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Tang R, Guan B, Xie J, Xu Y, Yan S, Wang J, Li Y, Ren L, Wan H, Peng T, Zeng L. Prediction model of malnutrition in hospitalized patients with acute stroke. Top Stroke Rehabil 2024:1-15. [PMID: 39024192 DOI: 10.1080/10749357.2024.2377521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 06/30/2024] [Indexed: 07/20/2024]
Abstract
OBJECTIVE The prognosis of stroke patients is greatly threatened by malnutrition. However, there is no model to predict the risk of malnutrition in hospitalized stroke patients. This study developed a predictive model for identifying high-risk malnutrition in stroke patients. METHODS Stroke patients from two tertiary hospitals were selected as the objects. Binary logistic regression was used to build the model. The model's performance was evaluated using various metrics including the receiver operating characteristic curve, Hosmer-Lemeshow test, sensitivity, specificity, Youden index, clinical decision curve, and risk stratification. RESULTS A total of 319 stroke patients were included in the study. Among them, 27% experienced malnutrition while in the hospital. The prediction model included all independent variables, including dysphagia, pneumonia, enteral nutrition, Barthel Index, upper arm circumference, and calf circumference (all p < 0.05). The AUC area in the modeling group was 0.885, while in the verification group, it was 0.797. The prediction model produces greater net clinical benefit when the risk threshold probability is between 0% and 80%, as revealed by the clinical decision curve. All p values of the Hosmer test were > 0.05. The optimal cutoff value for the model was 0.269, with a sensitivity of 0.849 and a specificity of 0.804. After risk stratification, the MRS scores and malnutrition incidences increased significantly with escalating risk levels (p < 0.05) in both modeling and validation groups. CONCLUSIONS This study developed a prediction model for malnutrition in stroke patients. It has been proven that the model has good differentiation and calibration.
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Affiliation(s)
- Rong Tang
- Department of Nursing, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
| | - Bi Guan
- Department of Nursing, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
| | - Jiaoe Xie
- Department of Neurology, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
| | - Ying Xu
- School of Nursing, Southwest Medical University, Luzhou, Sichuan, China
| | - Shu Yan
- Medical Affairs Department, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
| | - Jianghong Wang
- Department of Neurology, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
| | - Yan Li
- Department of Nursing, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
| | - Liling Ren
- Department of Neurology, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
| | - Haiyan Wan
- Department of Endocrinology, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
| | - Tangming Peng
- Department of Neurology, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
| | - Liangnan Zeng
- Department of Nursing, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
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Labeit B, Michou E, Trapl-Grundschober M, Suntrup-Krueger S, Muhle P, Bath PM, Dziewas R. Dysphagia after stroke: research advances in treatment interventions. Lancet Neurol 2024; 23:418-428. [PMID: 38508837 DOI: 10.1016/s1474-4422(24)00053-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/31/2024] [Accepted: 01/31/2024] [Indexed: 03/22/2024]
Abstract
After a stroke, most patients have dysphagia, which can lead to aspiration pneumonia, malnutrition, and adverse functional outcomes. Protective interventions aimed at reducing these complications remain the cornerstone of treatment. Dietary adjustments and oral hygiene help mitigate the risk of aspiration pneumonia, and nutritional supplementation, including tube feeding, might be needed to prevent malnutrition. Rehabilitative interventions aim to enhance swallowing function, with different behavioural strategies showing promise in small studies. Investigations have explored the use of pharmaceutical agents such as capsaicin and other Transient-Receptor-Potential-Vanilloid-1 (TRPV-1) sensory receptor agonists, which alter sensory perception in the pharynx. Neurostimulation techniques, such as transcranial direct current stimulation, repetitive transcranial magnetic stimulation, and pharyngeal electrical stimulation, might promote neuroplasticity within the sensorimotor swallowing network. Further advancements in the understanding of central and peripheral sensorimotor mechanisms in patients with dysphagia after a stroke, and during their recovery, will contribute to optimising treatment protocols.
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Affiliation(s)
- Bendix Labeit
- Department of Neurology, Medical Faculty, Heinrich Heine University Duesseldorf, Duesseldorf, North Rhine-Westphalia, Germany.
| | - Emilia Michou
- Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Achaia, Greece; Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, University of Manchester and the Manchester Academic Health Sciences Centre (MAHSC), Manchester, Greater Manchester, UK
| | - Michaela Trapl-Grundschober
- Karl Landsteiner University of Health Sciences, Krems, Lower Austria, Austria; Division of Neurology, University Hospital Tulln, Tulln, Lower Austria, Austria
| | - Sonja Suntrup-Krueger
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Muenster, North Rhine-Westphalia, Germany
| | - Paul Muhle
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Muenster, North Rhine-Westphalia, Germany
| | - Philip M Bath
- Stroke Trials Unit, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Rainer Dziewas
- Department of Neurology and Neurorehabilitation, Klinikum Osnabrueck - Academic teaching hospital of the University of Muenster, Osnabrueck, Lower Saxony, Germany
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Maruyama M, Kagaya Y, Kajiwara S, Oikawa T, Horikawa M, Fujimoto M, Sasaki M. The Validity of Quadriceps Muscle Thickness as a Nutritional Risk Indicator in Patients with Stroke. Nutrients 2024; 16:540. [PMID: 38398864 PMCID: PMC10891856 DOI: 10.3390/nu16040540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/08/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024] Open
Abstract
This study aimed to investigate whether quadriceps muscle thickness (QMT) is useful for nutritional assessment in patients with stroke. This was a retrospective cohort study. Nutritional risk was assessed using the Geriatric Nutritional Risk Index (GNRI), with GNRI < 92 indicating a risk of malnutrition and GNRI ≥ 92 indicating normal conditions. Muscle mass was assessed using QMT and calf circumference (CC). The outcome was Functional Independence Measure (FIM) effectiveness. The cutoff values of QMT and CC for discriminating between high and low GNRI were determined using the receiver operating characteristic curve. The accuracy of the nutritional risk discrimination model was evaluated using the Matthews correlation coefficient (MCC). Multiple regression analysis was performed to assess the relationship between nutritional risk, as defined by QMT and CC, and FIM effectiveness. A total of 113 patients were included in the analysis. The cutoff values of QMT and CC for determining nutritional risk were 49.630 mm and 32.0 cm for men (MCC: 0.576; 0.553) and 41.185 mm and 31.0 cm for women (MCC: 0.611; 0.530). Multiple regression analysis showed that only nutritional risk defined by QMT was associated with FIM effectiveness. These findings indicate that QMT is valid for assessing nutritional risk in patients with stroke.
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Affiliation(s)
- Motoki Maruyama
- Department of Rehabilitation, Akita Cerebrospinal and Cardiovascular Center, 6-10 Senshu-Kubota-Machi, Akita 010-0874, Japan
- Department of Physical Therapy, Akita University Graduate School of Health Science, 1-1-1 Hondo, Akita 010-8543, Japan
- Department of Rehabilitation Medicine, Akita Cerebrospinal and Cardiovascular Center, 6-10 Senshu-Kubota-Machi, Akita 010-0874, Japan
| | - Yuki Kagaya
- Department of Rehabilitation, Akita Cerebrospinal and Cardiovascular Center, 6-10 Senshu-Kubota-Machi, Akita 010-0874, Japan
| | - Sota Kajiwara
- Department of Rehabilitation, Akita Cerebrospinal and Cardiovascular Center, 6-10 Senshu-Kubota-Machi, Akita 010-0874, Japan
| | - Takuto Oikawa
- Department of Rehabilitation, Akita Cerebrospinal and Cardiovascular Center, 6-10 Senshu-Kubota-Machi, Akita 010-0874, Japan
- Department of Physical Therapy, Akita University Graduate School of Health Science, 1-1-1 Hondo, Akita 010-8543, Japan
| | - Manabu Horikawa
- Department of Rehabilitation, Akita Cerebrospinal and Cardiovascular Center, 6-10 Senshu-Kubota-Machi, Akita 010-0874, Japan
| | - Mika Fujimoto
- Department of Nutrition, Akita Cerebrospinal and Cardiovascular Center, 6-10 Senshu-Kubota-Machi, Akita 010-0874, Japan;
| | - Masahiro Sasaki
- Department of Rehabilitation Medicine, Akita Cerebrospinal and Cardiovascular Center, 6-10 Senshu-Kubota-Machi, Akita 010-0874, Japan
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Yang D, Huang J, Hu J, Zhang M, Xie H, Chen Y, Jin Y, Jiang Z, Wang Y, Zhu J, Lu X, Chen S, Weng Y, Chen G. Association of nutritional screening tools with 6-month outcomes in ischemic stroke patients: A retrospective study. Nutrition 2024; 117:112223. [PMID: 37913712 DOI: 10.1016/j.nut.2023.112223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 09/13/2023] [Accepted: 09/16/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE Nutritional screening tools based on laboratory examinations are relatively objective and available indicators. However, few studies have investigated whether malnutrition severity might be associated with adverse outcomes at the platform recovery period of 6 mo and differentiated in acute ischemic stroke patients with or without intravenous thrombolysis. Therefore, we assessed the association between malnutrition and 6-mo outcomes in both intravenous thrombolysis and non-intravenous thrombolysis patients. METHODS We retrospectively recruited 138 acute ischemic stroke patients who received intravenous thrombolysis and 311 who did not. The Geriatric Nutritional Risk Index, prognostic nutritional index, and Controlling Nutritional Status were used to assess nutritional status. The concordance between the 3 malnutrition screening tools was investigated with the κ statistic. Subgroups analyses were conducted to assess the correlation between malnutrition and functional outcomes in intravenous thrombolysis and non-intravenous thrombolysis patients. RESULTS A total of 17 (6.44%) patients were suffering from malnutrition, as indicated by the Geriatric Nutritional Risk Index, prognostic nutritional index, and Controlling Nutritional Status jointly. Moderate-severe malnutrition evaluated by the Geriatric Nutritional Risk Index was significantly associated with poor functional outcome (odds ratio = 4.074; P = 0.003). Patients in the good functional outcome group (modified Rankin scale scores = 0 to 2) had a higher proportion of intravenous thrombolysis treatment (32.79% versus 21.25%; P = 0.043). Furthermore, subgroup analyses found no significant interactions between malnourished levels and intravenous thrombolysis treatment (P interaction > 0.05). CONCLUSION The Geriatric Nutritional Risk Index, over ≤24 h, compared with the prognostic nutritional index and Controlling Nutritional Status, provided timely signals to improve acute ischemic stroke patients' nutritional status. Also, nutritional status might not lead todifferent 6-mo outcomes, whether or not patients received intravenous thrombolysis treatment.
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Affiliation(s)
- Dehao Yang
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiaqi Huang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China; The First School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, China
| | - Jingyu Hu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China; The First School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, China
| | - Minyue Zhang
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Haobo Xie
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China; The First School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, China
| | - Yilin Chen
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China; The First School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, China
| | - Yining Jin
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China; The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Zerui Jiang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China; The First School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, China
| | - Yanchu Wang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China; The First School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, China
| | - Jinrong Zhu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China; The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Xin Lu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China; The First School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, China
| | - Siqi Chen
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China; The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Yiyun Weng
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Guangyong Chen
- Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
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Tseng YT, Han DS, Lai JCY, Wang CH, Wang TG, Chen HH. The Influence of Hemoglobin and Swallowing Ability on Daily Living Activities After Hospital Discharge in Taiwanese Stroke Patients: A Longitudinal Study. Arch Phys Med Rehabil 2023; 104:1638-1645. [PMID: 37286069 DOI: 10.1016/j.apmr.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVE This study aimed to examine the mediating effect of swallowing ability on hemoglobin levels and activities of daily living (ADL). DESIGN Prospective longitudinal study. SETTING Two rehabilitation wards in a national referral center for Northern Taiwan, followed by discharge. PARTICIPANTS 101 participants were admitted for first or recurrent infarction or hemorrhagic stroke and transferred to the rehabilitation ward of a medical center (N=101). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Hemoglobin data were collected from medical records. Swallowing ability and ADL were measured using the Functional Oral Intake Scale and Barthel Index, respectively, with higher scores indicating better functioning. RESULTS Mediation analysis performed using path analysis illustrated that hemoglobin at the time of transfer to the rehabilitation ward had a direct and positive effect on swallowing ability at 1-3 days before discharge (path coefficient=0.21, 95% confidence interval [CI]: 0.04-0.35, P=.018), and swallowing ability at 1-3 days before discharge had a direct and positive effect on ADL at 1 month after discharge (path coefficient=0.36, 95% CI: 0.13-0.57, P=.002). Hemoglobin level at the time of transfer to the rehabilitation ward did not directly influence ADL 1 month after discharge (path coefficient=0.12, 95% CI: -0.05-0.28, P=.166). These results indicate that swallowing ability substantially mediates the relation between previous hemoglobin levels and subsequent ADL. CONCLUSION Low hemoglobin levels and poor swallowing ability should be concurrently addressed to improve ADL performance.
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Affiliation(s)
- Ying-Tzu Tseng
- Department of Nursing, National Taiwan University Hospital, Taipei City, Taiwan
| | - Der-Sheng Han
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, BeiHu Branch, Taipei City, Taiwan; Department of Physical Medicine and rehabilitation, National Taiwan University Hospital, Taipei City, Taiwan
| | - Jerry Cheng-Yen Lai
- Department of Medical Research, Taitung MacKay Memorial Hospital, Taitung City, Taiwan; College of Science and Engineering, National Taitung University, Taitung City, Taiwan
| | - Chien-Hui Wang
- Department of Nursing, National Taiwan University Hospital, Taipei City, Taiwan
| | - Tyng-Guey Wang
- Department of Physical Medicine and rehabilitation, National Taiwan University Hospital, Taipei City, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei City, Taiwan
| | - Hung-Hui Chen
- Department of Nursing, National Taiwan University Hospital, Taipei City, Taiwan; School of Nursing, College of Medicine, National Taiwan University, Taipei City, Taiwan.
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Di Vincenzo O, Pagano E, Cervone M, Natale R, Morena A, Esposito A, Pasanisi F, Scalfi L. High Nutritional Risk Is Associated with Poor Functional Status and Prognostic Biomarkers in Stroke Patients at Admission to a Rehabilitation Unit. Nutrients 2023; 15:4144. [PMID: 37836427 PMCID: PMC10574786 DOI: 10.3390/nu15194144] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
Considering that malnutrition (undernutrition) is common in stroke patients and may negatively impact body function, the aim of this study was to determine the relationship between nutritional risk and functional status in stroke patients at admission to a rehabilitation unit. Nutritional risk was assessed using the Geriatric Nutritional Risk Index (GNRI), the Prognostic Nutritional Index (PNI) and the Controlling Nutritional Status (CONUT) score. Functional status was assessed using the Barthel Index, the modified Rankin Scale, the Trunk Control Test and the Sitting Balance Scale, and cognitive function was assessed using the Short Portable Mental Status Questionnaire. C-reactive protein, fibrinogen and D-dimer were also evaluated as established prognostic biomarkers. Stroke patients (n = 245; age 69.7 ± 12.8 years; 47%, women; 82% ischemic stroke) at admission to a rehabilitation unit were included in this study. A high prevalence of nutritional risk was detected with each tool and was found to be greater using the GNRI and in patients aged ≥75 years. Multiple logistic regression analysis showed that age and dysphagia were independent predictors of high nutritional risk. High risk groups performed worse on all functional tests compared to the low-risk groups (p < 0.05). Nutritional risk with each tool was associated with functional and cognitive statuses (with the highest correlation being with the Trunk Control Test). Significant associations were also found with C-reactive protein, fibrinogen and D-dimer. In conclusion, a high nutritional risk, as evaluated with the GNRI, the PNI and the CONUT score, was detected in stroke patients at admission to a rehabilitation unit. High nutritional risk was associated with functional status and with predictors of clinical outcomes (and specifically in older patients).
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Affiliation(s)
- Olivia Di Vincenzo
- Department of Public Health, School of Medicine, Federico II University, via Sergio Pansini 5, 80131 Naples, Italy;
| | - Ermenegilda Pagano
- Casa di Cura Santa Maria del Pozzo Hospital, via Pomigliano 40, Somma Vesuviana, 80049 Naples, Italy; (E.P.); (M.C.); (A.E.)
| | - Mariarosaria Cervone
- Casa di Cura Santa Maria del Pozzo Hospital, via Pomigliano 40, Somma Vesuviana, 80049 Naples, Italy; (E.P.); (M.C.); (A.E.)
| | - Raffaele Natale
- Department of Clinical Medicine and Surgery, School of Medicine, Federico II University, via Sergio Pansini 5, 80131 Naples, Italy; (R.N.); (A.M.); (F.P.)
| | - Annadora Morena
- Department of Clinical Medicine and Surgery, School of Medicine, Federico II University, via Sergio Pansini 5, 80131 Naples, Italy; (R.N.); (A.M.); (F.P.)
| | - Alessandra Esposito
- Casa di Cura Santa Maria del Pozzo Hospital, via Pomigliano 40, Somma Vesuviana, 80049 Naples, Italy; (E.P.); (M.C.); (A.E.)
| | - Fabrizio Pasanisi
- Department of Clinical Medicine and Surgery, School of Medicine, Federico II University, via Sergio Pansini 5, 80131 Naples, Italy; (R.N.); (A.M.); (F.P.)
| | - Luca Scalfi
- Department of Public Health, School of Medicine, Federico II University, via Sergio Pansini 5, 80131 Naples, Italy;
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Labeit B, Michou E, Hamdy S, Trapl-Grundschober M, Suntrup-Krueger S, Muhle P, Bath PM, Dziewas R. The assessment of dysphagia after stroke: state of the art and future directions. Lancet Neurol 2023; 22:858-870. [PMID: 37596008 DOI: 10.1016/s1474-4422(23)00153-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 03/10/2023] [Accepted: 04/14/2023] [Indexed: 08/20/2023]
Abstract
Dysphagia is a major complication following an acute stroke that affects the majority of patients. Clinically, dysphagia after stroke is associated with increased risk of aspiration pneumonia, malnutrition, mortality, and other adverse functional outcomes. Pathophysiologically, dysphagia after stroke is caused by disruption of an extensive cortical and subcortical swallowing network. The screening of patients for dysphagia after stroke should be provided as soon as possible, starting with simple water-swallowing tests at the bedside or more elaborate multi-consistency protocols. Subsequently, a more detailed examination, ideally with instrumental diagnostics such as flexible endoscopic evaluation of swallowing or video fluoroscopy is indicated in some patients. Emerging diagnostic procedures, technical innovations in assessment tools, and digitalisation will improve diagnostic accuracy in the future. Advances in the diagnosis of dysphagia after stroke will enable management based on individual patterns of dysfunction and predisposing risk factors for complications. Progess in dysphagia rehabilitation are essential to reduce mortality and improve patients' quality of life after a stroke.
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Affiliation(s)
- Bendix Labeit
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Muenster, Germany; Institute for Biomagnetism and Biosignal Analysis, University Hospital Muenster, Muenster, Germany.
| | - Emilia Michou
- Department of Speech Language Therapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Achaia, Greece; Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Shaheen Hamdy
- Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | | | - Sonja Suntrup-Krueger
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Muenster, Germany
| | - Paul Muhle
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Muenster, Germany; Institute for Biomagnetism and Biosignal Analysis, University Hospital Muenster, Muenster, Germany
| | - Philip M Bath
- Stroke Trials Unit, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Rainer Dziewas
- Department of Neurology and Neurorehabilitation, Klinikum Osnabrueck-Academic Teaching Hospital of the WWU Muenster, Osnabrueck, Germany
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8
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Labeit B, Muhle P, Dziewas R, Suntrup-Krueger S. [Diagnostics and treatment of post-stroke dysphagia]. DER NERVENARZT 2023; 94:676-683. [PMID: 37160432 DOI: 10.1007/s00115-023-01483-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Post-stroke dysphagia is highly prevalent and leads to severe complications, such as aspiration pneumonia and malnutrition. Despite the high clinical relevance dysphagia management is heterogeneous and often inadequate. OBJECTIVE The aim of this review article is to provide an overview of the diagnostic and treatment strategies for post-stroke dysphagia based on recent studies. MATERIAL AND METHODS Narrative literature review. RESULTS Dysphagia screening should be performed as early as possible in every stroke patient, e.g., with a simple water swallowing test or a multiconsistency protocol. Subsequently, flexible endoscopic evaluation of swallowing (FEES) is indicated in patients with abnormal screening results or existing risk factors for dysphagia. Dietary modifications, oral hygiene measures, and nutritional therapy can help reduce complications. Behavioral swallowing therapy or experimental therapies, such as neurostimulation procedures and pharmacological approaches aim to improve swallowing function and have shown promising results in studies. CONCLUSION Timely management of dysphagia is necessary to reduce complications.
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Affiliation(s)
- Bendix Labeit
- Klinik für Neurologie, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland.
| | - Paul Muhle
- Klinik für Neurologie mit Institut für Translationale Neurologie, Universitätsklinikum Münster, Münster, Deutschland
| | - Rainer Dziewas
- Klinik für Neurologie und Neurologische Frührehabilitation, Klinikum Osnabrück, Osnabrück, Deutschland
| | - Sonja Suntrup-Krueger
- Klinik für Neurologie mit Institut für Translationale Neurologie, Universitätsklinikum Münster, Münster, Deutschland
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9
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Liu P, Tian H, Ji T, Zhong T, Gao L, Chen L. Predictive Value of Malnutrition, Identified via Different Nutritional Screening or Assessment Tools, for Functional Outcomes in Patients with Stroke: A Systematic Review and Meta-Analysis. Nutrients 2023; 15:3280. [PMID: 37513698 PMCID: PMC10383200 DOI: 10.3390/nu15143280] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/17/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Malnutrition affects more than half of patients with stroke. Although malnutrition leads to more deaths, a longer hospital stay, and higher costs, there is still a lack of consensus regarding the impact of malnutrition on physical functional outcomes in patients with stroke, and there are large differences in the diagnostic effects of nutritional screening or assessment tools for malnutrition. This study aimed to explore the impact of malnutrition in patients with stroke and assess the significance of current nutritional screening and assessment tools for these patients. METHODS Six databases were systematically searched until October 2022. Cohort studies meeting the eligibility criteria were included. Pooled effects were calculated using random-effects models. RESULTS Twenty-six studies with 21,115 participants were included. The pooled effects of malnutrition on poor functional outcome, FIM points, and dysphagia were OR = 2.72 (95% CI = 1.84-4.06), WMD = -19.42(95% CI = -32.87--5.96), and OR = 2.80 (95% CI = 1.67-4.67), respectively. CONCLUSION Malnutrition adversely affects the recovery of physical and swallowing functions in patients with stroke. Nutritional assessments consistently predict the outcomes of physical function in patients with stroke.
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Affiliation(s)
- Peiqi Liu
- School of Nursing, Jilin University, Changchun 130021, China
| | - Huimin Tian
- School of Nursing, Jilin University, Changchun 130021, China
| | - Tianliang Ji
- The First Hospital of Jilin University, Changchun 130021, China
| | - Tangsheng Zhong
- School of Nursing, Jilin University, Changchun 130021, China
- The First Hospital of Jilin University, Changchun 130021, China
| | - Lan Gao
- The First Hospital of Jilin University, Changchun 130021, China
| | - Li Chen
- School of Nursing, Jilin University, Changchun 130021, China
- Department of Pharmacology, College of Basic Medical Sciences, Jilin University, Changchun 130021, China
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10
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Chen Y, Yang H, Lan M, Wei H, Chen Y. The controlling nutritional status score and risk factors associated with malnutrition in patients with acute ischemic stroke. Front Neurol 2023; 14:1067706. [PMID: 36970524 PMCID: PMC10033595 DOI: 10.3389/fneur.2023.1067706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/16/2023] [Indexed: 03/11/2023] Open
Abstract
ObjectivesMalnutrition is an independent risk factor for poor outcomes in patients who suffered an acute ischemic stroke (AIS). The controlling nutritional status (CONUT) score can provide information for nutritional management in AIS patients. However, the risk factors associated with the CONUT score have not been established to date. Therefore, in this study, we aimed to investigate the CONUT score of patients with AIS and explore the potential risk factors associated with it.MethodsWe conducted a retrospective review of the data from consecutive AIS patients who were recruited in the CIRCLE study. Within 2 days of admission, we gathered the CONUT score, the Nutritional Risk Screening 2002, the Modified Rankin Scale, the National Institutes of Health Neurological Deficit Score (NIHSS), and demographic data from medical records. We used chi-squared tests to examine admission, and a logistic regression analysis was performed to explore the risk factors associated with CONUT in patients with AIS.ResultsA total of 231 patients with AIS participated in the study, with a mean age of 62.32 ± 13.0 years and a mean NIHSS of 6.77 ± 3.8. Of these patients, 41(17.7%) had hyperlipidemia. In terms of nutritional assessment, 137(59.3%) patients with AIS had high CONUT scores, 86(37.2%) patients with AIS had low or high BMI, and 117(50.6%) patients with AIS had NRS-2002 scores below 3. The chi-squared tests showed that age, NIHSS, body mass index (BMI), and hyperlipidemia were associated with the CONUT score (P < 0.05). The logistic regression analysis showed that low NIHSS scores (OR = 0.055 95% CI: 0.003–0.893), younger age (OR = 0.159 95% CI: 0.054–0.469), and hyperlipidemia (OR = 0.303 95% CI: 0.141–0.648) were independently associated with lower CONUT scores (P < 0.05), whereas BMI was not found to be independently associated with the CONUT.ConclusionsMore than half of the patients with AIS were at risk of malnutrition, with age and neurological deficits being identified as risk factors for nutritional control. Hyperlipidemia was found to be a protective factor of the CONUT, while NRS-2002 and BMI did not affect the nutritional control in patients with AIS.
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Correlation between nutritional status screening by MNA-SF and acute stroke-associated infections in older adults. Aging Clin Exp Res 2023; 35:717-721. [PMID: 36656506 DOI: 10.1007/s40520-022-02334-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/20/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE This study aimed to explore the correlation between nutritional status screening using the MNA-SF and stroke-associated infections (SAI) in older adults. METHODS A retrospective study of patients aged over 70 years with acute stroke was conducted. The patients were divided into normal nutritional status, malnutrition risk, and malnutrition groups depending on their baseline MNA-SF scores. The correlation between nutritional status and SAI was identified using multivariate logistic regression. The receiver operating characteristic (ROC) curve was used to demonstrate the predicted value of MNA-SF. RESULTS 497 patients were included, 101 (20.32%) developed SAI. 32.29% of patients with malnutrition developed SAI, while 25.14% of those with malnutrition risk developed SAI. Malnutrition (aOR 4.58, 95% CI 2.34-8.96, p < 0.001) and risk of malnutrition (aOR 3.70, 95%CI 2.01-6.85, p < 0.001) were independent risk factors for SAI in older stroke patients. The area under the curve (AUC) value of MNA-SF was 0.713. CONCLUSION MNA-SF is a simple and effective nutritional screening tool for predicting the occurrence of SAI in older patients with acute stroke.
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Labeit B, Jung A, Ahring S, Oelenberg S, Muhle P, Roderigo M, Wenninger F, von Itter J, Claus I, Warnecke T, Dziewas R, Suntrup-Krueger S. Relationship between post-stroke dysphagia and pharyngeal sensory impairment. Neurol Res Pract 2023; 5:7. [PMID: 36793109 PMCID: PMC9933330 DOI: 10.1186/s42466-023-00233-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 02/03/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Post-stroke dysphagia (PSD) is common and can lead to serious complications. Pharyngeal sensory impairment is assumed to contribute to PSD. The aim of this study was to investigate the relationship between PSD and pharyngeal hypesthesia and to compare different assessment methods for pharyngeal sensation. METHODS In this prospective observational study, fifty-seven stroke patients were examined in the acute stage of the disease using Flexible Endoscopic Evaluation of Swallowing (FEES). The Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS) and impaired secretion management according to the Murray-Secretion Scale were determined, as well as premature bolus spillage, pharyngeal residue and delayed or absent swallowing reflex. A multimodal sensory assessment was performed, including touch-technique and a previously established FEES-based swallowing provocation test with different volumes of liquid to determine the latency of swallowing response (FEES-LSR-Test). Predictors of FEDSS, Murray-Secretion Scale, premature bolus spillage, pharyngeal residue, and delayed or absent swallowing reflex were examined with ordinal logistic regression analyses. RESULTS Sensory impairment using the touch-technique and the FEES-LSR-Test were independent predictors of higher FEDSS, Murray-Secretion Scale, and delayed or absent swallowing reflex. Decreased sensitivity according to the touch-technique correlated with the FEES-LSR-Test at 0.3 ml and 0.4 ml, but not at 0.2 ml and 0.5 ml trigger volumes. CONCLUSIONS Pharyngeal hypesthesia is a crucial factor in the development of PSD, leading to impaired secretion management and delayed or absent swallowing reflex. It can be investigated using both the touch-technique and the FEES-LSR-Test. In the latter procedure, trigger volumes of 0.4 ml are particularly suitable.
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Affiliation(s)
- Bendix Labeit
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1; Building A1, 48149, Muenster, Germany.
- Institute for Biomagnetism and Biosignal Analysis, University Hospital Muenster, Muenster, Germany.
| | - Anne Jung
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1; Building A1, 48149, Muenster, Germany
| | - Sigrid Ahring
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1; Building A1, 48149, Muenster, Germany
| | - Stephan Oelenberg
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1; Building A1, 48149, Muenster, Germany
| | - Paul Muhle
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1; Building A1, 48149, Muenster, Germany
- Institute for Biomagnetism and Biosignal Analysis, University Hospital Muenster, Muenster, Germany
| | - Malte Roderigo
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1; Building A1, 48149, Muenster, Germany
| | - Fiona Wenninger
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1; Building A1, 48149, Muenster, Germany
| | - Jonas von Itter
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1; Building A1, 48149, Muenster, Germany
| | - Inga Claus
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1; Building A1, 48149, Muenster, Germany
| | - Tobias Warnecke
- Department of Neurology and Neurorehabilitation, Klinikum Osnabrueck - Academic teaching hospital of the WWU, Muenster, Germany
| | - Rainer Dziewas
- Department of Neurology and Neurorehabilitation, Klinikum Osnabrueck - Academic teaching hospital of the WWU, Muenster, Germany
| | - Sonja Suntrup-Krueger
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1; Building A1, 48149, Muenster, Germany
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The Assessment of the Risk of Malnutrition (Undernutrition) in Stroke Patients. Nutrients 2023; 15:nu15030683. [PMID: 36771390 PMCID: PMC9921740 DOI: 10.3390/nu15030683] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
Malnutrition is common in stroke patients, as it is associated with neurological and cognitive impairment as well as clinical outcomes. Nutritional screening is a process with which to categorize the risk of malnutrition (i.e., nutritional risk) based on validated tools/procedures, which need to be rapid, simple, cost-effective, and reliable in the clinical setting. This review focuses on the tools/procedures used in stroke patients to assess nutritional risk, with a particular focus on their relationships with patients' clinical characteristics and outcomes. Different screening tools/procedures have been used in stroke patients, which have shown varying prevalence in terms of nutritional risk (higher in rehabilitation units) and significant relationships with clinical outcomes in the short- and long term, such as infection, disability, and mortality. Indeed, there have been few attempts to compare the usefulness and reliability of the different tools/procedures. More evidence is needed to identify appropriate approaches to assessing nutritional risk among stroke patients in the acute and sub-acute phase of disease or during rehabilitation; to evaluate the impact of nutritional treatment on the risk of malnutrition during hospital stay or rehabilitation unit; and to include nutritional screening in well-defined nutritional care protocols.
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Lu HY, Ho UC, Kuo LT. Impact of Nutritional Status on Outcomes of Stroke Survivors: A Post Hoc Analysis of the NHANES. Nutrients 2023; 15:nu15020294. [PMID: 36678164 PMCID: PMC9864300 DOI: 10.3390/nu15020294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/19/2022] [Accepted: 12/28/2022] [Indexed: 01/11/2023] Open
Abstract
Stroke, a neurological emergency, is a leading cause of death and disability in adults worldwide. In acute or rehabilitative stages, stroke survivors sustain variable neurological recovery with long-term disabilities. The influence of post-stroke nutritional status on long-term survival has not been confirmed. Using the United States National Health and Nutrition Examination Survey data (2001−2010), we conducted a matched-cohort analysis (929 and 1858 participants in stroke and non-stroke groups, respectively) to investigate the influence of nutritional elements on post-stroke survival. With significantly lower nutrient consumption, the mortality risk was 2.2 times higher in stroke patients compared to non-stroke patients (Kaplan−Meier method with Cox proportional hazards model: adjusted hazard ratio, 2.208; 95% confidence interval: 1.887−2.583; p < 0.001). For several nutritional elements, the lower consumption group had significantly shorter survival than the higher consumption stroke subgroup; moreover, stroke patients with the highest 25% nutritional intake for each nutritional element, except moisture and total fat, had significantly shorter survival than non-stroke patients with the lowest 25% nutrition. Malnutrition is highly prevalent in stroke patients and is associated with high mortality rates. The dynamic change in energy requirements throughout the disease course necessitates dietary adjustment to ensure adequate nutritional intake.
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Affiliation(s)
- Hsueh-Yi Lu
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Yunlin 640, Taiwan
| | - Ue-Cheung Ho
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital Yunlin Branch, Yunlin 640, Taiwan
| | - Lu-Ting Kuo
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital Yunlin Branch, Yunlin 640, Taiwan
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei 100, Taiwan
- Correspondence: ; Tel.: +886-2-2312-3456
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15
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Labeit B, Kremer A, Muhle P, Claus I, Warnecke T, Dziewas R, Suntrup-Krueger S. Costs of post-stroke dysphagia during acute hospitalization from a health-insurance perspective. Eur Stroke J 2022; 8:361-369. [PMID: 37021194 PMCID: PMC10069210 DOI: 10.1177/23969873221147740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/09/2022] [Indexed: 12/30/2022] Open
Abstract
Purpose: Oropharyngeal dysphagia is a common and complication-prone symptom after stroke and is assumed to increase medical expenses. The purpose of this study was therefore to examine acute hospitalization costs associated with post-stroke dysphagia. Method: This retrospective study included patients with acute stroke who had been examined by Flexible Endoscopic Evaluation of Swallowing (FEES). Health insurance expenditures were determined for the patient cases according to the 2021 revenue criteria. Multiple linear regression was used to examine predictors of health insurance spending including age, sex, stroke severity, stroke characteristics, comorbidity, therapeutic interventions, duration of artificial ventilation, length of hospital stay, and severity of dysphagia, as assessed by the Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS), ranging from 1 (best) to 6 (worst). Findings: Six hundred seventy four patients (men/women: 367/307; mean age: 71.1 ± 12.8 years; mean National Institute of Health Stroke Scale: 11.2 ± 6.2; FEDSS 1/2/3/4/5/6: 113/73/144/119/124/101; mean health-insurance costs 11,521.5 ± 12,950.5€) were included in the analysis. Advanced age ( p = 0.007; B = 57.6), catheter interventions ( p < 0.001; B = 4105.6), tracheotomy ( p = 0.006; B = 5195.2), duration of artificial ventilation ( p < 0.001; B = 388.6), length of hospital stay ( p < 0.001; B = 441.9), and severe dysphagia with an FEDSS of 6 ( p = 0.004, B = 2554.3) were independent predictors of increased health insurance expenditures ( p < 0.001, R-squared = adjusted-R-squared = 0.83). Discussion and conclusion: The results of this study show an association between severe dysphagia and health care costs for acute hospitalization from a health-insurance perspective. Therefore, therapies that target severe dysphagia with impaired secretion management may have the potential to reduce costs.
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Affiliation(s)
- Bendix Labeit
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Germany
- Institute for Biomagnetism and Biosignal Analysis, University Hospital Muenster, Germany
| | - Almut Kremer
- DRG Research Group, University Hospital Muenster, Germany
| | - Paul Muhle
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Germany
- Institute for Biomagnetism and Biosignal Analysis, University Hospital Muenster, Germany
| | - Inga Claus
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Germany
| | - Tobias Warnecke
- Department of Neurology and Neurorehabilitation, Klinikum Osnabrueck – Academic teaching hospital of the WWU Muenster, Germany
| | - Rainer Dziewas
- Department of Neurology and Neurorehabilitation, Klinikum Osnabrueck – Academic teaching hospital of the WWU Muenster, Germany
| | - Sonja Suntrup-Krueger
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Germany
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Kamimoto T, Shindo K, Shimomura T, Akimoto T, Yamada T, Mori N, Nakao K, Tsujikawa M, Honaga K, Kutsuna T, Hiramatsu K, Kondo K, Liu M. Relationship between initial nutritional status and functional independence measures at discharge in subacute stroke. J Stroke Cerebrovasc Dis 2022; 31:106754. [PMID: 36115107 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106754] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 08/18/2022] [Accepted: 09/03/2022] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE This retrospective study examined the association between nutritional status at admission and functional independence measure (FIM™) at discharge. MATERIALS AND METHODS This study included 205 patients, aged ≥ 65, discharged from a convalescent ward between April 2017 and March 2018. The primary outcome was discharge FIMTM, and the secondary outcomes were the length of stay (LOS) and FIM efficiency. The explanatory variables included demographic data, stroke type, admission FIMTM, body mass index (BMI), controlling nutritional status (CONUT), and Geriatric Nutritional Risk Index (GNRI). Patients were divided into three groups based on BMI and GNRI scores and four groups based on the CONUT score. Univariate and multiple regression analyses were performed to predict discharge FIMTM. Kruskal-Wallis and Dunn's tests were also performed for intergroup comparisons. RESULTS In the univariate analyses, age, sex, onset-to-admission interval, admission FIMTM, GNRI, and BMI (all factors were p<0.001) were significant explanatory variables for discharge FIMTM. In the multiple linear regression analysis, admission FIMTM, LOS, age, and onset-to-admission interval were significant explanatory variables (adjusted R2 = 0.791; p<0.001). Although those with poor nutritional status required a longer hospital stay, they achieved the same FIM gain as those without poor nutritional status. CONCLUSIONS Nutritional status on admission did not affect the FIMTM at discharge in the convalescent ward. Patients with subacute stroke require adequate rehabilitation regardless of their nutritional status.
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Affiliation(s)
- Takayuki Kamimoto
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan; Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Keiichiro Shindo
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan; Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan; Department of Rehabilitation Medicine, Hikarigaoka Hospital, Shirankai Medical Corporation Takaoka, Toyama, Japan.
| | - Tadasuke Shimomura
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan; Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan; Department of Rehabilitation Medicine, Saiseikai Yokohama-shi Tobu Hospital, Kanagawa, Japan.
| | - Tomonori Akimoto
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan; Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takeshi Yamada
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Naoki Mori
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan; Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan; Department of Rehabilitation Medicine, Hatsudai Rehabilitation Hospital, Tokyo, Japan.
| | - Keiko Nakao
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan; Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan; Oriental Medicine Research Center, Kitasato University, Tokyo, Japan.
| | - Masahiro Tsujikawa
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan; Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Kaoru Honaga
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan; Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - Takeshi Kutsuna
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan.
| | - Kazuhisa Hiramatsu
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan.
| | - Kunitsugu Kondo
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan; Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Meigen Liu
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.
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Huppertz VAL, Pilz W, Pilz Da Cunha G, de Groot LCPGM, van Helvoort A, Schols JMGA, Baijens LWJ. Malnutrition risk and oropharyngeal dysphagia in the chronic post-stroke phase. Front Neurol 2022; 13:939735. [PMID: 36247786 PMCID: PMC9554502 DOI: 10.3389/fneur.2022.939735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/18/2022] [Indexed: 11/28/2022] Open
Abstract
Background Oropharyngeal dysphagia (OD) and malnutrition are associated with poor clinical outcomes after stroke. The present study evaluated (1) malnutrition risk and OD-related characteristics in patients with chronic post-stroke OD, and (2) the relationship between on the one hand OD severity and on the other hand functional oral intake and dysphagia-specific quality of life. Methods A cross-sectional study was conducted in a Dutch interdisciplinary outpatient clinic for OD. The standardized examination protocol comprised: clinical ear, nose, and throat examination, body mass index, the short nutritional assessment questionnaire (SNAQ), a standardized fiberoptic endoscopic evaluation of swallowing (FEES), the functional oral intake scale (FOIS), and the MD Anderson dysphagia inventory (MDADI). Results Forty-two consecutive patients with chronic post-stroke OD were included. Mean (±SD) age and BMI of the population were 69.1 (±8.7) years and 26.8 (±4.1) kg/m2 respectively. Seventeen (40.4%) patients presented a moderate to high risk of malnutrition (SNAQ score≥2). The FEES examination showed moderate to severe OD in 28 (66.7%) patients. The severity of OD was significantly related to the FOIS score but not to the MDADI scores. Conclusion In this specific sample of referred stroke patients, moderate to severe OD and moderate to high risk of malnutrition were common. Despite the use of clinical practice guidelines on stroke and a normal nutritional status at first sight, repeated screening for malnutrition and monitoring the severity and management of OD remain important elements in the care of patients with chronic post-stroke OD.
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Affiliation(s)
- V. A. L. Huppertz
- Department of Respiratory Medicine, Maastricht University, Maastricht, Netherlands
- School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, Netherlands
| | - W. Pilz
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands
- School for Oncology and Reproduction (GROW), Maastricht University, Maastricht, Netherlands
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, Netherlands
| | - G. Pilz Da Cunha
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - L. C. P. G. M. de Groot
- Division of Human Nutrition and Health, Wageningen University and Research Centre, Wageningen, Netherlands
| | - A. van Helvoort
- Department of Respiratory Medicine, Maastricht University, Maastricht, Netherlands
- School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, Netherlands
- Danone Nutricia Research, Utrecht, Netherlands
| | - J. M. G. A. Schols
- Department of Health Services Research, Maastricht University, Maastricht, Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
- Department of Family Medicine, Maastricht University, Maastricht, Netherlands
| | - L. W. J. Baijens
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands
- School for Oncology and Reproduction (GROW), Maastricht University, Maastricht, Netherlands
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Liu J, Dong J, Guo J. The effects of nutrition supplement on rehabilitation for patients with stroke: Analysis based on 16 randomized controlled trials. Medicine (Baltimore) 2022; 101:e29651. [PMID: 36123946 PMCID: PMC9478301 DOI: 10.1097/md.0000000000029651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Malnutrition is a relatively common and often unrecognized condition in stroke survivors, which may negatively affect functional recovery and survival. Though previous studies have indicated significant role of nutrition supplement for rehabilitation of patients with stroke, the results still remain controversy. OBJECTIVE The present analysis was designed to systematically review effective evidence of nutrition supplement on rehabilitation for patients with stroke. METHODS A systematic search of PubMed, EMBASE, the Cochrane Library, and Web of Science up to August 1, 2021 was performed to find relevant studies that analyzed the effect of nutrition supplement on rehabilitation of patients with stroke. The primary outcome was functional outcomes and activities of daily living (ADL). The secondary outcomes included disability, all-cause mortality, infections, pneumonia, walking ability, stroke recurrence, and laboratory results indicating nutrition status of patients. All statistical analyses were performed using standard statistical procedures with Review Manager 5.2. RESULTS Ultimately, 16 studies including 7547 patients were identified. Our pooled results found no significant difference in total, cognitive and motor FIM score between nutrition supplement and placebo groups, with pooled MDs of 7.64 (95% CI - 1.67 to 16.94; P = .11), 0.74 (95% CI - 1.33 to 2.81; P = .48), 1.11 (95% CI - 1.68 to 3.90; P = .44), respectively. However, our result showed that nutritional interventions had significant effect on ADL for patients with stroke (MD 3.26; 95% CI 0.59 to 5.93; P = .02). In addition, nutrition supplement reduced the incidence of infections for patients with stroke, with a pooled RR of 0.65 (95% CI 0.51 to 0.84; P = .0008). No significant results were found in disabilities, complication and laboratory outcomes. CONCLUSIONS The present meta-analysis indicated no statistically significant effect of nutrition supplement on functional outcomes as well as disabilities, complication and laboratory outcomes for patients with stroke. However, it increased ADL and reduced the incidence of infections.
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Affiliation(s)
- Jianhua Liu
- Department of Physical Therapy, Beijing Bo’ai Hospital, Chinese Rehabilitation Research Centre, Beijing, China
| | - Jige Dong
- Department of Rehabilitation and Treatment, Wangjing Hospital, Chinese Academy of Traditional Chinese Medicine, Beijing, China
| | - Jiangzhou Guo
- Department of Rehabilitation and Treatment, Wangjing Hospital, Chinese Academy of Traditional Chinese Medicine, Beijing, China
- *Correspondence: Jiangzhou Guo, Department of Rehabilitation and Treatment, Wangjing Hospital, Chinese Academy of Traditional Chinese Medicine, Huajiadi Street, Chaoyang District, Beijing 100102, China (e-mail: )
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Chen X, Li D, Liu Y, Zhu L, Jia Y, Gao Y. Nutritional risk screening 2002 scale and subsequent risk of stroke-associated infection in ischemic stroke: The REMISE study. Front Nutr 2022; 9:895803. [PMID: 36159470 PMCID: PMC9505510 DOI: 10.3389/fnut.2022.895803] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 08/08/2022] [Indexed: 11/30/2022] Open
Abstract
Background and aim Stroke-associated infection (SAI) is a common and serious complication in patients with IS. This study aimed to evaluate the impact of nutritional status at admission assessed on SAI, explore the predictive value of the Nutritional Risk Screening 2002 (NRS-2002 for SAI. Methods This study included patients with IS who were admitted to five major hospitals in Chengdu from January 2017 to February 2019. The nutritional status was assessed using the NRS-2002 tool. Logistic regression analysis was performed to explore the predictive value of NRS-2002 for SAI. Results A total of 594 patients with IS were included in this study; among them, 215 (36.20%) patients were at risk of malnutrition, and 216 (36.36%) patients developed SAI. The area under the curve of the NRS-2002 scores was smaller than A2DS2 (0.644 vs. 0.779), and NRS-2002 improved the predictive values of the A2DS2 score(Age, Atrial fibrillation, Dysphagia, Sex, Stroke Severity) for SAI (P < 0.001). Logistic regression analysis showed that patients with NRS-2002 score ≥ 3 had significantly higher risks of SAI (NRS-2002: odds ratios (OR) = 1.450, 95% confidence interval (CI): 1.184-1.692, P < 0.001). Conclusion NRS-2002 is a useful and simple tool for identifying the risk of SAI. Malnutrition is related to the development of SAI. Malnourished patients with stroke may benefit from further nutritional supplements and management.
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Affiliation(s)
- Xiaoli Chen
- Department of Emergency Medicine and West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Dongze Li
- Department of Emergency Medicine and West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Liu
- Department of Emergency Medicine and West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Ling Zhu
- Department of Emergency Medicine and West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Yu Jia
- Department of General Practice and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Yongli Gao
- Department of Emergency Medicine and West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
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Immune biomarkers are associated with poststroke fatigue at six months in patients with ischemic stroke. J Clin Neurosci 2022; 101:228-233. [DOI: 10.1016/j.jocn.2022.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/04/2022] [Accepted: 05/23/2022] [Indexed: 11/18/2022]
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21
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Zhang RX, Zhang WW, Luo YT, Liu GW. An mNUTRIC-based nomogram for predicting the in-hospital death risk in patients with acute stroke. Eur J Clin Nutr 2022; 76:1464-1469. [DOI: 10.1038/s41430-022-01127-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 03/07/2022] [Accepted: 03/18/2022] [Indexed: 11/09/2022]
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22
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Lee EC, Jeong YG, Jung JH, Moon HI. Validity of the Controlling Nutritional Status score as a Nutritional Assessment Tool early after stroke. Int J Rehabil Res 2022; 45:58-64. [PMID: 34726196 DOI: 10.1097/mrr.0000000000000503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Malnutrition is relatively common in stroke survivors and it also affects weight loss and muscle strength. Various nutritional assessment tools have been used to monitor changes in nutritional status. Among such tools, the Controlling Nutritional Status (CONUT) score is a convenient and cost-effective index calculated from serum albumin level, total peripheral lymphocyte count, and total cholesterol level. This study investigated the prognostic role of malnutrition, as assessed by the CONUT scoring system. We hypothesized that malnutrition negatively affects outcomes as expressed by Functional Independence Measure (FIM) motor or Berg Balance Scale (BBS) change in stroke patients. This was a retrospective cohort study involving 117 individuals including first-time subacute stroke inpatients from March 2017 to February 2020. All participants were evaluated with BBS and FIM. We used multiple linear regression analysis with backward stepwise selection to examine the association between CONUT and changes during rehabilitation. After adjusting for independent predictors, we found the CONUT score to be associated with FIM motor (B = -1.848 ± 5.811, P < 0.001) and BBS change (B = -2.035 ± 0.424, P < 0.001). The present study showed that the malnutritional status calculated by the CONUT score at admission might help to predict the functional outcomes of stroke patients. The CONUT score is a comprehensive and feasible marker that could provide information for the nutritional management of stroke patients to significantly improve their clinical outcomes.
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Affiliation(s)
- Eun Chae Lee
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, Bundang-gu, Seoungnam-si, Gyeonggi-do, Republic of Korea
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Yılmaz F, Keleş M, Bora F. Relationship between the prognostic nutritional index and resistant hypertension in patients with essential hypertension. Clin Exp Hypertens 2022; 44:326-333. [PMID: 35180826 DOI: 10.1080/10641963.2022.2036995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Immune system activation plays a role in resistant hypertension (RHTN) pathogenesis. The clinical effect of the prognostic nutritional index (PNI) on patients with RHTN remains unclear. The aim of this study investigated the possible correlation between PNI and RHTN. METHODS In this cross-sectional study, we enrolled 180 adult subjects. In patients were classified into three groups according to their office and ambulatory blood pressure measurements (ABPM): RHTN (n = 60), controlled hypertension (CHTN, n = 60), and normotension-control (NT-C, n = 60). RHTN was defined as BP ≥140/90 mm Hg while taking ≥3 antihypertensive medications or BP <140/90 mm Hg while taking ≥4 medications. The PNI was calculated from the 10 x serum albumin (g/dL) + 0.005 x total lymphocyte count (/μL) formula. RESULTS Office and ABPM were significantly higher in patients with RHTN. Patients in the RHTN (46.1 ± 5.3) had significantly lower PNI than that in the CHTN (54.9 ± 6.7) (P = .032), and PNIs of both hypertensive groups were significantly lower than the NT-C group (P = .019, for both). The ROC curve analysis performed to assess the predictive value of PNI for RHTN and using 50.9 optimal cutoff value of PNI for RHTN gave a sensitivity of 77% and a specificity of 68.5% (AUC = 0.73, 95% CI 0.69-0.96).Multivariate analysis indicated diabetes, 24-h ABPM SBP, CRP, pill burden, and PNI (<51.6) as independent predictors of RHTN. CONCLUSION This study showed that the level of PNI was significantly lower in patients with RHTN compared to patients with CHTN. PNI is independently related to RHTN.
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Affiliation(s)
- Fatih Yılmaz
- Department of Nephrology, Antalya Atatürk State Hospital, Antalya, Turkey
| | - Meryem Keleş
- Department of Nephrology, Ankara City Hospital, Ankara, Turkey
| | - Feyza Bora
- Department of Internal Medicine, Division of Nephrology, Akdeniz University Medicine of Faculty, Antalya, Turkey
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Huppertz V, Guida S, Holdoway A, Strilciuc S, Baijens L, Schols JMGA, van Helvoort A, Lansink M, Muresanu DF. Impaired Nutritional Condition After Stroke From the Hyperacute to the Chronic Phase: A Systematic Review and Meta-Analysis. Front Neurol 2022; 12:780080. [PMID: 35178021 PMCID: PMC8846185 DOI: 10.3389/fneur.2021.780080] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/09/2021] [Indexed: 12/25/2022] Open
Abstract
Background Malnutrition is common after stroke and can affect rehabilitation and healthcare costs. A comprehensive overview of stroke patients' nutritional condition from the hyperacute to the chronic phase is lacking. This systematic review aimed to investigate the prevalence of impaired nutritional condition (INC) across the continuum of care in specific phases after stroke. Methods CAB ABSTRACTS, Embase, MEDLINE, were used to collect studies published between 01-01-1999 and 26-08-2020. Primary and secondary outcomes were prevalence of INC and prevalence of malnutrition, respectively. Exploratory outcomes were prevalence of INC at follow-up, nutritional examination methods, prevalence of dysphagia, stroke severity, adverse events, and continent-specific prevalence of INC. A random-effects meta-analysis model was used to estimate the phase-specific pooled prevalence of INC and malnutrition. Results The dataset consisted of 78 study groups selected over a total of 1,244 identified records. The pooled prevalence of INC and malnutrition were 19% (95%CI:7–31) (N = 4) and 19% (95%CI:9–29) (N = 3), 34% (95%CI:25–43) (N = 34) and 26% (95%CI:18–35) (N = 29), 52% (95%CI:43–61) (N = 34) and 37% (95%CI:28–45) (N = 31), 21% (95%CI:12–31) (N = 3) and 11% (95%CI:0–24) (N = 3) and 72% (95%CI:41–100) (N = 3) and 30% (95%CI:0–76) (N = 2) in the hyperacute, acute, early subacute, late subacute, and chronic phase, respectively. Conclusion INC and malnutrition are highly prevalent in all stages of stroke care. Since malnutrition has been shown to negatively affect clinical outcomes, mortality, and overall healthcare expenditure in stroke survivors, it is essential to examine and monitor the nutritional status of stroke patients throughout their care journey to guide and plan, timely nutritional support and dietary modification.
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Affiliation(s)
- Viviënne Huppertz
- Department of Respiratory Medicine, Maastricht University, Maastricht, Netherlands
- *Correspondence: Viviënne Huppertz
| | - Sonia Guida
- Danone Nutricia Research, Utrecht, Netherlands
| | - Anne Holdoway
- DHealth, Consultant Dietitian, BMI/Circle Bath Clinic, Education Officer for the British Association for Parenteral and Enteral Nutrition and Chair of the UK Managing Adult Malnutrition in the Community Panel, Bath, United Kingdom
| | - Stefan Strilciuc
- Department of Neurosciences, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- “RoNeuro” Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Laura Baijens
- Department of Otorhinolaryngology, Head and Neck Surgery, and School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Jos M. G. A. Schols
- Department of Health Services Research, Maastricht University, Maastricht, Netherlands
| | - Ardy van Helvoort
- Department of Respiratory Medicine, Maastricht University, Maastricht, Netherlands
- Danone Nutricia Research, Utrecht, Netherlands
| | | | - Dafin F. Muresanu
- Department of Neurosciences, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- “RoNeuro” Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
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Kurita M, Fujita T, Kasahara R, Ohira Y, Otsuki K, Yamamoto Y. Cutoff Value for a Nutritional Indicator Related to Gait Independence in Elderly Fracture Patients: A Preliminary Study. Phys Ther Res 2021; 25:26-30. [PMID: 35582120 PMCID: PMC9095424 DOI: 10.1298/ptr.e10125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 10/01/2021] [Indexed: 06/11/2024]
Abstract
OBJECTIVE Previous studies have reported the relationship between nutritional status and gait independence in elderly fracture patients. However, the degree to which nutritional indicators are related to gait independence is unclear. The purpose of this study is to calculate a cutoff value for a nutritional indicator related to gait independence in patients with hip and vertebral compression fractures. METHOD This study included 69 patients (33 hip fracture, 36 vertebral compression fracture) who underwent rehabilitation at a convalescent rehabilitation ward. The relationships between nutritional indexes (Mini-Nutritional Assessment-Short Form [MNAⓇ-SF] and skeletal muscle mass index [SMI] ) at admission and gait independence at discharge were analyzed using logistic regression. In addition, receiver operating characteristic analysis was performed to calculate a cutoff value that predicts gait independence. RESULTS Among the nutritional indicators used in this study, only MNAⓇ-SF was significantly able to predict gait independence at discharge, and this association was maintained, even after adjustment for confounders. The calculated MNAⓇ-SF cutoff values were 5.5 (sensitivity 100%, specificity 46.3%) and 7.5 points (sensitivity 67.9%, specificity 78.0%). CONCLUSION This study suggests that MNAⓇ-SF may be an index for predicting gait independence in patients with hip or vertebral compression fractures in the convalescent rehabilitation ward. The cutoff values calculated in this study were simple and useful index for physical therapists to interpret the results of MNAⓇ-SF.
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Affiliation(s)
- Megumi Kurita
- Department of Rehabilitation, Kita-Fukushima Medical Center, Japan
| | - Takaaki Fujita
- Department of Occupational Therapy, School of Health Sciences, Fukushima Medical University, Japan
| | - Ryuichi Kasahara
- Department of Rehabilitation, Kita-Fukushima Medical Center, Japan
| | - Yoko Ohira
- Department of Rehabilitation, Kita-Fukushima Medical Center, Japan
| | - Koji Otsuki
- Department of Rehabilitation, Kita-Fukushima Medical Center, Japan
| | - Yuichi Yamamoto
- Department of Rehabilitation, Kita-Fukushima Medical Center, Japan
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Zhou J, Ma L, Zhao L, Sheng J, Xu Y, Chen J, Yu L, Sun Q, Zhou H, Zhu S, Lu Z, Wei B. Association Between the Prognostic Nutritional Index and Cognitive Function Among Older Adults in the United States: A Population-Based Study. J Alzheimers Dis 2021; 83:819-831. [PMID: 34366335 DOI: 10.3233/jad-210141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Nutritional status has been recognized as an important factor influencing cognitive function-related diseases, but few comprehensive nutrition indicators are available to assess the risk of cognitive decline. OBJECTIVE This study aimed to investigate the relationship between the prognostic nutritional index (PNI) and cognitive function in an elderly population, and the differences in nutrient intake between different levels of nutritional risk. METHODS Based on cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) 2011-2014, we included 2,564 older participants. The lower quartile of each of the four cognitive tests was considered to have cognitive function impairment (CFI). Binary and multivariate logistic regression models were used to estimate the relationship between the PNI and the odds ratio of CFI. RESULTS After adjustment for confounding variables, we found that the odds of CFI were significantly lower for participants with normal PNI levels than for those with low PNI levels. In a comparison of global cognitive impairment scores, participants with a normal PNI had lower ratios of poor cognitive performance than those with a low PNI. By comparing the nutrient intake at different PNI levels, we found a reduction in the intake of protein, dietary fiber, total saturated fatty acids, and multiple micronutrients in the low PNI group. CONCLUSION Our study shows that the PNI can be a good predictor of the odds of CFI in the elderly population and that it is a convenient indicator of reduced intake of nutrients which may be important to brain health.
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Affiliation(s)
- Jie Zhou
- Department of Radiology, Shaoxing 7th People's Hospital, Shaoxing, Zhejiang Province, China
| | - Luping Ma
- Department of Radiology, Affiliated Hospital of Shaoxing University, Shaoxing, Zhejiang Province, China
| | - Lulei Zhao
- Department of Radiology, Ningbo Yinzhou No.2 Hospital, Ningbo, Zhejiang Province, China
| | - Jiamin Sheng
- Department of Radiology, Affiliated Hospital of Shaoxing University, Shaoxing, Zhejiang Province, China
| | - Yuhua Xu
- Department of Radiology, Shaoxing 7th People's Hospital, Shaoxing, Zhejiang Province, China
| | - Jie Chen
- Department of Laboratory Medicine, Shaoxing 7th People's Hospital, Shaoxing, Zhejiang Province, China
| | - Liangjun Yu
- Department of Radiology, Shaoxing 7th People's Hospital, Shaoxing, Zhejiang Province, China
| | - Quan Sun
- Department of Radiology, Shaoxing 7th People's Hospital, Shaoxing, Zhejiang Province, China
| | - Hangyang Zhou
- Department of Radiology, Zhuji Affiliated Hospital of Wenzhou Medical University, Shaoxing, Zhejiang Province, China
| | - Shaofeng Zhu
- Department of Radiology, Shaoxing 7th People's Hospital, Shaoxing, Zhejiang Province, China
| | - Zefeng Lu
- Department of Radiology, Shaoxing Second Hospital, Shaoxing, Zhejiang Province, China
| | - Bo Wei
- Department of Neurology, Shaoxing People's Hospital, Shaoxing, Zhejiang Province, China
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Ko N, Lee HH, Sohn MK, Kim DY, Shin YI, Oh GJ, Lee YS, Joo MC, Lee SY, Song MK, Han J, Ahn J, Lee YH, Chang WH, Choi SM, Lee SK, Lee J, Kim YH. Status of dysphagia after ischemic stroke: A Korean nationwide study. Arch Phys Med Rehabil 2021; 102:2343-2352.e3. [PMID: 34348122 DOI: 10.1016/j.apmr.2021.07.788] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/24/2021] [Accepted: 07/01/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify the incidence of dysphagia after ischemic stroke and determine factors affecting the presence of dysphagia. DESIGN Retrospective case-control study. This was an interim analysis of a prospective multicenter Korean stroke cohort. SETTING Acute care university hospitals. PARTICIPANTS Patients (N=6000) with first-ever acute ischemic stroke. Patients were divided into two groups according to the presence or absence of dysphagia confirmed at 7 days after onset using the American Speech-Language-Hearing Association National Outcomes Measurement System (ASHA-NOMS) scale, which was determined after conducting screening or standardized tests. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Age at stroke onset, body mass index (BMI), premorbid modified Rankin Scale (mRS), brainstem lesions, National Institutes of Health Stroke Scale (NIHSS), post-stroke mRS, and ASHA-NOMS swallowing level at post-stroke day 7 were evaluated. RESULTS Among ischemic stroke patients, 32.3% (N=1940) had dysphagia at 7 days after stroke onset. At discharge, 80.5% (N=1561) still had dysphagia. The prediction model for the presence of dysphagia identified age at onset, underweight (BMI < 18.5 kg/m2), premorbid mRS, brainstem lesions, and NIHSS as independent predictors. The odds ratio (OR) for the presence of dysphagia significantly increased with underweight (OR [95% confidence interval]: 1.6684 [1.27-2.20]), increased age at onset (1.0318 [1.03-1.04]), premorbid mRS (1.1832 [1.13-1.24]), brainstem lesions (1.6494 [1.39-1.96]), and NIHSS (1.2073 [1.19-1.23]). CONCLUSIONS The incidence of dysphagia after ischemic stroke was 32.3%. The prediction model for the presence of dysphagia identified age, low BMI, premorbid disabilities, brainstem lesions, and NIHSS as predictive factors.
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Affiliation(s)
- Nayeon Ko
- Department of Rehabilitation Medicine, Konkuk University School of Medicine
| | - Hyun Haeng Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, School of Medicine, Chungnam National University
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital
| | - Gyung-Jae Oh
- Department of Preventive Medicine, Wonkwang University, School of Medicine
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine
| | - Min-Keun Song
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School
| | - Junhee Han
- Department of Statistics, Hallym University
| | - Jeonghoon Ahn
- Department of Health Convergence, Ewha Womans University
| | - Young-Hoon Lee
- Department of Preventive Medicine, Wonkwang University, School of Medicine
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Soo Mi Choi
- Korea Centers for Disease Control and Prevention, Division of Chronic Disease Prevention, Center for Disease
| | - Seon Kui Lee
- Korea Centers for Disease Control and Prevention, Division of Chronic Disease Prevention, Center for Disease
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine.
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine; Department of Health Science and Technology, Department of Medical Device Management and Research, Department of Digital Healthcare, SAIHST, Sungkyunkwan University.
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Yuan K, Zhu S, Wang H, Chen J, Zhang X, Xu P, Xie Y, Zhu X, Zhu W, Sun W, Xu G, Liu X. Association between malnutrition and long-term mortality in older adults with ischemic stroke. Clin Nutr 2021; 40:2535-2542. [PMID: 33932800 DOI: 10.1016/j.clnu.2021.04.018] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 03/15/2021] [Accepted: 04/10/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND & AIMS Malnutrition is associated with poor prognosis of different diseases. This study aimed to investigate the association of malnutrition with long-term mortality of older adults with ischemic stroke in China. METHODS We selected patients aged ≥65 years with first-ever ischemic stroke from the Nanjing Stroke Registry Program. Malnutrition was defined according to the controlling nutritional status score (CONUT), the geriatric nutritional risk index (GNRI), and the prognostic nutritional index score (PNI), respectively. Multivariable Cox proportional hazards regressions and competing risk regressions were performed to explore the relationship between malnutrition and the risk of mortality in older adults with ischemic stroke. RESULTS Among 1065 enrolled patients, 60.5%, 46.7%, and 30.6% of patients were malnourished according to CONUT, GNRI, and PNI score. During a median follow-up of 4.74 (3.73-5.82) years, 205 (19.2%) patients died. In multivariate analysis, malnutrition (severe risk versus normal nutrition) was associated with significantly increased risk for mortality by the CONUT (adjusted hazard ratio [HR] 4.615, 95% confidence interval [CI] 1.373-15.514, P = 0.013), GNRI (adjusted HR 3.641, 95% CI 1.924-6.891, P < 0.001), and PNI score (adjusted HR 1.587, 95% CI, 1.096-2.297, P = 0.014). Furthermore, adding the malnutrition indexes to models modestly improved the predictive ability of mortality. CONCLUSIONS Our study indicated that malnutrition was highly prevalent in older Chinese adults with ischemic stroke and associated with increased mortality. Further research is required to evaluate the efficacy of nutritional management in these patients.
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Affiliation(s)
- Kang Yuan
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, 210002, China
| | - Shuanggen Zhu
- Department of Neurology, Affiliated Longhua People's Hospital, Southern Medical University (Longhua People's Hospital), Shenzhen, 51800, Guangzhou, China
| | - Huaiming Wang
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China; Department of Neurology, The 80th Group Army Hospital of the People's Liberation Army, Weifang, Shandong, 261021, China
| | - Jingjing Chen
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, 210002, China
| | - Xiaohao Zhang
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China
| | - Pengfei Xu
- Stroke Center & Department of Neurology, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Yi Xie
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China
| | - Xinyi Zhu
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China
| | - Wusheng Zhu
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, 210002, China; Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China; Department of Neurology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, 210002, China
| | - Wen Sun
- Stroke Center & Department of Neurology, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230001, Anhui, China.
| | - Gelin Xu
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, 210002, China; Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China; Department of Neurology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, 210002, China
| | - Xinfeng Liu
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, 210002, China; Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China; Stroke Center & Department of Neurology, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230001, Anhui, China; Department of Neurology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, 210002, China.
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Hu Y, Cao Q, Wang H, Yang Y, Xiong Y, Li X, Zhou Q. Prognostic nutritional index predicts acute kidney injury and mortality of patients in the coronary care unit. Exp Ther Med 2020; 21:123. [PMID: 33335586 PMCID: PMC7739862 DOI: 10.3892/etm.2020.9555] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/29/2020] [Indexed: 02/07/2023] Open
Abstract
The current study aimed to investigate whether prognostic nutritional index (PNI) is an independent predictor of acute kidney injury (AKI) and mortality of patients in the coronary care unit (CCU). In the present two-stage observational study of patients in the CCU, 6,444 patients from the Medical Information Mart for Intensive Care (MIMIC) III database were first enrolled (test cohort), after which 412 patients from Zhongnan Hospital of Wuhan University were recruited in the validation cohort. AKI was defined based on the Kidney Disease Improving Global Outcomes AKI criteria. The primary endpoint was the incidence of AKI stratified by severity, while the second endpoint included in-hospital mortality and 2-year mortality. In the test cohort, 4,457 (69.2%) patients developed AKI during hospitalization. Following multivariable adjustment, the highest quartile of the PNI value was associated with a 1.8-fold increased risk of AKI compared with the lowest quartile. For the prediction of AKI, the area under the receiver operating characteristic curve outperformed the acute physiology score III score and clinical model in patients with or without preexisting chronic kidney disease, and this was further validated in the hospital cohort used in the present study. A total of 2,219 patients suffered mortality during the 2-year follow-up, and PNI was indicated to independently predict the risk of in-hospital mortality and 2-year mortality in the test cohort and in the validation cohort. Decision curve analysis indicated that the PNI values were clinically useful; Therefore, the current study demonstrated that the PNI value is an independent predictor of AKI and mortality in patients within the CCU.
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Affiliation(s)
- Yugang Hu
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, Hubei 430061, P.R. China
| | - Quan Cao
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, Hubei 430061, P.R. China
| | - Hao Wang
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, Hubei 430061, P.R. China
| | - Yuanting Yang
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, Hubei 430061, P.R. China
| | - Ye Xiong
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, Hubei 430061, P.R. China
| | - Xiaoning Li
- Department of Nephrology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Qing Zhou
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, Hubei 430061, P.R. China
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Tanislav C, Kostev K. Factors associated with fracture after stroke and TIA: a long-term follow-up. Osteoporos Int 2020; 31:2395-2402. [PMID: 32647951 DOI: 10.1007/s00198-020-05535-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 07/01/2020] [Indexed: 01/20/2023]
Abstract
UNLABELLED We assessed the long-term incidence of fractures after stroke and TIA and analyzed associated factors. The fracture incidence increases with age and is higher in stroke than in TIA. Dementia is associated with fractures after both. Our results indicate tailored measures are necessary for preventing fractures after stroke or TIA. INTRODUCTION In the present study, we aimed to assess the long-term incidence of fractures and analyze associated factors after stroke or transient ischemic attack (TIA). METHODS The current cohort study included patients who had received an initial ischemic stroke or TIA diagnosis documented anonymously in the Disease Analyzer database (IQVIA) between 2000 and 2016 by physicians in 1262 general practices in Germany. Univariate Cox and multivariate regression models were carried out. RESULTS Three groups (stroke, TIA, no stroke/TIA), each with 12,265 individuals, were selected (mean age 67.3 years, 48.1% female). A fracture was diagnosed in 12.9% of stroke patients and in 11.4% of TIA patients. Among male stroke patients, 11.1% had a fracture (15.4% among female stroke patients). The hazard ratio (HR) for fractures after stroke was 1.26 (CI: 1.15-1.39) and for fractures after TIA, it was 1.14 (CI: 1.03-1.25). In female stroke patients, the HR for fractures was 1.32 (CI: 1.15-1.60), while in males, it was 1.20 (CI: 1.03-1.39). Among TIA patients, females had an elevated HR for fractures (HR: 1.21; CI: 1.06-1.37). In individuals aged ≥ 80 years, an increased risk for fractures was only detected among TIA patients (HR: 1.26; CI: 1.05-1.51). Dementia and non-opioid analgesic therapy were positively associated with fracture after both stroke and TIA. CONCLUSION Stroke was positively associated with fracture in patients < 80 years, while TIA was positively associated with fracture in patients ≥ 80 years and females. Dementia and analgesic therapy were also associated with fracture after either stroke or TIA.
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Affiliation(s)
- C Tanislav
- Department of Geriatrics and Neurology, Diakonie Hospital Jung Stilling Siegen, Wichernstrasse 40, 57074, Siegen, Germany.
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- Epidemiology, IQVIA, Frankfurt am Main, Germany
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Nawata K. Risk Factors Affecting Ischemic Stroke: A Potential Side Effect of Antihypertensive Drugs. Health (London) 2020. [DOI: 10.4236/health.2020.125035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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