Association between nutritional, inflammatory and humoral factors with morbimortality 90 days after stroke

Introduction: Stroke is the leading cause of disability in adult life and two-thirds of patients remain in an incomplete recovery condition after the event. These patients nutritional status is of great importance, as they become more susceptible to involuntary weight loss, with decreased appetite, dysphagia, depression, and changes in mobility, with consequent functional dependence, biochemical changes and nutritional deficiencies of macro and micronutrients. However, little is known about the nutritional outcomes and their association with functional disability after the stroke. Methodology: Clinical, nutritional, biochemical and body composition evaluations were performed in the first 72 hours of hospitalization and repeated 30 days after hospital discharge. Functional capacity was assessed by modified Rankin scale (mRs) 90 days after stroke. To determine the associations, linear and logistic multiple regressions were performed, considering a significance level 5%. Result s: A total of 84 patients were included, mostly elderly men, with low severity stroke (NIHSS 5) and 18.1% were thrombolysed. We found increased values of IL-6, overweight and obesity, as well as low values of handgrip strength at hospitalization. After 30 days of discharge, patients showed maintenance of weight, body mass index and arm muscle area; reduction of adductor pollicis muscle thickness, arm circumference and triceps skinfold; and increase of handgrip strength. They presented increase in %body fat, body fat mass, affected leg lean mass, unaffected leg lean mass, affected leg water, unaffected leg water and reduction in median phase angle, fat free mass, soft lean mass, affected arm lean mass, unaffected arm lean mass, intracellular water, extracellular water, affected arm water and unaffected arm water. Regarding the association between initial characteristics with loss of lean mass 30 days after stroke, only body mass index, fat free mass index and soft lean mass index had statistical significance. The variation of arm muscle area values at admission and 30 days after discharge was associated with disability 90 days after the stroke. We found that each increase of 1 mg/dl in glycemia at admission increased the chance of disability by 2% 90 days after the event. Discussion: Regarding the change in body composition 30 days after stroke, it is observed that both the affected and the non-affected sides undergo changes and the lower limbs behave differently from the upper limbs. The gain of lean mass observed in the lower limbs may not be real and reflect the presence of edema. The increase in handgrip strength one month after the stroke shows interesting data suggesting that the acute phase inflammation reduces patient's strength. Only the arm muscle area variation was associated with worse functional capacity, when adjusted for factors known to be associated with a worse prognosis, such as NIHSS, gender, age and thrombolysis. Finally, among the initial parameters only glycemia was associated with worse mRs, when adjusted by NIHSS, gender, age and thrombolysis. Conclusion: Changes in body composition of patients who maintain weight after stroke suggest that early nutritional intervention is required in all individuals regardless of initial nutritional status in order to avoid impairment of functional capacity and gain of muscle strength. (AU)