Clinical Education and Research Center, Chuzan Hospital, 6-2-1 Matsumoto, Okinawa City, Okinawa 904-2151, Japan; Department of Clinical Research and Quality Management, Graduate School of Medicine, University of the Ryukyus, Nishihara-cho, Okinawa 903-0215, Japan; Department of Rehabilitation Medicine, Aichi Medical University, Nagakute City, Aichi 480-1103, Japan.
Clinical Education and Research Center, Chuzan Hospital, 6-2-1 Matsumoto, Okinawa City, Okinawa 904-2151, Japan.
Clin Nutr ESPEN. 2024 Oct;63:508-514. doi: 10.1016/j.clnesp.2024.07.013. Epub 2024 Jul 23.
BACKGROUND & AIMS: Depression symptoms are both prevalent and associated with poor prognosis in patients with convalescent stroke. Therefore, the improvement of depression symptoms is important for patients with convalescent stroke. This study aimed to examine whether malnutrition diagnosed using the Global Leadership Initiative on Malnutrition (GLIM) criteria and its components are associated with improvements in depression symptoms in patients with stroke undergoing rehabilitation.
This was a retrospective cohort study of older adult patients with convalescent stroke. Inclusion criteria comprised patients aged ≥65 years experiencing their first occurrence of stroke and admitted for rehabilitation therapy. Patients were classified into either the malnutrition or normal nutrition groups based on the diagnosis of malnutrition using the GLIM criteria. The Geriatric Depression Screening Scale (GDS)-15 was used to evaluate depression symptoms. The primary outcome of the study was the change in depression symptoms, indicating a change in GDS score from admission to discharge. The association between malnutrition diagnosed using the GLIM criteria and change in depression symptoms was assessed using multiple regression analysis. Additionally, associations with the constructs of the GLIM criteria were investigated.
The malnutrition group comprised 64 (45%) patients, with a mean age of 78.2 years; 77 (54%) and 66 (46%) were males and females, respectively. Multiple regression analysis showed that malnutrition, diagnosed using the GLIM criteria (β: -0.306, p < 0.001), was independently associated with changes in depression symptoms. Moreover, the GLIM criterion component of reduced muscle mass (β: -0.235, p < 0.001) demonstrated a negative association with a change in depression symptoms.
Malnutrition and reduced muscle mass, diagnosed using the GLIM criteria in patients with stroke undergoing convalescent rehabilitation, were found to suppress the improvement of depression symptoms.
抑郁症状在康复期卒中患者中普遍存在且与预后不良相关。因此，改善抑郁症状对康复期卒中患者非常重要。本研究旨在探讨采用全球营养不良倡议（GLIM）标准及其组成部分诊断的营养不良是否与接受康复治疗的卒中患者抑郁症状的改善相关。
这是一项对康复期卒中老年患者的回顾性队列研究。纳入标准包括年龄≥65 岁、首次发生卒中且接受康复治疗的患者。根据 GLIM 标准诊断的营养不良，将患者分为营养不良或正常营养组。采用老年抑郁量表（GDS-15）评估抑郁症状。研究的主要结局是抑郁症状的变化，即 GDS 评分从入院到出院的变化。采用多元回归分析评估 GLIM 标准诊断的营养不良与抑郁症状变化之间的关系。此外，还研究了与 GLIM 标准构建的相关性。
营养不良组 64 例（45%），平均年龄 78.2 岁；男性 77 例（54%），女性 66 例（46%）。多元回归分析显示，采用 GLIM 标准诊断的营养不良（β：-0.306，p<0.001）与抑郁症状变化独立相关。此外，GLIM 标准中肌肉减少的标准成分（β：-0.235，p<0.001）与抑郁症状变化呈负相关。
在接受康复治疗的卒中患者中，采用 GLIM 标准诊断的营养不良和肌肉减少与抑郁症状改善抑制有关。
