Nutritional follow-up in patients with ischemic stroke: With a screening test or with blood parameters?

Aim: The aim of this study was to evaluate the nutritional status of stroke patients and to investigate the value of screening tests andblood parameters in nutritional status follow-up.Material and Methods: This study was conducted on 42 patients who were hospitalized with ischemic stroke. Mini nutritionalassessment (MNA) test was performed at admission to all patients. Personalized oral nutritional support was initiated in patientswith malnutrition risk (MNA score < 24) or malnutrition (MNA score < 17). During the first visit, albumin, prealbumin, C - reactiveprotein (CRP), total cholesterol and hemogram tests were examined. After four weeks follow-up, MNA test and blood tests wererepeated in all patients included in the study. Data at baseline and at the end of four weeks were compared.Results: The mean MNA score was 22.44±3.13 at first visit. 15 patients (35.7%) were found to be at risk of malnutrition and 7 (16.6%)were malnourished at admission. Serum albumin and prealbumin levels were significantly lower in patients with abnormal nutritionalstatus (p0.05).Conclusion: The nutritional status of stroke patients should be evaluated at regular intervals after the admission and optimal nutritionplan should be made. MNA scoring is a safe method for both diagnosis and monitoring of malnutrition.

PDF

___

1. Barker LA, Gout BS, Crowe TC. Hospital malnutrition: prevalence, identification and impact on patients and the healthcare system. Int J Environ Res Public Health 2011;8:514-27.
2. Allard JP, Keller H, Jeejeebhoy KN, et al. Decline in nutritional status is associated with prolonged length of stay in hospitalized patients admitted for 7 days or more: a prospective cohort study. Clin Nutr 2016;35:144-52.
3. Kondrup J, Allison SP, Elia M, et al. Educational and clinical practice committee ErSoPaENE. ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003;22:415-421.
4. Crary MA, Carnaby-Mann GD, Miller L, et al. Dysphagia and nutritional status at the time of hospital admission for ischemic stroke. J Stroke Cerebrovasc Dis 2006;15:164- 171.
5. Crary MA, Humphrey JL, Carnaby-Mann G, et al. Dysphagia, nutrition, and hydration in ischemic stroke patients at admission and discharge from acute care. Dysphagia 2013;28:69-76.
6. Jauch EC, Saver JL, Adams Jr HP, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013;44:870–947.
7. Anthony PS. Nutrition screening tools for hospitalized patients. Nutr Clin Pract. 2008 2008;23:373-82.
8. Gariballa SE, Parker SG, Taub N, et al. Nutritional status of hospitalized acute stroke patients. Br J Nutr 1998;79:481- 487.
9. Aptaker RL, Roth EJ, Reichhardt G, et al. Serum albumin level as a predictor of geriatric stroke rehabilitation outcome. Arch Phys Med Rehabil 1994;75:80-84.
10. Hasselmann M, Alix E. Tools and procedures for screening for malnutrition and its associated risks in hospital. Nutr Clin Metabol 2003;17:218e26.
11. Guigoz Y, Vellas B, Garry P. The Mini Nutritional Assessment: a practical assessment tool for grading the nutritional state of elderly patients. Facts Res Gerontol 1994;4:15-59.
12. Ferrie S, Allman-Farinelli M. Commonly used nutrition indicators do not predict outcome in the critically ill: a systematic review. Nutr Clin Pract 2013 Aug;28:463e84.
13. Quinlan GJ, Martin GS, Evans TW. Albumin: Biochemical properties and therapeutic potential. Hepatology, 2005;41(6):1211–1219.
14. Cabrerizo S, Cuadras D, Gomez-Busto F, et al. Serum albumin and health in older people: Review and meta analysis. Maturitas 2015;81:17–27.
15. Shenkin, A. Serum prealbumin: Is it a marker of nutritional status or of risk of malnutrition? Clin. Chem. 2006, 52, 2177–2179.
16. Jain S, Gautam V, Naseem S. Acute-phase proteins: As diagnostic tool. J Pharm Bioallied Sci 2011;3:118–27.
17. Ingenbleek Y, Young VR. Significance of transthyretin in protein metabolism. Clin Chem Lab Med 2002;40:1281–91.
18. Winkler MF, Gerrior SA, Pomp A, et al. Use of retinolbinding protein and prealbumin as indicators of the response to nutrition therapy. J Am Diet Assoc 1989;89:684–7.
19. Arbab K, Majid H, Jafri L, et al. Assessing nutritional status of critically ill patients using serum prealbumin levels. J Ayub Med Coll Abbottabad 201931:178-81.
20. Hickson M. Malnutrition and ageing. Postgrad Med J 2006;82:2–8.
21. Budzyinski J, Tojek K, Czerniak B, et al. Scores of nutritional risk and parameters of nutritional status assessment as predictors of in-hospital mortality and readmissions in the general hospital population. Clin. Nutr 2016;35:1464–71.
22. Filipovic B, Kovcevic N, Randjelovic T, et al. Nutritional status in hospitalized patients in the department of gastroentero hepatology. Hepato-Gastroenterol 2011;58:1229–1234.
23. Pham NV, Cox-Reijven PL, Wodzig WK, et al. SGA and measures for muscle mass and strength in surgical vietnamese patients. Nutrition 2007;23:283–291.
24. Zheng T, Zhu X, Liang H, et al. Impact of early enteral nutrition on short term prognosis after acute stroke. J Clin Neurosc. 2015;22:1473–6.
25. Salvi F, Giorgi R, Grilli A, et al. Mini nutritional assessment (short form) and functional decline in older patients admitted to an acute medical ward. Aging Clin Exp Res 2008;20:322-8.
26. Ongun N. Does nutritional status affect Parkinson’s Disease features and quality of life? PLoS one 2018;13:e0205100.
27. Johansson L, Wijk H, Christensson L. Improving nutritional status of older persons with dementia using a national preventive care program. J Nutr Health Aging. 2017;21(3):292-298.
28. Zhang J, Zhao X, Wang A, et al. Emerging malnutrition during hospitalisation independently predicts poor 3-month outcomes after acute stroke: data from a Chinese cohort. Asia Pac J Clin Nutr 2015;24:379-386.
29. Goossens S, Bekele Y, Yun O, et al. Mid-Upper Arm circumference based nutrition programming: evidence for a new approach in regions with high burden of acute malnutrition. PLoS One 2012;7:e49320
30. Mosselman MJ, Kruitwagen CL, Schuurmans MJ, et al.. Malnutrition and risk of malnutrition in patients with stroke: prevalence during hospital stay. J Neurosci Nurs 2013;45:194-204.
31. Schnelldorfer T, Adams DB. The effect of malnutrition on morbidity after surgery for chronic pancreatitis. Am Surg 2005;71:466–73.