Nutritional Improvement and Energy Intake Are Associated with Functional Recovery in Patients after Cerebrovascular Disorders

https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.08.033Get rights and content

Background

Malnutrition affects the activities of daily living (ADLs) in convalescent patients with cerebrovascular disorders. We investigated the relationship between nutritional improvement, energy intake at admission, and recovery of ADLs.

Methods

We evaluated 67 patients with cerebrovascular disorders admitted to our rehabilitation hospital between April 2013 and April 2015. These patients received interventions from the rehabilitation nutritional support team according to the following criteria: weight loss of 2 kg or more and body mass index of 19 kg/m2 or lower. Exclusion criteria included a body mass index of 25 kg/m2 or higher, duration of intervention of less than 14 days, or transfer to an acute care hospital because of clinical deterioration. We assessed nutritional status using the Geriatric Nutritional Risk Index (GNRI) and ADL using the Functional Independence Measure (FIM) score, FIM gain, and FIM efficiency.

Results

The mean age of the patients was 78.7 ± 8.0 years. The numbers of patients in each category of cerebrovascular disorder were 39 with cerebral infarction, 16 with intracerebral hemorrhage, 8 with subarachnoid hemorrhage, and 4 others. Compared with the counterpart group, the group with an improvement in GNRI had a greater gain in FIM (median 17 and 20, respectively; P = .036) and a higher FIM efficiency (.14 and .22, respectively; P = .020). Multivariate stepwise regression analysis showed that an improvement in GNRI, increasing energy intake at admission, and intracerebral hemorrhage were associated independently with greater FIM efficiency.

Conclusions

This study suggested that nutritional improvement and energy intake at admission are associated with recovery of ADL after cerebrovascular disorders.

Introduction

The nutritional status of patients is an important parameter during the subacute and recovery stages following a cerebrovascular disorder. Poor nutritional status is associated with increased severity of the disease, mortality, infectious complications, swallowing difficulty, and less improvement in activities of daily living (ADLs).1, 2, 3, 4, 5 The number of patients with protein–energy malnutrition was shown to increase by approximately 60% (16.3%-26.4%) in the first week after a stroke, leading to a higher mortality rate and decline in ADL.6 Nutritional therapy for patients with cerebrovascular disorders in acute settings is known to result in better clinical outcomes, with studies showing that early enteral feeding improves nutritional status7 and early nutritional therapy is associated with lower mortality rates.7 In subacute and rehabilitation settings, an intensive nutritional approach in stroke patients may improve physical function to a greater extent than standard care.8 Nutritional support may therefore be a potential therapeutic strategy for patients with postcerebrovascular disorder.

Nutritional care in the rehabilitation setting is considered to be important because patients with cerebrovascular disorders in rehabilitation hospitals are more likely to have poor nutrition than patients in acute hospitals.5, 9 Although nutritional support is necessary for patients in this setting, to our knowledge, the association between changes in nutritional parameters and ADL has not been investigated. Recently, Beberashvili et al.10 reported that changes in the Geriatric Nutritional Risk Index (GNRI), a nutritional screening score, correlated with changes in nutritional status evaluated by body composition. Therefore, it is possible to assess the effects of nutritional care in stroke patients in rehabilitation hospitals using the GNRI.

This study therefore investigated the relationship between changes in nutritional status assessed by the GNRI, energy intake at admission, and ADL in patients with postcerebrovascular disorder in a rehabilitation setting.

Section snippets

Subjects

This cross-sectional, retrospective, single-center study investigated patients aged 65 years or older who were admitted consecutively to the convalescent rehabilitation ward in Sakurakai Hospital between April 2013 and April 2015 to receive rehabilitation for a cerebrovascular disorder. The mean duration of physical rehabilitation in patients in our rehabilitation hospital was 699 minutes per week. Patients who were treated by our rehabilitation nutrition team (RNT) were included in the study.

Results

During the study period, 87 patients with postcerebrovascular disorders requiring rehabilitation were admitted to the convalescent rehabilitation ward in the hospital. Patients who were either overweight (1 case), transferred to another hospital (4 cases), died (1 case), or with missing variables (14 cases in whom the change in GNRI could not be calculated because the serum albumin level was not measured at discharge) were excluded. The remaining 67 poststroke patients (45 males and 22 females;

Discussion

This study addressed 2 issues concerning the association between changes in nutritional status, energy intake, and rehabilitative outcome in patients in a rehabilitation hospital suffering from disabilities caused by cerebrovascular disorders. First, an improvement in nutritional status following admission to discharge from hospital was associated with improved ADL in these patients. Second, the amount of energy intake at admission was associated with the degree of improvement in ADL.

Our study

Acknowledgment

The authors wish to thank the rehabilitation nutrition team for their valuable assistance in this project.

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    Authors' contributions: Maria Nii: conception and design of the study, generation, collection, assembly, analysis and interpretation of data, drafting of the manuscript, and approval of the final version of the manuscript. Keisuke Maeda, Hidetaka Wakabayashi, Shinta Nishioka, and Atsuko Tanaka: conception and design of the study, analysis and interpretation of data, revision of the manuscript, and approval of the final version of the manuscript.

    Grant support: This work was supported by a research Grant-in-Aid for Scientific Research C (no. 25350611) from the Ministry of Education, Culture, Sports, Science, and Technology of Japan.

    The authors declare that they have no conflict of interest.

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