Malnutrition Diagnosis and Food Consumption in Subacute Post-Stroke Patients During Rehabilitation

Abstract

Background: Stroke survivors frequently encounter malnutrition, adversely impacting clinical outcomes. Nevertheless, malnutrition and food consumption in post-stroke patients have not been frequently assessed, and their correlation with rehabilitation outcomes remains inadequately explored. The objective of this observational study was to evaluate malnutrition at admission in these patients, assess food consumption during a six-week rehabilitation program, and analyze their correlation with rehabilitation outcomes.

Methods: Subacute post-stroke patients were evaluated at admission (T0) and after a six-week rehabilitation treatment (T1). At T0, we assessed clinical and demographic characteristics, and we diagnosed malnutrition according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. Weight, BMI, hematochemical parameters, and activities of daily living with the modified Barthel Index (mBI) were evaluated at both T0 and T1; recovery was registered as a change in the mBI (ΔmBI = mBIT1 - mBIT0). Patients' food consumption was recorded through visual plate waste estimation of three meals a day, 5 days a week, for six weeks of hospitalization for rehabilitation.

Results: A total of 109 patients completed the study (51 women, mean age 69 ± 11). According to the GLIM criteria, 105 of these patients were at risk of malnutrition, while 43 were malnourished, with 15 severely malnourished. Malnourished patients wasted more food, with respect to non-malnourished patients, as measured by visual plate waste of total meals (25 ± 17% vs. 15 ± 14%; p = 0.001) and reached a lower ΔmBI. A linear regression analysis found a significant correlation between the ΔmBI, the waste of a "second dish", which contained mainly protein, and serum albumin at admission, even after controlling for age.

Conclusions: Malnutrition assessed with the GLIM criteria at admission and food consumption are two important nutritional parameters to evaluate in post-stroke patients hospitalized for rehabilitation due to their association with recovery.

Keywords: GLIM criteria; food consumption; malnutrition; plate waste method; post-stroke; rehabilitation.

Figure 1

The diagnostic algorithm according to the GLIM criteria for case finding and the diagnosis of malnutrition at baseline in the enrolled patients. Risk screening (green boxes) was performed by using the Mini Nutritional Assessment Short-Form (MNA-SF^®), thus finding patients at risk of malnutrition. The diagnosis of malnutrition (yellow boxes) was made by assessing the presence of at least one phenotypic criterion (I) and one etiologic criterion (II). The diagnostic criteria reported in the yellow rectangular box were those used for the sample group of the study. Finally, malnutrition severity (orange boxes) was assessed using the low body mass index as phenotypic criteria to distinguish patients with moderate or severe malnutrition.

Figure 2

The pie charts display the percentages of daily average food consumption over the six weeks of treatment. Food consumption of meals served according to Italian customs is referred to as follows: (A) the totality of all meals; (B) the “first dish” (lunch + dinner) composed of carbohydrates, (e.g., cereals such as pasta, rice, or semolina), usually seasoned with legumes or vegetables, or both; (C) the “second dish” (lunch + dinner) made up of a protein source (meat, fish, eggs, or dairy products); (D) the “side dish” (lunch + dinner) which is usually vegetables; and (E) the fruit dish which consisted of a whole piece of seasonal fruit (e.g., an apple, a banana, or an orange) or as a mousse. The data are reported as the mean percentage (%). For dysphagic patients, meals were served with the same food modified in consistency or fluid.

Figure 3

Differences in food consumption of meals served according to Italian customs (first dish, second dish, side dish, and fruit) between malnourished patients (Maln) and non-malnourished ones (non-Maln). (A) Food consumption of all daily meals expressed as the average percentage. (B) Food consumption of the “first dish” (lunch + dinner) expressed as the average percentage. (C) Food consumption of the “second dish” (lunch + dinner) as the average percentage. The p-value refers to the Mann–Whitney test.