Low handgrip strength is associated with reduced functional recovery and longer hospital stay in patients with osteoporotic vertebral compression fractures: a prospective cohort study

Gut microbiome diversity is associated with muscle mass, strength and quality in post-stroke patients

BACKGROUND

The gut microbiome has emerged as a potential influencer of muscle health; however, its role in hospitalized patients remains unclear. This study aimed to investigate the association between gut microbiome diversity and skeletal muscle mass, strength, and quality in hospitalized post-stroke patients.

METHODS

We conducted a cross-sectional study of post-stroke patients admitted to a rehabilitation facility. Gut microbiome diversity was assessed using 16S ribosomal ribonucleic acid (rRNA) gene sequencing, calculating Operational Taxonomic Unit (OTU) Richness, Faith's Phylogenetic Diversity (PD), and Shannon index. Muscle health was evaluated using skeletal muscle index (SMI) for muscle mass, handgrip strength (HGS) for muscle strength, and bioimpedance analysis-derived phase angle (PhA) for muscle quality. Multiple linear regression analyses were performed, adjusting for potential confounders.

RESULTS

A total of 156 patients (mean age 78.4 years; 55.7 % male) were analyzed. OTU Richness showed significant positive associations with SMI (β = 0.197, p = 0.025), HGS (β = 0.180, p = 0.005), and PhA (β = 0.178, p = 0.022). The Shannon index was also positively associated with SMI (β = 0.120, p = 0.041), HGS (β = 0.140, p = 0.028), and PhA (β = 0.164, p = 0.032). Faith's PD did not demonstrate significant associations with muscle health parameters.

CONCLUSIONS

Higher gut microbiome diversity, assessed by OTU Richness and Shannon index, is associated with better muscle mass, strength, and quality in post-stroke patients. These findings suggest a potential role for gut microbiota in muscle health during stroke rehabilitation.

Sex differences in sarcopenia prevalence and muscle-related outcomes among post-stroke inpatients

BACKGROUND

Sex differences in sarcopenia prevalence and recovery patterns among post-stroke patients remain poorly understood. This study aimed to investigate sex differences in sarcopenia prevalence, improvement rates, and changes in muscle-related indices among post-stroke patients in rehabilitation settings.

METHODS

A retrospective cohort study was conducted at a post-acute rehabilitation hospital. Sarcopenia was diagnosed using the Asian Working Group for Sarcopenia 2019 criteria. The primary outcomes were sarcopenia status and muscle-related indices (handgrip strength and skeletal muscle mass index) at discharge. Propensity score-adjusted logistic regression analysis was performed to examine the association between sex and non-sarcopenia at discharge.

RESULTS

A total of 598 patients (274 women) with a mean age of 71.6 years were analyzed. Women showed higher sarcopenia prevalence at admission compared to men (47.4% vs 34.2%, p = 0.001). After adjusting for confounders, male sex was positively associated with non-sarcopenia at discharge (OR 1.046, 95% CI 1.009-1.104, p < 0.001) and greater improvements in handgrip strength (B = 1.93, p = 0.031) and skeletal muscle mass index (B = 0.322, p = 0.019).

CONCLUSION

This study revealed significant sex differences in sarcopenia among post-stroke rehabilitation patients. While women showed higher sarcopenia prevalence at admission, men demonstrated better improvements in muscle-related outcomes.

Coexistence of low body mass index and poor oral health negatively affects activities of daily living, swallowing, and cognition after stroke

AIM

Low body mass index (BMI) and poor oral health are prevalent among older stroke patients and associated with adverse outcomes. However, their combined impact on functional recovery after stroke remains unclear. This study investigated the synergistic effects of low BMI and poor oral health on activities of daily living (ADL) independence, swallowing function, and cognitive status in post-stroke older patients.

METHODS

A retrospective cohort study was conducted on 708 hospitalized post-stroke patients aged ≥70 years. Low BMI was defined as <20 kg/m2, and poor oral health was assessed using the Revised Oral Assessment Guide (ROAG) with a score ≥13 indicating oral problems. The primary outcome was ADL independence (Functional Independence Measure-motor score >78) at discharge. Secondary outcomes included swallowing level (Food Intake Level Scale) and cognitive status (Functional Independence Measure-cognition score). Multiple regression analyses were performed to examine the associations of low BMI, poor oral health, and their combination with outcomes of interest.

RESULTS

The coexistence of low BMI and poor oral health was independently associated with lower odds of achieving ADL independence (odds ratio 0.130, 95% confidence interval [CI] 0.023-0.718), worse swallowing level (B = -0.878, 95% CI -1.280 to -0.476), and poorer cognitive status (B = -1.872, 95% CI -2.960 to -0.784) at discharge, after adjusting for confounders. The combined impact was stronger than either condition alone.

CONCLUSIONS

The coexistence of low BMI and poor oral health exerts a synergistic negative impact on functional recovery in older stroke inpatients. Comprehensive interventions integrating nutritional support, oral management, and rehabilitation are crucial to optimizing outcomes in this vulnerable population. Geriatr Gerontol Int 2024; 24: 1045-1052.

Dual burden of sarcopenia and impaired oral status on activities of daily living, cognition and swallowing outcomes in post-stroke patients

BACKGROUND AND AIMS

Sarcopenia and poor oral health are common in older patients and are associated with negative outcomes. However, evidence of their combined impact on post-stroke rehabilitation outcomes is limited. This study aimed to investigate the combined impact of sarcopenia and impaired oral health on activities of daily living (ADL), cognition, and swallowing outcomes in post-stroke patients.

METHODS

A retrospective cohort study was conducted using 1,012 post-stroke patients (median age 75.6 years; 54.1 % men). Sarcopenia was diagnosed using the Asian Working Group for Sarcopenia 2019 criteria. Poor oral health was assessed using the Revised Oral Assessment Guide (ROAG) with a score ≥13 indicating impaired oral status. Functional outcomes were measured using the Functional Independence Measure (FIM) for ADL and cognition, and the Food Intake Level Scale (FILS) for swallowing status.

RESULTS

The prevalence of sarcopenia was 45.6 % (492/1,080), impaired oral health was 27.5 % (297/1,080), and the coexistence of both conditions was 12.0 % (130/1,080). The coexistence of sarcopenia and impaired oral health was associated with poorer outcomes compared to either condition alone. After adjusting for confounders, the combination of sarcopenia and impaired oral status showed the strongest negative impact on FIM-motor (B=-8.666, 95 % CI -11.484 to -5.847), FIM-cognition (B=-1.122, 95 % CI -1.987 to -0.256), and FILS (B=-0.785, 95 % CI -1.055 to -0.514) scores at discharge.

CONCLUSION

The dual burden of sarcopenia and impaired oral health significantly impacts functional recovery in post-stroke patients. Comprehensive assessments and interventions targeting both conditions may optimize rehabilitation outcomes in this population.

Association of Phase Angle Dynamics with Sarcopenia and Activities of Daily Living in Osteoporotic Fracture Patients

BACKGROUND

This study aimed to determine whether changes in phase angle during rehabilitation are associated with clinical outcomes such as activities of daily living (ADL), skeletal muscle mass index (SMI), and strength in patients with osteoporotic fractures.

METHODS

This retrospective observational study included patients with osteoporotic fractures admitted to convalescent rehabilitation wards. Changes in phase angle were defined as the difference between the phase angle values at discharge and on admission. The primary outcome was the Functional Independence Measure motor (FIM-motor) score at discharge. The secondary outcomes were SMI and handgrip strength at discharge. We used multivariate analysis to adjust for confounding factors and examine the association between changes in the phase angle and outcomes.

RESULTS

We analyzed a total of 115 patients (97 women, mean age of 81.0±10.0 years), with a median change in phase angle of 0° during hospitalization. We observed increased phase angles in 49 patients (43%), with a median increase of 0.2°. Multiple regression analysis showed that changes in phase angle were independently associated with FIM-motor score at discharge (β=0.238, p=0.027). Changes in phase angle were not significantly associated with SMI (β=0.059, p=0.599) or handgrip strength (β=-0.032, p=0.773) at discharge.

CONCLUSION

An increased phase angle during rehabilitation was positively associated with ADL improvement in patients with osteoporotic fractures. These findings may help clinicians make informed decisions regarding patient care and treatment strategies for better outcomes.

Better Handgrip Strength Is Related to the Lower Prevalence of Pain and Anxiety in Community-Dwelling Older Adults

Although handgrip strength (HGS) may be treated as a biomarker of many health problems, there is little evidence on the potential role of HGS in the prevention of pain or anxiety in older adults. We investigated the relationship of HGS to the presence of pain and anxiety among community-dwelling older adults. The study was performed in 2038 outpatients, aged 60 to 106 years. The Jamar hand-held hydraulic dynamometer was used to measure HGS. The prevalence of pain and anxiety was assessed with the Euroqol 5D questionnaire. Symptoms of depression were recorded with 15-item Geriatric Depression Scale (GDS). In the multivariate logistic regression model taking into account age, sex, BMI and concomitant diseases, the significant influence of HGS on the presence of pain (odds ratio [OR]  =  0.988) in the entire study population and among men (OR  =  0.983) was found. HGS was a significant independent predictor for the presence of anxiety in the entire study population (OR  =  0.987), in women (OR  =  0.985) and in men (OR  =  0.988). In the fully adjusted model with included GDS, 1 kg higher HGS was still associated with 1.2% and 1.3% lower probability of the presence of pain and anxiety, respectively. We conclude that low HGS is associated with the presence of pain and anxiety among older adults, independent of age, sex, depression symptoms and concomitant chronic diseases. Future research should assess whether improvement of HGS would alleviate psychological dysfunction in older adults.