Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Geriatrics
Published in: BMC Geriatrics 1/2010

Open Access 01-12-2010 | Research article

Body composition in older acute stroke patients after treatment with individualized, nutritional supplementation while in hospital

Authors: Lisa Ha, Truls Hauge, Per Ole Iversen

Published in: BMC Geriatrics | Issue 1/2010

Login to get access

Abstract

Background

Individualized, nutritional support reduced undernutrition among older stroke patients and improved quality of life in our recent randomized, controlled trial. Weight control thus seems to be important after stroke, and methods for monitoring nutritional status need to be simple and non-invasive. Here we aimed to assess if the nutritional intervention altered body composition in men and women in this study cohort, and also to examine the correlation between the methods for assessing body-, fat- and fat-free mass.

Methods

Acute stroke patients > 65 years at nutritional risk were randomized to either individualized, nutritional treatment with energy- and protein rich supplementation (intervention, n = 58) or routine, nutritional care (control, n = 66) while in hospital. Body composition was assessed with anthropometry and bioelectrical impedance. The follow-up period was three months.

Results

During the first week while in hospital, weight loss was smaller in the intervention group compared with the controls (P = 0.013). After three months weight- and fat loss were significant in both men and women. Whereas no significant differences were found in changes in body composition between the male study groups, in the women both weight loss (P = 0.022) and fat loss (P = 0.005) was smaller in the intervention group compared with the controls. A high correlation (r = 0.87) between mid upper arm circumference (MUAC) and body mass index (BMI) was found.

Conclusions

Individualized nutritional support to older stroke patients in hospital was beneficial for maintaining an adequate body mass and body composition the first week and seemed to have a preventive effect on fat loss among women, but not among men after three months. Measurement of MUAC may be used in the assessment of nutritional status when BMI cannot be obtained.

Trial registration

This trial is registered with ClinicalTrials.gov, number NCT00163007.
Appendix
Available only for authorised users
Literature
1.
Davalos A, Ricart W, Gonzalez-Huix F, Soler S, Marrugat J, Molins A, Suner R, Genis D: Effect of malnutrition after acute stroke on clinical outcome. Stroke. 1996, 27 (6): 1028-1032.CrossRefPubMed
2.
Jonsson AC, Lindgren I, Norrving B, Lindgren A: Weight loss after stroke: a population-based study from the Lund Stroke Register. Stroke. 2008, 39 (3): 918-923. 10.1161/STROKEAHA.107.497602.CrossRefPubMed
3.
Axelsson K, Asplund K, Norberg A, Alafuzoff I: Nutritional status in patients with acute stroke. Acta Med Scand. 1988, 224 (3): 217-224. 10.1111/j.0954-6820.1988.tb19364.x.CrossRefPubMed
4.
Axelsson K, Asplund K, Norberg A, Eriksson S: Eating problems and nutritional status during hospital stay of patients with severe stroke. J Am Diet Assoc. 1989, 89 (8): 1092-1096.PubMed
5.
Unosson M, Ek AC, Bjurulf P, von Schenck H, Larsson J: Feeding dependence and nutritional status after acute stroke. Stroke. 1994, 25 (2): 366-371.CrossRefPubMed
6.
Brynningsen PK, Damsgaard EM, Husted SE: Improved nutritional status in elderly patients 6 months after stroke. J Nutr Health Aging. 2007, 11 (1): 75-79.PubMed
7.
Davis JP, Wong AA, Schluter PJ, Henderson RD, O'Sullivan JD, Read SJ: Impact of premorbid undernutrition on outcome in stroke patients. Stroke. 2004, 35 (8): 1930-1934. 10.1161/01.STR.0000135227.10451.c9.CrossRefPubMed
8.
Yoo SH, Kim JS, Kwon SU, Yun SC, Koh JY, Kang DW: Undernutrition as a predictor of poor clinical outcomes in acute ischemic stroke patients. Arch Neurol. 2008, 65 (1): 39-43. 10.1001/archneurol.2007.12.CrossRefPubMed
9.
Gariballa SE, Parker SG, Taub N, Castleden M: Nutritional status of hospitalized acute stroke patients. Br J Nutr. 1998, 79 (6): 481-487. 10.1079/BJN19980085.CrossRefPubMed
10.
FOOD Trial Collaboration: Poor nutritional status on admission predicts poor outcomes after stroke: observational data from the FOOD trial. Stroke. 2003, 34 (6): 1450-1456. 10.1161/01.STR.0000074037.49197.8C.CrossRef
11.
Volkert D, Berner YN, Berry E, Cederholm T, Coti Bertrand P, Milne A, Palmblad J, Schneider S, Sobotka L, Stanga Z, DGEM (German Society for Nutritional Medicine), Lenzen-Grossimlinghaus R, Krys U, Pirlich M, Herbst B, Schutz T, Schroer W, Weinrebe W, Ockenga J, Lochs H, ESPEN (European Society for Parenteral and Enteral Nutrition): ESPEN Guidelines on Enteral Nutrition: Geriatrics. Clin Nutr. 2006, 25 (2): 330-360. 10.1016/j.clnu.2006.01.012.CrossRefPubMed
12.
Gariballa SE, Parker SG, Taub N, Castleden CM: A randomized, controlled, a single-blind trial of nutritional supplementation after acute stroke. JPEN J Parenter Enteral Nutr. 1998, 22 (5): 315-319. 10.1177/0148607198022005315.CrossRefPubMed
13.
Rabadi MH, Coar PL, Lukin M, Lesser M, Blass JP: Intensive nutritional supplements can improve outcomes in stroke rehabilitation. Neurology. 2008, 71 (23): 1856-1861. 10.1212/01.wnl.0000327092.39422.3c.CrossRefPubMed
14.
Ha L, Hauge T, Spenning AB, Iversen PO: Individual, Nutritional Support Prevents Undernutrition, Increases Muscle Strength and Improves QoL among Elderly at Nutritional Risk Hospitalized for Acute Stroke: A Randomized, Controlled trial. Clin Nutr. 2010, 29 (5): 567-573. 10.1016/j.clnu.2010.01.011.CrossRefPubMed
15.
Stratton RJ, King CL, Stroud MA, Jackson AA, Elia M: 'Malnutrition Universal Screening Tool' predicts mortality and length of hospital stay in acutely ill elderly. Br J Nutr. 2006, 95 (2): 325-330. 10.1079/BJN20051622.CrossRefPubMed
16.
Lauque S, Arnaud-Battandier F, Gillette S, Plaze JM, Andrieu S, Cantet C, Vellas B: Improvement of weight and fat-free mass with oral nutritional supplementation in patients with Alzheimer's disease at risk of malnutrition: a prospective randomized study. J Am Geriatr Soc. 2004, 52 (10): 1702-1707. 10.1111/j.1532-5415.2004.52464.x.CrossRefPubMed
17.
Schofield WN: Predicting basal metabolic rate, new standards and review of previous work. Hum Nutr Clin Nutr. 1985, 39 (Suppl 1): 5-41.PubMed
18.
Chumlea WC, Roche AF, Steinbaugh ML: Estimating stature from knee height for persons 60 to 90 years of age. J Am Geriatr Soc. 1985, 33 (2): 116-120.CrossRefPubMed
19.
Foley N, Finestone H, Woodbury MG, Teasell R, Greene Finestone L: Energy and protein intakes of acute stroke patients. J Nutr Health Aging. 2006, 10 (3): 171-175.PubMed
20.
Lammes E, Akner G: Resting metabolic rate in elderly nursing home patients with multiple diagnoses. J Nutr Health Aging. 2006, 10 (4): 263-270.PubMed
21.
Jorgensen L, Jacobsen BK: Changes in muscle mass, fat mass, and bone mineral content in the legs after stroke: a 1 year prospective study. Bone. 2001, 28 (6): 655-659. 10.1016/S8756-3282(01)00434-3.CrossRefPubMed
22.
Carin-Levy G, Greig C, Young A, Lewis S, Hannan J, Mead G: Longitudinal changes in muscle strength and mass after acute stroke. Cerebrovasc Dis. 2006, 21 (3): 201-207. 10.1159/000090792.CrossRefPubMed
23.
Dey DK, Bosaeus I, Lissner L, Steen B: Body composition estimated by bioelectrical impedance in the Swedish elderly. Development of population-based prediction equation and reference values of fat-free mass and body fat for 70- and 75-y olds. Eur J Clin Nutr. 2003, 57 (8): 909-916. 10.1038/sj.ejcn.1601625.CrossRefPubMed
24.
Finestone HM, Greene-Finestone LS, Foley NC, Woodbury MG: Measuring longitudinally the metabolic demands of stroke patients: resting energy expenditure is not elevated. Stroke. 2003, 34 (2): 502-507. 10.1161/01.STR.0000053031.12332.FB.CrossRefPubMed
25.
Ralph A, Garrow JS, James WPT: Human nutrition and dietetics. 1993, Edinburgh: Churchill Livingstone, 9
26.
Kondrup J, Allison SP, Elia M, Vellas B, Plauth M, Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN): ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003, 22 (4): 415-421. 10.1016/S0261-5614(03)00098-0.
27.
Price R, Daly F, Pennington CR, McMurdo ME: Nutritional supplementation of very old people at hospital discharge increases muscle strength: a randomised controlled trial. Gerontology. 2005, 51 (3): 179-185. 10.1159/000083991.CrossRefPubMed
28.
Harari D, Norton C, Lockwood L, Swift C: Treatment of constipation and fecal incontinence in stroke patients: randomized controlled trial. Stroke. 2004, 35 (11): 2549-2555. 10.1161/01.STR.0000144684.46826.62.CrossRefPubMed
29.
Edington J, Barnes R, Bryan F, Dupree E, Frost G, Hickson M, Lancaster J, Mongia S, Smith J, Torrance A, West R, Pang F, Coles SJ: A prospective randomised controlled trial of nutritional supplementation in malnourished elderly in the community: clinical and health economic outcomes. Clin Nutr. 2004, 23 (2): 195-204. 10.1016/S0261-5614(03)00107-9.CrossRefPubMed
30.
Carnaby G, Hankey GJ, Pizzi J: Behavioural intervention for dysphagia in acute stroke: a randomised controlled trial. Lancet Neurol. 2006, 5 (1): 31-37. 10.1016/S1474-4422(05)70252-0.CrossRefPubMed
31.
Olde Rikkert MG, Deurenberg P, Jansen RW, van't Hof MA, Hoefnagels WH: Validation of multifrequency bioelectrical impedance analysis in monitoring fluid balance in healthy elderly subjects. J Gerontol A Biol Sci Med Sci. 1997, 52 (3): M137-41.CrossRefPubMed
32.
Kyle UG, Bosaeus I, De Lorenzo AD, Deurenberg P, Elia M, Manuel Gomez J, Lilienthal Heitmann B, Kent-Smith L, Melchior JC, Pirlich M, Scharfetter H, Schols AMWJ, Pichard C, ESPEN: Bioelectrical impedance analysis-part II: utilization in clinical practice. Clin Nutr. 2004, 23 (6): 1430-1453. 10.1016/j.clnu.2004.09.012.CrossRefPubMed
33.
Jaffrin MY, Morel H: Body fluid volumes measurements by impedance: A review of bioimpedance spectroscopy (BIS) and bioimpedance analysis (BIA) methods. Med Eng Phys. 2008, 30 (10): 1257-1269. 10.1016/j.medengphy.2008.06.009.CrossRefPubMed
34.
Kyle UG, Bosaeus I, De Lorenzo AD, Deurenberg P, Elia M, Gomez JM, Heitmann BL, Kent-Smith L, Melchior JC, Pirlich M, Scharfetter H, Schols AM, Pichard C, Composition of the ESPEN Working Group: Bioelectrical impedance analysis--part I: review of principles and methods. Clin Nutr. 2004, 23 (5): 1226-1243. 10.1016/j.clnu.2004.06.004.CrossRefPubMed
35.
Moissl UM, Wabel P, Chamney PW, Bosaeus I, Levin NW, Bosy-Westphal A, Korth O, Muller MJ, Ellegard L, Malmros V, Kaitwatcharachai C, Kuhlmann MK, Zhu F, Fuller NJ: Body fluid volume determination via body composition spectroscopy in health and disease. Physiol Meas. 2006, 27 (9): 921-933. 10.1088/0967-3334/27/9/012.CrossRefPubMed
36.
Tengvall M, Ellegard L, Malmros V, Bosaeus N, Lissner L, Bosaeus I: Body composition in the elderly: reference values and bioelectrical impedance spectroscopy to predict total body skeletal muscle mass. Clin Nutr. 2009, 28 (1): 52-58. 10.1016/j.clnu.2008.10.005.CrossRefPubMed
Metadata
Title
Body composition in older acute stroke patients after treatment with individualized, nutritional supplementation while in hospital
Authors
Lisa Ha
Truls Hauge
Per Ole Iversen
Publication date
01-12-2010
Publisher
BioMed Central
Published in
BMC Geriatrics / Issue 1/2010
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/1471-2318-10-75

Other articles of this Issue 1/2010

BMC Geriatrics 1/2010 Go to the issue

Technical advance

Improving diaper design to address incontinence associated dermatitis

Correspondence

Engaging the oldest old in research: lessons from the Newcastle 85+ study

Research article

Effects of Ginkgo biloba in dementia: systematic review and meta-analysis

Research article

Short-term geriatric assessment units: 30 years later

Research article

Predictors of inhospital mortality and re-hospitalization in older adults with community-acquired pneumonia: a prospective cohort study

Study protocol

The study protocol of a blinded randomised-controlled cross-over trial of lavender oil as a treatment of behavioural symptoms in dementia
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits