Lower nutrient adequacy despite comparable nutrient density and diet quality in adults with chronic spinal cord injury

CONTEXT/OBJECTIVE: To compare nutrient adequacy and diet quality between adults with chronic spinal cord injury (SCI) and matched controls and examine whether between-group differences in nutrient adequacy were attenuated after standardization for reported energy intake. DESIGN: Cross-sectional. SETTING: University-based research center. PARTICIPANTS: Fifty-three adults with chronic SCI and 53 age- and sex-matched controls. INTERVENTION: N/A. OUTCOME MEASURES: Participants completed 3-day food records reviewed by a registered dietitian. Reported energy intake was evaluated relative to measured resting metabolic rate (RMR). Dietary outcomes included nutrient (NARs) and mean (MAR) adequacy ratios, energy-adjusted NARs (eNARs) and MAR (eMAR), Healthy Eating Index-2020 (HEI-2020) scores, and absolute and per-1000-kcal food-group intakes. Potential inadequacy was defined as NAR <0.77. RESULTS: Adults with SCI reported 34% lower energy intake and 613.4 kcal/day less at a common RMR (p < 0.001). Unadjusted NARs were lower for all nutrients except vitamin B12, and MAR was also lower in SCI. After energy adjustment, neither eNARs nor eMAR differed. Among nutrients with an recommended dietary allowance, more than 90% of participants with SCI fell below the prespecified threshold for vitamin D and vitamin E. Several food-group intakes were lower in SCI, whereas per-1000-kcal food-group densities and HEI-2020 total and component scores were similar. Total HEI-2020 scores indicated a need for dietary improvement in both groups. CONCLUSIONS: These findings suggest that nutritional vulnerability after SCI may reflect lower reported energy intake more than poorer diet quality. Meeting general-population nutrient targets within a smaller "energy budget" requires a more nutrient-dense diet, even when diet-quality scores appear similar.