Malnutrition identified based on GLIM criteria and diet quality in post-stroke rehabilitation patients

Malnutrition is one of the important consequences of stroke and has been strongly associated with negative clinical outcomes.

We aimed to investigate (1) the prevalence of malnutrition based on the Global Leadership Initiative on Malnutrition (GLIM) criteria in post-stroke rehabilitation patients, (2) the associations of malnutrition with stroke-related clinical characteristics, and (3) the dietary intake of patients after stroke.

Eighty-one post-stroke patients undergoing in-patient rehabilitation were included. Spasticity, motor function, ambulation levels, functionality and burden of co-morbidities were assessed making use of the Modified-Ashworth-Scale (MAS), Brunnstrom Staging, the Functional-Ambulation-Classification (FAC), the Barthel-Index and the Cumulative-Illness-Rating-Scale (CIRS), respectively. GLIM criteria were used for the diagnosis of malnutrition. We considered two alternative definitions of low muscle mass (LMM), i.e., skeletal muscle mass (SMM)/ height², and SMM/body mass index (BMI). Dietary intake was evaluated using a 24-hour recall.

Malnutrition was present in 21% and 53.1% of the participants when SMM was adjusted for height² and BMI, respectively. The MAS-hip [odds ratio (OR) = 14.973, p = 0.03], FAC (OR = 0.01, p = 0.002) and CIRS (OR = 2.33, p = 0.006) were independently associated with GLIM (LMM adjusted for height²)-identified malnutrition; while ankle spasticity by MAS was the only independent associate of GLIM (LMM adjusted for BMI)-identified malnutrition (OR = 0.36, p = 0.047). Of the 10 participants, nine did not reach a protein intake of at least 1 g/kg/d. The median daily intake of calories and elemental calcium was low.

Malnutrition was found to be highly prevalent among post-stroke rehabilitation patients, with prevalence varying based on the approach to the standardization of muscle mass and was associated with indicators of functional impairment.