Malnutrition Rate in Stroke Patients on Admission

Comparison of the performance of different nutritional indicators for predicting poststroke depression in older adults with ischemic stroke

Objective

This study aimed to investigate the relationships between three different nutritional indicators and poststroke depression (PSD) and to analyze the performance of these nutritional indicators in predicting the occurrence of PSD in older adults with ischemic stroke to provide a reference for nurses to identify high-risk patients with PSD early, optimize stroke management, and improve patient prognosis.

Methods

This cohort study prospectively included 239 older adults with ischemic stroke in the Department of Neurology of a hospital in Shenzhen from September 2022 to May 2023. The nutritional status of the patients were evaluated by laboratory indicators, the Mini Nutritional Assessment Short Form (MNA-SF), and the Geriatric Nutrition Risk Index (GNRI). The Hospital Anxiety and Depression Scale-Depression (HADS-D) was used to evaluate PSD. A self-designed questionnaire was used to collect demographic information and disease-related information. Binary logistic regression analysis was performed to analyze factors related to PSD, and receiver operating characteristic curve analysis was also used to compare the performance of these nutritional indicators.

Results

A total of 239 older adults with ischemic stroke were included; the mean age was 71.10 ± 7.41 years, and 66.5% (159/239) were males. The incidence of PSD was 32.6% (78/239). The incidence of PSD in the low-value group was significantly greater than that in the high-value group according to the different nutritional indices, and the difference was statistically significant (all P < 0.05). Binary logistic regression analysis revealed that the albumin (ALB) level (OR = 0.681; 95% CI, 0.508-0.913; P = 0.010), GNRI score (OR = 1.238; 95% CI, 1.034-1.483; P = 0.020), and MNA-SF score (OR = 0.708; 95% CI, 0.614-0.815; P < 0.001) were influencing factors for PSD in this population (P < 0.05). Combined with the ALB, GNRI, and MNA-SF, the area under the ROC curve for predicting the incidence of PSD in older adults with ischemic stroke was the largest and had a high degree of differentiation (AUC, 0.738; sensitivity, 75.6%; specificity, 60.9%).

Conclusion

The nutritional indices ALB, GNRI, and MNA-SF can be used as auxiliary tools to predict the risk of PSD in older adults with ischemic stroke malnutrition. Further validation by nurses in a more diverse patient population is needed to demonstrate the accuracy of the predictions.

Predictive Value of Nutritional Risk for All-Cause Death and Functional Outcomes in Chinese Elderly Patients with Acute Stroke: A 3-Year Follow-Up Study

Purpose

To explore the predictive value of nutritional risk for all-cause death and functional outcomes among elderly acute stroke patients.

Patients and Methods

A total of 479 elderly acute stroke patients were enrolled in this study. The nutritional risk of patients was screened by the GNRI and NRS-2002. The primary outcome was all-cause death, and the secondary outcome was poor prognosis defined as a modified Rankin Scale (mRS) score ≥3.

Results

Based on the NRS-2002, patients with nutritional risk had a higher risk of all-cause death at 3 months (adjusted OR: 3.642, 95% CI 1.046~12.689) and at 3 years (adjusted OR: 2.266, 95% CI 1.259~4.076) and a higher risk of adverse functional outcomes at 3 months (adjusted OR: 2.748, 95% CI 1.518~4.972. Based on the GNRI, compared to those without nutritional risk, patients with mild malnutrition also had a higher risk of all-cause death at 3 months (adjusted OR: 7.186, 95% CI 1.550~33.315) and at 3 years (adjusted OR: 2.255, 95% CI 1.211~4.199) and a higher risk of adverse functional outcomes at 3 months (adjusted OR: 1.947, 95% CI 1.030~3.680), so patients with moderate and severe malnutrition had a higher risk of all-cause death at 3 months (adjusted OR: 6.535, 95% CI 1.380~30.945) and at 3 years (adjusted OR: 2.498, 95% CI 1.301~4.799) and a higher risk of adverse functional outcomes at 3 months (adjusted OR: 2.213, 95% CI 1.144~4.279).

Conclusion

Nutritional risk increases the risk of poor short-term and long-term outcomes in elderly patients with acute stroke. For elderly stroke patients, we should pay attention to early nutritional risk screening, and effective intervention should be provided to improve the prognosis of such patients.

Impaired Nutritional Condition After Stroke From the Hyperacute to the Chronic Phase: A Systematic Review and Meta-Analysis

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.

Subjective global assessment of malnutrition and dysphagia effect on the clinical and Para-clinical outcomes in elderly ischemic stroke patients: a community-based study

Background

Malnutrition as a result of insufficient intake or uptake of nutrition leads to increasing rate of chronic diseases such as stroke. Stroke is one of the most common causes of death in western countries and its increasing trend has attracted lots of attention. In this regard, it seems logical to focus on modifiable risk factors such as nutrition, in order to reduce the resulting complications. Accordingly, this study aimed at evaluating nutrition status of stroke patients to estimate its relationship with clinical outcomes of stroke.

Methods

In the present cross-sectional study, 349 patients were recruited. Nutrition assessment was performed using Patient-Generated Subjective Global Assessment (PG-SGA). In addition, National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), and biochemical tests were performed.

Results

Our findings elucidated a significant positive correlation of mRS with PG-SGA and consciousness score, as well as a negative correlation with BMI, calf circumference, mid-arm circumference, and triceps skinfold at admission time (P ≤ 0.002). Moreover, a direct correlation was found between mRS and PG-SGA and consciousness score at discharge time (P ≤ 0.001). In contrast, an inverse correlation was established between mRS and mid-arm circumference (P = 0.02). Furthermore, univariate analysis indicated significant associations between mRS ≥ 3 and age (OR: 1.02; 95%CI: 1.00–1.04), PG-SGA (OR: 1.08; 95%CI: 1.03–1.13), NIHSS (OR: 1.04; 95%CI: 1.02–1.07), dysphagia (OR: 1.69; 95%CI: 1.03–2.77), consciousness (OR: 1.48; 95%CI: 1.07–2.04), and mid-arm circumference (OR: 0.95; 95%CI: 0.90–1.00). In addition, these associations remained significant in multivariate analysis for PG-SGA (OR: 1.07; 95%CI: 1.00–1.13) and NIHSS (OR: 1.04; 95%CI: 1.01–1.07).

Conclusion

This study revealed a positive correlation between mRS and consciousness status and PG-SGA score, as well as a negative one between mRS and MAC at discharge time.