1
|
Costa Pereira JPD, Rüegg RAB, Costa EC, Fayh APT. Muscle quality and major adverse cardiovascular events in post-acute myocardial infarction: A prospective cohort study. Nutr Metab Cardiovasc Dis 2024; 34:2266-2272. [PMID: 38866608 DOI: 10.1016/j.numecd.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/23/2024] [Accepted: 04/24/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND & AIMS Functional muscle quality, as assessed through the muscle quality index (MQI), represents a contemporary method to measure the capacity to generate force. Despite its potential, the prognostic significance of MQI remains uncertain in various clinical conditions, particularly among patients following acute myocardial infarction (AMI). In light of this, our study sought to evaluate the prognostic relevance of MQI concerning major adverse cardiovascular events (MACE) in patients following AMI. METHODS AND RESULTS This is a secondary analysis of a prospective cohort study that included subjects aged ≥20 years from a Cardiovascular Unit Hospital. Functional muscle quality was estimated using MQI, defined as the ratio of handgrip strength (HGS) to muscle mass (MM) derived from bioelectrical impedance analysis. The outcomes included prolonged length of hospital stay, new adverse cardiovascular events (AMI, stroke and hospital readmission for unstable angina), and cardiovascular mortality. A composite score comprising all adverse events over the 1-year follow-up was calculated and defined as MACE. This study included 163 patients, with a median age of 61 years (IQ: 54-69 years), and the majority consisted of males (76.1%). Individual components of the functional muscle quality (HGS and MM) were not associated with any of the adverse outcomes. Only MQI was associated mortality over the 1-year follow-up. For each increase in MQI, the hazard of mortality decreases: adjusted HR: 0.08 (95% CI 0.01-0.84). CONCLUSION Functional muscle quality assessed by the MQI may be a valuable clinical predictor of 1-year cardiovascular mortality in patients hospitalized post-AMI.
Collapse
Affiliation(s)
- Jarson Pedro da Costa Pereira
- Postgraduate Program in Nutrition and Public Health, Department of Nutrition, Federal University of Pernambuco, Recife, PE, Brazil
| | - Rodrigo Albert Baracho Rüegg
- Postgraduate Program in Health Science, Health Science Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Eduardo Caldas Costa
- ExCE Research Group, Department of Physical Education, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Ana Paula Trussardi Fayh
- Postgraduate Program in Health Science, Health Science Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil; PesqClin Lab, Onofre Lopes University Hospital, Brazilian Company of Hospital Services (EBSERH), Federal University of Rio Grande do Norte, Natal, Brazil.
| |
Collapse
|
2
|
Sato K, Ogawa T. Reduced trunk muscle mass in patients with stroke is associated with reduced balance function recovery. Clin Nutr ESPEN 2024; 62:115-119. [PMID: 38901932 DOI: 10.1016/j.clnesp.2024.05.004] [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: 12/21/2023] [Revised: 04/18/2024] [Accepted: 05/07/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND & AIMS Skeletal muscles are essential for postural retention and balance function. However, the relationship between trunk muscle mass (TMM) and balance function has not yet been clarified. This study aimed to examine the impact of TMM on the change in balance function in patients with stroke from admission to a rehabilitation hospital to discharge. METHODS This retrospective observational study included patients aged ≥65 years with cerebral infarction admitted to our rehabilitation hospital from May 2018 to July 2022. The trunk muscle mass index (TMI) was calculated at admission and discharge using bioelectrical impedance analysis. Patients were divided into low and high TMI groups according to the median TMI at admission. The primary outcome was the change in the Berg Balance Scale (BBS) score (BBS score at discharge - BBS score at admission). RESULTS A total of 315 patients (mean age, 78.9 ± 8.0 years; 172 men and 143 women) were included. The median TMI was 7.31 kg/m2 in men and 6.30 kg/m2 in women. Among male patients, the high TMI group had higher BBS scores at admission (31.2 ± 18.2 vs. 23.4 ± 17.7, P = 0.005) and discharge (43.0 ± 15.3 vs. 33.4 ± 19.0, P < 0.001) than those in the low TMI group. After adjusting for confounding factors, TMI at admission was independently associated with the change in BBS score (β = 0.587, P = 0.002). CONCLUSIONS Reduced TMM negatively influences balance function recovery in patients after stroke. A strategy aimed at increasing TMM could have beneficial effects on balance function.
Collapse
Affiliation(s)
- Keisuke Sato
- Ginowan-kinen Hospital, 3-3-13 Ginowan, Ginowan city, Okinawa, 901-2211, Japan; Chuzan Hospital Clinical Education and Research Center, 6-2-1 Matsumoto, Okinawa city, Okinawa, 904-2151, Japan; Department of Rehabilitation Medicine, Aichi Medical University Graduate School of Medicine, 1-1 Yazakokarimata, Nagakute-city, Aichi, 480-1195, Japan.
| | - Takahiro Ogawa
- Chuzan Hospital Clinical Education and Research Center, 6-2-1 Matsumoto, Okinawa city, Okinawa, 904-2151, Japan; Department of Rehabilitation Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute-city, Aichi, 480-1195, Japan.
| |
Collapse
|
3
|
Ishiyama D, Toi K, Aoyagi Y, Suzuki K, Takayama T, Yazu H, Yoshida M, Kimura K. The extracellular-to-total body water ratio reflects improvement in the activities of daily living in patients who experienced acute stroke. J Stroke Cerebrovasc Dis 2024; 33:107810. [PMID: 38851546 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107810] [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: 11/19/2023] [Revised: 06/03/2024] [Accepted: 06/05/2024] [Indexed: 06/10/2024] Open
Abstract
OBJECTIVES To determine the relationship between bioelectrical impedance analysis (BIA) parameters, including the extracellular water-to-total body water ratio (ECW/TBW), and the activities of daily living (ADL) improvement, in patients who experienced acute stroke. MATERIALS AND METHODS This retrospective cohort study included 307 patients (mean age, 72 years; 39 % female) who experienced acute stroke and were admitted to the stroke unit of the Nippon Medical School Hospital (Bunkyo-ku, Tokyo, Japan) between April 2021 and March 2022. The Functional Independence Measure (FIM) was assessed at initial rehabilitation and discharge, and FIM effectiveness was calculated as ADL improvement in the participating acute care hospitals. BIA markers included the skeletal muscle mass index (SMI), phase angle (PhA), and ECW/TBW. Multiple linear regression models were used to estimate the relationship between the FIM effectiveness and each BIA marker. RESULTS The mean (±SD) FIM effectiveness was 0.45 ± 0.36. The proportions of low SMI (male, <7.0 kg/m2; female, <5.7 kg/m2) and low PhA (male <5.36 degrees, female <3.85 degrees), were 48.9 % and 43.3 %, respectively. In addition, the proportions of of low (<0.36), normal (0.36-0.40), and high (>0.4) ECW/TBW ratios were 1.3 %, 78.5 %, and 20.2 %, respectively. After adjustments for demographic and clinical variables, low PhA, low ECW/TBW, and high ECW/TBW were all significantly associated with FIM effectiveness (P < 0.05), with β coefficients of -0.126, -0.089, and -0.117, respectively. CONCLUSIONS Low and High ECW/TBW and low PhA levels were negatively correlated with improvements in ADL. The ECW/TBW ratio may be an additional indicator of rehabilitation trainability in patients who experience acute stroke.
Collapse
Affiliation(s)
- Daisuke Ishiyama
- Department of Rehabilitation Medicine, Nippon Medical School Hospital, Japan.
| | - Kennosuke Toi
- Department of Rehabilitation Medicine, Nippon Medical School Hospital, Japan
| | - Yoichiro Aoyagi
- Department of Rehabilitation Medicine, Nippon Medical School Hospital, Japan
| | - Kentaro Suzuki
- Department of Neurology, Nippon Medical School Hospital, Japan
| | - Toshiyuki Takayama
- Department of Rehabilitation Medicine, Nippon Medical School Hospital, Japan
| | - Hitomi Yazu
- Department of Rehabilitation Medicine, Nippon Medical School Hospital, Japan
| | - Madoka Yoshida
- Department of Rehabilitation Medicine, Nippon Medical School Hospital, Japan
| | - Kazumi Kimura
- Department of Neurology, Nippon Medical School Hospital, Japan
| |
Collapse
|
4
|
Sato K, Wakugami K, Iwata T, Tanaka S, Koike M, Ogawa T. Low muscle mass in patients with stroke on admission reduces walking ability at discharge. Clin Nutr ESPEN 2024; 61:333-337. [PMID: 38777452 DOI: 10.1016/j.clnesp.2024.03.024] [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: 10/30/2023] [Revised: 02/05/2024] [Accepted: 03/22/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND & AIMS Reduced skeletal muscle mass may negatively influence postural retention and walking function. This study aimed to examine the influence of the skeletal muscle mass index on walking function in patients with stroke. METHODS This study included patients with cerebral infarction aged ≥65 years. The Asian Working Group for Sarcopenia's skeletal muscle mass index criteria were used to classify the participants into the low and high skeletal muscle mass index groups. The patient characteristics of the two groups were compared. The primary and secondary outcome measures were independent walking and walking speed, respectively. RESULTS In total, 174 participants were included. There were no significant differences in the length of hospital stay, rehabilitation volume, or functional independence measure score at discharge between the males and females. Multivariate logistic regression analysis revealed that independent walking was independently associated with the skeletal muscle mass index on admission. The SMI, as an explanatory variable, was independently associated with the comfortable and fastest walking speeds. Faster walking was associated with higher skeletal muscle mass indexes on admission for both males and females. CONCLUSIONS A low skeletal muscle mass index negatively influences walking function improvement in patients with stroke. A strategy aimed at increasing skeletal muscle mass can have beneficial effects on walking function in patients with stroke.
Collapse
Affiliation(s)
- Keisuke Sato
- Ginowan-kinen Hospital, 3-3-13 Ginowan, Ginowan City, Okinawa, 901-2211, Japan; Chuzan Hospital Clinical Education and Research Center, 6-2-1 Matsumoto, Okinawa City, Okinawa, 904-2151, Japan; Department of Rehabilitation Medicine, Aichi Medical University Graduate School of Medicine, 1-1 Yazakokarimata, Nagakute-city, Aichi, 480-1195, Japan.
| | - Kiyoshi Wakugami
- Ginowan-kinen Hospital, 3-3-13 Ginowan, Ginowan City, Okinawa, 901-2211, Japan.
| | - Tsuyoshi Iwata
- Ginowan-kinen Hospital, 3-3-13 Ginowan, Ginowan City, Okinawa, 901-2211, Japan.
| | - Seiji Tanaka
- Department of Rehabilitation Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute-city, Aichi, 480-1195, Japan.
| | - Masaki Koike
- Kobe College of Medical Welfare, 501-85, Fukushima, Mita City, Hyogo, 669-1313, Japan.
| | - Takahiro Ogawa
- Chuzan Hospital Clinical Education and Research Center, 6-2-1 Matsumoto, Okinawa City, Okinawa, 904-2151, Japan; Department of Rehabilitation Medicine, Aichi Medical University Graduate School of Medicine, 1-1 Yazakokarimata, Nagakute-city, Aichi, 480-1195, Japan.
| |
Collapse
|
5
|
Kim E, Jung S, Lee MY, Park CH, Cho SJ. Exploring the Association between Elevated Anxiety Symptoms and Low Skeletal Muscle Mass among Asymptomatic Adults: A Population-Based Study in Republic of Korea. Brain Sci 2024; 14:438. [PMID: 38790417 PMCID: PMC11119912 DOI: 10.3390/brainsci14050438] [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: 03/14/2024] [Revised: 04/17/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024] Open
Abstract
Individuals with mental health problems are at higher risk of musculoskeletal diseases. However, the association between low muscle mass (LMM) and anxiety symptoms remains uninvestigated. This cross-sectional study enrolled 174,262 adults (73,833 women, 100,429 men), aged 18 to 89, who completed the anxiety scale and body composition analyses. Using bio-electrical impedance analysis, skeletal muscle mass index (SMI) was calculated based on appendicular skeletal muscle mass (ASM) (kg)/height (m2). LMM was defined as SMI < 7.0 kg/m2 in men and <5.4 kg/m2 in women. Anxiety symptoms were screened using the Clinical Useful Anxiety Outcome Scale (CUXOS) with cut-off scores of 20, 30, and 40. Multivariable logistic regression analyses were performed. LMM prevalence was 20.17% in women, 3.86% in men (p < 0.001). The prevalence of anxiety symptoms in LMM group decreased from mild (CUXOS > 20: women, 32.74%, men, 21.17%) to moderate (CUXOS > 30: 13.34%, 7.32%), to severe anxiety symptoms (CUXOS > 40: 4.00%, 1.73%). In multivariable-adjusted models, LMM was associated with mild (aOR (95% confidence interval)), women, 1.13 (1.08-1.17); men, 1.17 (1.08-1.27)), moderate (1.17 (1.11-1.24); 1.35 (1.19-1.53) and severe anxiety symptoms (1.18 (1.07-1.3), 1.36 (1.06-1.74)), demonstrating an increased risk of ORs with escalating anxiety severity. LMM was independently associated with a higher prevalence of anxiety symptoms.
Collapse
Affiliation(s)
- Eunsoo Kim
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea;
| | - Sra Jung
- Department of Psychiatry, Cha University Ilsan Medical Center, Goyang 10223, Republic of Korea;
| | - Mi Yeon Lee
- Division of Biostatistics, Department of Academic Research, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea;
| | - Chul-Hyun Park
- Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea
| | - Sung Joon Cho
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea;
- Workplace Mental Health Institute, Kangbuk Samsung Hospital, Seoul 03181, Republic of Korea
| |
Collapse
|
6
|
Mat Nawi NF, Simok AA, Hanafi MH, Mohd Ismail ZI. Improvements of mid-thigh circumferences following robotic rehabilitation in hemiparetic stroke patients. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2024; 29:e2091. [PMID: 38642068 DOI: 10.1002/pri.2091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 08/22/2023] [Accepted: 03/31/2024] [Indexed: 04/22/2024]
Abstract
INTRODUCTION Stroke has emerged as the leading cause of disability globally. The provision of long-term rehabilitation to stroke survivors poses a health care burden to many countries. Robotic devices have created a major turning point in stroke rehabilitation program. Currently, the anthropometric evidence to support the benefit of robotic rehabilitation (RR) among stroke patients is scarce. Therefore, the aim of this study was to evaluate the impact of RR on the mid-thigh circumferences of the paretic limbs in stroke patients. METHODS Twenty stroke patients from conventional rehabilitation (CR) (n = 10) and RR (n = 10) groups were recruited through a purposive sampling method. Patients in the CR group received a two-hour session of a five-day-a-week home-based CR program for 4 weeks. Patients in the RR group received a five-day-a-week of an hour combined physiotherapy and occupational therapy session and a one-hour robotic therapy session using the HAL® Cyberdyne lower-limb, for 4 weeks. The mid-thigh circumferences of both limbs were measured on day 1 (baseline), week 2 and week 4 of rehabilitation program. RESULTS The results revealed no statistically significant difference in the mid-thigh circumferences between the paretic (F1.05,9.44 = 1.96, p = 0.20), and the normal (F1.05,9.44 = 1.96, p = 0.20) sides in the CR group (n = 10). For the comparison between the paretic and normal sides in the RR group (n = 10), the paretic mid-thigh circumferences revealed significant time effect results (F2,18 = 11.91, p = 0.001), which were due to changes between baseline and week 2, and baseline and week 4 measurements. Interestingly, the normal mid-thigh circumferences also revealed a significant time effect (F2,18 = 6.56, p = 0.007), which is due to changes between baseline and week 4. One-way analysis of variance was employed to compare the mean average between groups due to the difference in the baseline measurements of the mid-thigh circumferences between the paretic side of the CR and the RR groups. With this adjustment, the average means mid-thigh circumferences after 4 weeks of therapy were shown to be significantly different between the CR and RR groups (F1,18 = 12.49, p = 0.02). CONCLUSION Significant increments in the mid-thigh circumferences following RR were seen in the paretic limbs of stroke patients. Hence, this study may provide some insights into further potential research related to the benefits of RR in stroke patients.
Collapse
Affiliation(s)
- Nur Fasihah Mat Nawi
- Department of Anatomy, School of Medical Sciences, Universiti Sains Malaysia Health Campus, Kubang Kerian, Kelantan, Malaysia
| | - Anna Alicia Simok
- Department of Anatomy, School of Medical Sciences, Universiti Sains Malaysia Health Campus, Kubang Kerian, Kelantan, Malaysia
| | - Muhammad Hafiz Hanafi
- Department of Neuroscience, School of Medical Sciences, Universiti Sains Malaysia Health Campus, Kubang Kerian, Kelantan, Malaysia
- Rehabilitation Medicine Unit, Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Zul Izhar Mohd Ismail
- Department of Anatomy, School of Medical Sciences, Universiti Sains Malaysia Health Campus, Kubang Kerian, Kelantan, Malaysia
| |
Collapse
|
7
|
Sato K, Ogawa T. Impact of increased trunk muscle mass on trunk function and activities of daily living in older individuals with cerebral infarction. Clin Nutr ESPEN 2024; 60:203-209. [PMID: 38479911 DOI: 10.1016/j.clnesp.2024.01.023] [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: 12/14/2023] [Revised: 01/18/2024] [Accepted: 01/22/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND & AIMS The association between trunk muscle mass or trunk function or trunk muscle strength and activities of daily living (ADLs) has been reported, but no studies have examined the impact of increased trunk muscle mass on trunk function or ADL. This study aimed to determine whether increased trunk muscle mass is associated with trunk function and ADL in older individuals with cerebral infarction during rehabilitation. METHODS This retrospective observational study enrolled 158 patients with cerebral infarction aged ≥65 years who were admitted for post-stroke rehabilitation. The trunk muscle mass index (TMI) was calculated at admission and discharge using bioelectrical impedance analysis. Patients were divided into two groups: one with increased TMI (64 participants; 41 %) and the other without TMI increase (94 participants; 59 %). Multiple linear regression analysis was performed with functional assessment for control of trunk (FACT) or functional independence measure (FIM)-motor gain as the objective variable and increased TMI group as the explanatory variable. RESULTS We analyzed a total of 158 patients (79.5 ± 7.8 years of age, 51.9 % men). TMI increase was independently associated with FACT gain (coefficient = 1.413, 95 % confidence interval = 0.34-2.49, P = 0.010), but not with FIM-motor gain. CONCLUSIONS The results suggest that increased TMI is independently associated with recovery of trunk function. Further prospective studies are needed to elucidate the relationship between increased TMI and ADL.
Collapse
Affiliation(s)
- Keisuke Sato
- Ginowan-kinen Hospital, 3-3-13 Ginowan, Ginowan City, Okinawa, 901-2211, Japan; Chuzan Hospital Clinical Education and Research Center, 6-2-1 Matsumoto, Okinawa City, Okinawa 904-2151, Japan; Department of Rehabilitation Medicine, Aichi Medical University Graduate School of Medicine, 1-1 Yazakokarimata, Nagakute-city, Aichi 480-1195, Japan.
| | - Takahiro Ogawa
- Chuzan Hospital Clinical Education and Research Center, 6-2-1 Matsumoto, Okinawa City, Okinawa 904-2151, Japan; Department of Rehabilitation Medicine, Aichi Medical University Graduate School of Medicine, 1-1 Yazakokarimata, Nagakute-city, Aichi 480-1195, Japan.
| |
Collapse
|
8
|
Ogino T, Nozoe M, Inoue T, Ishida M, Yamamoto K. Impact of possible sarcopenia on functional prognosis in patients with acute stroke with premorbid disability. Geriatr Gerontol Int 2024; 24:359-363. [PMID: 38410028 DOI: 10.1111/ggi.14840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/18/2024] [Accepted: 02/07/2024] [Indexed: 02/28/2024]
Abstract
AIM How possible sarcopenia affects functional prognosis in patients with premorbid disability remains unclear. This study aimed to compare and investigate the impact of possible sarcopenia at admission on functional outcomes at discharge in patients with acute stroke with and without premorbid disability. METHODS This cohort study enrolled patients who were consecutively admitted to a single center for acute stroke. Calf circumference and grip strength were measured within 7 days of admission, and possible sarcopenia was determined using the Asian Working Group for Sarcopenia 2019 criteria. The Functional Independence Measure (FIM) score at discharge during the acute phase was the primary outcome. To examine the impact of possible sarcopenia on FIM scores at discharge, patients were divided into two groups according to being with or without premorbid disability according to the modified Rankin Scale, and multiple linear regression analysis was performed in each group. RESULTS This study included 456 patients with acute stroke (median age, 80 years). In the premorbid-disability group (n = 166), possible sarcopenia was present in 140 patients (84%). Patients without possible sarcopenia had significantly higher FIM scores at discharge compared with those with possible sarcopenia (P < 0.001). However, multiple linear regression analysis showed that possible sarcopenia was not associated with FIM scores at discharge in the premorbid-disability group (β = -0.054, P = 0.346). CONCLUSIONS The results of this study demonstrated that a high rate of possible sarcopenia was observed in patients with stroke with premorbid disability; however, this did not affect functional prognosis. Geriatr Gerontol Int 2024; 24: 359-363.
Collapse
Affiliation(s)
- Tomoyuki Ogino
- Department of Physical Therapy, School of Rehabilitation, Hyogo Medical University, Kobe, Japan
| | - Masafumi Nozoe
- Department of Physical Therapy, School of Rehabilitation, Kansai Medical University, Hirakata, Japan
| | - Tatsuro Inoue
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Mitsuru Ishida
- Department of Rehabilitation, Konan Medical Center, Kobe, Japan
| | - Kenta Yamamoto
- Department of Rehabilitation, Konan Medical Center, Kobe, Japan
| |
Collapse
|
9
|
Nozoe M, Kubo H, Yamamoto M, Ikeji R, Seike H, Majima K, Shimada S. Muscle weakness is more strongly associated with functional outcomes in patients with stroke than sarcopenia or muscle wasting: an observational study. Aging Clin Exp Res 2024; 36:4. [PMID: 38261059 PMCID: PMC10806041 DOI: 10.1007/s40520-023-02672-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/21/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Stroke-related sarcopenia is an important prognosis factor and an intervention target for improving outcomes in patients with stroke. AIM This study aimed to identify the association between sarcopenia, possible sarcopenia, muscle weakness, muscle mass and calf circumference, and the functional outcomes 3 months after stroke. METHODS In this single-centre prospective observational study, muscle strength, muscle mass, and calf circumference were measured in patients with acute stroke at hospital discharge. Diagnosis of sarcopenia, possible sarcopenia, muscle weakness, low muscle mass, and low calf circumference were defined according to the 2019 Asian Working Group for Sarcopenia criteria. The primary outcome measure was the modified Rankin Scale (mRS) score at 3 months, with an mRS score of 3 or higher indicating a poor outcome. Logistic regression analysis was conducted to examine independent associations between each assessment and functional outcomes. RESULTS A total of 247 patients (median age: 73 years) were included in this study. The prevalence of sarcopenia was 28% (n = 70), and in the adjusted model, sarcopenia (aOR = 2.60, 95% CI 1.07-6.31, p = 0.034), muscle weakness (aOR = 3.40, 95% CI 1.36-8.52, p = 0.009), and low muscle mass (aOR = 2.61, 95% CI 1.04-6.52) were significantly associated with poor functional outcome. Nevertheless, other evaluations did not demonstrate an independent association with the outcome. CONCLUSION Sarcopenia, muscle weakness, and low muscle mass were found to be independently associated with functional outcomes 3 months after stroke, and muscle weakness exhibited the strongest association with outcomes among them.
Collapse
Affiliation(s)
- Masafumi Nozoe
- Department of Physical Therapy, Faculty of Rehabilitation, Kansai Medical University, 18-89 Uyamahigashicho, Hirakata, Osaka, Japan.
| | - Hiroki Kubo
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, Kobe, Japan
| | - Miho Yamamoto
- Department of Rehabilitation Medicine, Nishiyamato Rehabilitation Hospital, Nara, Japan
| | - Rio Ikeji
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Haruka Seike
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Kazuki Majima
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Shinichi Shimada
- Department of Neurosurgery, Itami Kousei Neurosurgical Hospital, Itami, Japan
| |
Collapse
|
10
|
Hou L, Chen X, Zhu C. A baseline sarcopenia index based on creatinine/cystatin C for the prediction of stroke recurrence and mortality in older survivors of first ischemic strokes. Front Public Health 2023; 11:1049738. [PMID: 37841730 PMCID: PMC10568011 DOI: 10.3389/fpubh.2023.1049738] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
Objective Older adults individuals have a higher risk of stroke recurrence, leading to high mortality and disability rates, which, in turn, hinders the achievement of healthy aging. This study aimed to assess the utility of a baseline sarcopenia index (SI) based on serum creatinine (Cr)/cystatin C (CysC) as a prognostic marker for the risk of stroke recurrence and mortality in first-ever ischemic stroke older survivors (ISOS). Materials and methods Data were obtained from an ischemic stroke cohort study. The baseline information was collected from medical records and face-to-face interviews with patients admitted between January 2010 and June 2016. Follow-up information was obtained from telephone interviews every 3 months to determine stroke recurrence and survival status. The SI was calculated from the Cr and CysC values in the medical records as Cr/CysC × 100. Using the first quantile of the SI as the cut-off value, the study participants were divided into the low muscle-mass group (low SI) and the high muscle-mass group (high SI). Cox regression analysis was used to assess the association between SI and recurrence and mortality. Results A total of 415 first-ever ISOS were enrolled, including 242 (58.31%) male and 173 (41.69%) female participants. In the high-SI group, the relapse and mortality rates were lower than those in the low-SI group (relapse: 20.58% vs. 30.77%; mortality:13.5% vs. 29.81%). After adjusting for confounding factors, the high-SI group was found to have a lower risk of relapse and mortality than the low-SI group (relapse: HR = 0.571; mortality: HR = 0.294). Conclusion The SI was predictive of the long-term prognosis of IS recurrence and mortality in first-ever ISOS. After discharge, in addition to conventional medication, it is recommended that patients with low SI values actively receive treatment for sarcopenia to reduce the risk of stroke recurrence and mortality and promote healthy aging.
Collapse
Affiliation(s)
- Lisha Hou
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Xiaoyan Chen
- Zigong Psychiatric Research Center, Zigong Affiliated Hospital of Southwest Medical University, Zigong, Sichuan Province, China
| | - Cairong Zhu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
11
|
Matsumoto A, Yoshimura Y, Nagano F, Bise T, Kido Y, Shimazu S, Shiraishi A. Statin use impairs muscle strength recovery in post-stroke patients with sarcopenia. Geriatr Gerontol Int 2023; 23:676-683. [PMID: 37485543 DOI: 10.1111/ggi.14646] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/29/2023] [Accepted: 07/08/2023] [Indexed: 07/25/2023]
Abstract
AIM The effects of statins on muscle health are not well established. Therefore, this study investigated the impact of statin use on muscle strength and mass recovery in patients with sarcopenia after stroke. METHODS This retrospective cohort study included stroke patients with sarcopenia hospitalized between 2015 and 2021 at a post-acute rehabilitation hospital. Sarcopenia was diagnosed using handgrip strength and skeletal muscle mass index measured using bioelectrical impedance analysis according to the 2019 criteria of the Asian Working Group for Sarcopenia. The study outcomes included handgrip strength and skeletal muscle mass index at hospital discharge. We used multivariate analyses to examine whether statin use was independently associated with the outcomes. Statistical significance was set at P < 0.05. RESULTS Of the 586 patients enrolled, 241 (mean age 79.3 years, 44.4% men) presented with sarcopenia and were included in the analysis. Statin use was observed in 61 (25.3%) patients. Statin use was independently negatively associated with handgrip strength at discharge (β = -0.095, P = 0.032), but not with skeletal muscle mass index at discharge (β = 0.019, P = 0.692). CONCLUSIONS Statin use was negatively associated with muscle strength recovery, but not with muscle mass in patients with sarcopenia who underwent rehabilitation after stroke. To maximize outcomes, sufficient consideration is needed for statin use in these patients. Geriatr Gerontol Int 2023; 23: 676-683.
Collapse
Affiliation(s)
- Ayaka Matsumoto
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Yoshihiro Yoshimura
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Fumihiko Nagano
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Takahiro Bise
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Yoshifumi Kido
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Sayuri Shimazu
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Ai Shiraishi
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| |
Collapse
|
12
|
Wakisaka K, Matsuo R, Matsumoto K, Nohara Y, Irie F, Wakisaka Y, Ago T, Nakashima N, Kamouchi M, Kitazono T. Non-linear association between body weight and functional outcome after acute ischemic stroke. Sci Rep 2023; 13:8697. [PMID: 37248256 DOI: 10.1038/s41598-023-35894-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/25/2023] [Indexed: 05/31/2023] Open
Abstract
This study aimed to determine whether body weight is associated with functional outcome after acute ischemic stroke. We measured the body mass index (BMI) and assessed clinical outcomes in patients with acute ischemic stroke. The BMI was categorized into underweight (< 18.5 kg/m2), normal weight (18.5-22.9 kg/m2), overweight (23.0-24.9 kg/m2), and obesity (≥ 25.0 kg/m2). The association between BMI and a poor functional outcome (modified Rankin Scale [mRS] score: 3-6) was evaluated. We included 11,749 patients with acute ischemic stroke (70.3 ± 12.2 years, 36.1% women). The risk of a 3-month poor functional outcome was higher for underweight, lower for overweight, and did not change for obesity in reference to a normal weight even after adjusting for covariates by logistic regression analysis. Restricted cubic splines and SHapley Additive exPlanation values in eXtreme Gradient Boosting model also showed non-linear relationships. Associations between BMI and a poor functional outcome were maintained even after excluding death (mRS score: 3-5) or including mild disability (mRS score: 2-6) as the outcome. The associations were strong in older patients, non-diabetic patients, and patients with mild stroke. Body weight has a non-linear relationship with the risk of a poor functional outcome after acute ischemic stroke.
Collapse
Affiliation(s)
- Kayo Wakisaka
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryu Matsuo
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.
| | - Koutarou Matsumoto
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
- Biostatistics Center, Kurume University, Kurume, Japan
| | - Yasunobu Nohara
- Big Data Science and Technology, Faculty of Advanced Science and Technology, Kumamoto University, Kumamoto, Japan
| | - Fumi Irie
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Yoshinobu Wakisaka
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tetsuro Ago
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Naoki Nakashima
- Medical Information Center, Kyushu University Hospital, Fukuoka, Japan
| | - Masahiro Kamouchi
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| |
Collapse
|
13
|
Nagano F, Yoshimura Y, Matsumoto A, Sato Y, Abe T, Bise T, Kido Y, Shimazu S, Shiraishi A. Cut-off values for severe low muscle strength and skeletal muscle mass in post-acute patients with sarcopenia. Geriatr Gerontol Int 2023. [PMID: 37248662 DOI: 10.1111/ggi.14599] [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: 12/30/2022] [Revised: 04/18/2023] [Accepted: 04/29/2023] [Indexed: 05/31/2023]
Abstract
AIM This study aimed to calculate the cut-off values for severe decline in muscle strength and skeletal muscle mass in post-acute patients with sarcopenia and to determine their effect on activities of daily living. METHODS This retrospective cohort study included patients with sarcopenia consecutively admitted to a Japanese rehabilitation hospital between 2014 and 2016. Sarcopenia was diagnosed based on handgrip strength and skeletal muscle mass index. The outcome was the functional independence measure of motor function at discharge. Cut-off values for predicting severe decline in handgrip strength and skeletal muscle mass index were calculated separately by sex. Values below the cut-off were used to define severely low handgrip strength and severely low skeletal muscle mass index. RESULTS Overall, 451 patients (median age, 83 years; 61.4% women) were evaluated. The median functional independence measure of motor function score at discharge was 57. The optimal cut-off values for severely low handgrip strength were 9.0 kg for women and 14.6 kg for men, and those for severely low skeletal muscle mass index were 4.6 kg/m2 for women and 5.6 kg/m2 for men. Severely low handgrip strength and skeletal muscle mass index were independently associated with the functional independence measure of motor function score at discharge (β = -0.178, P = 0.005). CONCLUSIONS In post-acute patients with sarcopenia, a severe decline in muscle strength and skeletal muscle mass is further negatively associated with an improvement in activities of daily living. The cut-off values herein can serve as indicators to assess sarcopenia severity. Geriatr Gerontol Int 2023; ••: ••-••.
Collapse
Affiliation(s)
- Fumihiko Nagano
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Yoshihiro Yoshimura
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Ayaka Matsumoto
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Yoichi Sato
- Department of Rehabilitation, Uonuma Kikan Hospital, Niigata, Japan
| | - Takafumi Abe
- Department of Rehabilitation, Uonuma Kikan Hospital, Niigata, Japan
| | - Takahiro Bise
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Yoshifumi Kido
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Sayuri Shimazu
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Ai Shiraishi
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| |
Collapse
|
14
|
Honma K, Honda Y, Nagase M, Nakao Y, Harada T, Sasanuma N, Uchiyama Y, Kodama N, Domen K. Impact of skeletal muscle mass on functional prognosis in acute stroke: A cohort study. J Clin Neurosci 2023; 112:43-47. [PMID: 37062242 DOI: 10.1016/j.jocn.2023.04.006] [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: 01/10/2023] [Revised: 03/15/2023] [Accepted: 04/04/2023] [Indexed: 04/18/2023]
Abstract
INTRODUCTION Changes in skeletal muscle mass affect physical performance in chronic stroke survivors. The skeletal muscle mass index is thus an important assessment factor in stroke; however, its value in the acute phase is unclear. OBJECTIVE This study investigated the association between skeletal muscle mass and acute stroke outcome. DESIGN This was a single-center cohort study design. PARTICIPANTS A total of 189 consecutively hospitalized patients with acute stroke were included in the study. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The main outcome of the study was a good modified Rankin Scale (mRS) score at hospital discharge. We divided the participants into good (mRS score 0-2) and poor (mRS score 3-6) function groups. Logistic regression was performed to identify the factors associated with functional prognosis. RESULTS Atrial fibrillation (odds ratio [OR], 14.95; 95% confidence interval [CI], 2.45-91.39; P = 0.003), pre-mRS (OR, 2.22; 95% CI, 1.05-4.68; P = 0.036), National Institutes of Health Stroke Scale (OR, 1.32; 95% CI, 01.12-1.56; P = 0.001), skeletal muscle mass index (OR, 0.31; 95% CI, 0.11-0.87; P = 0.027), and Lower Extremity Fugl-Meyer Assessment (OR, 0.68; 95% CI, 0.56-0.82; P = 0.000) were all independently associated with the functional prognosis of the patients included in the study. CONCLUSION This study confirmed that skeletal muscle mass is a strong prognostic factor in acute stroke. Thus, prestroke skeletal muscle mass, along with stroke severity and lower limb paralysis, needs to be assessed to more accurately determine the prognosis of patients with stroke.
Collapse
Affiliation(s)
- Keisuke Honma
- Department of Rehabilitation, Hyogo Medical University Hospital, Nishinomiya, Hyogo, Japan
| | - Yosuke Honda
- Department of Rehabilitation, Hyogo Medical University Hospital, Nishinomiya, Hyogo, Japan
| | - Masahiro Nagase
- Department of Rehabilitation, Hyogo Medical University Hospital, Nishinomiya, Hyogo, Japan
| | - Yuta Nakao
- Department of Rehabilitation Therapy, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Tetsuya Harada
- Department of Rehabilitation, Hyogo Medical University Hospital, Nishinomiya, Hyogo, Japan
| | - Naoki Sasanuma
- Department of Rehabilitation, Hyogo Medical University Hospital, Nishinomiya, Hyogo, Japan
| | - Yuki Uchiyama
- Department of Rehabilitation Medicine, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Norihiko Kodama
- Department of Rehabilitation Medicine, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo Medical University, Nishinomiya, Hyogo, Japan.
| |
Collapse
|
15
|
Gungor L, Arsava EM, Guler A, Togay Isikay C, Aykac O, Batur Caglayan HZ, Kozak HH, Aydingoz U, Topcuoglu MA. Determinants of in-hospital muscle loss in acute ischemic stroke - Results of the Muscle Assessment in Stroke Study (MASS). Clin Nutr 2023; 42:431-439. [PMID: 36805095 DOI: 10.1016/j.clnu.2023.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/10/2023] [Accepted: 01/23/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND & AIMS There is a change in the mass and composition of paretic and non-paretic skeletal muscles in the chronic phase of stroke. The multi-center, prospective, and observational Muscle Assessment in Stroke Study (MASS) was performed to evaluate the degree of muscle loss during the in-hospital acute stroke setting and determine factors contributing to this loss. METHODS Acute dysphagic ischemic stroke patients (n = 107) admitted to neuro-intensive care units were evaluated by computed tomography on days 1 and 14 after admission to determine the cross-sectional muscle area (CSMA) at the level of the mid-humerus, mid-thigh, and third lumbar vertebra. The percentage change in CSMA and variables associated with this change were evaluated by univariate and multivariate analyses. RESULTS There were significant reductions in CSMA in all the muscle groups analyzed; the most prominent change was observed in the arms (both: 14.2 ± 10.7%; paretic: 17.7 ± 11.6%; non-paretic: 10.1 ± 12.5%), followed by the muscles in the legs (both: 12.4 ± 8.7%; paretic: 12.9 ± 9.9%; non-paretic: 12.0 ± 9.3%) and L3-vertebra level (5.6 ± 9.8%) (P < 0.001 for all). Higher calorie (r = -0.378, P < 0.001) or protein (r = -0.352, P < 0.001) intake was negatively associated with the decrease in CSMA of upper extremities. A substantial protein (≥0.4 g/kg/d) or calorie (≥5 kcal/kg/d) gap between targeted or actual intake was related to a larger decrease in CSMA in all the anatomic regions (P ≤ 0.05 for all). Other significant predictors of muscle loss included history of diabetes mellitus, male sex, higher BMI, in-hospital infections, and the necessity for invasive mechanical ventilation. CONCLUSIONS There is a considerable degree of loss in the global muscle mass in acute ischemic stroke patients over a two-week period. Along with several factors, falling significantly behind the daily protein or calorie targets was related to the decrease in the muscle area. TRIAL REGISTRATION INFORMATION: clinicaltrials.gov identifier NCT03825419.
Collapse
Affiliation(s)
- Levent Gungor
- Department of Neurology, Ondokuz Mayis University, Samsun, Turkey
| | | | - Ayse Guler
- Department of Neurology, Ege University, Izmir, Turkey
| | | | - Ozlem Aykac
- Department of Neurology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | | | | | - Ustun Aydingoz
- Department of Radiology, Hacettepe University, Ankara, Turkey
| | | |
Collapse
|
16
|
Abe T, Yoshimura Y, Sato Y, Nagano F, Matsumoto A. Validity of sarcopenia diagnosis defined by calf circumference for muscle mass to predict functional outcome in patients with acute stroke. Arch Gerontol Geriatr 2023; 105:104854. [PMID: 36370655 DOI: 10.1016/j.archger.2022.104854] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/23/2022] [Accepted: 11/03/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study examined the association between sarcopenia diagnosed by defining muscle mass with calf circumference and physical function at hospital discharge in patients with acute stroke and to perform a comparison with sarcopenia diagnosis according to the Asian Working Group for Sarcopenia. RESEARCH METHODS & PROCEDURES This retrospective cohort study included patients with acute stroke. We calculated the calf circumference cut-off value defining low skeletal muscle index for the Asian Working Group for Sarcopenia diagnostic criteria and used a combination of low calf circumference and low grip strength to define sarcopenia-calf circumference. A combination of low skeletal muscle index and low grip strength defined sarcopenia-Asian Working Group for Sarcopenia. Associations between sarcopenia-calf circumference, sarcopenia-Asian Working Group for Sarcopenia, and Functional Independence Measure motor score were evaluated using multiple regression analysis. RESULTS The study included 308 patients (198 men; mean age, 73.2 years). Sarcopenia-calf circumference prevalence was 24.7% in men and 46.4% in women. In men, sarcopenia-calf circumference (β=-0.178; 95% CI: -0.284, -0.073; p=0.001) and sarcopenia-Asian Working Group for Sarcopenia (β=-0.228; 95% CI: -0.330, -0.127; p<0.001) were significantly associated with Functional Independence Measure motor score at discharge. CONCLUSIONS Sarcopenia diagnosed by defining muscle mass with calf circumference was negatively associated with physical function at discharge in male patients with acute stroke. Sarcopenia diagnosed using Asian Working Group for Sarcopenia criteria was superior to sarcopenia-calf circumference for predicting physical function at discharge. Our findings suggest that the use of CC enables assessment of sarcopenia even at facilities where muscle mass measurements may be difficult.
Collapse
Affiliation(s)
- Takafumi Abe
- Department of Rehabilitation, Uonuma Kikan Hospital, 4132, Urasa, Minamiuonuma City, Niigata, 949-7302, Japan
| | - Yoshihiro Yoshimura
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, 760 Magate, Kikuyo Town, Kikuchi County, Kumamoto, 869-1106, Japan.
| | - Yoichi Sato
- Department of Rehabilitation, Uonuma Kikan Hospital, 4132, Urasa, Minamiuonuma City, Niigata, 949-7302, Japan
| | - Fumihiko Nagano
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, 760 Magate, Kikuyo Town, Kikuchi County, Kumamoto, 869-1106, Japan
| | - Ayaka Matsumoto
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, 760 Magate, Kikuyo Town, Kikuchi County, Kumamoto, 869-1106, Japan
| |
Collapse
|
17
|
Combination of High Energy Intake and Intensive Rehabilitation Is Associated with the Most Favorable Functional Recovery in Acute Stroke Patients with Sarcopenia. Nutrients 2022; 14:nu14224740. [PMID: 36432427 PMCID: PMC9694182 DOI: 10.3390/nu14224740] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/03/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022] Open
Abstract
Energy intake and rehabilitation time individually contribute to the improvement of activities of daily living (ADL). This study aimed to investigate the additive effect of energy intake and rehabilitation time on ADL improvement in acute stroke patients with sarcopenia. The study included 140 patients (mean age 82.6 years, 67 men) with stroke. Energy intake during the first week of hospitalization was classified as “Sufficiency” or “Shortage” based on the reported cutoff value and rehabilitation time was classified as “Long” or “Short” based on the median. The study participants were categorized into four groups based on the combination of energy intake and rehabilitation time. The primary outcome was the gain of functional independence measure (FIM) motor during hospitalization. The secondary outcomes were length of stay and home discharge rates. Multivariate analysis was performed with primary/secondary outcomes as the dependent variable, and the effect of each group on the outcome was examined. Multivariate analysis showed that “long rehabilitation time and sufficient energy intake” (β = 0.391, p < 0.001) was independently associated with the gain of FIM motor items. The combination of high energy intake and sufficient rehabilitation time was associated with ADL improvement in acute stroke patients with sarcopenia.
Collapse
|
18
|
Luo Y, Li Y, Dong S, Fang J, Liu Y, Hong Y, Bao J, He L. Development and validation of a prognostic nomogram based on objective nutritional indexes in ischemic stroke patients with large vessel occlusion undergoing endovascular thrombectomy. Nutr Metab Cardiovasc Dis 2022; 32:1903-1912. [PMID: 35606225 DOI: 10.1016/j.numecd.2022.03.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/14/2022] [Accepted: 03/29/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND AIMS Preserved nutritional status in acute ischemic stroke patients with large vessel occlusion (LVO) undergoing endovascular thrombectomy (EVT) is important but lacks an effective evaluation method. We aimed to investigate the prognostic value of objective nutritional indexes (ONIs) in LVO patients after EVT that were validated by studies in patients with other vascular diseases receiving intervention therapy and to develop a functional prediction nomogram for better stroke management. METHODS AND RESULTS LVO patients undergoing EVT from 2016 to 2020 were retrospectively enrolled and randomly classified into training and validation cohorts at a ratio of 7:3. The ONIs, including the Controlling Nutritional Status (CONUT) score, Nutritional Risk Index (NRI), and Prognostic Nutritional Index (PNI), were calculated. A stepwise logistic regression model for 3-month poor functional outcome based on the smallest Akaike information criterion was employed to develop the nomogram, and the nomogram's determination and clinical use were tested by area under the curve (AUC), calibration plots, and decision curve analysis and compared with three earlier prognostic models. A total of 418 patients were enrolled. The CONUT independently related and increased the risk of 3-month poor functional outcome with an OR of 1.387 (95% CI: 1.133-1.698, p = 0.002). A nomogram including CONUT and other seven factors (AIC = 274.568) was developed. The AUC of the nomogram was 0.847 (95% CI: 0.799-0.894) and 0.836 (95% CI: 0.755-0.916) in the training and validation cohort, respectively, with better predictive performance and clinical utility than previous models. CONCLUSION The CONUT independently related to the poor functional outcome, and the newly established nomogram reliably predicted the functional outcome in LVO patients after EVT.
Collapse
Affiliation(s)
- Yaxi Luo
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yanbo Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Shuju Dong
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Jinghuan Fang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yanqin Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Ye Hong
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Jiajia Bao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Li He
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
| |
Collapse
|
19
|
Relationship Between Trunk Muscle Mass and Activities of Daily Living at Discharge in Acute Stroke Patients. Nutrition 2022; 103-104:111833. [DOI: 10.1016/j.nut.2022.111833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 08/01/2022] [Accepted: 08/12/2022] [Indexed: 11/24/2022]
|
20
|
Sato Y, Yoshimura Y, Abe T, Nagano F, Matsumoto A. Impact of trunk and appendicular skeletal muscle mass on improving swallowing function in acute stroke patients. J Stroke Cerebrovasc Dis 2022; 31:106636. [PMID: 35914513 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106636] [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: 05/19/2022] [Revised: 06/20/2022] [Accepted: 06/30/2022] [Indexed: 10/16/2022] Open
Abstract
OBJECTIVES To investigate the effect of trunk and appendicular skeletal muscle mass on the swallowing function at discharge in acute stroke patients. MATERIALS AND METHODS This retrospective cohort study included patients hospitalized after acute strokes. Skeletal muscle mass was measured by bioelectrical impedance analysis within 5 days of admission. The primary outcome was swallowing function at acute hospital discharge, assessed using the Functional Oral Intake Scale (FOIS). Secondary outcomes were Functional Independence Measure-eating (FIM-eating) scores and length of hospital stay. RESULTS Data from 231 patients (age 72.2 years; 151 men) were included in the analysis. The median trunk muscle mass index (TMI) was 8.2 and 6.8 kg/m2 in men and women, respectively. The median appendicular skeletal muscle mass index (ASMI) was 7.7 and 5.7 kg/m2 in men and women, respectively. The high TMI group had higher FIM-eating scores at discharge in each sex (p < 0.001). The high ASMI group had higher FOIS (p = 0.039 and 0.048) and FIM-eating scores at discharge (p = 0.046 and 0.047) in men and women, respectively. On multivariate analysis, TMI was independently associated with FIM-eating scores (β = 0.330, p < 0.001); ASMI was independently associated with FOIS (β = 0.229, p = 0.039) and FIM-eating scores (β = 0.111, p = 0.032). CONCLUSIONS Skeletal muscle mass had site-specific impacts on swallowing function and eating activities. This finding may contribute to the design of more individualized rehabilitation programs.
Collapse
Affiliation(s)
- Yoichi Sato
- Department of Rehabilitation, Uonuma Kikan Hospital, Minamiuonuma, Japan
| | - Yoshihiro Yoshimura
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, 760 Magate, Kikuyo-machi, Kikuchi-gun, Kumamoto 869-1106, Japan.
| | - Takafumi Abe
- Department of Rehabilitation, Uonuma Kikan Hospital, Minamiuonuma, Japan
| | - Fumihiko Nagano
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, 760 Magate, Kikuyo-machi, Kikuchi-gun, Kumamoto 869-1106, Japan
| | - Ayaka Matsumoto
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, 760 Magate, Kikuyo-machi, Kikuchi-gun, Kumamoto 869-1106, Japan
| |
Collapse
|
21
|
Nozoe M, Noguchi M, Kubo H, Kanai M, Shimada S. Association between the coexistence of premorbid sarcopenia, frailty, and disability and functional outcome in older patients with acute stroke. Geriatr Gerontol Int 2022; 22:642-647. [PMID: 35848637 DOI: 10.1111/ggi.14432] [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: 04/21/2022] [Revised: 05/26/2022] [Accepted: 06/14/2022] [Indexed: 11/29/2022]
Abstract
AIM To investigate the effects of coexisting conditions such as premorbid sarcopenia, frailty, and disability on functional outcomes in older patients with acute stroke. METHODS This prospective cohort study included older patients (aged ≥65 years) hospitalized for acute stroke at a single neurosurgical hospital. Premorbid sarcopenia, frailty, and disability were diagnosed using the strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC-F) questionnaire, frailty index, and modified Rankin Scale (mRS) on admission. The primary outcome was the mRS score 3 months after stroke, and a poor outcome was defined as mRS ≥4. RESULTS This study included 317 older patients with acute stroke (median [interquartile range] age: 76 [12] years). Premorbid sarcopenia, frailty, and disability (mRS = 2 or 3) were identified in 59 (19%), 27 (9%), and 54 (17%) patients, respectively. Two coexisting conditions were observed in 26 patients (8%), and three were observed in 18 patients (6%). Adjusted logistic regression analysis revealed that coexisting conditions were independently associated with poor outcomes (one condition, adjusted OR: 3.20 [95%CI: 0.98-10.45]; two conditions, adjusted OR: 6.57 [95%CI: 1.74-24.87]; three conditions, adjusted OR: 12.70 [95%CI: 2.65-60.91]). CONCLUSIONS The coexistence of premorbid sarcopenia, frailty, and disability was associated with poor functional outcomes in older patients with acute stroke. Geriatr Gerontol Int 2022; ••: ••-••.
Collapse
Affiliation(s)
- Masafumi Nozoe
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, Kobe, Japan
| | - Madoka Noguchi
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Hiroki Kubo
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Masashi Kanai
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, Kobe, Japan
| | - Shinichi Shimada
- Department of Neurosurgery, Itami Kousei Neurosurgical Hospital, Itami, Japan
| |
Collapse
|
22
|
Choi JH, Seo JW, Lee MY, Lee YT, Yoon KJ, Park CH. Association between Elevated Plasma Homocysteine and Low Skeletal Muscle Mass in Asymptomatic Adults. Endocrinol Metab (Seoul) 2022; 37:333-343. [PMID: 35144330 PMCID: PMC9081311 DOI: 10.3803/enm.2021.1202] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/02/2021] [Accepted: 11/29/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Homocysteine has been drawing attention with a closed linkage with skeletal muscle. However, the association of hyperhomocysteinemia with decreased skeletal muscle mass remains unclear. We aimed to investigate the association of hyperhomocysteinemia with low skeletal muscle mass (LMM) in asymptomatic adults. METHODS This was a cross-sectional study of 114,583 community-dwelling adults without cancer, stroke, or cardiovascular diseases who underwent measurements of plasma homocysteine and body composition analysis from 2012 to 2018. Hyperhomocysteinemia was defined as >15 μmol/L. Skeletal muscle mass index (SMI) was calculated based on appendicular muscle mass (kg)/height (m)2. Participants were classified into three groups based on SMI: "normal," "mildly low," and "severely low." RESULTS The prevalence of hyperhomocysteinemia was the highest in subjects with severely LMM (12.9%), followed by those with mildly LMM (9.8%), and those with normal muscle mass (8.5%) (P for trend <0.001). In a multivariable logistic regression model, hyperhomocysteinemia was significantly associated with having a mildly LMM (odds ratio [OR], 1.305; 95% confidence interval [CI], 1.224 to 1.392) and severely LMM (OR, 1.958; 95% CI, 1.667 to 2.286), respectively. One unit increment of log-transformed homocysteine was associated with 1.360 and 2.169 times higher risk of having mildly LMM and severely LMM, respectively. CONCLUSION We demonstrated that elevated homocysteine has an independent association with LMM in asymptomatic adults, supporting that hyperhomocysteinemia itself can be a risk for decline in skeletal musculature.
Collapse
Affiliation(s)
- Jae-Hyeong Choi
- Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin-Woo Seo
- Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mi-Yeon Lee
- Division of Biostatistics, Department of R&D Management, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong-Taek Lee
- Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Jae Yoon
- Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- Medical Research Institute, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chul-Hyun Park
- Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- Medical Research Institute, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
23
|
Bise T, Yoshimura Y, Wakabayashi H, Nagano F, Kido Y, Shimazu S, Shiraishi A, Matsumoto A. Association between BIA-derived Phase Angle and Sarcopenia and Improvement in Activities of Daily Living and Dysphagia in Patients undergoing Post-Stroke Rehabilitation. J Nutr Health Aging 2022; 26:590-597. [PMID: 35718868 DOI: 10.1007/s12603-022-1803-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To investigate the predictive value of the BIA-derived phase angle with respect to the functional prognosis and baseline sarcopenia in patients undergoing post-stroke rehabilitation. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS Overall, 577 Japanese patients admitted to a post-acute care hospital from 2016 to 2020 were recruited. MEASUREMENTS Body composition analysis, which included BIA-derived phase angle and skeletal muscle mass, was performed using bioelectrical impedance analysis (BIA). Study outcomes included physical function assessed using the Functional Independence Measure (FIM-motor) and the level of dysphagia assessed using the Food Intake LEVEL Scale (FILS). Sarcopenia was defined as the loss of skeletal muscle mass and decreased muscle strength. Receiver operating characteristic curves were used to calculate the optimal cutoff value of BIA-derived phase angle to diagnose sarcopenia. Multivariate analyses were used to determine whether the BIA-derived phase angle at admission was associated with outcomes at discharge and baseline sarcopenia. RESULTS After enrollment, 499 patients (mean age: 74.0 ± 13.1 years; 52.0% men) were examined. The median FIM-motor and FILS scores at admission were 47 (20-69) and 8 (7-10), respectively. Sarcopenia was observed in 43.2% of patients. After adjusting for potential confounders, BIA-derived phase angle was positively associated with FIM-motor scores at discharge (β = 0.134, P < 0.001), FIM-motor score gain (β = 2.504, P < 0.001), and FILS scores at discharge (β = 0.120, P = 0.039). BIA-derived phase angle was negatively associated with the sarcopenia diagnosis at baseline (odds ratio = -0.409, P < 0.001); its cutoff value was 4.76° (sensitivity 0.800, specificity 0.790, P < 0.001) for sarcopenia diagnosis in men and 4.11° (sensitivity 0.735, specificity 0.829, P < 0.001) in women. CONCLUSION BIA-derived phase angle was positively associated with the recovery of physical function and dysphagia level and negatively associated with baseline sarcopenia in patients undergoing post-stroke rehabilitation. The BIA-derived phase angle cutoff for sarcopenia diagnosis was 4.76° for men and 4.11° for women.
Collapse
Affiliation(s)
- T Bise
- Yoshihiro Yoshimura, Kumamoto Rehabilitation Hospital, Kikuchi, Kumamoto, Japan,
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Abe T, Yoshimua Y, Imai R, Sato Y. A Combined Assessment Method of Phase Angle and Skeletal Muscle Index to Better Predict Functional Recovery after Acute Stroke. J Nutr Health Aging 2022; 26:445-451. [PMID: 35587756 DOI: 10.1007/s12603-022-1777-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES We aimed to investigate whether combination assessment of phase angle (PhA) and skeletal muscle index (SMI), was a possible predictor of physical function at discharge from the hospital in patients with acute stroke. RESEARCH METHODS AND PROCEDURES In this retrospective cohort study that was conducted from May 2020 and July 2021, we determined PhA and SMI using bioimpedance analysis (BIA) in patients with acute stroke. Patients were classified as normal, low PhA + SMI group, pre-sarcopenia (low SMI only), and dynapenia (low PhA only) using cut-off points (men: SMI < 7.0 kg/m2, PhA < 4.05 degrees; women: SMI < 5.7 kg/m2, PhA < 3.55 degrees). The main outcome was physical function based on functional independence measure motor (FIM-motor) score at discharge. Multiple regression analysis was used to determine the association between low PhA + SMI and FIM-motor score. RESULTS We included 244 patients (161 men; mean age, 73.9 years). low PhA + SMI was found in 21 (8.6%) patients. Multiple regression analysis showed that low PhA + SMI was independently associated with the FIM-motor score at discharge (β= -0.099, 95%CI: -0.193,-0.005, p = 0.039). The PhA cutoff values for determining good functional results using receiver operating characteristic (ROC) curves were 5.36 for men (sensitivity = 0.769, specificity = 0.586, area under the curve [AUC] = 0.682), and 3.85 for women (sensitivity = It was 0.881, specificity = 0.481, AUC). Further, pearson correlation coefficient showed that PhA was significantly related to FIM-motor score in patients with mild or moderately severe stroke (mild: r = 0.472, p < 0.001; moderate: r = 0.524, p < 0.001). CONCLUSIONS Combination of low PhA and SMI values at baseline, was an independent predictor of physical function at discharge in patients with acute stroke. The findings highlighted the importance of measuring PhA and SMI using BIA in patients with acute stroke.
Collapse
Affiliation(s)
- T Abe
- Yoshihiro Yoshimura, Kumamoto Rehabilitation Hospital, Kikuchi, Kumamoto Japan,
| | | | | | | |
Collapse
|
25
|
Nozoe M, Kubo H, Kanai M, Yamamoto M. Relationships between Pre-Stroke SARC-F Scores, Disability, and Risk of Malnutrition and Functional Outcomes after Stroke-A Prospective Cohort Study. Nutrients 2021; 13:nu13103586. [PMID: 34684587 PMCID: PMC8537569 DOI: 10.3390/nu13103586] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/30/2021] [Accepted: 10/09/2021] [Indexed: 12/24/2022] Open
Abstract
SARC-F is a screening tool for sarcopenia; however, it has not yet been established whether SARC-F scores predict functional outcomes. Therefore, we herein investigated the relationship between SARC-F scores and functional outcomes in stroke patients. The primary outcome in the present study was the modified Rankin Scale (mRS) 3 months after stroke. The relationship between SARC-F scores and poor functional outcomes was examined using a logistic regression analysis. Furthermore, the applicability of SARC-F scores to the assessment of poor functional outcomes was analyzed based on the area under the receiver operating curve (ROC). Eighty-one out of the 324 patients enrolled in the present study (25%) had poor functional outcomes (mRS ≥ 4). The results of the multivariate analysis revealed a correlation between SARC-F scores (OR = 1.29, 95% CI = 1.05–1.59, p = 0.02) and poor functional outcomes. A cut-off SARC-F score ≥ 4 had low-to-moderate sensitivity (47.4%) and high specificity (87.3%). The present results suggest that the measurement of pre-stroke SARC-F scores is useful for predicting the outcomes of stroke patients.
Collapse
Affiliation(s)
- Masafumi Nozoe
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women’s University, Kobe 658-0001, Japan;
- Correspondence: ; Tel.: +81-78-413-3584
| | - Hiroki Kubo
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami 664-0028, Japan; (H.K.); (M.Y.)
| | - Masashi Kanai
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women’s University, Kobe 658-0001, Japan;
| | - Miho Yamamoto
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami 664-0028, Japan; (H.K.); (M.Y.)
| |
Collapse
|
26
|
Abe T, Yoshimura Y, Imai R, Yoneoka Y, Tsubaki A, Sato Y. Impact of Phase Angle on Physical Function in Patients with Acute Stroke. J Stroke Cerebrovasc Dis 2021; 30:105941. [PMID: 34217068 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105941] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/27/2021] [Accepted: 06/03/2021] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Phase angle, an assessment of muscle quality, might be a possible predictor of physical function in patients with an acute stroke; however, the evidence for the same is limited. Therefore, this study aimed to investigate whether phase angle is associated with improved physical function at discharge. METHODS In this observational cohort study, we determined the phase angle in patients with an acute stroke using a portable, noninvasive multifrequency bio-impedance device. The primary objective was the assessment of physical function using the Functional Independence Measure motor (FIM-motor) at discharge in the acute phase. The secondary outcome was home discharge. Multiple regression analysis was used to determine the association between phase angle, FIM-motor score, and home discharge. RESULTS The study included 129 patients (78 men; mean age 75.2 years). Multiple linear regression analysis showed that the phase angle was independently associated with FIM-motor score at discharge in all models (Model 1: β= 0.27, p < 0.001; Model 2: β = 0.234, p < 0.001; Model 3: β = 0.201, p = 0.017). However, multiple logistic regression analysis showed that the phase angle was not associated with home discharge (p = 0.464). CONCLUSIONS The phase angle at the onset of a stroke, is an independent predictor of physical function at discharge in the acute phase. Our findings highlight the importance of determining the phase angle in patients with an acute stroke.
Collapse
Affiliation(s)
- Takafumi Abe
- Department of Rehabilitation, Uonuma Kikan Hospital, 4132 Urasa, Minami Uonuma, Niigata 949-7302, Japan
| | - Yoshihiro Yoshimura
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, 760 magarite, kikuchi-gun kikuyou-cho, Kumamoto 869-1106, Japan.
| | - Ryota Imai
- Department of Rehabilitation, Uonuma Kikan Hospital, 4132 Urasa, Minami Uonuma, Niigata 949-7302, Japan
| | - Yuichiro Yoneoka
- Department of Neurosurgery, Uonuma Kikan Hospital, 4132 Urasa, Minami Uonuma, Niigata 949-7302, Japan
| | - Atsuhiro Tsubaki
- Graduate School of Health and Welfare, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata 950-3198, Japan
| | - Yoichi Sato
- Department of Rehabilitation, Uonuma Kikan Hospital, 4132 Urasa, Minami Uonuma, Niigata 949-7302, Japan
| |
Collapse
|
27
|
Nakanishi N, Okura K, Okamura M, Nawata K, Shinohara A, Tanaka K, Katayama S. Measuring and Monitoring Skeletal Muscle Mass after Stroke: A Review of Current Methods and Clinical Applications. J Stroke Cerebrovasc Dis 2021; 30:105736. [PMID: 33756264 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105736] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/16/2021] [Accepted: 02/28/2021] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES Muscle mass at admission is important to survive stroke, and stroke-induced sarcopenia is a serious problem because of its poor prognosis. Muscle mass measurement and monitoring are essential for appropriate rehabilitation and nutrition management. However, few reviews are available about the muscle mass measurement and monitoring after stroke. MATERIAL AND METHODS Several methods are used to assess skeletal muscle mass in stroke, such as computed tomography (CT), ultrasound, bioelectrical impedance analysis, dual-energy X-ray absorptiometry, biomarkers, and anthropometrics. We summarized the current methods and clinical applications in stroke. RESULTS In stroke, a head CT is used to estimate muscle mass by measuring the temporal muscle. However, it can be conducted retrospectively due to radiation exposure. After stroke, limb muscle atrophy and diaphragm dysfunction are observed using ultrasound. However, ultrasound requires an understanding of the methods and skill. A bioelectrical impedance analysis can be used to assess muscle mass in patients after a stroke unless they have dynamic fluid changes. Dual-energy X-ray absorptiometry is used for follow-up after hospital discharge. Urinary titin N-fragment and serum C-terminal agrin fragment reflect muscle atrophy after stroke. Anthropometrics may be useful with limited resources. CONCLUSIONS We summarized the features of each measurement and proved the recent evidence to properly measure and monitor skeletal muscle mass after stroke.
Collapse
Affiliation(s)
- Nobuto Nakanishi
- Emergency and Critical Care Medicine, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima 770-8503, Japan.
| | - Kazuki Okura
- Department of Rehabilitation, Akita University Hospital, 44-2 Hasunuma, Aza, Hiroomote, Akita 010-8543, Japan
| | - Masatsugu Okamura
- Department of Rehabilitation, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa, Yokohama, Kanagawa 236-0004, Japan
| | - Keishi Nawata
- Department of Rehabilitation, University Hospital of Occupational and Environmental Health, 1-1 Iseigaoka, Yahata-nishi, Kitakyushu, Fukuoka 807-8556, Japan
| | - Ayato Shinohara
- Department of Rehabilitation, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi 470-1192, Japan
| | - Kohei Tanaka
- Department of Rehabilitation Medicine, Osaka Police Hospital, 10-31 Kitayama, Tennouji, Osaka 543-0035, Japan
| | - Sho Katayama
- Department of Rehabilitation Medicine, Okayama University Hospital, 2-5-1 shikata, Kitaku, Okayama 700-8558, Japan
| |
Collapse
|
28
|
Nutrition in the First Week after Stroke Is Associated with Discharge to Home. Nutrients 2021; 13:nu13030943. [PMID: 33804072 PMCID: PMC8001465 DOI: 10.3390/nu13030943] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/12/2021] [Accepted: 03/12/2021] [Indexed: 02/07/2023] Open
Abstract
Malnutrition is associated with poor clinical outcomes in stroke patients. The effect of early nutritional intake after admission on home discharge is unclear. We evaluated the impact of energy intake in the first week of hospitalization of acute stroke patients on home discharge and activities of daily living (ADL). A retrospective cohort study was conducted with 201 stroke patients admitted to an acute care hospital in Japan. The energy and protein intake during the first week were evaluated. Multivariate models were used to estimate variables related to discharge destination and ADL at discharge. The cut-off point of nutritional intake for determining the discharge destination was evaluated using the receiver operating characteristic curve. Out of 163 patients included in the analysis, 89 (54.6%) and 74 (45.4%) were discharged home and elsewhere, respectively. Those discharged home had higher energy and protein intake than those discharged elsewhere. In multiple regression analysis, energy intake was independently associated with ADL at discharge and home discharge (odds ratio 1.146). Those with energy intake >20.7 kcal/kg/day had higher ADL at discharge and more patients discharged home than those with energy intake <20.7 kcal/kg/day. Energy intake during the first week affected home discharge in acute stroke patients.
Collapse
|
29
|
Nozoe M, Kubo H, Kanai M, Yamamoto M, Okakita M, Suzuki H, Shimada S, Mase K. Reliability and validity of measuring temporal muscle thickness as the evaluation of sarcopenia risk and the relationship with functional outcome in older patients with acute stroke. Clin Neurol Neurosurg 2021; 201:106444. [PMID: 33395619 DOI: 10.1016/j.clineuro.2020.106444] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Pre-stroke sarcopenia associated with poor functional outcomes. However, diagnosis of pre-stroke sarcopenia is often difficult in patients with acute stroke. Thus, we investigated the reliability and validity of measuring temporal muscle thickness (TMT) as an indicator of sarcopenia risk and its relationship with functional outcome in older patients with acute stroke. METHODS We conducted a cross-sectional and longitudinal study of the patients with acute elderly stroke in a single neurosurgical hospital. We measured TMT manually using brain computed tomography (CT) by two examiners. Sarcopenia risk, malnutrition risk, inflammation, comorbidities, and modified Rankin Scale (mRS) scores at 3 months after stroke were additionally assessed. Inter-rater reliability of TMT was determined by calculating the intra-class correlation coefficient ([ICC] 2,1). Multiple linear regression analyses was used to determine whether sarcopenia risk was independently associated with TMT, and logistic regression was used to evaluate the relationship between TMT and poor functional outcome (mRS > 3). RESULTS A total 289 acute elderly stroke patients (163 men and 126 women; mean age: 76 years) were enrolled in this study. Regarding the reproducibility of TMT, good reliability was found; ICC2,1 = 0.759 (95 % confidence interval = 0.705-0.804). Multiple linear regression analyses for TMT after adjusting for potential confounders showed that sarcopenia risk was independently associated with TMT in older patients with acute stroke (β = -0.138, p = 0.02). After adjusting for variables, disease severity and comorbidities were the only independent predictors for poor functional outcome, but not TMT. CONCLUSIONS TMT measurement using brain CT is a reliable and variable method to evaluate sarcopenia risk, but is not related to functional outcome in older patients with acute stroke.
Collapse
Affiliation(s)
- Masafumi Nozoe
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, Kobe, Japan.
| | - Hiroki Kubo
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Masashi Kanai
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, Kobe, Japan
| | - Miho Yamamoto
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Masaki Okakita
- Department of Radiology, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Hidetsugu Suzuki
- Department of Radiology, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Shinichi Shimada
- Department of Neurosurgery, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Kyoshi Mase
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, Kobe, Japan
| |
Collapse
|