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www.jgeriatricmedicine.com J Lat Am Geriat Med. 2022;8(1):6-17
Impact of sarcopenia in clinical and functional
outcomes and dependency degree in stroke patients
Jorge A. Morcillo-Muñoz1*, Felipe Marulanda-Mejia1, Clara H. González-Correa2,
Andrés F. Morcillo-Muñoz3, Bernardo Uribe1, and Juan C. Ibarra-Jurado4
1Clinical Departament, Faculty of Sciences for Health, Universidad de Caldas, Manizales; 2Department of Basic Sciences for Health, Faculty
of Sciences for Health, Universidad de Caldas, Manizales; 3Unit of Neurology, Departament of Intern Medicine, Faculty of Medicine,
Universidad Nacional de Colombia, Bogota; 4Department of Intern Medicine, Faculty of Medicine, Universidad Nacional de Colombia,
Bogota. Colombia
Abstract
Background: Stroke presents high morbidity. Sarcopenia is a poorer prognostic factor in different pathologies.
Objective: The aim of this study was to establish the impact of sarcopenia on important outcomes in patients with ischemic
stroke. Patients and methods: Aprospective cohort study of patients > 45years of age with recent ischemic stroke was per-
formed, assessed at inclusion, and followed up at 3months. The presence of sarcopenia, clinical, and functional outcomes and
degree of dependence was evaluated. Results: Twenty-eight stroke patients were included, the mean aged was 68.5years, 42.8%
had sarcopenia, the patients with sarcopenia presented statistically significantly lower strength on the healthy body side, lower
bilateral brachial and calf circumference, and lower skeletal muscle mass and a tendency to present greater disability, depen-
dence, and low muscle mass after 3months. Conclusions: Patients with ischemic stroke and sarcopenia have worse clinical
outcomes, lower strength, as well as a trend towards increased risk of disability, dependency, and low muscle mass after 3months.
Sarcopenia assessment should be routinely performed in stroke patients.
Keywords: Stroke. Hand strength. Functional status. Dynamometer. Muscle strength dynamometer. Electric impedance.
Impacto de la sarcopenia en desenlaces clínicos, funcionales y dependencia en
pacientes con ACV
Resumen
Antecedentes: El Ataque cerebrovascular (ACV) presenta alta morbilidad. La sarcopenia es un factor de peor pronóstico en dis-
tintas patologías. Objetivo: Establecer el impacto de la sarcopenia en desenlaces de importancia en pacientes con ACV isquémico.
Pacientes y métodos: Se realizó un estudio de cohorte prospectiva de pacientes > 45 años de edad con ACV isquémico reciente,
evaluando al momento de la inclusión del estudio y con seguimiento a los 3 meses. Se evaluó la presencia de sarcopenia y el
comportamiento de desenlaces clínicos, funcionalidad y grado de dependencia. Resultados: Se incluyeron 28 pacientes con
ACV, con edad de 68,5 años, el 42,8% tenían sarcopenia. Estos pacientes presentaron, estadística, estadísticamente significativa
menor fuerza en el lado sano, menor circunferencia braquial y de pantorrilla bilateral y menor masa muscular esquelética y una
tendencia a presentar mayor discapacidad, dependencia y menor masa muscular después de 3 meses. Conclusiones: Los paci-
entes con ACV isquémico y sarcopenia tienen peores desenlaces clínicos, menor fuerza, así como una tendencia a mayor riesgo
de discapacidad, dependencia y baja masa muscular después de 3 meses. Debería realizarse la evaluación de la sarcopenia de
forma rutinaria en los pacientes con ACV.
Palabras clave: Sarcopenia. Accidente cerebrovascular. Fuerza de la mano. Estado funcional. Dinamometría manual.
Impedancia eléctrica.
ORIGINAL ARTICLE
THE JOURNAL OF LATIN AMERICAN GERIATRIC MEDICINE
Correspondence:
*Jorge A. Morcillo-Muñoz
E-mail:jamorcillom@outlook.com
2462-4616/© 2022 Colegio Nacional de Medicina Geriátrica, A.C. Published by Permanyer. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Date of reception: 28-06-2022
Date of acceptance: 20-07-2022
DOI: 10.24875/LAGM.22000003
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J.A. Morcillo-Muñoz et al.: Impact of sarcopenia
HIGHLIGHTS
– Stroke is the leading cause of disability worldwide
– Sarcopenia is highly prevalent in ischemic stroke
patients
– Patients with stroke and sarcopenia are older and
have lower skeletal muscle mass at diagnosis.
– After 3months of follow-up, patients with stroke
and sarcopenia have decreased grip strength,
decreased calf and brachial circumference,
increased disability, and dependency.
INTRODUCTION
Stroke is the fourth leading cause of death and the
second leading cause of non-communicable diseases
worldwide1, after only to coronary heart disease2;
also, this pathology has in low-and middle-income
countries – such as Colombia – a higher burden of dis-
ease2,3. The global incidence in 2016 was 13.7 million of
cases, and in Latin America, it has increased in recent
decades4. In Colombia, the incidence is estimated at
85-87cases per 100,000 people5. It is estimated that in
the coming years, there will be a progressive increase
due to increased life expectancy of the population6, as
well as better detection of cases due to the increased
availability of diagnostic aids7. Stroke occurs more in
men and the elderly4.
In the world, 75-80% of stroke episodes are ischemic
and although in Latin America, it is 57%, it still repre-
sents the main burden of the disease5. Risk factors for
stroke include older age, smoking, diabetes mellitus,
hypertension, obesity, sedentary lifestyle, and high
blood cholesterol levels7-10. It is known that approxi-
mately two-thirds of patients who suffer at least one
stroke survive the first year after11.
The state of health of these patients is altered in
several ways; the most studied is the aerobic capac-
ity, as their oxygen consumption is reduced by half12.
Recently, the study of muscle strength and its rela-
tionship with atrophy in the paretic limb13, due to
the change in the composition of the type of skeletal
muscle fibers and the increase in intramuscular adi-
posity, has gained great importance14.
Sarcopenia is a pathology commonly associated
with aging (primary sarcopenia), and with chronic
inflammatory states (secondary sarcopenia)13.
Sarcopenia is characterised by decreased strength
and muscle mass due, in part, to insulin resistance
and increased adipose tissue at the expense of loss
of lean mass13-15. There is little scientific literature on
the impact of sarcopenia in stroke patients in Latin
America and particularly in Colombia.
The aim of the present study was to determine the
impact of sarcopenia on clinical and functional out-
comes and degree of dependence in patients with
ischemic stroke after 3months of follow-up.
MATERIAL AND METHODS
The study was an observational prospective cohort
study, we study patients with a recent diagnosis of
ischemic stroke in the service of neurology in the city
of Manizales. Temporal convenience sampling was
performed between September 2020 and October
2021, two collaborating neurologists sent the data of
the patients who were candidates for evaluation, and
patients who met the inclusion criteria were evalu-
ated by telephone, they were subsequently scheduled
by telephone for a home medical evaluation, where
demographic data and physical assessment (weight,
arm, and calf circumference) were obtained, skeletal
muscle mass measured by electrical bioimpedance
measurement with BIODY XPERTzm® equipment, and
manual hydraulic dynamometry assessment with
Jamar® digital equipment. The patients were assigned
to two groups: those who presented probable sarco-
penia at the time of the initial evaluation and those
who did not. After 3 months, a second assessment
was performed to determine the impact of sarcope-
nia on clinical and functional outcomes and degree of
dependence.
Patients with sarcopenia were classified at the initial
assessment according to the 2019 revised European
consensus16 into sarcopenia probable group with the
International Mobility in Aging Study cutoff point
for dynamometry17. Confirmed sarcopenia was diag-
nosed according to the study by Villada et al.18
Inclusion criteria
The following criteria were included in the study:
– Patients over 45years of age with a recent diag-
nosis (up to 15days) of ischemic stroke assessed
by clinical neurology and radiological diagnosis
presenting hemiplegia or hemiparesis as neuro-
logical sequelae.
– National Institutes of Health Stroke Score (NIHSS)
scale score between 6 and 20.
– Signed informed consent
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J Lat Am Geriatric Med. 2022;8(1)
Exclusion criteria
The following criteria were excluded from the study:
Patients with:
– Recurrent stroke
– Any exacerbated chronic disease or clinical and
hemodynamic instability.
– Other generalized edematous states.
– Any advanced chronic disease considered termi-
nal and precluding evaluation such as cancer.
– Inherent conditions that would contraindicate
or prevent assessment testing (limb amputation,
impaired comprehension, and coma).
Statistical analysis
For the statistical analysis, the statistical package
Jamovi – Stats Open Now, free license, was used. The vari-
ables were described according to their nature as follows:
qualitative variables were expressed as absolute and rela-
tive frequencies; quantitative variables were expressed
as mean with their respective standard deviation, and as
median with their respective interquartile range, accord-
ing to the distribution of each variable. The Shapiro–Wilk
test was used to determine normality. Some quantitative
variables were recategorised into qualitative variables
(age, body mass index [BMI], NIHSS, Barthel, and modi-
fied rankin [mRankin] scale). For the analysis of compari-
son of quantitative variables between patients with and
without sarcopenia, the Student’s t-test for indepen-
dent samples and the Mann–Whitney U-test were used,
according to their distribution. For qualitative variables,
the Chi-square test was used. p < 0.05 was established to
determine statistical significance. For the initial and final
comparison analysis, Student’s t-test for dependent sam-
ples and the Wilcoxon test were used, according to their
distribution. p < 0.05 was established to determine statis-
tical significance. To establish the impact of sarcopenia on
the mRankin and Barthel functionality scales, they were
recategorized according to their severity in dichotomous
variables and in the case of low muscle mass according
to the cutoff point of probable sarcopenia. Chi-square
was used for comparison and p < 0.05 was established
to determine statistical significance. Percentage change
in muscle strength and skeletal muscle mass was calcu-
lated for both groups. Relative risk (RR) was calculated to
determine the magnitude of risk and RR adjustment was
performed through binomial logistic regression with age
and BMI as confounding variables from the literature. Sex
was not included as a confounder as the sarcopenia clas-
sification took into account the difference between men
and women.
Parameters for the definition of
sarcopenia
– Probable sarcopenia: Defined by dynamometry
< 23.2 kg/force in men and < 17.05 kg/force in
women17.
– Confirmed sarcopenia: In addition to probable
sarcopenia, defined by BIA, skeletal muscle mass
index (SMMI) < 8.39kg/m2 in men and 6.42kg/m2
in women18.
Clinical parameters assessed
– Days of hospitalization
– Bilateral brachial circumference
– Bilateral calf circumference
– Skeletal muscle mass and SMMI.
Functional parameters assessed
– mRankin scale categories and score
– Muscle grip strength.
Dependency parameter to be assessed
– Barthel scale categories and score.
RESULTS
Baseline characteristics in the overall
group
Between September 14 of 2020 and October 31of
2021, 169 patients were referred for evaluation, of
which 141patients did not meet the inclusion criteria
or had some exclusion criteria, as shown in figure1.
Of the 28 patients included, the majority were men
who recognised themselves as of mestizo ethnic-
ity and were from Manizales, with an average age of
68.5years, as shown in Tables1 and 2.
Hospitalization stay was 8 days. The left side was
affected in 64.3% of patients. The median NIHSS score
was seven points and 92.9% of the patients had a
moderate NIHSS score, the median Barthel scale score
was 57.5 points and the median mRankin scale score
was four points.
The mean weight was 59.4kg, most patients had a
BMI > 25kg/m2. The average brachial circumference of
the diseased and healthy sides was 29.1 and 29.2 cms,
respectively. The average calf circumference on the dis-
eased and healthy side was 32.8 and 33.3 cms, respec-
tively. The average skeletal muscle mass was 23.7kg
and the SMMI was 9.46kg/m2, as shown in Table2.
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J.A. Morcillo-Muñoz et al.: Impact of sarcopenia
Baseline characteristics according to
presence or absence of sarcopenia
The frequency of probable sarcopenia was 42.8% and
of confirmed sarcopenia 14.2%. The sarcopenia group
was older, had lower grip strength on the healthy, and
affected diseased side. Patients with sarcopenia had
higher NIHSS, lower Barthel, and higher mRankin,
although none were statistically significant. In addi-
tion, the sarcopenia group had lower weight, BMI, bra-
chial circumference on the diseased and healthy sides,
as well as lower calf circumference on the healthy side.
Skeletal muscle mass and SMMI were also lower in the
sarcopenic group, as shown in Table 3.
Second assessment
After 3months of initial evaluation, one patient in
the sarcopenia group died. In the non-sarcopenia,
Group 1 patient moved residence and was lost to
follow-up.
Characteristics of the second
assessment in the general group
The values of the variables in the general group at the
second assessment are shown in Table4, for this com-
parative analysis data from 26patients who had data at
both assessments which were taken into account.
The average strength on the diseased side increased
by up to 13.9kg of force with statistical significance
p = 0.038.
Refered patients: 169
Included patients: 28
Excluded patients: 141
– Low NIHSS: 50
– Difficulties in logistics of the evaluation: 14
– Previous Stroke: 13
– Prolonged previous hospital stay: 12
– Age: 10
– TIA: 10
– High NIHSS: 6
– Hospital death: 5
– Severe or advanced disease: 6
– No hemiparesis: 4
– No telephone response: 3
– Rejected evaluation: 3
– Hemorragic Stroke: 3
– Optic neuritis: 1
– Paliative management: 1
Figure 1. Patient flow chart. 169 patients were referred,
141 were excluded, and 28 patients were included for
initial assessment.
The average calf circumference on the healthy and
diseased side increased to 34 cms (p < 0.008) and 34.2
cms (p < 0.024), respectively.
Second assessment: comparison
between patients with and without
sarcopenia
Table5 shows the values and the comparative analy-
sis of the variables at the second assessment between
the sarcopenia and non-sarcopenia groups.
For the sarcopenia group, the median number
of days to second assessment was 107 days versus
99days in the non-sarcopenia group.
Table 1. Demographic characteristics and
frequency distribution of the NIHSS, Barthel and
mRankin scales
Variable n Percentaje (%)
Sex
Male
Female
15
13
53,6
46,4
Ethnicity
Mestizo
Other
24
4
85,7
14,3
Origin
Manizales
Chinchiná
Other
18
4
6
64,3
14,3
21,4
Age
< 65 years
> 65 years
12
16
42,9
57,1
BMI
< 25 kg/m2
> 25 kg/m2
12
16
42,9
57,1
Body side affected
Right
Left
10
18
35,7
64,3
NIHSS
Moderate
Severe
26
2
92,9
7, 1
Barthel
Independent
Low dependency
Moderate dependency
Severe dependency
Total dependency
6
2
4
11
5
21,4
7, 1
14,3
39,3
21,4
mRankin
1
2
3
4
5
3
7
3
10
5
10,7
25
10,7
35,7
1 7, 9
Total 28 100
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J Lat Am Geriatric Med. 2022;8(1)
Although the Barthel scale was higher in the sarcopenic
patients, there was no statistically significant difference.
The mRankin score was lower in patients with sarco-
penia, with no statistically significant difference.
With statistical significance, the average strength on
the healthy side was lower in the sarcopenia group,
as well as the brachial circumference on the affected
and healthy sides, and the calf circumference on the
diseased and healthy sides was lower in patients with
sarcopenia. Mean skeletal muscle mass and SMMI
were lower in patients with sarcopenia.
Adverse outcomes
The sarcopenia group had a 2.27 RR (95% CI: 0.68-
7.55) for severe or total dependency, but not sta-
tistically significant p = 0.165, adjusting for age and
BMI did not lose the trend in risk (RR: 2.09 95% CI:
0.31-13.77).
For disability, the sarcopenia group had 1.59 of
RR (95% CI 0.74-3.41) of having severe or moder-
ately severe disability; however, this was not statis-
tically significant p = 0.234 and when adjusting for
Table 2. Demographic characteristics and frequency distribution of the categorical variables in patients with
and without sarcopenia
Variable n Percentaje (%) Sarcopenia p
Yes No
n Percentaje (%) n Percentaje (%)
Sex
Male
Female
15
13
53,6
46,4
6
6
50
50
9
7
56,3
43,7
0,743
Ethnicity
Mestizo
Other
24
4
85,7
14,3
9
3
75
25
15
1
93,7
6,3
0,161
Origin
Manizales
Chinchiná
Other
18
4
6
64,3
14,3
21,4
8
2
2
66,6
16,7
16,7
10
2
4
62,5
12,5
25
0,851
Age
< 65 years
> 65 years
12
16
42,9
57,1
3
9 25
75
9
7
56,2
43,8
0,098
BMI
< 25 kg/m2
> 25 kg/m2
12
16
42,9
57,1
7
5
58,3
41,7
5
11
31,2
68,8
0,152
Body side affected
Right
Left
10
18
35,7
64,3
4
8
33,3
66,7
6
10
37,5
62,5
0,821
NIHSS
Moderate
Severe
26
2
92,9
7, 1
12
0
100
0
14
2
87,5
12,5
0,204
Barthel
Independent
Low dependency
Moderate dependency
Severe dependency
Total dependency
6
2
4
11
5
21,4
7, 1
14,3
39,3
1 7, 9
2
0
1
5
4
16,7
0
8,3
41,7
33,3
4
2
3
6
1
25
12,5
18,7
37,5
6,3
0,278
mRankin
1
2
3
4
5
3
7
3
10
5
10,7
25
10,7
35,7
1 7, 9
2
0
2
4
4
16,7
0
16,7
33,3
33,3
1
7
1
6
1
6,2
43,8
6,2
37,6
6,2
0,05
Total 28 100 12 42,8 16 57,2
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J.A. Morcillo-Muñoz et al.: Impact of sarcopenia
Table 3. Baseline characteristics and frequency distribution of continuous variables in patients with and
without sarcopenia
Variable Mean (sd) Sarcopenia p
Yes No
Mean (sd) Mean (sd)
Age (years) 68,5 (14,3) 76,5 (14,9) 62,6 (10,7) 0,008
Weight (kg) 59,4 (11,8) 53,3 (12,8) 64,1 (8,8) 0,014
BMI (kg/m2)* 25,9 (16,5) 22,1 (5,1) 25,6 (3,1) 0,03
NIHSS scale* 7 (12) 9 (7) 7 (12) 0,182
Barthel scale* 57,5 (95) 40 (95) 75 (95) 0,052
mRankin scale* 4 (4) 4 (4) 2,5 (4) 0,13
Affected side strength (kg/force) 12,1 (9,4) 10,1 (9,2) 13,6 (9,6) 0,349
Healthy side strength (kg/force) 21,6 (10) 13,2 (6,4) 27,9 (7,1) <0,001
Affected side brachial circumference (cms) 29,1 (4,6) 26,2 (4,1) 31,2 (3,8) 0,046
Healthy brachial circumference healthy side
(cms)
29,2 (4,2) 26,6 (3,9) 31,1 (3,4) 0,034
Affected side calf circumference (cms) 32,8 (4,7) 30,7 (5,2) 34,3 (3,8) 0,05
Healthy side calf circumference (cms) 33,3 (4,5) 31,3 (5,1) 34,9 (3,5) 0,015
Skeletal muscle mass (kg) 23,7 (4,6) 21,8 (3,2) 25,2 (5,0) 0,05
SMMI (kg/m2) 9,46 (1,4) 8,73 (1,3) 10 (1,3) 0,015
Hospitalisation stay (days)* 8 (12) 7,5 (12) 8 (6) 0,57
n (%) 28 (100) 12 (42,8) 16 (57,2)
Means and interquartile range are reported (Shapiro-Wilk p < 0.05), Median comparison is performed using the
Mann-Whitney U-test, * Median and interquartile range (Shapiro-Wilk p < 0.05), Median comparison is performed using the
Mann-Whitney U-test.
Table 4. Comparison between the rst and second assessment in the overall group
Variable Baseline Final p
Mean (sd) Mean (sd)
Barthel scale* 55 (95) 73,1 (95) 0,003
mRankin scale* 4 (4) 2,5 (1,45) <0,001
Affected side strength (kg/force) 11,8 (9,7) 13,9 (10,5) 0,038
Healthy side strength (kg/force) 21,5 (10,1) 23,2 (9,9) 0,071
Affected side brachial circumference (cms) 29,1 (4,8) 28,8 (4,5) 0,631
Healthy side brachial circumference (cms) 29,2 (4,4) 29,1 (4,1) 0,872
Affected side calf circumference (cms) 32,5 (4,8) 34,0 (4,5) 0,008
Healthy side calf circumference (cms) 33,1 (4,5) 34,2 (4,5) 0,024
Skeletal muscle mass (kg) 23,6 (4,8) 23,4 (4,7) 0,723
SMMI (kg/m2) 9,4 (1,5) 9,4 (1,6) 0,943
N 26
Mean and standard deviation are reported. Student’s t-test p value result for dependent variables. *Median and interquartile
range are reported: Wilcoxon p value test result.
Data from the 26 patients who were followed up at the second evaluation were used.
12
J Lat Am Geriatric Med. 2022;8(1)
age and BMI the direction of risk was not lost, RR
1.08(95% CI: 0.15-7.73).
Finally, for skeletal muscle mass, patients with
probable sarcopenia had an increased risk of low
muscle mass at final assessment of 5.25 of RR (95%
CI: 0.46-59.28), but not statistically significant p = 0.15
and when adjusted for age and BMI, the RR was
2.27(95% CI: 0.15-34.46).
DISCUSSION
In this cohort of patients with first episode of
ischemic stroke, the association of sarcopenia with
adverse outcomes at 3-month follow-up was studied
according to the 2019 European Working Group on
Sarcopenia in Older People (EWGSOP) approach16.
The main findings of this study were that sarcopenia
probable was highly prevalent in this cohort 42.8%
and confirmed sarcopenia in 14.8%. These data are
within the range reported in the literature. Arecent
systematic review established that sarcopenia in
stroke patients averaged 42%; however, it ranged
from 16.8 to 60.3%. The high heterogeneity between
the included studies, their approaches (question-
naires, grip strength, and body composition) and
methods (dynamometry, bioimpedance, and dual-
energy X-ray absorptiometry) and cutoff points to
determine sarcopenia (EWGSOP, SMMI, Asian Working
Group for Sarcopenia) are underlined, particularly in
this systematic review, a 50% prevalence of sarcope-
nia was found in patients with < 1month of stroke
diagnosis19. In a study in China with after 4-year fol-
low-up, stroke occurred in 245patients, of whom 22%
had probable sarcopenia20. Nozoe et al., in Japanese,
patients included 152patients with a stroke episode,
the researchers found an 18% frequency of previous
sarcopenia; however, they used the SARC-F as a diag-
nostic tool21, and in Heredia’s study using dynamom-
etry as an instrument, they found 51.4% of patients
with sarcopenia in the ICU in Argentina22.
Confirmed sarcopenia was found in 14.8% of
patients in the present study, while the study by
Shiraishi’s group23 found a frequency of 53.5% in
patients in a Japanese rehabilitation centre; and in the
study by Park et al., 30.7% of patients in SouthKorea
had confirmed sarcopenia using the same methods as
our study; however, these last two studies used differ-
ent cutoff points23,24.
In this study, the mean age was 68 years, similar
to Park’s study24 and lower than that reported by
Nozoe21. Patients with sarcopenia had an average
age of 76.5 years, being the oldest, similar to that
reported in the Japanese21 and SouthKorean24 popu-
lation study. Stroke severity according to the NIHSS
Table 5. Final comparison of quantitative variables between the group of patients with and without sarcopenia
Variable Mean (sd) Sarcopenia P
Yes No
Mean (sd) Mean (sd)
Days to second assessment* 103 (50) 107 (39) 99 (50) 0.016
Barthel scale* 73,1 (95) 65 (95) 90 (55) 0.076
mRankin scale* 2,5 (1,4) 3 (4) 2 (3) 0.091
Affected side strength (kg/force) 13,9 (10,5) 10.2 (8,3) 16.6 (11,3) 0.128
Healthy side strength (kg/force) 23,2 (9,9) 15.6 (7,6) 28.8 (7,5) <.001
Affected side brachial circumference (cms) 28,8 (4,5) 26.1 (4,2) 30.7 (3,7) 0.007
Healthy side brachial circumference (cms) 29,1 (4,1) 26.9 (4,3) 30.6 (3,1) 0.019
Affected side calf circumference (cms) 34,0 (4,5) 31.5 (4,1) 35.9 (3,9) 0.012
Healthy side calf circumference (cms) 34,2 (4,5) 31.6 (4,6) 36.1 (3,4) 0.008
SMMI (kg/m2) 9,43 (1,6) 8.55 (1,4) 10.1 (1,4) 0.011
Skeletal muscle mass (kg) 23,4 (4,7) 21.2 (3,6) 25.1 (4,8) 0.033
n (%) 26 (100) 11 (39,3) 15 (57,7)
Comparison of means with Student’s t-test for independent samples, *Median and interquartile range are indicated
(Shapiro-Wilk p < 0.05), Comparison of medians by Mann-Whitney U-test.
Data from the 26 patients who were followed up at the second assessment were used.
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J.A. Morcillo-Muñoz et al.: Impact of sarcopenia
Figure 2. Approval certificate by group of professors of the clinical department.
in the total cohort was seven points, similar to that
reported by Yi in a SouthKorean population25, the
sarcopenia group had higher NIHSS, similar to that
found in two other studies21,24. Hospitalization stay
was similar in both groups, in the study by Nozoe et
al., patients with sarcopenia had significantly more
days of hospitalization stay21, in the ICU setting
Heredia et al. found longer inpatient service stay in
sarcopenia group22.
In our study, the median Barthel scale score was 55
points, in Yi’s study, it was 30.9 points25, and we found
that sarcopenic patients at the first assessment had a
tendency towards greater disability and dependency,
as reported by Park24, as well as less strength in the
affected upper extremity, a difference that was veri-
fied in Nozoe’s21 and Park’s24 study.
Sarcopenic patients had lower weight and BMI than
non-sarcopenic patients, which was not found in other
studies23. Calf circumference on the healthy and dis-
eased side was smaller in patients with sarcopenia,
which has also been demonstrated in the ICU setting22.
In this cohort of patients, the average muscle strength
14
J Lat Am Geriatric Med. 2022;8(1)
on the healthy side was 21.5 kgs/force, in Yi’s study in a
SouthKorean population, it was 17.6 kgs/force25. Basal
skeletal muscle mass was similar between patients
with and without sarcopenia; however, patients with
sarcopenia had lower SMMI than patients without sar-
copenia, also reported by Park24.
In this study at the follow-up assessment, there was
an improvement of almost 18 points on the Barthel
scale and a reduction in the mRankin scale, a signifi-
cant increase in calf circumference on the healthy side
and a more marked increase on the sick side, which is
probably due in part to hypostatic edema.
Patients with sarcopenia had greater disability and
dependency at baseline and at 3months, consistent
with Nozoe’s report at 3-month follow-up21, but not
with Park’s study at 3-week follow-up24. Healthy upper
limb strength remained lower in the sarcopenia
group, strength on the diseased side was numerically
lower, but not statistically significant.
Grip strength has been associated as a predictor of
improvement on the Barthel scale in the short term25,26,
and in the long term26. In the present study, patients
with sarcopenia scored worse on the disability and
dependency scales compared to the group without
sarcopenia, although without achieving statistical
significance, patients with sarcopenia have 2 times
higher risk of having severe or total dependency,
adjusting for age and BMI the trend was maintained,
Figure 3. Approval certificate by the bioethics committee.
15
J.A. Morcillo-Muñoz et al.: Impact of sarcopenia
Figure 4. Informed consent form.
without being statistically significant. Similarly, in
the final assessment patients with sarcopenia scored
worse on the mRankin scale, such and had a higher
risk of severe or moderately severe disability although
with a lower magnitude in the direction of risk with-
out achieving statistical significance, probably due to
the small sample size of this study.
The strengths of this study are: (1) it is a pioneer
in the subject in Colombia and Latin America, (2)
methodologies recommended by the international
literature were used, (3) it included a population from
several municipalities in the department of Caldas
and adult and elderly patients, (4) the evaluations
were carried out at home, facilitating the usual per-
formance of the patients in their daily lives, and (5)
the statistical analysis carried out was in accordance
with the objectives set out and shows the probable
usefulness of dynamometry and body composition
measurements as accessible instruments in the clini-
cal setting.
The main limitation of this study was the sample
size, although it is similar to those previously dis-
cussed. Patients with severe stroke were excluded,
which may have overestimated the proportion of
patients’ improvement, and this study is not represen-
tative of all stroke patients.
16
J Lat Am Geriatric Med. 2022;8(1)
Ethical issues
– Approval was obtained from the group of profes-
sors of the clinical department of the University
of Caldas (Fig.2).
– According to resolution 8430 of 1993, it is a study
with minimal risk given its observational nature.
– Approval was obtained from the ethics commit-
tee of the University of Caldas on March 31, 2020,
consecutive number CBCS-021, in act number
005 (Fig.3).
– Informed consent was requested from the par-
ticipants, in case of impossibility to sign, a fam-
ily member or companion was asked to sign
the authorization, the author J.A.M.M. only had
access to this data and this information was not
provided to third parties (Fig.4).
CONCLUSIONS
This is the first study to describe, characterize, and
evaluate stroke patients according to the presence of
sarcopenia and their clinical outcomes in Colombia
and Latin America. Sarcopenia is a highly frequent
clinical entity in ischemic stroke patients, especially in
those with older age, lower body weight, BMI, and SMI
at diagnosis.
Patients with ischemic stroke and a diagnosis of sar-
copenia had lower strength on the healthy side, lower
brachial, and calf circumference on the healthy and
diseased side, lower SMMI, and lower skeletal muscle
mass at 3-month follow-up.
Patients with stroke and sarcopenia appeared to
have a higher tendency to disability, dependency, and
lower skeletal muscle mass, however, due to study
limitations, statistical significance was not reached.
FUNDING
This research has not received any specific grant
from public, commercial, or non-profit sector agencies.
CONFLICTS OF INTEREST
The authors declare that they have no conflicts of
interest.
ETHICAL DISCLOSURES
Protection of human and animal subjects. The
authors declare that the procedures followed were
in accordance with the regulations of the relevant
clinical research ethics committee and with those of
the Code of Ethics of the World Medical Association
(Declaration of Helsinki).
Confidentiality of data. The authors declare that
they have followed the protocols of their work center
on the publication of patient data.
Right to privacy and informed consent. The
authors have obtained the written informed consent
of the patients or subjects mentioned in the article.
The corresponding author is in possession of this
document.
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