Relationship between Nutritional Status, Food Consumption and Sarcopenia in Post-Stroke Rehabilitation: Preliminary Data

Abstract

After a stroke, patients can suffer from sarcopenia, which can affect recovery. This could be closely related to an impairment in nutritional status. In this preliminary analysis of a longitudinal prospective study, we screened 110 subjects admitted to our rehabilitation center after a stroke. We then enrolled 61 patients, who underwent a 6-week course of rehabilitation treatment. We identified a group of 18 sarcopenic patients (SG), according to the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), by evaluating muscle strength with the handgrip test, and muscle mass with bioelectrical impedance analysis (BIA). With respect to the non-sarcopenic group (NSG), the SG at admission (T0) had worse muscle quality, according to the BIA-derived phase angle, and a lower score of MNA®-SF. In contrast to the NSG, the SG also exhibited lower values for both BMI and the Geriatric Nutritional Risk Index (GNRI) at T0 and T1. Moreover, 33% of the SG had a major risk of nutrition-related complications (GNRI at T0 < 92) and discarded on average more food during the six weeks of rehabilitation (about one-third of the average daily plate waste). Of note is the fact that the Barthel Index’s change from baseline indicated that the SG had a worse functional recovery than the NGS. These results suggest that an accurate diagnosis of sarcopenia, along with a proper evaluation of the nutritional status on admission to rehabilitation centers, appears strictly necessary to design individual, targeted physical and nutritional intervention for post-stroke patients, to improve their ability outcomes.

Keywords: Geriatric Nutritional Risk Index; bioelectrical impedance analysis; food consumption; functional recovery; malnutrition: nutrition; nutritional intake; plate waste; post-stroke; rehabilitation; sarcopenia.

Figure 1

EWGSOP2 algorithm for case finding and diagnosis of sarcopenia at baseline in the sample group. Patients enrolled (n = 61) were assessed by handgrip test and the diagnosis in patients with probable sarcopenia (n = 32) was confirmed by muscle-quantity assessment using bioelectrical impedance analysis (BIA), identifying a Sarcopenic Group (SG) of 18 subjects and a Non-Sarcopenic Group (NSG) of 43 subjects.

Figure 2

Distribution of the change from baseline of the modified Barthel Index (ΔBI) after 6 weeks of rehabilitation in Non-Sarcopenic Group (NSG, n = 42) and Sarcopenic Group (SG, n = 16). Mean bars and 95% CI are reported. * Refers to the statistically significant difference (p value = 0.038).