Body composition in older acute stroke patients after treatment with individualized, nutritional supplementation while in hospital

Abstract

Background: Individualized, nutritional support reduced undernutrition among older stroke patients and improved quality of life in our recent randomized, controlled trial. Weight control thus seems to be important after stroke, and methods for monitoring nutritional status need to be simple and non-invasive. Here we aimed to assess if the nutritional intervention altered body composition in men and women in this study cohort, and also to examine the correlation between the methods for assessing body-, fat- and fat-free mass.

Methods: Acute stroke patients > 65 years at nutritional risk were randomized to either individualized, nutritional treatment with energy- and protein rich supplementation (intervention, n = 58) or routine, nutritional care (control, n = 66) while in hospital. Body composition was assessed with anthropometry and bioelectrical impedance. The follow-up period was three months.

Results: During the first week while in hospital, weight loss was smaller in the intervention group compared with the controls (P = 0.013). After three months weight- and fat loss were significant in both men and women. Whereas no significant differences were found in changes in body composition between the male study groups, in the women both weight loss (P = 0.022) and fat loss (P = 0.005) was smaller in the intervention group compared with the controls. A high correlation (r = 0.87) between mid upper arm circumference (MUAC) and body mass index (BMI) was found.

Conclusions: Individualized nutritional support to older stroke patients in hospital was beneficial for maintaining an adequate body mass and body composition the first week and seemed to have a preventive effect on fat loss among women, but not among men after three months. Measurement of MUAC may be used in the assessment of nutritional status when BMI cannot be obtained.

Trial registration: This trial is registered with ClinicalTrials.gov, number NCT00163007.

Figure 1

Change (mean ± SEM) in anthropometry during the first week after study inclusion in the study groups. ∆: Change. *Significantly different between the groups; **Significant change from baseline.

Figure 2

Scatterplot of paired values for baseline BMI and baseline MUAC. The corresponding Pearson correlation coefficient was r = 0.87 for all patients (n = 157), and r = 0.91 for women and r = 0.88 for men.

Figure 3

Receiver operating characteristic (ROC) curve. For each cut-off point for mid-upper arm circumference (MUAC) as a test to distinguish between BMI ≤ 20 kg/m² and BMI > 20 kg/m², the values for the sensitivity and 1-specificity is plotted. Area under the curve (AUC) = 0.95 (P < 0.001).