1. Spina Bifida and Nutrition Elizabeth Bentz and Raymond Payne Introduction Spinal Bifida literally means “split spine.” This very general term is used to describe a set of conditions caused by a disturbance in the development of the vertebral arches. 1 There are four distinct types of Spina Bifida. Spina Bifida Occulta which ​ is the least severe form of Spinal Bifida where there is a defect that is localized to one or more of the vertebral arches. The meninges and the spinal cord itself are within the vertebral canal. ​ Spina Bifida Dysraphism ​ is a defect of the lower lumbar which includes marked distortion of the spinal cord. 2 Spina Bifida Meningocele ​ occurs when fluid cystic swelling that protrudes through the vertebral arches under skin. The spinal cord may exhibit abnormalities, the spinal cord itself is confined within the vertebral arches. 1 Spina bifida Myelomeningocele ​ occurs when fluid cystic swelling that protrudes through the vertebral arches under skin. With this condition which is worst then Meningocele the nerve roots and the spinal cord are in the fundus of the sac. 1 ​ Research Findings Prevention Non-Nutrition Clinical Application Children ages 1-20: Children with Spina Bifida receive their care at a children’s hospital or a pediatric unit. 3 Care team consists of multiple doctors, surgeons and specialists. 3 Majority taken to spina bifida care center A few are taken care of by family doctor/ physician In 2009, 10,960 children with spina bifida were discharged (.4% of those admitted) 3 Children are in frequent need of services Most specialists are located at specialty hospitals that are far away from patient’s home Adults ages 21 and up: Adult health care for patients with spina bifida varies slightly. Health of adults vary depending on age, level of lesion, severity of disease and level of self and family care. 4 Adults with spina bifida do not have special clinics like children do They may be looked at by their pediatric physician Have a few more health risks than children do including 4 : Hypertension, Hyperlipidemia, Diabetes, Sexually transmitted diseases, Cancer The three most common problems that adults have are: Shunt complications, or ventricular shunting, occurs in about 80-85% of patients and is when the patient is seen as not needing the shunt anymore, but then the shunt goes into failure. 4 A tethered spinal cord is when adults with repaired myelomeningocele have tethering syndrome which can be set off by falls, back trauma, heavy lifting and vaginal childbirth. 4 Syringomylia which is when a syrinx, fluid filled cavity in the spinal cord, occurs. 4 Due to the advances in the medical field spina bifida patients are living longer and at least 75% of children born with spina bifida will reach early adulthood. 5 However, studies show that teen with chronic illnesses such as spina bifida are as likely or even more likely to partake in risky behaviors. 5 These Include: Physical activity and diet, substance abuse and depression and self-rated health: Teens report engagement in physical activity and healthy eating less than healthy individuals. 5 Report spending 3 or more hours watching T.V Prevalence of overweight individuals rose as the age of these individuals rose Substance abuse 5 Reported to abuse smoking, alcohol, and illegal drugs Most abused drugs are marijuana, pain pills and anti-anxiety drugs. Partake in activities in order to cope with their problems. May feel that they are already stuck with debilitating disease so why not. Depression and self-rated health 5 Experience mild or major depressive symptoms Problems getting around Can lead to substance or alcohol abuse for some Spinal Bifida prevention starts with: Increased folic acid intake of 400 mcg per day. Adequate B12 intake of 2.6 mcg per day. Several foods are now fortified with folic acid such as wheat and maize flour and white flour. Drug Interactions​ Valproic acid or carbamazepine or in combination with other anticonvulants. ​Free radicals formed from drug metabolism might damage embryonic tissues. Table below shows increased risk by percentage for spinal bifida to occur. Treatment Hypertension and obesity are major problems that occur in patients with spina bifida. They can be controlled by: Diet low in sodium Exercise, such as Swimming, Lifting weights, horseback riding. 9 Patients with spina bifida have a higher risk for pressure ulcers and other wounds. These issues can be helped with: Higher protein intake, for example, Red meat, Nuts, Spinach Obesity 23% were at great than 95th percentile of BMI for age 6 18% of children were obese 8% of adolescence were obese 37% of adults were obese 11% of women and 4% of men were extremely obese Convenience sample Children and adolescence are within normal ranges compared to gen. public Adults were above norm limits compared to gen public 6 Hypertension 41.5% met definition for hypertension 4% of 41.5% had stage 1, 6% had stage 2 18.7% were classified as pre-hypertension Children with spina bifida at higher risk for hypertension Wound Care Wounds mostly develop in fee These wounds normally healed without further problems Second most common wound was in the buttock Children most likely to develop wounds in the trunk or abdominal area Abdominal wounds harder to heal 1 in 3 patients will develop some type of wound Severity depends on age, state of care and whether they still have feeling in their limbs. Summary Spina Bifida and other neural tube defects can be prevented with increased awareness of causes, proper nutrition, and education. Knowing a person’s limitations with Spina Bifida can be difficult. An individualized approach to diet is necessary because every person with Spina Bifida is different. Children and adults with Spina Bifida are at an increased risk of hypertension, diabetes, obesity, wounds, bowel and bladder incontinence, latex allergies, sexual issues, osteoporosis. There is no cure for Spina Bifida but with good nutrition some symptoms can be alleviated. Good nutrition is also essential to prevention 10 Established risk factorsIncreased risk by percentage History of previous affected pregnancy with same partner30 Inadequate maternal intake of folic acid2-8 Pregestational maternal diabetes2-10 Valproic acid and carbazepine10-20 Suspected risk factorsIncreased risk by percentage Maternal vitamin B12 status3 Maternal obesity 1.5-3.5 Maternal hyperthermia2 Maternal diarrhea3-4