Functional performance, nutritional status, and body composition in ambulant community-dwelling individuals 1-3 years after suffering from a cerebral infarction or intracerebral bleeding

Birgit Vahlberg, Lena Zetterberg, Birgitta Lindmark, Karin Hellström, Tommy Cederholm, Birgit Vahlberg, Lena Zetterberg, Birgitta Lindmark, Karin Hellström, Tommy Cederholm

Abstract

Background: Muscle wasting and obesity may complicate the post-stroke trajectory. We investigated the relationships between nutritional status, body composition, and mobility one to 3 years after stroke.

Methods: Among 279 eligible home-dwelling individuals who had suffered a stroke (except for subarachnoid bleeding) 1-3 years earlier, 134 (74 ± 5 years, 69% men) were examined according to the Mini Nutritional Assessment-Short Form (MNA-SF, 0-14 points), including body mass index (BMI, kg/m(2)), body composition by bio-impedance analyses (Tanita BC-545), the Short Physical Performance Battery (SPPB, 0-12 points) combining walking speed, balance, and chair stand capacity, and the self-reported Physical Activity Scale for the Elderly (PASE).

Results: BMI ≥ 30 kg/m(2) was observed in 22% of cases, and 14% were at risk for malnutrition according to the MNA-SF. SPPB scores ≤ 8 in 28% of cases indicated high risk for disability. Mobility based on the SPPB was not associated with the fat-free mass index (FFMI) or fat mass index (FMI). Multivariate logistic regression indicated that low mobility, i.e., SPPB ≤ 8 points, was independently related to risk for malnutrition (OR 4.3, CI 1.7-10.5, P = 0.02), low physical activity (PASE) (OR 6.5, CI 2.0-21.2, P = 0.02), and high age (OR 0.36, CI 0.15-0.85, P = 0.02). Sarcopenia, defined as a reduced FFMI combined with SPPB scores ≤ 8 or reduced gait speed (<1 m/s), was observed in 7% of cases. None of the individuals displayed sarcopenic obesity (SO), defined as sarcopenia with BMI > 30 kg/m(2).

Conclusions: Nutritional disorders, i.e., obesity, sarcopenia, or risk for malnutrition, were observed in about one-third of individuals 1 year after stroke. Risk for malnutrition, self-reported physical activity, and age were related to mobility (SPPB), whereas fat-free mass (FFM) and fat mass (FM) were not. Nutrition and exercise treatment could be further evaluated as rehabilitation opportunities after stroke.

Figures

Fig. 1
Fig. 1
Flow chart describing the inclusion process. Abbreviation: BIA = bioelectric impedance analysis

References

    1. Gariballa SE. Nutritional factors in stroke. Br J Nutr. 2000;84(1):5–17. doi: 10.1017/S0007114500001173.
    1. Foley NC, Salter KL, Robertson J, Teasell RW, Woodbury MG. Which reported estimate of the prevalence of malnutrition after stroke is valid? Stroke. 2009;40(3):e66–74. doi: 10.1161/STROKEAHA.108.518910.
    1. Jönsson AC, Lindgren I, Norrving B, Lindgren A. Weight loss after stroke: a population-based study from the Lund Stroke Register. Stroke. 2008;39(3):918–923. doi: 10.1161/STROKEAHA.107.497602.
    1. Aquilani R, Scocchi M, Iadarola P, Franciscone P, Verri M, Boschi F, Pasini E, Viglio S. Protein supplementation may enhance the spontaneous recovery of neurological alterations in patients with ischaemic stroke. Clin Rehabil. 2008;22(12):1042–1050. doi: 10.1177/0269215508094244.
    1. Fielding RA, Vellas B, Evans WJ, Bhasin S, Morley JE, Newman AB, van Kan Abellan G, Andrieu S, Bauer J, Breuille D, et al. Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia. J Am Med Dir Assoc. 2011;12(4):249–256. doi: 10.1016/j.jamda.2011.01.003.
    1. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, Martin FC, Michel JP, Rolland Y, Schneider SM, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European working group on sarcopenia in older people. Age Ageing. 2010;39(4):412–423. doi: 10.1093/ageing/afq034.
    1. Jørgensen L, Jacobsen BK. Changes in muscle mass, fat mass, and bone mineral content in the legs after stroke: a 1 year prospective study. Bone. 2001;28(6):655–659. doi: 10.1016/S8756-3282(01)00434-3.
    1. Cruz-Jentoft AJ, Landi F, Schneider SM, Zúñiga C, Arai H, Boirie Y, Chen LK, Fielding RA, Martin FC, Michel JP, et al. Prevalence of and interventions for sarcopenia in ageing adults: a systematic review. Report of the International Sarcopenia Initiative (EWGSOP and IWGS) Age Ageing. 2014;43(6):748–759. doi: 10.1093/ageing/afu115.
    1. Zamboni M, Mazzali G, Fantin F, Rossi A, Di Francesco V. Sarcopenic obesity: a new category of obesity in the elderly. Nutr Metab Cardiovasc Dis. 2008;18(5):388–395. doi: 10.1016/j.numecd.2007.10.002.
    1. Prado CM, Wells JC, Smith SR, Stephan BC, Siervo M. Sarcopenic obesity: A Critical appraisal of the current evidence. Clin Nutr. 2012;31(5):583–601. doi: 10.1016/j.clnu.2012.06.010.
    1. Batsis JA, Mackenzie TA, Barre LK, Lopez-Jimenez F, Bartels SJ. Sarcopenia, sarcopenic obesity and mortality in older adults: results from the National Health and Nutrition Examination Survey III. Eur J Clin Nutr. 2014;68(9):1001–1007. doi: 10.1038/ejcn.2014.117.
    1. Charlson ME, Pompei P, Ales K, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies; developement and validation. J Chronic Dis. 1987;40:373–383. doi: 10.1016/0021-9681(87)90171-8.
    1. Olsson T, Terent A, Lind L. Charlson Comorbidity Index can add prognostic information to Rapid Emergency Medicine Score as a predictor of long-term mortality. Eur J Emerg Med. 2005;12(5):220–224. doi: 10.1097/00063110-200510000-00004.
    1. Pfeiffer E. A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc. 1975;23(10):433–441. doi: 10.1111/j.1532-5415.1975.tb00927.x.
    1. Roccaforte WH, Burke WJ, Bayer BL, Wengel SP. Reliability and validity of short portable mentale status questionnaire administered by telephone. J Geriatr Psychiatry Neurol. 1994;7(1):33–38.
    1. Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, Wallace RB. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49(2):M85–94. doi: 10.1093/geronj/49.2.M85.
    1. Tyson S, Connell L. The psychometric properties and clinical utility of measures of walking and mobility in neurological conditions: a systematic review. Clin Rehabil. 2009;23(11):1018–1033. doi: 10.1177/0269215509339004.
    1. Guralnik JM, Ferrucci L, Pieper CF, Leveille SG, Markides KS, Ostir GV, Studenski S, Berkman LF, Wallace RB. Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. J Gerontol A Biol Sci Med Sci. 2000;55(4):M221–231. doi: 10.1093/gerona/55.4.M221.
    1. Carr JH, Shepherd RB, Nordholm L, Lynne D. Investigation of a new motor assessment scale for stroke patients. Phys Ther. 1985;65(2):175–180.
    1. Vahlberg B, Cederholm T, Lindmark B, Zetterberg L, Hellström K. Factors Related to Performance-Based Mobility and Self-reported Physical Activity in Individuals 1–3 Years after Stroke: A Cross-sectional Cohort Study. J Stroke Cerebrovasc Dis. 2013;22(8):e426–34. doi: 10.1016/j.jstrokecerebrovasdis.2013.04.028.
    1. Ostir GV, Volpato S, Fried LP, Chaves P, Guralnik JM, Study WsHaA Reliability and sensitivity to change assessed for a summary measure of lower body function: results from the Women’s Health and Aging Study. J Clin Epidemiol. 2002;55(9):916–921. doi: 10.1016/S0895-4356(02)00436-5.
    1. Washburn RA, Smith KW, Jette AM, Janney CA. The Physical Activity Scale for the Elderly (PASE): development and evaluation. J Clin Epidemiol. 1993;46(2):153–162. doi: 10.1016/0895-4356(93)90053-4.
    1. Washburn RA, McAuley E, Katula J, Mihalko SL, Boileau RA. The Physical Activity Scale for the Elderly (PASE): evidence for validity. J Clin Epidemiol. 1999;52(7):643–651. doi: 10.1016/S0895-4356(99)00049-9.
    1. Lindahl MHL, Petersen A, Truelsen T, Boysen G. Self-reported physical activity after ischemic stroke correlates with physical capacity. Adv Physiother. 2008;10:188–194. doi: 10.1080/14038190802490025.
    1. Bauer JM, Kaiser MJ, Anthony P, Guigoz Y, Sieber CC. The Mini Nutritional Assessment--its history, today’s practice, and future perspectives. Nutr Clin Pract. 2008;23(4):388–396. doi: 10.1177/0884533608321132.
    1. Kaiser MJ, Bauer JM, Ramsch C, Uter W, Guigoz Y, Cederholm T, Thomas DR, Anthony P, Charlton KE, Maggio M, et al. Validation of the Mini Nutritional Assessment short-form (MNA-SF): a practical tool for identification of nutritional status. J Nutr Health Aging. 2009;13(9):782–788. doi: 10.1007/s12603-009-0214-7.
    1. Schutz Y, Kyle UU, Pichard C. Fat-free mass index and fat mass index percentiles in Caucasians aged 18–98 y. Int J Obes Relat Metab Disord. 2002;26(7):953–960. doi: 10.1038/sj.ijo.0802037.
    1. Abernathy RP, Black DR. Healthy body weights: an alternative perspective. Am J Clin Nutr. 1996;63(3 Suppl):448S–451S.
    1. Engvall IL, Elkan AC, Tengstrand B, Cederholm T, Brismar K, Hafstrom I. Cachexia in rheumatoid arthritis is associated with inflammatory activity, physical disability, and low bioavailable insulin-like growth factor. Scand J Rheumatol. 2008;37(5):321–328. doi: 10.1080/03009740802055984.
    1. Pietrobelli A, Rubiano F, St-Onge MP, Heymsfield SB. New bioimpedance analysis system: improved phenotyping with whole-body analysis. Eur J Clin Nutr. 2004;58(11):1479–1484. doi: 10.1038/sj.ejcn.1601993.
    1. Doehner W, Schenkel J, Anker SD, Springer J, Audebert HJ. Overweight and obesity are associated with improved survival, functional outcome, and stroke recurrence after acute stroke or transient ischaemic attack: observations from the TEMPiS trial. Eur Heart J. 2013;34(4):268–277. doi: 10.1093/eurheartj/ehs340.
    1. Legrand D, Vaes B, Matheï C, Swine C, Degryse JM. The prevalence of sarcopenia in very old individuals according to the European consensus definition: insights from the BELFRAIL study. Age Ageing. 2013;42(6):727–734. doi: 10.1093/ageing/aft128.
    1. English C, Thoirs K, Coates A, Ryan A, Bernhardt J. Changes in fat mass in stroke survivors: a systematic review. Int J Stroke. 2012;7(6):491–498.
    1. English C, McLennan H, Thoirs K, Coates A, Bernhardt J. Loss of skeletal muscle mass after stroke: a systematic review. Int J Stroke. 2010;5(5):395–402. doi: 10.1111/j.1747-4949.2010.00467.x.
    1. Andersen KK, Olsen TS. The obesity paradox in stroke: Lower mortality and lower risk of readmission for recurrent stroke in obese stroke patients. Int J Stroke. 2013;10(1):99–104. doi: 10.1111/ijs.12016.
    1. Kaiser MJ, Bauer JM, Rämsch C, Uter W, Guigoz Y, Cederholm T, Thomas DR, Anthony PS, Charlton KE, Maggio M, et al. Frequency of malnutrition in older adults: a multinational perspective using the mini nutritional assessment. J Am Geriatr Soc. 2010;58(9):1734–1738. doi: 10.1111/j.1532-5415.2010.03016.x.
    1. Schaap LA, Koster A, Visser M. Adiposity, muscle mass, and muscle strength in relation to functional decline in older persons. Epidemiol Rev. 2012;35:51–65. doi: 10.1093/epirev/mxs006.
    1. Danielsson A, Meirelles C, Willen C, Sunnerhagen KS. Physical activity in community-dwelling stroke survivors and a healthy population Is not explained by motor function only. PM R. 2013;6(2):139–145. doi: 10.1016/j.pmrj.2013.08.593.
    1. World Health Organization . International classification of functioning, disability and health: ICF. Geneva: World Health Organization; 2008.

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