A Study Of The Nutritional Status Of Post-stroke Patients And The Factors Related To Malnutrition In Hongkou District Of Shanghai

Background: Malnutrition is as an independent risk factor of poor outcome after stroke. Previous studies have estimated that 16%～35% of patients suffer from malnutrition in the acute phase of stroke, but so far few studies have focused on the nutritional status in the late rehabilitation phase after stroke in patients in community hospitals, where the attention on nutrition may be reduced. Though the catabolic metabolism in the rehabilitation phase is not as severe as that in the acute phase for stroke patients, the rehabilitation phase may last much longer than the acute phase, therefore more attention is needed for nutritional management at this stage. Previous studies have estimated that 19%～60% of patients suffer from malnutrition in the rehabilitation phase of stroke, but insufficient attention has been paid to nutrition related issues of post-stroke patients in the clinical practice in our country in the past. There is also a lack of multi-center studies and related data about nutritional status, the relevant factors that precipitate malnutrition and the relationship between nutritional status and the prognosis of patients after stroke, hence we are not able to assess the basic nutritional status and understand the factors related to malnutrition, as a result, we are unable to prevent, intervene and manage the malnutrition of stroke patients appropriately.Objective: To investigate the nutritional status of post-stroke patients in community hospitals and unravel the relevant factors that precipitate malnutrition after stroke. Through understanding the relationship of malnutrition with neurological deficit, disability, activities of daily living and the incidences of infections and complications, we try to reinforce the conception of nutritional management of post-stroke patients and figure out the standard nutritional support mode for stroke patients. Methods: Based on 438 post-stroke patients who were admitted in community hospitals in Hongkou district of Shanghai, we examined the nutritional indices, the possible malnutrition related factors, NIHSS, Barthel index, mRS and the incidences of infections and complications and analyzed the relationship of them through the cross-sectional study, which formulated"The questionnaire of the nutritional status among patients after stroke in Hongkou district of Shanghai". All of the data were collected by trained clinicians, marks were given immediately after cross-sectional collecting. Information obtained from the questionnaire was tested through quality control and reliability detection. Quality control measures include: collective training of investigators, investigating the trial, modifying the questionnaire in time when questions were found, repetitive confirmation were required to reduce the recall bias. Reliability: repetitive investigating 20 copies of the questionnaire, make sure that the relevance of main indicators was equal or greater than 0.7.Outcome: (1)The detection rate of dysphagia and hypoalbuminemia and malnutrition was 18.6%,42.7%and 52.7%respectively. There were 376 patients with oral feeding and 61 patients with nasal feeding and 1 patient with percutaneous endoscopic gastrostomy. 32% of 376 patients with oral feeding returned to normal food intaking, 60% for more than half of the normal state, 8% for less than half of the normal state; Energy was not provided according to the requirement of"Enteral and parenteral nutrition clinical guidelines (2006 edition)"for 46 patients among 62 patients with enteral nutrition. (2)Group comparison through multivariate logistic regression analysis showed that there was a higher malnutrition detection rate in the post-stroke patients with more stroke attacks (group with three stroke attackes and above, 0R=11.00,95%CI:1.14-106.34), higher NIHSS scores (group with NHISS≥15, 0R=7.09, 95%CI:2.90-17.36), higher modified Rankin scales (group mRS 4-5, OR=15.77,95%CI:6.61-37.59), lower BI (group BI 0～20,OR=20.02,95%CI:6.31-63.52) (trend test p<0.0001) and paralysis of the predominant limbs (OR=3.70,95%CI:1.87-7.31). The risk of malnutrition was also correlated with the post-stroke depression, family care, family nutrtition support, early-stage rehabilitation, history of malignant tumors and severe alcoholism.(3) Among these patients, the number of patients with moderate and severe neurological deficits (NIHSS>4 score) accounted for 77.1%, those with severe disability (mRS 4～5 score) accounted for 70.1%, the incidence of severe and complete dependence of activities of daily living (Barthel index 0～45 score) was 69.7 %, the incidences of infection and complication were 34.6 % and 55.4% respectively ; whereas the corresponding incidences were respectively 24.2%, 21.3%, 19.8%, 11.6% and 18.8% among eutrophic patients.Conclusion: (1)There was a high detection rate of dysphagia and hypoalbuminemia and malnutrition among post-stroke patients in community hospitals;The lack of unified management of eating, the random intake and the lack of eating supervision were revealed among these patients. (2)There were many factors related to malnutrition among post-stroke patients in the community. More attention to controllable influencing factors would improve the prognosis of post-stroke patients. (3)There was a significant relationship between malnutrition of post-stroke patients in community hospitals and neurological deficit, decline of activity of daily living, disability, the incidences of infections and complications. Malnourished post-stroke patients were always accompanied with serious neurological deficit, serious disability, poor activities of daily living, high incidences of infections and complications. Treatment of the malnutritional status of post-stroke patients would improve the prognosis of post-stroke patients.