Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan.
Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan.
Nutrition. 2021 Mar;83:111091. doi: 10.1016/j.nut.2020.111091. Epub 2020 Nov 24.
Evidence for appropriate nutritional assessment, energy prediction, and adaptation and their effect on outcomes after stroke is scarce. We sought to determine the frequency of individualized dietary prescriptions issued for individuals undergoing rehabilitation after stroke and to analyze the effect of diet-prescription frequency on outcomes after stroke.
This single-center prospective cohort study included poststroke patients newly admitted to convalescent rehabilitation wards. The frequency and content of dietary prescriptions issued as part of nutritional assessments were examined. Study outcomes were nutritional status assessed using changes in skeletal muscle mass, physical function assessed using the Functional Independence Measure motor score, dysphagia status assessed using the Food Intake LEVEL Scale (score < 7), and length of hospital stay. Multivariate analyses were performed to determine whether the frequency of dietary prescriptions issued during hospitalization was independently associated with outcomes of interest, after adjusting for potential confounders.
A total of 454 participants (mean age = 71.8 y; 53.1% men, 46.9% women) were included in the final analysis data set. A median of five (range, 2-11) dietary prescriptions were issued per participant during the median 96 d of hospitalization, with the most common items being diet-texture modification for dysphagia and oral energy/protein enhancement. In multivariate analyses, the frequency of dietary prescriptions was independently associated with the change in skeletal muscle mass (β = 0.165, P = 0.028), Functional Independence Measure motor scores at discharge (β = 0.104, P = 0.045), length of stay (β = -0.056, P = 0.019), and presence of dysphagia at discharge (odds ratio = 0.949, P = 0.032).
Frequent and individualized nutritional support is associated with improved nutritional status, physical function, and dysphagia after stroke. Intensive nutritional support through multidisciplinary discussion plays a central role in the prevention and management of malnutrition to maximize the improvement of patient outcomes. This study is the first to report this association.
有关适当的营养评估、能量预测和适应以及它们对中风后结局影响的证据很少。我们旨在确定为中风后接受康复治疗的个体开具个体化饮食处方的频率，并分析饮食处方频率对中风后结局的影响。
这项单中心前瞻性队列研究纳入了新入住康复病房的中风后患者。检查了营养评估中开具的饮食处方的频率和内容。研究结局为使用骨骼肌质量变化评估营养状况、使用功能性独立测量运动评分评估身体功能、使用食物摄入水平量表（评分<7）评估吞咽困难状态以及住院时间。进行多变量分析以确定住院期间开具饮食处方的频率是否与感兴趣的结局独立相关，在调整了潜在混杂因素后。
共有 454 名参与者（平均年龄 71.8 岁；53.1%为男性，46.9%为女性）纳入最终分析数据集。中位数为每位患者在中位数 96 天的住院期间开具五份（范围 2-11 份）饮食处方，最常见的项目是为吞咽困难进行饮食质地调整和口服能量/蛋白质增强。在多变量分析中，饮食处方的频率与骨骼肌质量变化独立相关（β=0.165，P=0.028）、出院时功能性独立测量运动评分（β=0.104，P=0.045）、住院时间（β= -0.056，P=0.019）和出院时吞咽困难的存在（比值比=0.949，P=0.032）。
频繁和个体化的营养支持与中风后营养状况、身体功能和吞咽困难的改善有关。通过多学科讨论进行强化营养支持在预防和管理营养不良方面发挥着核心作用，以最大限度地提高患者结局的改善。这项研究首次报告了这种关联。
