The Assessment of the Risk of Malnutrition (Undernutrition) in Stroke Patients

Overview

Journal Nutrients

Date 2023 Feb 11

PMID 36771390

Authors

Olivia Di Vincenzo

Maria Luisa Eliana Luisi

Paola Alicante

Giada Ballarin

Barbara Biffi

Chiara Francesca Gheri

Luca Scalfi

Affiliations

Soon will be listed here.

Abstract

Malnutrition is common in stroke patients, as it is associated with neurological and cognitive impairment as well as clinical outcomes. Nutritional screening is a process with which to categorize the risk of malnutrition (i.e., nutritional risk) based on validated tools/procedures, which need to be rapid, simple, cost-effective, and reliable in the clinical setting. This review focuses on the tools/procedures used in stroke patients to assess nutritional risk, with a particular focus on their relationships with patients' clinical characteristics and outcomes. Different screening tools/procedures have been used in stroke patients, which have shown varying prevalence in terms of nutritional risk (higher in rehabilitation units) and significant relationships with clinical outcomes in the short- and long term, such as infection, disability, and mortality. Indeed, there have been few attempts to compare the usefulness and reliability of the different tools/procedures. More evidence is needed to identify appropriate approaches to assessing nutritional risk among stroke patients in the acute and sub-acute phase of disease or during rehabilitation; to evaluate the impact of nutritional treatment on the risk of malnutrition during hospital stay or rehabilitation unit; and to include nutritional screening in well-defined nutritional care protocols.

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References

Liu Y, Yang X, Kadasah S, Peng C . Clinical Value of the Prognostic Nutrition Index in the Assessment of Prognosis in Critically Ill Patients with Stroke: A Retrospective Analysis. Comput Math Methods Med. 2022; 2022:4889920. PMC: 9110188. DOI: 10.1155/2022/4889920. View

Xiang W, Chen X, Ye W, Li J, Zhang X, Xie D . Prognostic Nutritional Index for Predicting 3-Month Outcomes in Ischemic Stroke Patients Undergoing Thrombolysis. Front Neurol. 2020; 11:599. PMC: 7333017. DOI: 10.3389/fneur.2020.00599. View

Gon Y, Kabata D, Kawano T, Kanki H, Todo K, Sasaki T . Hematological Abnormalities and Malnutrition Mediate Pathway between Cancer and Outcomes in Ischemic Stroke Patients. J Stroke Cerebrovasc Dis. 2020; 29(8):104943. DOI: 10.1016/j.jstrokecerebrovasdis.2020.104943. View

Hua J, Lu J, Tang X, Fang Q . Association between Geriatric Nutritional Risk Index and Depression after Ischemic Stroke. Nutrients. 2022; 14(13). PMC: 9268883. DOI: 10.3390/nu14132698. View

Scrutinio D, Lanzillo B, Guida P, Passantino A, Spaccavento S, Battista P . Association Between Malnutrition and Outcomes in Patients With Severe Ischemic Stroke Undergoing Rehabilitation. Arch Phys Med Rehabil. 2020; 101(5):852-860. DOI: 10.1016/j.apmr.2019.11.012. View

Matsumoto A, Yoshimura Y, Nagano F, Bise T, Kido Y, Shimazu S . Polypharmacy and Its Association with Dysphagia and Malnutrition among Stroke Patients with Sarcopenia. Nutrients. 2022; 14(20). PMC: 9609259. DOI: 10.3390/nu14204251. View

Sremanakova J, Burden S, Kama Y, Gittins M, Lal S, Smith C . An Observational Cohort Study Investigating Risk of Malnutrition Using the Malnutrition Universal Screening Tool in Patients with Stroke. J Stroke Cerebrovasc Dis. 2019; 28(12):104405. DOI: 10.1016/j.jstrokecerebrovasdis.2019.104405. View

Nozoe M, Kubo H, Kanai M, Yamamoto M, Okakita M, Suzuki H . Reliability and validity of measuring temporal muscle thickness as the evaluation of sarcopenia risk and the relationship with functional outcome in older patients with acute stroke. Clin Neurol Neurosurg. 2021; 201:106444. DOI: 10.1016/j.clineuro.2020.106444. View

Zhang G, Pan Y, Zhang R, Wang M, Meng X, Li Z . Prevalence and Prognostic Significance of Malnutrition Risk in Patients With Acute Ischemic Stroke: Results From the Third China National Stroke Registry. Stroke. 2021; 53(1):111-119. DOI: 10.1161/STROKEAHA.121.034366. View

10.

Kokura Y, Nishioka S . Nutritional Risk Indicators for Predicting a Change in Quadriceps Muscle Thickness in Acute Patients with Stroke. JMA J. 2022; 5(1):62-71. PMC: 8826440. DOI: 10.31662/jmaj.2021-0107. View

11.

Kamimoto T, Shindo K, Shimomura T, Akimoto T, Yamada T, Mori N . Relationship between initial nutritional status and functional independence measures at discharge in subacute stroke. J Stroke Cerebrovasc Dis. 2022; 31(11):106754. DOI: 10.1016/j.jstrokecerebrovasdis.2022.106754. View

12.

Naito H, Hosomi N, Nezu T, Kuzume D, Aoki S, Morimoto Y . Prognostic role of the controlling nutritional status score in acute ischemic stroke among stroke subtypes. J Neurol Sci. 2020; 416:116984. DOI: 10.1016/j.jns.2020.116984. View

13.

Chen X, Li D, Liu Y, Zhu L, Jia Y, Gao Y . Nutritional risk screening 2002 scale and subsequent risk of stroke-associated infection in ischemic stroke: The REMISE study. Front Nutr. 2022; 9:895803. PMC: 9505510. DOI: 10.3389/fnut.2022.895803. View

14.

Nishioka S, Wakabayashi H, Kayashita J, Taketani Y, Momosaki R . Predictive validity of the Mini Nutritional Assessment Short-Form for rehabilitation patients: A retrospective analysis of the Japan Rehabilitation Nutrition Database. J Hum Nutr Diet. 2021; 34(5):881-889. DOI: 10.1111/jhn.12887. View

15.

Shiga Y, Nezu T, Hosomi N, Aoki S, Nishi H, Naito H . Effect of tooth loss and nutritional status on outcomes after ischemic stroke. Nutrition. 2019; 71:110606. DOI: 10.1016/j.nut.2019.110606. View

16.

Tang H, Gong F, Guo H, Dai Z, Wang J, Liu B . Malnutrition and Risk of Mortality in Ischemic Stroke Patients Treated With Intravenous Thrombolysis. Front Aging Neurosci. 2022; 14:834973. PMC: 8901046. DOI: 10.3389/fnagi.2022.834973. View

17.

Zhang M, Ye S, Huang X, Sun L, Liu Z, Liao C . Comparing the prognostic significance of nutritional screening tools and ESPEN-DCM on 3-month and 12-month outcomes in stroke patients. Clin Nutr. 2020; 40(5):3346-3353. DOI: 10.1016/j.clnu.2020.11.001. View

18.

Sabbouh T, Torbey M . Malnutrition in Stroke Patients: Risk Factors, Assessment, and Management. Neurocrit Care. 2017; 29(3):374-384. PMC: 5809242. DOI: 10.1007/s12028-017-0436-1. View

19.

Fluck D, Fry C, Gulli G, Affley B, Robin J, Kakar P . Association of risk of malnutrition with adverse outcomes and early support on discharge in acute stroke patients without prestroke disability: A multicenter, registry-based cohort study. Nutr Clin Pract. 2021; 37(5):1233-1241. DOI: 10.1002/ncp.10790. View

20.

Yuan C, Zhang Y, Chen X, Hu B . Association between malnutrition risk and hemorrhagic transformation in patients with acute ischemic stroke. Front Nutr. 2022; 9:993407. PMC: 9579279. DOI: 10.3389/fnut.2022.993407. View