Original Article

How Does Nutritional Status Affect Outcomes in Patients with Neurological Diseases?

Abstract

Background: To evaluate the nutritional status of patients with neurological diseases during the rehabilitation process and to investigate the relationships between the nutritional status and disease severity and clinical evaluation outcomes.

Methods: In this prospective trial, 109 patients with a disease duration of <6 months, hospitalized for neurological rehabilitation in Physical Medicine and Rehabilitation Clinic, Ankara, Turkey were enrolled from 2014-17. All patients were assessed with the Mini Mental State Examination (MMSE) test, European Quality of Life Scale (Euro-QoL), Hospital Anxiety and Depression Scale (HADS), Pittsburg Rehabilitation Participation Scale (PRPS), and Functional Ambulation Category (FAC). Nutritional status was analyzed by biochemical and anthropometric parameters. The patients received a conventional rehabilitation program and a nutritional support according to clinical and laboratory findings for 4 weeks. The outcome data were evaluated at baseline and at the end of 4-week treatment.

Results: Linear regressions analysis revealed that the significant independent predictors that associated positively with baseline insulin (P=0.010) and negatively with baseline cortisol (P=0.020) levels were Brunnstrom upper and hand stages. Additionally, the significant independent predictor that associated positively with baseline insulin (P=0.041) was Brunnstrom lower stage.

Conclusion: Insulin and cortisol levels may be predictors in motor function recovery of stroke patients in rehabilitation process. Early detection and treatment of malnutrition both during hospitalization and follow-up might be important for the improvement of outcomes.

1. Verbrugghe M, Beeckman D, Van Hecke A, et al (2013). Malnutrition and associated factors in nursing home residents: a cross-sectional, multi-centre study. Clin Nutr, 32(3):438-43.
2. Dionyssiotis Y (2012). Dual Energy X-Ray Absorptiometry. Rijeka: InTech. Crotia.
3. Burgos R, Bretón I, Cereda E, et al (2018). ESPEN guideline clinical nutrition in neu-rology. Clin Nutr, 37(1):354-96.
4. Roubenoff RA, Borel CO, Hanley DF (1992). Hypermetabolism and hyperca-tabolism in Guillain-Barré syndrome. JPEN J Parenter Enteral Nutr, 16(5):464-72.
5. Martineau J, Bauer JD, Isenring E, et al (2005). Malnutrition determined by the patient-generated subjective global as-sessment is associated with poor out-comes in acute stroke patients. Clin Nutr, 24(6):1073-7.
6. Dionyssiotis Y (2012). Malnutrition in spinal cord injury: more than nutritional defi-ciency. J Clin Med Res, 4(4):227-36.
7. Kaiser MJ, Bauer JM, Rämsch C, et al (2010). Mini Nutritional Assessment In-ternational Group. Frequency of malnu-trition in older adults: a multinational per-spective using the mini nutritional as-sessment. J Am Geriatr Soc, 58(9):1734-8.
8. Laporte M, Villalon L, Thibodeau J, et al (2001). Validity and reliability of simple nutrition screening tools adapted to the elderly population in healthcare facilities. J Nutr Health Aging, 5(4):292-4.
9. Jensen GL, Mirtallo J, Compher C, et al (2010). International Consensus Guide-line Committee. Adult starvation and dis-ease-related malnutrition: a proposal for etiology-based diagnosis in the clinical practice setting from the International Consensus Guideline Committee. JPEN J Parenter Enteral Nutr, 34(2):156-9.
10. Devoto G, Gallo F, Marchello C, et al (2006). Prealbumin serum concentrations as a useful tool in the assessment of mal-nutrition in hospitalized patients. Clin Chem, 52(12):2281-5.
11. Hopkins B (1989). Assessment of nutritional status. American Society for Parenteral and En-teral Nutrition.
12. Tombaugh TN, McIntyre NJ (1992). The mini-mental state examination: a com-prehensive review. J Am Geriatr Soc, 40(9):922-35.
13. Balestroni G, Bertolotti G (2012). (EuroQol-5D (EQ-5D): an instrument for measur-ing quality of life). Monaldi Arch Chest Dis, 78(3):155-9.
14. Snaith RP (2003). The Hospital Anxiety And Depression Scale. Health Qual Life Out-comes, 1:29.
15. Lenze EJ, Munin MC, Quear T, et al (2004). The Pittsburgh Rehabilitation Participa-tion Scale: reliability and validity of a clini-cian-rated measure of participation in acute rehabilitation. Arch Phys Med Rehabil, 85(3):380-4.
16. Kwakkel G, Kollen B, Twisk J (2006). Im-pact of time on improvement of out-come after stroke. Stroke, 37(9):2348-53.
17. Patrick JM, Bassey EJ, Fentem PH (1982). Changes in body fat and muscle in man-ual workers at and after retirement. Eur J Appl Physiol Occup Physiol, 49(2):187-96.
18. Gomes F, Emery PW, Weekes CE (2016). Risk of Malnutrition Is an Independent Predictor of Mortality, Length of Hospi-tal Stay, and Hospitalization Costs in Stroke Patients. J Stroke Cerebrovasc Dis, 25(4):799-806.
19. Aadal L, Mortensen J, Nielsen JF (2015). Weight reduction after severe brain injury: a challenge during the rehabilitation course. J Neurosci Nurs, 47(2):85-90.
20. Kaur S, Miller MD, Halbert J, et al (2008). Nutritional status of adults participating in ambulatory rehabilitation. Asia Pac J Clin Nutr, 17(2):199-207.
21. Shen HC, Chen HF, Peng LN, et al (2011). Impact of nutritional status on long-term functional outcomes of post-acute stroke patients in Taiwan. Arch Gerontol Geriatr, 53(2): e149-52.
22. Espuela FL, Cuenca JCP, Mohedas MH, et al (2017). Nutritional status and the rela-tionship regarding functional status after stroke. Nutr Hosp, 34(5): 1353-1360.
23. Kernan WN, Viscoli CM, Inzucchi SE, et al (2005). Prevalence of abnormal glucose tolerance following a transient ischemic attack or ischemic stroke. Arch Intern Med, 165(2): 227-33.
24. Mitchell A, Kirckpatrick P (1997). Hypergly-caemia after acute stroke. May occur as result of neuroendocrine response. BMJ, 315(7111): 810-811.
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IssueVol 49 No 10 (2020) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijph.v49i10.4689
PMCIDPMC7719642
PMID33346224
Keywords
Stroke Malnutrition Function Rehabilitation

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How to Cite
1.
GÜZEL Şükran, GÜRÇAY E, KARACA UMAY E, MERCİMEKÇİ S, ÇAKCI A. How Does Nutritional Status Affect Outcomes in Patients with Neurological Diseases?. Iran J Public Health. 2020;49(10):1868-1877.