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Balanced nutrition and eating right is a vital part of staying healthy. Because of the impact of nutrition on function, quality of life, and life expectancy, it is important to assess nutritional status when a disability is involved. Under an emerging framework of health promotion for persons with disabilities, health problems in addition to the primary disability are referred to as secondary conditions. Although information on secondary conditions experienced by people with disabilities is limited, there are risk factors and suggested health practices that might lead to the prevention of secondary conditions.
Needing assistance from others
Many disabled individuals living in the community need personal assistants to help them with shopping and preparing meals due to physical limitations from their disability. There may be limited time to prepare meals because of time constraints and incomes allocated for assistance with grocery shopping, meal preparation and clean up or lack of assistance available to prepare meals. Some folks with limited income may need to choose between paying basic living and health care costs associated with their disability or paying for food. Oftentimes, food and nutrition suffer, as there is not enough money left for food. These factors can adversely affect health and nutrition.
Assistants often have a great influence on consumer choice or directly control how to plan and/or prepare the food. The quality of diet among consumers with a significant disability is often influenced by family or personal assistants who do the grocery shopping and meal preparation. Assistant turnover can add to the difficulty of continuous training needed. In addition, stable, individualized, and healthful food habits are created over time using a long-term plan. This is difficult to achieve with unstable assistance.
It is important for people with disabilities to take control of their diet and the food they are eating. Each person who depends on someone else for assistance needs to find ways to ensure good eating habits in order to maintain optimum health. Taking charge may mean introducing change gradually into a family setting or directing personal assistants in grocery shopping or food preparation. Today, the Internet provides a major source of information about nutrition and recipes that can be given to assistants to make. Some grocery stores deliver directly to your home, which may be more convenient and reduce time needed from assistants. If time for assistants is limited in the area of food preparation, look for ways to get the job done more efficiently. Look for simple-to-make healthy recipes. The goal is to develop a healthy lifestyle that depends on being informed and providing input to those who are assisting.
Dietary
Recommendations
Developed by nutrition experts at the U.S. Department of Agriculture,
the Dietary Guidelines for Americans will help direct you to better
health. The major principles of the Guidelines are:
1. Eat
a wide variety of foods. Since no single food can provide
all the nutrients you need, a varied diet increases the chances
of a balanced diet and helps you reduce your consumption of foods
that are higher in fat, sugar and calories.
2. Maintain a healthy weight. After a physical
disability, a spinal cord injury for example, your physical activity
decreases and your body burns fewer calories. By performing some
physical activity each day, you will burn off more calories, increase
your stamina, and strengthen your respiratory and heart systems.
3. Choose a diet with plenty of grain products, fruits,
and vegetables. These foods should be the foundation of
what you eat. They provide excellent sources of vitamins, minerals,
and complex carbohydrates (starch and dietary fiber) that maintain
healthy body systems.
4. Choose a diet moderate in sugars. Foods containing
large amounts of sugar are high in calories and low in nutrients
and should be eaten in moderation.
5. Choose a diet moderate in salt and sodium. In
your body, sodium regulates fluid balance and affects your blood
pressure. Too much salt may raise your blood pressure.
6. Choose a diet low in fat and cholesterol. Since
fat contains over twice the calories of carbohydrates or protein,
foods high in fat should be eaten less frequently and in much smaller
amounts than grains, fruits and vegetables. Diets high in fat also
increase your chances for heart disease and certain cancers.
7. Drink alcohol in moderation. Moderate alcohol
consumption is one drink or less per day for women (none for pregnant
women) and two alcoholic drinks or less for men. Alcohol is high
in calories and is harmful in large quantities.
Good nutrition is the cornerstone of any healthy lifestyle. What you eat can determine your health, your resistance to stress and illnesses, as well as your energy and attitude. While some people may have specific dietary needs, a person's diet, in general, should be balanced and varied. An important point to remember is that moderation can make the difference between a good diet and a poor one.
Suggestions
and Future Perspective
It is important for consumers to educate themselves. Including a
dietician on the rehabilitation/treatment/support team could improve
the nutritional status of individuals with disabilities who live
in community-based settings with the help of personal assistants
or without or in an institutional setting that utilizes a support
staff. The Internet is a very useful resource for getting information
on nutrition.
A program for weight management for a person with a disability must address individual characteristics of motivation, food preferences, metabolic individuality, mobility, and feeding problems as well as environmental contributors to overweight and obesity. A weight management program for a person without a disability must address the same issues. In addition, studies on the role of nutritional therapy in increasing quality of life are urgently needed.
On-line Resources
All Recipes
This website provides a recipe collection, meal ideas, and cooking advice. This information will help you take control of your diet. If you require the assistance of someone else with your grocery shopping or meal preparation, you can give these recipes to your assistants.
Allrecipes
400 Mercer Street
Suite 302
Seattle, WA 98109 USA
206-292-3990
http://www.allrecipes.com
Nutrition.gov
This is a user-friendly database that contains information that promotes the improvement of the overall health of Americans through regular physical activity, proper nutrition, prevention screening, and healthy lifestyle choices. This web site has a partnership with other Federal and management agencies to provide information about all federal recreation areas. This site allows you to search for recreation areas by state, by recreational activity, by agency or by map
http://www.nutrition.gov/
Getting A Grip On Vitamins
This article appeared in the MDA publication Quest, Vol. 7, No. 5, October 2000. The article examines whether or not vitamins are of more use to people affected by a neuromuscular disease. Topics include the ABC’s of vitamins, RDI’s, minerals, and antioxidants and neuromuscular diseases.
http://www.mdausa.org/publications/Quest/q75vitamins.html
Food and Nutrition Information Center (FNIC)
FNIC is located at the National Agricultural Library that is part of the U.S. Department of Agriculture and the Agricultural Research Service. This website includes information on topics from A-Z, dietary supplements, food composition, food guide pyramid, databases, and a consumer’s corner.
Food and Nutrition Information Center
Agricultural Research Service, USDA
National Agricultural Library, Room 105
10301 Baltimore Avenue
Beltsville, MD 20705-2351
301-504-5719
301-504-6856 (TTY)
fnic@nal.usda.gov
http://www.nal.usda.gov/fnic
National Policy & Resource Center On Nutrition & Aging
This website provides information for older adults, prviding articles and educational resources on topics that range from diet assessment and diet guidelines, food safety, hunger and food security, nutrition screening, meal programs: congregate and home delivered, and more.
National Policy & Resource Center on Nutrition & Aging
Florida International University, OE 200,
Miami, FL 33199
305-348-1517
nutrionandaging@fiu.edu
http://nutritionandaging.fiu.edu/
Office of Dietary Supplements
National Institutes of Health
Bethesda, Maryland 20892 USA
ods@nih.gov
http://ods.od.nih.gov/health_information/health_information.aspx
Rehabilitation Research and Training Center: Health and Wellness Consortium
The RRTC on Health and Wellness is a Rehabilitation Research and Training Center (RRTC) that conducts research and training to support the health and wellness of persons with long-term disabilities, specifically the conditions of cerebral palsy, multiple sclerosis, post-polio syndrome, amputation and spinal cord injury. This website is rich with general health information that might be of interest and value to all persons with disabilities as well as persons without disabilities. Go to “Health Info,” then click on the buttons on the left for further information.
RRTC: Health & Wellness Consortium
Oregon Health & Science University
707 SW Gaines, Suite 1254
Portland, OR 97239
503-494-3534
rrtc@ohsu.edu
http://www.healthwellness.org
Montana Disability & Health Program
This program is dedicated to supporting various programs that prevent secondary conditions in people with disabilities. Although the organization is based in Montana, it has useful online resources regarding community support, health, and other disability issues. The nutrition section under the Resource Directory has links to national programs related to disability and nutritional health.
Meg Traci, Ph.D., Project Director
Research and Training Center on Disability in Rural Communities
The University of Montana Rural Institute:
Center for Excellence in Disability Education, Research and Services
52 Corbin Hall, Missoula, MT 59812-7056
406-243-4956
matraci@ruralinstitute.umt.edu
http://mtdh.ruralinstitute.umt.edu
Nutrition and Disability
This article “Nutrition and Disability,” by Kathleen Humphries, Meg Traci, Tom Seekins, and Joyce Brusin, focuses on secondary conditions and disability. It describes malnutrition, obesity, and issues related to the support staff responsible for food planning and preparation as three risk factors for secondary conditions. The article also includes suggestions for change and possible areas for future research.
Kathleen Humphries, Ph.D.
Research and Training Center on Disability in Rural Communities
The University of Montana Rural Institute:
A Center of Excellence for Disability Education, Research and Services,
52 Corbin Hall, Missoula, MT 59812-7056
888-268-2743
406-243-2515
406-243-5467 (TTY)
http://rtc.ruralinstitute.umt.edu/health/Nutrition.htm
Publication on Neuromuscular Diseases and Nutrition
The research on nutrition, health, and disability is increasing all the time. We have given a few examples of recent findings related to the subject of nutrition to get you started on your search and to whet your appetite. In addition, you can visit PubMed Central (PMC), which is the U.S. National Library of Medicine’s digital archive of life sciences journal literature at http://www.pubmedcentral.nih.gov. This website has a list of journals that you can click on to review their current and past issues. At the same time, you can search by specific topic, author, or title using the different search options.
1) McCrory MA,
Wright NC, Kilmer DD. “Nutritional Aspects of Neuromuscular
Diseases.” The American Journal of Physical Medicine and
Rehabilitation. (1998) February; 9(1): 127-143.
This study focuses on weight management in overweight individuals
with a neuromuscular disease because excess fat tissue affects mobility
and breathing. Furthermore, the study discusses the fact that in
the latter stages of the disease, most NMD patients become underweight
because of the acceleration in skeletal muscle protein degradation
relative to its synthesis.
2) McCrory MA, Kim HR, Wright NC, Lovelady CA, Aitkens S, Kilmer DD “Energy expenditure, physical activity, and body composition of ambulatory adults with hereditary neuromuscular disease.” American Journal of Nutrition. (1998) June; 67(6): 1162-1169.
This study is
examining the roles of energy expenditure, physical activity, and
diet in the development of excess fat tissue and risk for secondary
chronic diseases in persons with neuromuscular disabilities. Persons
with neuromuscular disabilities have progressive weakness and wasting
of skeletal muscles, reduced fat-free mass and increased fat mass
relative to people without an NMD. Reduced physical activity and
increased fat tissue put people with NMD at risk of developing secondary
conditions such as cardiovascular disease, hypertension, and diabetes.
http://www.ajcn.org/cgi/reprint/67/6/1162.pdf
3) Fernando
Augusto Pessolano, RD and others. “Nutritional Assessment
of Patients with Neuromuscular Diseases.” American Journal
of Physical Medicine & Rehabilitation. (2003); 82(3): 182-185.
The main focus of this research study was to examine the nutritional
status of persons with Duchenne muscular dystrophy and amyotrophic
lateral sclerosis. The study emphasizes that nutritional assessment
is an essential component of patient management and rehabilitation
because both under-nutrition and over-nutrition are common in people
with neuromuscular disease.
http://www.amjphysmedrehab.com
