Effects of an individualized dietitian-led nutrition intervention on body composition during the first year after traumatic spinal cord injury: A randomized controlled trial

Background & aims Traumatic spinal cord injury (SCI) induces rapid and adverse changes in body composition, yet effective strategies to prevent excess fat accumulation are limited. This study aimed to evaluate the effect of an individualized dietitian-led nutrition intervention on change in fat mass and related markers of adiposity during the first year following SCI. Methods In this single-center, open-label randomized controlled trial, adults with subacute traumatic SCI were randomized to an individualized dietitian-led intervention or usual care. The primary outcome was change in total fat mass (FM) over one year, assessed by multifrequency bioimpedance analysis. Secondary outcomes included fat mass index (FMI), visceral adipose tissue (VAT), waist circumference, fat-free mass, fat-free mass index, body weight, body mass index (BMI) and biomarkers (fasting glucose, 2-h oral glucose tolerance test, HbA1c, LDL, HDL and triglycerides). Intention-to-treat analyses used mixed-effects models adjusted for age, sex, and neurological severity. Results Sixty-two participants were randomized (32 intervention, 30 control). Participants were predominantly male (76%) with a mean age of 48 (SD 17) years. At 1 year, the adjusted between-group difference in FM change was −1.5 kg (95% CI −4.8 to 1.9; p = 0.39). Significant between-group differences were observed for VAT (−0.5 L; 95% CI −1.0 to −0.1; p = 0.02) and waist circumference (−4.0 cm; 95% CI −7.0 to −1.0; p = 0.01), with borderline significance for FMI (−1.6 kg/m²; 95% CI −3.2 to 0.0; p = 0.05). No significant between-group differences were observed for body weight, BMI, fat-free mass, or biomarkers. Sensitivity and per-protocol analyses yielded consistent results. Conclusions Although the intervention did not significantly affect the primary endpoint of total fat mass, between-group differences were observed for VAT and waist circumference. These findings suggest that structured, individualized dietetic care initiated during SCI rehabilitation and continued post-discharge may attenuate accumulation of abdominal adiposity. Longer-term follow-up is needed to determine whether early attenuation of abdominal adiposity translates into reduced cardiometabolic risk and improved functional outcomes. Clinical Trial Identifier NCT04109586.