This chapter reviews methods of nutritional assessment and describes the physiopathological mechanisms of malnutrition, reviews specific nutritional studies, and the supplemental support which can be used in paraplegic subjects. Nutritional assessment For an initial assessment of nutritional status serial measurements to assess trends over time and then monitor the response to a dietary intervention may be useful. The proposed assessments should be interpreted collectively including the

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... ion of possible factors that contribute to the nutritional status, such as age, sex, over-or under-hydration, interactions between drugs-food, metabolic stress, infection, and the existence of other diseases[13]. Diet history During hospitalization adequate intake of nutrients is intercepted by many factors, and may be caused by anorexia, early satiety, immobility, depression. Moreover, gastrointestinal function is compromised: gastric dilatation and paralytic ileus occurs often, although the intestinal activity usually returns within the first week after injury. Nutritional requirements The provision of energy and nutritional requirements is a very important factor for patient management. Malnutrition, in this case undernourishment or over nutrition-obesity, can lead to muscle loss, atrophy of the lining of the intestine, immunochemical reduction, poor wound healing and fluid overload, hyperglycemia, high levels of urea nitrogen in blood, high triglycerides, elevated liver enzymes, respiratory exhaustion due to increased production of CO 2 , and difficulty weaning from the oxygen, respectively. The assessment of nutritional requirements includes not only calculations but also the opinion of an expert clinician in order to assess the clinical and morphometric data before applying the equations that provide the energy and protein requirements [14] . There have been several methods for predicting energy expenditure (EE); the components and the methods for its determination and estimation, summarizing their main advantages and limitations have been recently reviewed [15] . However, because of various confusing factors such as infections and sepsis, hyper nutrition supportive nutritional diets, clinical procedures, postoperative medications, and changes in body weight such as sarcopenia, obesity, amputations and significant weight loss, the prediction equations can be complex and invalid [16] . A group of equations among these are Mifflin-St Jeor equation [17], the Harris-Benedict equation [18], the American College of Chest Physicians (ACCP) recommendation based on kcal/kg body weight [19], the Faisy equation [20], the Ireton-Jones equations [21, 22] and the Penn State equations [23, 24]. Because the Mifflin equation was designed for healthy people is not analyzed here. The Harris-Benedict is calculated by sex with the following formula: Topics in Paraplegia 130 Topics in Paraplegia 132