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 Diet & Nutrition

December 2011
Diet for the Bedridden and Wheelchair Bound
Dr Harita shyam
 
People in wheelchairs must take extra care not to put on excess weight that will impair transferring in and out of the chair, spinal alignment and internal organ function. In addition, their body needs fewer calories to function properly.

Calories
  • People confined to a wheelchair typically need fewer calories than those who can walk.
  • Doctors at the Spina Bifida Association, a group that provides support and education for people with the disorder that typically causes paralysis, report that most adults in wheelchairs only need fewer than 1,400 calories per day, significantly less than other people.
Carbohydrates
  • Maintaining a diet high in complex carbohydrates is important for people who are wheelchair bound because it can help to maintain a healthy body weight.
  • High fibre diets also help those with compromised digestive systems to maintain proper bowel movements and healthy skin, avoiding pressure sores and constipation.
  • Complex carbohydrates also contribute to sufficient energy needed to make transferring in and out of the chair easier.Therefore fruits high in fibre like guava, pomegranate, pears, etc., should be consumed on a regular basis or specially when suffering from constipation in particular.
  • Raw vegetables and adequate quantity of cooked vegetables at least twice daily is essential to ensure enough roughage present in the diet.
Proteins
  • It becomes doubly important to keep the wheelchair bound, to take special care of their protein intake.
  • Pressure sores are a common problem for them, and if the diet is inadequate in protein the healing does not happen as protein is important for repairs and builds muscles and body tissues.
  • Proper protein intake diminishes the risks of developing health ailments such as bed sores.
  • one gm protein for every kg of ideal body weight is important. For an average adult weighting 60 kg an approximate protein intake of at least 60 gm is required to fight infection.
  • Therefore intake of low fat milk, curd, egg whites, dal, fish, sprouts, etc., should be part of the daily diet.
Vitamins
  • Diets rich in Vitamins A and C are vital for people confined to wheelchairs because they promote a healthy urinary tract and build immunity to skin problems.
  • Calcium is important to prevent osteoporosis, a common disease that affects people in wheelchairs because weight-bearing exercises are not possible.
  • Milk and milk products like curd, low fat milk, ragi, spinach, etc., are essential as calcium sources need to be part of the regular diet regime.
Diet for the Bedridden
For those who are totally immobile, careful planning goes into maintaining dietary regimen keeping in mind the nutrient balance. Such patients are tube fed, or have peg feed inserted.
  • A minimum of 2000 ml to 2500 ml feeds that are isocaloric need to be given to ensure that nutritional demands are met. They can consult a clinical dietician who will be the right person to guide them about the choice of ingredients, method of preparation and use of any nutritional supplements if required.
  • The commercially available medical nutrition formulas are well planned and balanced, and when given under prescription, are easier options than compared to making them at home, as monitoring the proportions used for preparation of kitchen based feeds needs careful planning and understanding of the feed preparation method.
  • At least half of the calories should be coming from nutritional supplements, especially after immediate discharge from the hospital or a recent episode of infection or ill health.
Weight monitoring on a regular basis and checking blood proteins to know the adequacy of the diet intake helps to assure the caregiver that they are on the right path.
  Dr Harita shyam is a Registered Dietician Clinical Nutritionist Apollo, Hyderabad


    
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