People with physical disabilities (PWPD) often experience altered body composition due to changes in metabolic requirements, dysmotility and blunted energy metabolism. They have an increased risk for chronic diseases associated with poor nutrition and reduction in physical activity. They may develop secondary conditions -including pressure ulcers, bowel problems, and dysphagia-, which can affect their quality of life and lead to more serious health problems. Adequate nutrition is an essential determinant for the quality of life and health. Therefore, the alterations in body composition and their comorbid conditions must be considered when estimating their energy needs and recommending an appropriate diet. However, the authoritative dietary guidelines are designed for the general public and may not provide sufficient information and proper recommendations (i.e., underestimated or overestimated) for specific populations, such as PWPD. Several studies have been conducted to develop validated nutrition guidelines focusing on various conditions. Nevertheless, the nutritional needs of people with spinal cord Injury, cerebral palsy, and arthritis have not been extensively investigated. Moreover, PWPD experience barriers to nutrition and in-person counseling because of personal and environmental limitations. There are various personalized software programs that have been shown they can be used as an effective tool to improve nutrition and promote a healthy lifestyle. Nevertheless, those programs rely on nutrition guidelines designed for the general public and don’t have an inclusive framework for PWPD. Therefore, there is a need to develop a personalized and scalable approach that considers all stakeholders, including dietitians and users with disabilities. Considering these deficiencies, we propose to develop a personalized nutrition recommendation expert system (PNRES) for people with physical disabilities (PWPD) that utilizes disability-inclusive nutrition guidelines de
veloped using a Delphi methodology. The study specifically aims to: 1- Generate an up-to-date consensus-based nutrition guideline for adults with spinal cord injury, cerebral palsy, and arthritis using a computer-mediated international Delphi methodology. 2-Development of the Personalized Nutrition Recommendation Expert system including a Participant-centered design and usability evaluation of the system. The proposed system will consume the generated nutrition guideline and reflect the user’s needs, including medical conditions, disabilities, capabilities, activity level, caloric intake, personal preferences, and restrictions. The design and content of this online application will be tailored and inclusive of PWPD, including spinal cord injury, cerebral palsy, arthritis, multiple sclerosis and stroke. The aims of the project are consistent with the recommendation of the advisory committee of Dietary Guidelines for Americans, 2020, which noted the interest and need for guidelines for populations living with various disorders, including disabilities. The study will lead to the first dietary recommendation system that is inclusive to PWPD, applicable to populations with other specific needs as well. When implemented, the proposed system shall lay the foundational fabric for clinical trials focused on improving the dietary behavior of PWPD and other populations. The University of Alabama at Birmingham, with the collaboration of the Lakeshore Foundation, will facilitate the resources to conduct and complete the proposed project.