Nutritional status, abdominal muscle thickness, and functional outcomes in patients with subacute to chronic stroke

Nutritional status is an important determinant of rehabilitation outcomes after stroke; however, its relationship with abdominal muscle morphology remains unclear. Given the role of abdominal muscles in trunk stability, postural control, and functional mobility, this study aimed to evaluate the association between nutritional status, abdominal muscle thickness, and functional recovery in patients with subacute to chronic stroke.

In this prospective observational study, patients with subacute to chronic stroke who were admitted to an inpatient rehabilitation program were evaluated at baseline and after a 4-week rehabilitation program. Nutritional status was assessed using the Mini Nutritional Assessment-Short Form (MNA-SF), reflecting screening-defined nutritional risk. Abdominal muscle thicknesses of the external oblique, internal oblique, and transversus abdominis were measured by ultrasonography on the non-paretic side. Clinical, functional, cognitive, and biochemical parameters were recorded at baseline and discharge. The primary outcome was functional independence at discharge, assessed by the Barthel Index.

Sixty patients were included, of whom 38 had normal nutritional status and 22 were classified as having nutritional risk based on the MNA-SF. Significant within-group improvements in motor recovery and mobility were observed in both groups following rehabilitation (p < 0.05). Although both groups demonstrated improvements, patients with normal nutritional status had higher functional independence levels at both baseline and post-treatment assessments. Baseline abdominal muscle thicknesses were similar between groups (p > 0.05) and did not change significantly after rehabilitation (p > 0.05). Multivariable analysis showed that nutritional risk was independently associated with lower discharge Barthel Index scores (B = -2.99, 95% CI -5.65 to -0.33, p = 0.028), after adjustment for prespecified covariates. In contrast, nutritional risk was not independently associated with discharge cognitive outcomes (MMSE) or mobility outcomes (FAC and mRS).

In patients with subacute to chronic stroke, functional recovery during rehabilitation appears to be associated with nutritional risk, whereas no significant association was observed with abdominal muscle thickness. Although muscle thickness remained unchanged, screening-defined nutritional risk was independently associated with functional independence at discharge. These findings underscore the importance of early nutritional screening and comprehensive evaluation during stroke rehabilitation.