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Jong SC, Fuentes JA, Seow AEQ, Lim CJ, Chandran G, Chua KSG. Effect of body mass index on inpatient rehabilitation outcome after stroke in a Southeast Asian cohort: a prospective study. Singapore Med J 2024; 65:223-228. [PMID: 34717300 PMCID: PMC11132619 DOI: 10.11622/smedj.2021190] [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: 02/27/2021] [Accepted: 10/18/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION We examined the association between admission body mass index (BMI) and discharge rehabilitation functional outcome using the functional independence measure (FIM) in a Southeast Asian cohort of stroke patients during inpatient rehabilitation. METHODS A prospective, observational cohort study of stroke patients admitted to a single inpatient rehabilitation unit was conducted. Using the World Health Organization Asian standards, BMI was classified as underweight (<18.5 kg/m 2 ), normal (18.5-22.9 kg/m 2 ) and overweight (≥23 kg/m 2 ). The primary outcome measure was discharge FIM, and secondary outcomes included FIM gain, FIM efficiency and FIM effectiveness. RESULTS Two hundred and forty-seven stroke subjects were enrolled. The mean age of the cohort was 59.48 (standard deviation [SD] 12.35) years; 64.4% ( n = 159) were male and 52.6% ( n = 130) had ischaemic stroke. The distributions of underweight, normal and overweight based on BMI on admission were 10.9% ( n = 27), 33.2% ( n = 82) and 55.9% ( n = 138), respectively, and the distributions upon discharge were 11.7% ( n = 29), 38.1% ( n = 94) and 50.2% (n = 124), respectively. Significant small decreases in BMI from admission to discharge were found (median [interquartile range] 23.58 [23.40-24.70] vs. 23.12 [22.99-24.21]; P < 0.001). Similarly, clinically significant FIM gains (mean ΔFIM 26.71; 95% confidence interval 24.73, 28.69, P < 0.001) were noted after a median length of stay of 36 days. No significant relationships were found between BMI and discharge FIM ( P = 0.600), FIM gain ( P = 0.254), FIM efficiency ( P = 0.412) or FIM effectiveness ( P = 0.796). CONCLUSION Findings from this study unequivocally support the benefits of acute inpatient stroke rehabilitation. Patients in the obese BMI range tended to normalise during rehabilitation. Body mass index, whether underweight, normal or overweight, did not correlate with discharge FIM.
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Affiliation(s)
- Sze Chin Jong
- Division of Rehabilitation Medicine, University Medicine Cluster, National University Hospital, Singapore
| | | | | | - Chien Joo Lim
- Clinical Research and Innovation Office, Tan Tock Seng Hospital, Singapore
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Li X, Xu Q, Wang A, Zheng P, Zhu H, Guo A, Meng X, Jiang Y. Association of body mass index and waist-to-height ratio with outcomes in ischemic stroke: results from the Third China National Stroke Registry. BMC Neurol 2023; 23:152. [PMID: 37060000 PMCID: PMC10103413 DOI: 10.1186/s12883-023-03165-y] [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: 12/26/2022] [Accepted: 03/14/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND AND PURPOSE Conflicting reports of obesity paradox have led to confusion about weight management strategies for post-stroke patients. The main purpose of this study is to determine whether the obesity paradox measured by body mass index (BMI) or by waist-to-height ratio (WHtR) is real. METHODS We evaluated the association of general obesity measured by BMI, and abdominal obesity measured by WHtR with 1-year all-cause mortality, recurrence of stroke and combined vascular events of acute ischemic stroke (AIS) patients in a cohort -- the Third China National Stroke Registry (CNSR-III). Cox proportional hazards models and restricted cubic splines were performed to investigate the association between obesity and clinical outcomes. RESULTS A total of 14,146 patients with ischemic stroke were included. When BMI was used as a measure of obesity, compared to the normal weight patients, mortality decreased in overweight patients (hazard ratio [HR] 0.74 [95% confidence interval (CI) 0.61-0.91], P = 0.0035) and obese patients (HR 0.54 [0.40-0.73], P < 0.0001); and increased in underweight patients (HR 2.55 [1.75-3.73], P < 0.0001). After adjustment for confounding factors, the protective effect of obesity and overweight disappeared. BMI had no association with recurrence of stroke or combined vascular events. When WHtR was used as a measure of obesity, obese patients had lower 1-year all-cause mortality (HR 0.64 [0.43-0.97], P = 0.0357). After adjustment for confounding factors, this difference disappeared; overweight patients still had lower all-cause mortality (adjusted hazard ratio [aHR] 0.42 [0.26-0.67], P = 0.0003), recurrence of stroke (aHR 0.77 [0.60-0.99], P = 0.0440) and combined vascular events (aHR 0.75 [0.58-0.95], P = 0.0198). CONCLUSIONS Among Chinese patients with AIS, our study does not support the BMI paradox; overweight patients measured by WHtR had a more favorable prognosis. TOAST subtypes did not modify the association.
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Affiliation(s)
- Xiaolin Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 S Fourth Ring West Rd, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Qin Xu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 S Fourth Ring West Rd, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 S Fourth Ring West Rd, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Pei Zheng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 S Fourth Ring West Rd, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Huimin Zhu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 S Fourth Ring West Rd, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Ai Guo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 S Fourth Ring West Rd, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 S Fourth Ring West Rd, Beijing, 100070, China.
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
- Research Unit of Artificial Intelligence in Cerebrovascular Disease (2019RU018), Chinese Academy of Medical Sciences, Beijing, China.
- Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China.
| | - Yong Jiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 S Fourth Ring West Rd, Beijing, 100070, China.
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
- Research Unit of Artificial Intelligence in Cerebrovascular Disease (2019RU018), Chinese Academy of Medical Sciences, Beijing, China.
- Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China.
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Valera RJ, Botero-Fonnegra C, Cogollo VJ, Sarmiento-Cobos M, Montorfano L, Rivera C, Hong L, Lo Menzo E, Szomstein S, Rosenthal RJ. Does bariatric surgery change the risk of acute ischemic stroke in patients with a history of transient ischemic attack? A nationwide analysis. Surg Obes Relat Dis 2022; 19:548-554. [PMID: 36581552 DOI: 10.1016/j.soard.2022.11.013] [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: 08/29/2022] [Revised: 11/12/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Stroke is the second leading cause of death worldwide and fifth in the United States, and it represents the major cause of disability in older adults. OBJECTIVE We aimed to determine the risk of acute ischemic stroke (AIS) in individuals with obesity with a history of transient ischemic attack (TIA) compared with patients with a history of bariatric surgery. SETTING Academic hospital, United States. METHODS Using the Nationwide Inpatient Sample (NIS) database from 2010 to 2015, we retrospectively identified patients with obesity and past medical history of TIA and divided them into 2 groups: a treatment group of patients who underwent bariatric surgery, and a control group of patients with obesity. We compared incidence of new AIS in both groups using a univariate analysis and multivariate regression model. Covariates included were lifestyle (smoking status, alcohol habits, cocaine use), family history of stroke, co-morbidities (diabetes, hypertension, hyperlipidemia, atrial fibrillation) and long-term medical treatment (antiplatelet/antithrombotic treatment). RESULTS A total of 91,640 patients met inclusion criteria, of which treatment patients were 12.3% (n = 11,284) and control patients 87.6% (n = 80,356). The average age of the treatment group was 62.9 ± 17.08 years, and the average of the control was 59.6 ± 12.74 years. The rate of AIS in the treatment group was significantly lower compared with the control group (2.8% versus 4.2%, P < .0001). After adjusting for covariables, the risk difference of AIS was still significant between groups (odds ratio = 1.33, P < .0001), showing that patients in the treatment group were less likely to have AIS compared with the control group. CONCLUSIONS After analyzing nationwide information, we conclude bariatric surgery helps decrease risk of AIS in patients with a history of TIA. However, this comparison is limited by the nature of the database; further studies are needed to better understand these results.
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Affiliation(s)
- Roberto J Valera
- Department of Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Cristina Botero-Fonnegra
- Department of Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Vicente J Cogollo
- Department of Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Mauricio Sarmiento-Cobos
- Department of Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Lisandro Montorfano
- Department of Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Carlos Rivera
- Department of Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Liang Hong
- Biostatistics Section, Department of Clinical Research, Cleveland Clinic Florida, Weston, Florida
| | - Emanuele Lo Menzo
- Department of Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Samuel Szomstein
- Department of Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Raul J Rosenthal
- Department of Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida.
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Mehta A, De Paola L, Pana TA, Carter B, Soiza RL, Kafri MW, Potter JF, Mamas MA, Myint PK. The relationship between nutritional status at the time of stroke on adverse outcomes: a systematic review and meta-analysis of prospective cohort studies. Nutr Rev 2022; 80:2275-2287. [PMID: 35640017 PMCID: PMC9647329 DOI: 10.1093/nutrit/nuac034] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023] Open
Abstract
CONTEXT AND OBJECTIVE The impact of existing malnutrition on stroke outcomes is poorly recognised and treated. Evidence was systematically reviewed and quantified by meta-analysis. METHODS MEDLINE, EMBASE and Web of Science were searched from inception to 11 January 2021 and updated in July. Prospective cohort studies, in English, evaluating anthropometric and biomarkers of nutrition on stroke outcomes were included. Risk of bias was assessed using the Scottish Intercollegiate Guidelines Network checklist. RESULTS Twenty-six studies (n = 156 249) were eligible (follow-up: One month-14 years). Underweight patients had increased risk of long-term mortality (adjusted hazard ratio = 1.65,1.41-1.95), whilst overweight (0.80,0.74-0.86) and obese patients (0.80,0.75-0.85) had decreased risk compared to normal weight. Odds of mortality decreased in those with high serum albumin (odds ratio = 0.29,0.18-0.48) and increased with low serum albumin (odds ratio = 3.46,1.78-6.74) compared to normal serum albumin (30-35 g/L). Being malnourished compared to well-nourished, as assessed by the Subjective Global Assessment (SGA) or by a combination of anthropometric and biochemical markers increased all-cause mortality (odds ratio = 2.38,1.85-3.06) and poor functional status (adjusted odds ratio = 2.21,1.40-3.49). CONCLUSION Nutritional status at the time of stroke predicts adverse stroke outcomes.
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Affiliation(s)
- Arnav Mehta
- Aberdeen Cardiovascular & Diabetes Centre, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, Scotland, United Kingdom
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, United Kingdom
| | - Lorenzo De Paola
- Aberdeen Cardiovascular & Diabetes Centre, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, Scotland, United Kingdom
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, United Kingdom
| | - Tiberiu A Pana
- Aberdeen Cardiovascular & Diabetes Centre, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, Scotland, United Kingdom
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, United Kingdom
| | - Ben Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Roy L Soiza
- Aberdeen Cardiovascular & Diabetes Centre, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, Scotland, United Kingdom
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, United Kingdom
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, Scotland, United Kingdom
| | - Mohannad W Kafri
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, United Kingdom
- Department of Nutrition & Dietetics, Birzeit University, Birzeit, West Bank, Palestine
| | - John F Potter
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom
| | - Phyo K Myint
- P. K. Myint, School of Medicine, Medical Sciences and Nutrition Foresterhill, Room 4:013, Polwarth Building, Aberdeen AB25 2ZD, Scotland, UK. E-mail:
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Kamo A, Nozoe M, Kubo H, Shimada S. Care-needs certification in the national long-term care insurance is useful for assessment of premorbid function in older Japanese patients with stroke. J Stroke Cerebrovasc Dis 2022; 31:106493. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/03/2022] [Indexed: 11/30/2022] Open
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Weidman M, MacDonald SL. The Impact of Body Mass Index Classification on Outcomes After Stroke Rehabilitation: A Retrospective Study. Am J Phys Med Rehabil 2022; 101:714-717. [PMID: 35067556 DOI: 10.1097/phm.0000000000001966] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
ABSTRACT With improving stroke mortality rates, more individuals are living with the consequences of stroke. Obesity is a known risk factor for stroke, but its effect on functional outcomes poststroke is less clear. The aim of this study was to determine the association between body mass index classification (underweight, normal weight, overweight, and obese) and functional outcomes, as measured by Functional Independence Measure change, Functional Independence Measure efficiency, and rehabilitation length of stay after inpatient stroke rehabilitation. A retrospective cohort study of individuals with a diagnosis of stroke admitted to a high-intensity inpatient rehabilitation program was performed. Patients were divided into 4 groups based on body mass index category using normal body mass index as the reference. Overall, 34 individuals (4.5%) were classified as underweight, 303 (40.1%) had body mass indices within the normal range, 269 (35.6%) were overweight, and 149 (19.7%) were obese. Ischemic stroke was the most common stroke type across all body mass index categories. Patients in the overweight and obese groups tended to be younger. There were no statistically significant differences in rehabilitation length of stay, Functional Independence Measure change, or Functional Independence Measure efficiency with all groups demonstrating significant functional improvements. Based on these findings, patients admitted for inpatient rehabilitation after stroke can be expected to make similar functional improvements regardless of BMI class.
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Affiliation(s)
- Melissa Weidman
- From the Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Canada (MW, SLM); and Bridgepoint Active Healthcare, Sinai Health, Toronto, Canada (SLM)
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Chang WH, Lee J, Chung JW, Kim YH, Bang OY. Probable Factors Associated with Response to Mesenchymal Stem Cell Therapy in Stroke Patients: A Post Hoc Analysis of the STARTING-2 Trial. J Pers Med 2021; 11:jpm11111137. [PMID: 34834489 PMCID: PMC8621313 DOI: 10.3390/jpm11111137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/25/2021] [Accepted: 10/29/2021] [Indexed: 01/01/2023] Open
Abstract
The aim of this study was to identify factors associated with improved motor function of the lower extremities in response to mesenchymal stem cell (MSC) therapy in patients with ischemic stroke. This study was a post hoc analysis of data from a prospective, open-label, randomized controlled trial of MSC therapy for patients with ischemic stroke patients associated with severe middle cerebral artery territory (STARTING-2 trial). Lower limb motor function was scored based on the lower limb of Fugl-Meyer assessment (FMA-LL) score before MSC therapy and at 3 months after stroke. All FMA-LL changes greater than or equal to six points were considered clinically significant. Univariate and multivariate binary logistic regression models were used to determine possible predictors of clinically significant lower limb motor response to MSC therapy. Twelve (33%) of the thirty-six patients receiving MSC therapy reached a minimal clinically important difference (MCID) of FMA-LL. The two independent factors with the greatest impact on response to MSC therapy for achieving an MCID in FMA-LL score were: (1) the time from stroke onset to MSC therapy, and (2) age (p < 0.05). In addition, obese stroke patients responded better to MSC therapy than stroke patients with normal weight. In conclusion, this post hoc analysis might suggest the need for recruiting stroke patients at younger and early after stroke onset in future clinical trials of MSC therapy for stroke.
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Affiliation(s)
- 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, Seoul 06351, Korea; (W.H.C.); (J.L.)
| | - Jungsoo Lee
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (W.H.C.); (J.L.)
| | - Jong-Won Chung
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
- Translational and Stem Cell Research Laboratory on Stroke, Samsung Medical Center, Seoul 06351, Korea
| | - 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, Seoul 06351, Korea; (W.H.C.); (J.L.)
- Department of Health Sciences and Technology, Department of Medical Device Management & Research, Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul 06351, Korea
- Correspondence: (Y.-H.K.); (O.Y.B.); Tel.: +82-2-3410-2824 (Y.-H.K.); +82-2-3410-3599 (O.Y.B.)
| | - Oh Young Bang
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
- Translational and Stem Cell Research Laboratory on Stroke, Samsung Medical Center, Seoul 06351, Korea
- Correspondence: (Y.-H.K.); (O.Y.B.); Tel.: +82-2-3410-2824 (Y.-H.K.); +82-2-3410-3599 (O.Y.B.)
| | - The STARTING-2 Collaborators
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
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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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Freeman C, Blough A, Rotich D, Curl A, Eickmeyer SM. The obesity paradox may not lead to functional gains in stroke patients undergoing acute inpatient rehabilitation. PM R 2021; 14:931-938. [PMID: 34240565 DOI: 10.1002/pmrj.12671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 06/23/2021] [Accepted: 07/02/2021] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Obesity is a risk factor for many adverse health outcomes. However for some cardiac conditions and cancers, evidence of an "obesity paradox" seems to exist where an elevated body mass index (BMI) is linked to protective effects in mortality and functional outcomes. Within the stroke rehabilitation literature, there are conflicting findings on this phenomenon possibly due to unaccounted for variables, such as comorbid medical conditions. OBJECTIVE To investigate the association between BMI and functional gains made in acute inpatient stroke rehabilitation, and the effects of multiple confounding variables. DESIGN Retrospective cohort study. SETTING Tertiary academic hospital. PATIENTS Three hundred ninety-two adults following a recent ischemic (82%) or hemorrhagic (18%) stroke with a mean age 62.9 years. INTERVENTIONS Acute inpatient rehabilitation. MAIN OUTCOME MEASURES Functional Independence Measure (FIM) score and BMI. RESULTS A significant association was found between motor FIM score gains and elevated BMI when BMI was treated as a continuous variable (p < .05). However, this association disappeared when patient factors and comorbid conditions were taken into account and when BMI was conceptualized categorically (underweight [BMI <18.5], normal [BMI 18.5-24.9], overweight [BMI 25.0-29.9], obese [BMI 30.0-39.9], and severely obese [BMI ≥40.0]). Advanced age, higher motor function on admission, and a diagnosis of diabetes were all significantly associated with decreased motor FIM gains. CONCLUSIONS The results from this study provide insufficient evidence to support the "obesity paradox" once patient factors and comorbid conditions are taken into account. Diabetes was the single comorbidity tracked that showed a significant association with change in motor function (p = .01). Further studies might explore how the unique interventions of rehabilitation physicians and ancillary health professionals might mitigate the functional debility associated with diabetes and obesity in stroke patients.
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Affiliation(s)
- Casey Freeman
- Physical Medicine and Rehabilitation, University of Washington Medical Center, Seattle, Washington, USA
| | - Allison Blough
- Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | - Amanda Curl
- Medical student at the time of this study, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Sarah M Eickmeyer
- Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas City, Kansas, USA
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Yun SM, Lee SY, Sohn MK, Lee J, Kim DY, Lee SG, Shin YI, Lee YS, Joo MC, Lee SY, Han J, Ahn J, Oh GJ, Lee YH, Chang WH, Kim YH. Factors Associated with Changes in Functional Independence after Six Months of Ischemic Stroke. BRAIN & NEUROREHABILITATION 2020; 13:e19. [PMID: 36741795 PMCID: PMC9879371 DOI: 10.12786/bn.2020.13.e19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/09/2020] [Accepted: 06/20/2020] [Indexed: 11/08/2022] Open
Abstract
The aim of this study is to investigate the changes in functional independence and their associated factors during the first 6 months to 1 year after stroke onset. This study is the interim results of the Korean Stroke Cohort for Functioning and Rehabilitation. A total of 1,011 participants were included and classified into 3 subgroups according to changes in the Korean version of Modified Barthel Index (K-MBI) scores that occurred between 6 months to 1 year after stroke onset: the improved group (IG), with scores that increased 5 points or more; the stationary group (SG), with the K-MBI score changes ranging from -4 to +4 points; and the declined group (DG), with the K-MBI scores that decreased 5 points or more. Ordinal logistic regression analyses were used to assess the factors influencing changes in the K-MBI score. Among 1,011 patient, 436 patients (43.1%), 398 patients (39.4%) and 117 patients (17.5%) were classified into the IG, SG, and DG, respectively. Obesity and Geriatric Depression Scale score were significant influencing factors for changes in the K-MBI scores. Obesity showed a positive influence on the K-MBI score, while depression showed a negative influence.
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Affiliation(s)
- Sang Moon Yun
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Yeol Lee
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sam-Gyu Lee
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University, School of Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Junhee Han
- Department of Statistics, Hallym University, Chuncheon, Korea
| | - Jeonghoon Ahn
- Department of Health Convergence, Ewha Womans University, Seoul, Korea
| | - Gyung-Jae Oh
- Department of Preventive Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Young Hoon Lee
- Department of Preventive Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Kim KA, Lee JS, Chang WH, Kim DY, Shin YI, Kim SY, Kim YT, Kang SH, Choi JY, Kim YH. Changes in Language Function and Recovery-Related Prognostic Factors in First-Ever Left Hemispheric Ischemic Stroke. Ann Rehabil Med 2020; 43:625-634. [PMID: 31918525 PMCID: PMC6960086 DOI: 10.5535/arm.2019.43.6.625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 06/24/2019] [Indexed: 11/25/2022] Open
Abstract
Objective To investigate longitudinal changes in language function in left-hemispheric ischemic stroke patients as well as factors that influence language recovery until 1 year after stroke onset. Methods We analyzed data from 235 patients with first-ever left-hemispheric ischemic stroke. All patients completed the Korean version of the Frenchay Aphasia Screening Test (K-FAST) at 7 days (T1), 3 months (T2), 6 months (T3), and 1 year (T4) after stroke onset. Repeated measures analysis of variance (ANOVA) was used to investigate changes in language function between time points. Subgroup analysis was performed according to the K-FAST scores at T1. Stroke lesion volume was assessed using diffusion tensor images, and involvement of language-related brain regions was examined. Multiple regression analysis was used to analyze factors influencing improvement of K-FAST score. Results The K-FAST scores at T1, T2, T3, and T4 differed significantly (p<0.05). In the subgroup analysis, only the severe group showed continuous significant improvement by 1 year. Factors that negatively influenced improvement of language function were the age at onset, initial National Institutes of Health Stroke Scale (NIHSS) score, and initial K-FAST score, whereas education level and stroke lesion volume positively affected recovery. Involvement of language-related brain regions did not significantly influence long-term language recovery after ischemic stroke. Conclusion Recovery of language function varied according to the severity of the initial language deficit. The age at stroke onset, education level, initial severity of aphasia, initial NIHSS score, and total stroke lesion volume were found to be important factors for recovery of language function.
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Affiliation(s)
- Kyung Ah Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Soo Lee
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - 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, Seoul, Korea
| | - Deog Young Kim
- Department of Rehabilitation Medicine and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Soo-Yeon Kim
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Young Taek Kim
- Division of Chronic Disease Control, Center for Disease Prevention, Korea Centers for Disease Control and Prevention, Osong, Korea
| | - Sung Hyun Kang
- Division of Chronic Disease Control, Center for Disease Prevention, Korea Centers for Disease Control and Prevention, Osong, Korea
| | - Ji Yoo Choi
- Division of Chronic Disease Control, Center for Disease Prevention, Korea Centers for Disease Control and Prevention, Osong, Korea
| | - 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, Seoul, Korea.,Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Korea
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12
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Celap I, Nikolac Gabaj N, Demarin V, Basic Kes V, Simundic AM. Genetic and lifestyle predictors of ischemic stroke severity and outcome. Neurol Sci 2019; 40:2565-2572. [PMID: 31327072 DOI: 10.1007/s10072-019-04006-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 07/08/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Different models that include clinical variables and blood markers have been investigated to predict acute ischemic stroke treatment course and recovery. AIM The aim of the study was to investigate associations between lipid levels, lifestyle factors, hemostatic (F5, F2, SERPINE1, F13A1, and FGB), and atherogenic (APOA5 and ACE) gene variants and acute ischemic stroke (AIS) severity. MATERIALS AND METHODS This study included 250 patients with AIS in which F5, F2, SERPINE1, F13A1, FGB, APOA5, and ACE genotypes were determined. Total cholesterol (TC), high-density cholesterol, low-density cholesterol, and triglycerides concentrations were measured within 24 h of the AIS onset. Examination of the neurological deficit was done using National Institutes of Health Stroke Scale/Score (NIHSS). RESULTS APOA5 genotype [TC + CC] was more frequent (P = 0.026) in patients with the NIHSS score ≥ 21. Univariate regression analysis has shown that triglycerides (OR 0.55, 95% CI 0.34-0.91; P = 0.019), obesity (0.28, 95% CI 0.10-0.73; P = 0.010), age (OR 1.08, 95% CI 1.04-1.13; P < 0.001), and APOA5 genotype (TC + CC) (OR 2.40, 95% CI 1.10-5.25; P = 0.034) are significantly associated with a severe stroke. When all variables were included in model age (OR 1.06, 95% CI 1.01-1.11; P = 0.018), obesity (OR 0.25, 95% CI 0.08-0.77; P = 0.016) and APOA5 genotype (TC + CC) (OR 3.26, 95% CI 1.29-8.23; P = 0.012) remained significant for the risk of severe AIS. CONCLUSION APOA5 genotype (TC + CC), age, and obesity could be used as prognostic risk factors for a very severe stroke (NIHSS ≥ 21).
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Affiliation(s)
- Ivana Celap
- Department of Clinical Chemistry, Sestre milosrdnice University Hospital Center, Zagreb, Croatia.
| | - Nora Nikolac Gabaj
- Department of Clinical Chemistry, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Vida Demarin
- Department of Neurology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Vanja Basic Kes
- Department of Neurology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics, University Hospital Sveti Duh, Zagreb, Croatia
- Department of Medical Biochemistry and Hematology, Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
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Obesity Paradox in Ischemic Stroke: Clinical and Molecular Insights. Transl Stroke Res 2019; 10:639-649. [PMID: 30980283 DOI: 10.1007/s12975-019-00695-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/14/2019] [Accepted: 02/15/2019] [Indexed: 01/21/2023]
Abstract
It has recently emerged the concept of "obesity paradox," a term used to describe the unexpected improved prognosis and lower mortality rates found in several diseases in patients with higher body weight. Concerning stroke, few clinical studies have assessed this obesity paradox showing contradictory results. Therefore, our aim was to compare clinical evolution and inflammatory balance of obese and non-obese patients after ischemic stroke. We designed a prospective case-control study in patients with acute ischemic stroke categorized into obese (body mass index, BMI ≥ 30 kg/m2) and non-obese (BMI < 30 kg/m2). We compared clinical, anthropometric, radiological, and laboratory variables. The main outcome variable was the functional outcome at 3 months. We included 98 patients (48 non-obese and 50 obese). No differences in functional outcome at 3 months were found (p = 0.882) although a tendency of a greater recovery on neurological impairments was seen in obese subjects. Importantly, obese patients (p = 0.007) and patients who experienced poor outcome (p = 0.006) exhibited a higher reduction in body weight at 3 months after stroke. Moreover, pro-inflammatory IL-6 levels (p = 0.002) were higher in the obese group. However, IL-6 levels decreased over the first week in obese while increased in non-obese. On the contrary, levels of the anti-inflammatory IL-10 rose over the first week in obese patients, whereas remained stable in non-obese. In summary, despite exhibiting several factors associated with poor outcome, obese patients do not evolve worse than non-obese after ischemic stroke. Obesity may counterbalance the inflammatory reaction through an anti-inflammatory stream enhanced in the first moments of stroke.
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14
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The relationship between body mass index and disability-free survival in elderly Japanese: the Ohsaki Cohort 2006 Study. Int J Obes (Lond) 2019; 43:2254-2263. [PMID: 30940914 DOI: 10.1038/s41366-019-0359-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 02/26/2019] [Accepted: 02/28/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND The relationship between body mass index (BMI) and disability-free survival (DFS) remains unclear. METHODS We conducted a 10-year prospective cohort study of 12,666 Japanese individuals aged ≥ 65 y. Information on BMI and lifestyle factors was collected via a questionnaire in 2006. Functional disability data were retrieved from the public Long-term Care Insurance database. Subjects were divided into seven groups according to BMI (<19, 19-21, 21-23, 23-25, 25-27, 27-29 and ≥29). Fiftieth percentile differences (PDs) and 95% confidence intervals (CIs) in the DFS period (differences of period until the first 50% of the composite outcome (disability or death) occurred in each of the BMI groups) were calculated using the Laplace regression model. RESULTS There was a U-shaped relationship between BMI and the risk of incident composite outcome, with a BMI nadir of 25-27. Based on BMI 25-27 as a reference, the 50th PDs (95% CIs) (in months) in age at disability or death (median DFS) were -20.8 (-26.4, -15.2) (P < 0.001) months for BMI <19, -13.5 (-18.2, -8.7) (P < 0.001) months for BMI 19-21, -9.8 (-14.2, -5.4) (P < 0.001) months for BMI 21-23, -2.9 (-7.5, 1.7) (P = 0.21) months for BMI 23-25, -2.7 (-8.4, 2.9) (P = 0.34) months for BMI 27-29, and -11.5 (-19.6, -3.5) (P = 0.005) months for BMI ≥ 29. These relationships did not differ by sex. CONCLUSION Older individuals with a BMI of <23 or ≥29 have a significantly shorter DFS period than those with a BMI of 25-27. It is suggested that the optimal BMI range for maximization of disability-free life expectancy in the elderly population is 23-29.
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Bauza C, Yeatts SD, Borg K, Magwood G, Martin RH, Selassie A, Ford ME. Determining the joint effect of obesity and diabetes on functional disability at 3-months and on all-cause mortality at 1-year following an ischemic stroke. BMC Endocr Disord 2018; 18:40. [PMID: 29914457 PMCID: PMC6006988 DOI: 10.1186/s12902-018-0255-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/03/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Obesity and diabetes mellitus, or diabetes, are independently associated with post-ischemic stroke outcomes (e.g., functional disability and all-cause mortality). Although obesity and diabetes are also associated with post-ischemic stroke outcomes, the joint effect of obesity and diabetes on these post-ischemic stroke outcomes has not been explored previously. The purpose of the current study was to explore whether the effect of obesity on post-ischemic stroke outcomes differed by diabetes status in a cohort of acute ischemic stroke subjects with at least a moderate stroke severity. METHODS Data from the Interventional Management of Stroke (IMS) III clinical trial was analyzed for this post-hoc analysis. A total of 656 subjects were enrolled in IMS III and were followed for one year. The joint effects of obesity and diabetes on functional disability at 3-months and all-cause mortality at 1-year were examined. RESULTS Of 645 subjects with complete obesity and diabetes information, few were obese (25.74%) or had diabetes (22.64%). Obese subjects with diabetes and non-obese subjects without diabetes had similar odds of functional disability at 3-months following an ischemic stroke (adjusted common odds ratio, 1.038, 95% CI: 0.631, 1.706). For all-cause mortality at 1-year following an ischemic stroke, obese subjects with diabetes had a similar hazard compared with non-obese subjects without diabetes (adjusted hazard ratio, 1.005, 95% CI: 0.559, 1.808). There was insufficient evidence to declare a joint effect between obesity and diabetes on either the multiplicative scale or the additive scale for both outcomes. CONCLUSIONS In this post-hoc analysis of data from the IMS III clinical trial of acute ischemic stroke patients with at least a moderate stroke severity, there was not sufficient evidence to determine that the effect of obesity differed by diabetes status on post-ischemic stroke outcomes. Additionally, there was not sufficient evidence to determine that either factor was independently associated with all-cause mortality. Future studies could differentiate between metabolically healthy and metabolically unhealthy patients within BMI categories to determine if the effect of obesity on post-stroke outcomes differs by diabetes status.
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Affiliation(s)
- Colleen Bauza
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC USA
- Department of Health Informatics, Johns Hopkins All Children’s Hospital, 601 5th Street South, Suite 707, St. Petersburg, FL 33701 USA
| | - Sharon D. Yeatts
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC USA
| | - Keith Borg
- Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC USA
| | - Gayenell Magwood
- Department of Nursing, Medical University of South Carolina, Charleston, SC USA
| | - Renee’ H. Martin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC USA
| | - Anbesaw Selassie
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC USA
| | - Marvella E. Ford
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC USA
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16
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The Importance of Assessing Nutritional Status to Ensure Optimal Recovery during the Chronic Phase of Stroke. Stroke Res Treat 2018; 2018:1297846. [PMID: 29568480 PMCID: PMC5820574 DOI: 10.1155/2018/1297846] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 08/29/2017] [Indexed: 11/17/2022] Open
Abstract
Background Despite evidence that many of the consequences of stroke that hinder recovery (i.e., obesity, muscle atrophy, and functional declines) have nutritionally modifiable behavior components, little attention has been focused on the significance of nutrition beyond the acute phase of stroke. Objective This literature review summarizes the evidence for and against the influence of nutrition on optimal recovery and rehabilitation in chronic (>6 months) stroke. Results The literature, which is mainly limited to cross-sectional studies, suggests that a suboptimal nutritional status, including an excess caloric intake, reduced protein intake, and micronutrient deficiencies, particularly the B-vitamins, vitamin D, and omega 3 fatty acids, may have deleterious effects on metabolic, physical, and psychological functioning in chronic stroke survivors. Conclusions Careful evaluation of dietary intake, especially among those with eating disabilities and preexisting malnutrition, may aid in the identification of individuals at increased nutritional risk through which early intervention may benefit recovery and rehabilitation and prevent further complications after stroke.
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17
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Jang SY, Park SW, Kim YW, Kim DK. Survival Rates in Peripheral Artery Disease. J Lipid Atheroscler 2017. [DOI: 10.12997/jla.2017.6.1.39] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Shin Yi Jang
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Woo Park
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Wook Kim
- Division of Vascular Surgery, Department of Surgery, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Duk-Kyung Kim
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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18
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Kimura Y, Yamada M, Kakehi T, Itagaki A, Tanaka N, Muroh Y. Combination of Low Body Mass Index and Low Serum Albumin Level Leads to Poor Functional Recovery in Stroke Patients. J Stroke Cerebrovasc Dis 2016; 26:448-453. [PMID: 27856112 DOI: 10.1016/j.jstrokecerebrovasdis.2016.10.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 09/16/2016] [Accepted: 10/10/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Nutritional status is associated with the functional recovery of stroke patients. This study aimed to examine the influence of the combination of body mass index (BMI) and serum albumin level on functional recovery in subacute stroke patients. METHODS This retrospective cohort study included 259 subacute stroke patients (mean age 68.9 ± 12.3 years). Patients were categorized into 4 groups according to their BMI and serum albumin level: group 1, low BMI (<18.5 kg/m2) and low serum albumin level (<3.5 g/dL); group 2, low BMI and high serum albumin level (≥3.5 g/dL); group 3, normal weight (≥18.5 kg/m2) and low serum albumin level; and group 4, normal weight and high serum albumin level. The outcome variable was the motor subscale of the Functional Independence Measure (M-FIM) effectiveness. We defined the first quartile of M-FIM effectiveness as poor functional recovery. Multivariate logistic regression analysis was performed to examine the influence of the combination of BMI and serum albumin level on poor functional recovery. RESULTS Multivariate logistic regression analysis adjusted for baseline characteristics (reference, group 4) showed that group 1 was mostly associated with a significant risk of poor functional recovery (odds ratio, 4.13; 95% confidence interval, 1.53-11.15). CONCLUSIONS Our results suggested that the combination of low BMI and low serum albumin level was more significantly associated with poor functional recovery in subacute stroke patients than either factor alone. The combination of BMI and serum albumin level should be taken into account when predicting functional recovery in subacute stroke patients.
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Affiliation(s)
- Yosuke Kimura
- Department of Rehabilitation, Tokyo Shinjuku Medical Center, Japan Community Health Care Organization, 5-1 Tsukudocho, Shinjuku-ku, Tokyo 162-8543, Japan; Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo 112-0012, Japan.
| | - Minoru Yamada
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo 112-0012, Japan
| | - Tomohiro Kakehi
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo 112-0012, Japan
| | - Atsunori Itagaki
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo 112-0012, Japan
| | - Naoki Tanaka
- Department of Rehabilitation, Tokyo Shinjuku Medical Center, Japan Community Health Care Organization, 5-1 Tsukudocho, Shinjuku-ku, Tokyo 162-8543, Japan
| | - Yasushi Muroh
- Department of Rehabilitation Medicine, Tokyo Shinjuku Medical Center, Japan Community Health care Organization, 5-1 Tukudocho, Shinjuku-ku, Tokyo 162-8543, Japan
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Nishioka S, Maeda K, Wakabayashi H, Shamoto H. Relationship between body mass index and functional recovery in stroke rehabilitation setting. Disabil Rehabil 2016; 39:1146-1147. [PMID: 27008207 DOI: 10.3109/09638288.2016.1161083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Shinta Nishioka
- a Department of Clinical Nutrition and Food Services , Nagasaki Rehabilitation Hospital , Nagasaki-city , Japan
| | - Keisuke Maeda
- b Department of Nutrition and Dysphagia Rehabilitation , Tamana Regional Health Medical Center , Tamana-city , Japan
| | - Hidetaka Wakabayashi
- c Department of Rehabilitation Medicine , Yokohama City University Medical Center , Yokohama-city , Japan
| | - Hiroshi Shamoto
- d Department of Neurosurgery , Minamisoma Municipal General Hospital , Minamisoma-city , Japan
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20
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Chang WH, Sohn MK, Lee J, Kim DY, Lee SG, Shin YI, Oh GJ, Lee YS, Joo MC, Han EY, Han J, Kim YH. Role of Intensive Inpatient Rehabilitation for Prevention of Disability after Stroke: The Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO) Study. BRAIN & NEUROREHABILITATION 2016. [DOI: 10.12786/bn.2016.9.e4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- 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, Seoul, Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sam-Gyu Lee
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Gyung-Jae Oh
- Department of Preventive Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Eun Young Han
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University, School of Medicine, Jeju, Korea
| | - Junhee Han
- Division of Biostatistics, Research Institute of Convergence for Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - 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, Seoul, Korea
- Department of Health Sciences and Technology, Department of Medical Device Management & Research, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Seoul, Korea
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