lean mass index (p &lt; 0.05). Muscle mass was maintained while fat components increased in both groups. Functional improvement was negatively correlated with an increase in fat components (p &lt; 0.05). A personalized rehabilitation nutrition intervention improved the nutritional status, body composition, and functional outcomes in motor-complete tetraplegia. The increase in muscle mass was associated with functional gain; healthy weight gain or maintenance may improve the level of independence. Further studies to endorse this beneficial evidence of rehabilitation nutrition in the maintenance of muscle component are needed.<\/jats:p>","DOI":"10.3390\/jcm11174970","type":"journal-article","created":{"date-parts":[[2022,8,24]],"date-time":"2022-08-24T23:48:58Z","timestamp":1661384938000},"page":"4970","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Impact of Rehabilitation Nutrition and Healthy Weight Maintenance in Motor-Complete Tetraplegia Patients"],"prefix":"10.3390","volume":"11","author":[{"given":"Ji Cheol","family":"Shin","sequence":"first","affiliation":[{"name":"Department and Research Institute of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3818-9403","authenticated-orcid":false,"given":"Kye Hee","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, CHA Ilsan Medical Center, CHA University School of Medicine, Goyang 10414, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eun Young","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Jeju National University School of Medicine, Jeju 63243, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwang Ho","family":"Ahn","sequence":"additional","affiliation":[{"name":"Department and Research Institute of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang Hee","family":"Im","sequence":"additional","affiliation":[{"name":"Department and Research Institute of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,8,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1055\/s-0031-1296049","article-title":"Diagnosis and prognosis of traumatic spinal cord injury","volume":"1","author":"Goss","year":"2011","journal-title":"Glob. Spine J."},{"key":"ref_2","first-page":"1","article-title":"Neurological recovery following traumatic spinal cord injury: A systematic review and meta-analysis","volume":"15","author":"Khorasanizadeh","year":"2019","journal-title":"J. Neurosurg. Spine"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1038\/sc.2017.23","article-title":"Long-term survival after traumatic spinal cord injury: A 70-year British study","volume":"55","author":"Savic","year":"2017","journal-title":"Spinal Cord"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"113","DOI":"10.24095\/hpcdp.33.3.01","article-title":"The economic burden of traumatic spinal cord injury in Canada","volume":"33","author":"Krueger","year":"2013","journal-title":"Chronic Dis. Inj. Can."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1179\/2045772314Y.0000000264","article-title":"Weight change after spinal cord injury","volume":"40","author":"Powell","year":"2017","journal-title":"J. Spinal Cord Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.11005\/jbm.2013.20.1.1","article-title":"Sarcopenia: Definition, epidemiology, and pathophysiology","volume":"20","author":"Kim","year":"2013","journal-title":"J. Bone Metab."},{"key":"ref_7","first-page":"75","article-title":"Skeletal Muscle Pathology after Spinal Cord Injury: Our 20 Year Experience and Results on Skeletal Muscle Changes in Paraple-gics, Related to Functional Rehabilitation","volume":"11","author":"Scelsi","year":"2001","journal-title":"Basic Appl. Myol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1038\/sj.sc.3101729","article-title":"A prospective assessment of mortality in chronic spinal cord injury","volume":"43","author":"Garshick","year":"2005","journal-title":"Spinal Cord"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1038\/sc.2012.17","article-title":"Influence of the neurological level of spinal cord injury on cardiovascular outcomes in humans: A meta-analysis","volume":"50","author":"West","year":"2012","journal-title":"Spinal Cord"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"S229","DOI":"10.1016\/j.spinee.2019.05.578","article-title":"P153. Sarcopenia, independent of age, predicts mortality and acute care adverse events in patients with traumatic spinal cord injury","volume":"19","author":"Banaszek","year":"2019","journal-title":"Spine J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1007\/s13539-014-0162-x","article-title":"Rehabilitation nutrition for sarcopenia with disability: A combination of both rehabilitation and nutrition care management","volume":"5","author":"Wakabayashi","year":"2014","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1007\/s12603-018-1150-1","article-title":"Rehabilitation Nutrition for Iatrogenic Sarcopenia and Sarcopenic Dysphagia","volume":"23","author":"Nagano","year":"2019","journal-title":"J. Nutr. Health Aging"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"111091","DOI":"10.1016\/j.nut.2020.111091","article-title":"Frequent and personalized nutritional support leads to improved nutritional status, activities of daily living, and dysphagia after stroke","volume":"83","author":"Shimazu","year":"2021","journal-title":"Nutrition"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1016\/j.clnesp.2021.02.018","article-title":"Clinical practice guidelines for rehabilitation nutrition in cerebrovascular disease, hip fracture, cancer, and acute illness: 2020 update","volume":"43","author":"Nishioka","year":"2021","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"101674","DOI":"10.1016\/j.nicl.2019.101674","article-title":"Reorganization of the somatosensory pathway after subacute incomplete cervical cord injury","volume":"21","author":"Chen","year":"2019","journal-title":"NeuroImage Clin."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1016\/j.clnu.2008.06.013","article-title":"Cachexia: A new definition","volume":"27","author":"Evans","year":"2008","journal-title":"Clin. Nutr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1038\/s41393-018-0172-1","article-title":"Obesity cutoff values in Korean men with motor complete spinal cord injury: Body mass index and waist circumference","volume":"57","author":"Yun","year":"2019","journal-title":"Spinal Cord"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1038\/sc.2009.33","article-title":"Lowering body mass index cutoffs better identifies obese persons with spinal cord injury","volume":"47","author":"Laughton","year":"2009","journal-title":"Spinal Cord"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1038\/s41393-017-0035-1","article-title":"Bedside quantification of fat-free mass in acute spinal cord injury using bioelectrical impedance analysis: A psychometric study","volume":"56","author":"Panisset","year":"2018","journal-title":"Spinal Cord"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1016\/j.jamda.2019.12.012","article-title":"Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment","volume":"21","author":"Chen","year":"2020","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"119","DOI":"10.4163\/kjn.2009.42.2.119","article-title":"Development and Evaluation of a Nutritional Risk Screening Tool (NRST) for Hospitalized Patients","volume":"42","author":"Han","year":"2009","journal-title":"Korean J. Nutr."},{"key":"ref_22","first-page":"1","article-title":"Ideal body weight estimated from the body mass index with the lowest morbidity","volume":"15","author":"Tokunaga","year":"1991","journal-title":"Int. J. Obes."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1038\/s41393-018-0218-4","article-title":"Nutritional status in chronic spinal cord injury: A systematic review and meta-analysis","volume":"57","author":"Farkas","year":"2019","journal-title":"Spinal Cord"},{"key":"ref_24","unstructured":"Academy of Nutrition and Dietetics (2009). Spinal Cord Injury (SCI) Evidence-Based Nutrition Practice Guideline, Guidelines International Network."},{"key":"ref_25","first-page":"145","article-title":"Outcome of comprehensive medical rehabilitation: Measurement by PULSES profile and the Barthel Index","volume":"60","author":"Granger","year":"1979","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"115","DOI":"10.2340\/165019771994263115119","article-title":"Interrater reliability of the 7-level functional independence measure (FIM)","volume":"26","author":"Hamilton","year":"1994","journal-title":"Scand. J. Rehabil. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1080\/10790268.2008.11760704","article-title":"Functional recovery measures for spinal cord injury: An evidence-based review for clinical practice and research","volume":"31","author":"Anderson","year":"2008","journal-title":"J. Spinal Cord Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1038\/sj.sc.3101315","article-title":"Rasch analysis of the Catz-Itzkovich spinal cord independence measure","volume":"40","author":"Itzkovich","year":"2002","journal-title":"Spinal Cord"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1926","DOI":"10.1080\/09638280601046302","article-title":"The Spinal Cord Independence Measure (SCIM) version III: Reliability and validity in a multi-center international study","volume":"29","author":"Itzkovich","year":"2007","journal-title":"Disabil. Rehabil."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"175","DOI":"10.3758\/BF03193146","article-title":"G * Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences","volume":"39","author":"Faul","year":"2007","journal-title":"Behav. Res. Methods"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1555","DOI":"10.1038\/s41430-018-0194-y","article-title":"Detecting malnutrition risk and obesity after spinal cord injury: A quality improvement project and systematic review","volume":"72","author":"Wong","year":"2018","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_32","first-page":"1010","article-title":"Age Associated Changes in Body Mass Index and Body Fat Distribution","volume":"24","author":"Lee","year":"2003","journal-title":"J. Korean Acad. Fam. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1007\/s004210050606","article-title":"Influence of complete spinal cord injury on skeletal muscle cross-sectional area within the first 6 months of injury","volume":"80","author":"Castro","year":"1999","journal-title":"Eur. J. Appl. Physiol. Occup. Physiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1291","DOI":"10.1007\/s10557-020-07136-0","article-title":"Restoring perivascular adipose tissue function in obesity using exercise","volume":"35","author":"Saxton","year":"2021","journal-title":"Cardiovasc. Drugs Ther."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1080\/10790268.2017.1370207","article-title":"Management of obesity after spinal cord injury: A systematic review","volume":"40","author":"Shojaei","year":"2017","journal-title":"J. Spinal Cord Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1080\/10790268.2019.1710939","article-title":"Electrically induced cycling and nutritional counseling for counteracting obesity after spinal cord injury: A pilot study","volume":"44","author":"Dolbow","year":"2020","journal-title":"J. Spinal Cord Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2398","DOI":"10.1152\/japplphysiol.00729.2002","article-title":"Factors influencing body composition in persons with spinal cord injury: A cross-sectional study","volume":"95","author":"Spungen","year":"2003","journal-title":"J. Appl. Physiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"738","DOI":"10.3945\/an.115.009415","article-title":"Effect of nutritional status and dietary patterns on human serum C-reactive protein and interleukin-6 concentrations","volume":"6","author":"Smidowicz","year":"2015","journal-title":"Adv. Nutr."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1549","DOI":"10.1038\/nn.4643","article-title":"Spinal cord injury-induced immunodeficiency is mediated by a sympathetic-neuroendocrine adrenal reflex","volume":"20","author":"Tedeschi","year":"2017","journal-title":"Nat. Neurosci."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1002\/ncp.10588","article-title":"The Use of Visceral Proteins as Nutrition Markers: An ASPEN Position Paper","volume":"36","author":"Evans","year":"2021","journal-title":"Nutr. Clin. Pract."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1038\/s41393-019-0245-9","article-title":"Relationship between nutritional status and improved ADL in individuals with cervical spinal cord injury in a convalescent rehabilitation ward","volume":"57","author":"Tanaka","year":"2019","journal-title":"Spinal Cord"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/17\/4970\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:14:45Z","timestamp":1760141685000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/17\/4970"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,24]]},"references-count":41,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2022,9]]}},"alternative-id":["jcm11174970"],"URL":"https:\/\/doi.org\/10.3390\/jcm11174970","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,24]]}}}