Sains Malaysiana 48(1)(2019): 129–135

http://dx.doi.org/10.17576/jsm-2019-4801-15

Nutritional Status of Post-Acute Stroke Patients during Rehabilitation Phase in Hospital

(Status Pemakanan Pesakit Selepas Strok semasa Fasa Pemulihan di Hospital)

CHONG CHIN WEUN¹, NAZIRAH HASNAN², LYDIA ABDUL LATIF² & HAZREEN ABDUL MAJID^1*

¹Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Federal Territory, Malaysia

²Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Federal Territory, Malaysia

Received: 2 May 2018/Accepted: 30 August 2018

ABSTRACT

Malnutrition is highly prevalent among stroke patients during post-acute rehabilitation phase and may give a negative effect on rehabilitation and impair recovery. However, to date, there is no reported study in Malaysia investigating the nutritional status of stroke patients during rehabilitation phase. Thus, this paper aims to report the preliminary results of nutritional assessment for a randomized controlled trial at baseline. All participating patients were assessed for anthropometric measurements, nutritional status using validated Mini Nutrition Assessment (MNA), 24 h diet recall, and handgrip strength. Demographic data, biochemical profiles and functional outcomes (Modified Barthel Index Score, Motor Assessment Scale) were obtained from patients’ medical record. From a total of 45 post-acute stroke patients at baseline, 24.4% of them were malnourished during admission to rehabilitation ward and 66.7% of the patients were at risk of malnutrition. Mean dietary intake and protein intake of the patients were 1489 ± 297 kcal/day and 66.1 ± 17.2 g/day, respectively. Mean handgrip strength for the patients was 17.9 ± 8.1 kg. Weight, body mass index, serum albumin, handgrip strength, Modified Barthel Index and Motor Assessment Scale score were positively correlated with MNA score (p<0.05), but no correlation was found for the dietary intake (r=0.163, p=0.285) and protein intake (r=0.288, p=0.055). This preliminary result showed that stroke patients are particularly at risk of malnutrition or malnourished during the rehabilitation period. Therefore, early identification of malnutrition for stroke patients is important for a successful rehabilitation program.

Keywords: Dietary intake; malnutrition; nutritional assessment

ABSTRAK

Malnutrisi adalah umum dalam kalangan pesakit strok semasa fasa pemulihan dan ini mungkin akan memberikan kesan negatif kepada proses pemulihan dan melambatkan proses penyembuhan. Walau bagaimanapun, tiada kajian di Malaysia yang menilai status pemakanan pesakit strok semasa fasa pemulihan. Kertas ini bertujuan untuk melaporkan keputusan penilaian pemakanan asas bagi satu kajian percubaan terkawal rawak (RCT). Semua pesakit yang terlibat dalam kajian tersebut telah dinilai dengan pengukuran antropometri, status pemakanan menggunakan Penilaian Pemakanan Mini (MNA), ingatan diet 24 jam dan kekuatan genggaman tangan. Data demografi, profil biokimia dan hasil ukuran kefungsian (Modified Barthel Index Score/MBI, Motor Assessment Scale/MAS) telah diperoleh daripada rekod perubatan pesakit. Daripada 45 orang pesakit selepas strok yang telah dinilai, 24.4% pesakit adalah malnutrisi manakala 66.7% pesakit adalah berisiko untuk mendapat malnutrisi. Purata pengambilan pemakanan dan pengambilan protein masing-masing adalah 1489 ± 297 kkal/hari dan 66.1 ± 17.2 g/hari. Purata kekuatan genggaman tangan adalah 17.9 ± 8.1 kg. Berat badan, indeks jisim tubuh, albumin darah, kekuatan tangan, MBI dan MAS menunjukkan hubungan kolerasi positf dengan skor MNA (p<0.05) manakala tiada kolerasi antara skor MNA dengan pengambilan pemakanan (r=0.163, p=0.285) dan pengambilan protein (r=0.288, p=0.055). Keputusan asas kajian ini menunjukkan pesakit strok adalah berisiko tinggi untuk mendapat malnutrisi semasa fasa pemulihan. Dengan sedemikian, pengesanan awal risiko malnutrisi adalah sangat penting dalam kalangan pesakit strok untuk proses pemulihan yang berkesan.

Kata kunci: Malnutrisi; penilaian pemakanan; pengambilan pemakanan

REFERENCES

Aziz, A.F.A., Nordin, N.A.M., Aziz, N.A., Abdullah, S., Sulong, S. & Aljunid, S.M. 2014. Care for post-stroke patients at Malaysian public health centres: Self-reported practices of family medicine specialists. BMC Family Practice 15(1): 1.

Bouziana, S.D. & Tziomalos, K. 2011. Malnutrition in patients with acute stroke. Journal of Nutrition and Metabolism 2011: 167898.

Burgos, R., Bretón, I., Cereda, E., Desport, J.C., Dziewas, R., Genton, L., Gomes, F., Jésus, P., Leischker, A., Muscaritoli, M., Poulia, K.A., Preiser, J.C., Van der Marck, M., Wirth, R., Singer, P. & Bischoff, S.C. 2018. ESPEN guideline clinical nutrition in neurology. Clinical Nutrition 37(1): 354-396.

Carr, J.H., Shepherd, R.B., Nordholm, L. & Lynne, D. 1985. Investigation of a new motor assessment scale for stroke patients. Phys. Ther. 65(2): 175-180.

Charlton, K.E., Nichols, C., Bowden, S., Lambert, K., Barone, L., Mason, M. & Milosavljevic, M. 2010. Older rehabilitation patients are at high risk of malnutrition: Evidence from a large Australian database. The Journal of Nutrition, Health & Aging 14(8): 622-628.

Chumlea, W.C., Roche, A.F. & Steinbaugh, M.L. 1985. Estimating stature from knee height for persons 60 to 90 years of age. J. Am. Geriatr. Soc. 33(2): 116-120.

Cifu, D.X. & Stewart, D.G. 1999. Factors affecting functional outcome after stroke: A critical review of rehabilitation interventions. Archives of Physical Medicine and Rehabilitation 80(5): S35-S39.

Crary, M.A., Carnaby-Mann, G.D., Miller, L., Antonios, N. & Silliman, S. 2006. Dysphagia and nutritional status at the time of hospital admission for ischemic stroke. Journal of Stroke and Cerebrovascular Diseases 15(4): 164-171.

Finestone, H.M., Greene-Finestone, L.S., Wilson, E.S. & Teasell, R.W. 1995. Malnutrition in stroke patients on the rehabilitation service and at follow-up: Prevalence and predictors. Archives of Physical Medicine and Rehabilitation 76(4): 310-316.

Foley, N.C., Martin, R.E., Salter, K.L. & Teasell, R.W. 2009. A review of the relationship between dysphagia and malnutrition following stroke. Journal of Rehabilitation Medicine 41(9): 707-713.

Gariballa, S.E., Parker, S.G., Taub, N. & Castleden, C.M. 1998. A randomized, controlled, single-blind trial of nutritional supplementation after acute stroke. Journal of Parenteral and Enteral Nutrition 22(5): 315-319.

Guigoz, Y., Vellas, B. & Garry, P.J. 1996. Assessing the nutritional status of the elderly: The Mini Nutritional Assessment as part of the geriatric evaluation. Nutr. Rev. 54(1 Pt 2): S59-S65.

Ha, L., Hauge, T. & Iversen, P.O. 2010. Body composition in older acute stroke patients after treatment with individualized, nutritional supplementation while in hospital. BMC Geriatr. 10: 75.

Hamidon, B.B., Abdullah, S.A., Zawawi, M.F., Sukumar, N., Aminuddin, A. & Raymond, A.A. 2006. A prospective comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding in patients with acute dysphagic stroke. Med. J. Malaysia 61(1): 59-66.

Heller, A., Wade, D.T., Wood, V.A., Sunderland, A., Hewer, R.L. & Ward, E. 1987. Arm function after stroke: Measurement and recovery over the first three months. J. Neurol. Neurosurg. Psychiatry 50(6): 714-719.

Kim, D. 2016. The effects of hand strength on upper extremity function and activities of daily living in stroke patients, with a focus on right hemiplegia. Journal of Physical Therapy Science 28(9): 2565-2567.

Loo, K.W. & Gan, S.H. 2012. Burden of stroke in Malaysia. International Journal of Stroke 7(2): 165-167.

Naing, L., Winn, T. & Rusli, B. 2006. Sample Size Calculator for Prevalence Studies. Version 1.0.01. http://www.kck.usm. my/ppsg/stats_resources.htm.

Nii, M., Maeda, K., Wakabayashi, H., Nishioka, S. & Tanaka, A.2016. Nutritional improvement and energy intake are associated with functional recovery in patients after cerebrovascular disorders. Journal of Stroke and Cerebrovascular Diseases 25(1): 57-62.

Nip, W., Perry, L., McLaren, S. & Mackenzie, A. 2011. Dietary intake, nutritional status and rehabilitation outcomes of stroke patients in hospital. Journal of Human Nutrition and Dietetics 24(5): 460-469.

Paquereau, J., Allart, E., Romon, M. & Rousseaux, M. 2014. The long-term nutritional status in stroke patients and its predictive factors. Journal of Stroke and Cerebrovascular Diseases 23(6): 1628-1633.

Perry, L. & McLaren, S. 2004. An exploration of nutrition and eating disabilities in relation to quality of life at 6 months post-stroke. Health & Social Care in the Community 12(4): 288-297.

Shah, S., Vanclay, F. & Cooper, B. 1989. Improving the sensitivity of the Barthel Index for stroke rehabilitation. Journal of Clinical Epidemiology 42(8): 703-709.

Sun, Y., Roth, D.L., Ritchie, C.S., Burgio, K.L. & Locher, J.L. 2010. Reliability and predictive validity of energy intake measures from the 24-hour dietary recalls of homebound older adults. Journal of the American Dietetic Association 110(5): 773-778.

Sunderland, A., Tinson, D., Bradley, L. & Hewer, R.L. 1989. Arm function after stroke. An evaluation of grip strength as a measure of recovery and a prognostic indicator. Journal of Neurology, Neurosurgery & Psychiatry 52(11): 1267-1272.

Sura, L., Madhavan, A., Carnaby, G. & Crary, M.A. 2012. Dysphagia in the elderly: Management and nutritional considerations. Clin. Interv. Aging 7(7): 287-298.

Suzana, S. & Siti Saifa, H. 2007. Validation of nutritional screening tools against anthropometric and functional assessments among elderly people in Selangor. Malays J. Nutr. 13(1): 29-44.

Suzana, S., Nik Shanita, S., Zahara, A.M. & Hasnah, H. 2015. Atlas Makanan: Saiz Pertukaran dan Porsi. 3rd ed.

Teasell, R., Foley, N., Richardson, M., Bhogal, S. & Speechley, M. 2013. Nutritional Interventions Following Stroke. http:// ebrsr.com/evidence-review/16-nutritional-interventions-following-stroke.

van Zwienen-Pot, J., Visser, M., Kuijpers, M., Grimmerink, M. & Kruizenga, H. 2016. Undernutrition in nursing home rehabilitation patients. Clinical Nutrition 2016: 1-5.

Vellas, B., Guigoz, Y., Garry, P.J., Nourhashemi, F., Bennahum, D., Lauque, S. & Albarede, J.L. 1999. The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition 15(2): 116-22.

Wright, L., Cotter, D., Hickson, M. & Frost, G. 2005. Comparison of energy and protein intakes of older people consuming a texture modified diet with a normal hospital diet. Journal of Human Nutrition and Dietetics 18(3): 213-219.

*Corresponding author; email: hazreen@ummc.edu.my