Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taiwan; Community and Geriatric Medicine Research Center, National Taiwan University Hospital, Bei-Hu Branch, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan.
Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taiwan.
Clin Nutr. 2020 Jun;39(6):1968-1973. doi: 10.1016/j.clnu.2019.08.024. Epub 2019 Aug 31.
BACKGROUND & AIMS: Loss of muscle and bone mass is prevalent in the stroke population. Few studies have investigated the difference between having a stroke and hemiplegia and their influence on segmental body composition. This study aimed to evaluate the changes of body composition in the extremities and trunk of stroke patients in comparison with those of the healthy controls.
Stroke patients with an onset of longer than 6 months and healthy participants matched by age and gender were recruited. Body weight, height, grip strength, and gait speed were measured, and a dual-energy x-ray absorptiometry was used to evaluate body composition. The generalized estimation equation model was employed to explore factors influencing extremity body composition, whereas those influencing the trunk body composition were analyzed using the general linear model.
The study included 37 stroke patients and 37 healthy controls. The stroke group had significantly slower gait speeds, weaker hand grip strength, and a lower skeletal muscle index than the controls. Using 7.0 kg/m for men and 5.14 kg/m for women as the cutoff value for the skeletal muscle index, the prevalence of sarcopenia in our stroke group was found to be 48.6% (18/37). Being a stroke patient was associated with a decrease in bone (β = -21.89 g, p = 0.001) and lean mass (β = -210.46 g, p = 0.031) of the upper extremity and bone mass (β = -39.28 g, p = 0.008) of the lower extremity, regardless of the presence of limb paralysis. The limbs on the hemiplegic side had a further decline of extremity bone and lean mass. The stroke patients had an increase in trunk fat mass (β = 1392.68 g, p = 0.004) but not that of the extremities.
Having a stroke and hemiparesis are both associated with body composition changes of the extremities, especially for bone and lean mass. A stroke is likely to increase the fat mass of the trunk rather than that of the extremities. A future cohort study is needed to clarify the causal relationship between stroke and transition of body composition and to investigate whether these changes are related to the disease prognosis or can be reversed by exercise and nutritional support.
肌肉和骨量的流失在脑卒中患者中很常见。很少有研究调查过脑卒中与偏瘫之间的差异，以及它们对身体成分节段性的影响。本研究旨在评估与健康对照组相比，脑卒中患者四肢和躯干的身体成分变化。
招募了发病时间超过 6 个月的脑卒中患者和年龄、性别相匹配的健康参与者。测量体重、身高、握力和步态速度，并使用双能 X 射线吸收仪评估身体成分。采用广义估计方程模型探讨影响四肢身体成分的因素，采用一般线性模型分析影响躯干身体成分的因素。
研究共纳入 37 例脑卒中患者和 37 例健康对照者。与对照组相比，脑卒中组的步态速度明显较慢，手握力较弱，骨骼肌指数较低。使用男性 7.0kg/m 和女性 5.14kg/m 作为骨骼肌指数的截断值，我们发现脑卒中组的肌少症患病率为 48.6%（18/37）。脑卒中患者与上肢骨量（β=-21.89g，p=0.001）和瘦体重（β=-210.46g，p=0.031）以及下肢骨量（β=-39.28g，p=0.008）减少有关，而与肢体瘫痪无关。偏瘫侧肢体的四肢骨量和瘦体重进一步下降。脑卒中患者的躯干脂肪量增加（β=1392.68g，p=0.004），但四肢脂肪量没有增加。
脑卒中及偏瘫均与四肢身体成分的变化有关，特别是与骨量和瘦体重有关。脑卒中可能会增加躯干的脂肪量，而不是四肢的脂肪量。未来的队列研究需要阐明脑卒中与身体成分变化之间的因果关系，并研究这些变化是否与疾病预后有关，或者是否可以通过运动和营养支持来逆转。
