ArticlePDF Available

Abstract and Figures

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: A prospective cohort study of patients > 45 years of age with recent ischemic stroke was performed, assessed at inclusion, and followed up at 3 months. 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 68.5 years, 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, dependence, and low muscle mass after 3 months. 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 3 months. Sarcopenia assessment should be routinely performed in stroke patients.
Content may be subject to copyright.
6
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 > 45years of age with recent ischemic stroke was per-
formed, assessed at inclusion, and followed up at 3months. 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 68.5years, 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 3months. 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 3months.
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
7
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 3months 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
85-87cases 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 3months 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 45years of age with a recent diag-
nosis (up to 15days) 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
8
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) < 8.39kg/m2 in men and 6.42kg/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 141patients did not meet the inclusion criteria
or had some exclusion criteria, as shown in figure1.
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
68.5years, as shown in Tables1 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 59.4kg, most patients had a
BMI > 25kg/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 23.7kg
and the SMMI was 9.46kg/m2, as shown in Table2.
9
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 3months 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 Table4, for this com-
parative analysis data from 26patients who had data at
both assessments which were taken into account.
The average strength on the diseased side increased
by up to 13.9kg 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
Table5 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
99days 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
10
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
11
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. Arecent
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 < 1month of stroke
diagnosis19. In a study in China with after 4-year fol-
low-up, stroke occurred in 245patients, of whom 22%
had probable sarcopenia20. Nozoe et al., in Japanese,
patients included 152patients 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 SouthKorea
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 SouthKorean24 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.
13
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 SouthKorean 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
SouthKorean 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 3months, 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.
REFERENCES
1. World Health Organization. World Health Statistics 2019: Monitoring
Health for the SDGs, Sustainable Development Goals. Geneva: World
Health Organization; 2019.
2. Johnson W, Onuma O, Owalabi M, Sachdev S. Stroke: a global response
is needed. Bull World Health Organ. 2016;94:634.
3. De la Cruz R, Andrian LG, Loterszpil M. Colombia Hacia Un País De Altos
Ingresos Con Movilidad Social. Colombia: Banco Interamericano De
Desarrollo; 2016.
4. Feigin VL, Roth GA, Naghavi M, Parmar P, Krishnaumurthi R, Chugh S,
et al. Global burden of stroke and risk factors in 188 countries, during
1990-2013: a systematic analysis for the global burden of disease study
2013. Lancet Neurol. 2016;15:913-24.
5. Martins SC, Sacks C, Hacke W, Brainin M, Figueredo FA, Pontes-NetoOM,
et al. Priorities to reduce the burden of stroke in Latin American
Countries. Lancet Neurol. 2019;18:674-83.
6. Bogousslavsky JL, Moncayo J, Norrving B. Stroke. Neurological
Disorders: Public Health Challenges. Geneva: World Health Organization
Press; 2006.
7. Hankey GJ. Stroke. Lancet. 2017;389:641-54.
8. Ekker MS, Boot EM, Singhal AB, Tan KS, Debette S, Tuladhar AM, et al.
Epidemiology, aetiology, and management of ischaemic stroke in
young adults. Lancet Neurol. 2018;17:790-801.
9. Muñoz M. Enfermedad cerebrovascular. Acta Neurol Colomb.
2010;26:205-37.
10. Ministerio De Salud y Protección Social. Guía De Práctica Clínica de
Diagnóstico, Tratamiento Y Rehabilitación Del Episodio Agudo Del
Ataque Cerebrovascular Isquémico En Población Mayor De 18 Años.
Colombia: Ministerio de Salud Y Protección Social; 2015.
11. Kudling P, Billinger SA. Exercise-induced changes of the upper extrem-
ity in chronic stroke survivors. Top Stroke Rehabil. 2005;12:58-68.
12. Ivey FM, Hafer-Macko CE, Macko RF. Exercise rehabilitation after stroke.
NeuroRx. 2006;3:439-50.
13. Severinsen K, Jakobsen JK, Overgaard K, Andersen H. Normalized
muscle strength, aerobic capacity, and walking performance in chronic
stroke: a population-based study on the potential for endurance and
resistance training. Arch Phys Med Rehabil. 2011;92:1663-8.
14. Cruz-Jentoft A, Triana FC, Gómez-Cabrera M, Lopez-Soto A, Masanés F,
Martin PM, et al. La eclosión de la sarcopenia: informe preliminar del
observatorio de la sarcopenia de la sociedad española de geriatría y
gerontología. Rev Esp Geriatr Gerontol. 2011;46:100-10.20.
15. Yoo C, Kim J, Yang Y, Lee J, Jeon G. Bioelectrical impedance analysis for
severe stroke patients with upper extremity hemiplegia. JPhys Ther Sci.
2016;28:2708-12.
16. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al.
Sarcopenia: revised European consensus on definition and diagnosis.
Age Ageing. 2019;48:16-31.
17. Barbosa JF, Zepeda MU, Béland F, Guralnik JM, Zunzunegui MV,
GuerraRO. Clinically relevant weakness in diverse populations of older
adults participating in the international mobility in aging study. Age
(Dordr). 2016;38:25.
18. Villada-Gómez, JS, González- Correa CH, Marulanda-Mejía F. Puntos de
corte provisionales para el diagnóstico de sarcopenia en ancianos de
Caldas, Colombia. Biomédica. 2018;38:521-26.
19. Su Y, Yuki M, Otsuki M. Prevalence of stroke-related sarcopenia: a system-
atic review and meta-analysis. JStroke Cerebrovas Dis. 2020;29:105092.
20. Liu G, Xue Y, Wang S, ZhangY, Geng Q. Association between hand grip
strength and stroke in China: a prospective cohort study. Aging (Albany
NY). 2021;13:8204-13.
17
J.A. Morcillo-Muñoz et al.: Impact of sarcopenia
21. Nozoe M, Kanai M, Kubo H, Yamamoto M, Shimada S, Mase K. Prestroke
sarcopenia and functional outcomes in elderly patients who have had
an acute stroke: Aprospective cohort study. Nutrition. 2019;66:44-7.
22. Heredia Y, Impagliazzo L, Messina D. Prevalencia De Sarcopenia En Pacientes
Internados En Una Clínica de Rehabilitación En La Provincia De Mendoza:
Resultados Preliminares; 2018. Available from: https://www.repositorio.
umaza.edu.ar/handle/00261/897 [Last accessed on 2022Apr8].
23. Shiraishi A, Yoshimura Y, Wakabayashi H, Tsuji Y. Prevalence of stroke-
related sarcopenia and its association with poor oral status in post-acute
stroke patients: implications for oral sarcopenia. Clin Nutr. 2018;37:204-7.
24. Park JG, Lee KW, Kim SB, Lee JH, Kim YH. Effect of decreased skel-
etal muscle index and hand grip strength on functional recov-
ery in subacute ambulatory stroke patients. Ann Rehabil Med.
2019;43:535-43.
25. Yi Y, Shim JS, Oh BM, Seo HG. Grip strength on the unaffected side as
an independent predictor of functional improvement after stroke. Am J
Phy Med Rehabil. 2017;96:616-20.
26. Bae JH, Kang SH, Seo KM, Kim DK, Shin HI, Shin HE. Relationship
between grip and pinch strength and activities of daily living in stroke
patients. Ann Rehabil Med. 2015;39:752-62.
... La hipótesis de este proceso se fundamenta en un mecanismo de compensación, así evidenciando un cambio fenotípico molecular de las fibras musculares en estudios de comparación entre la extremidad parética y su contraparte sana como una herramienta biológica de adaptación, ganancia en la función y velocidad de respuesta muscular (63) , sin embargo, existe un fenómeno paradójico en la extremidad parética en la cual relaciona inversamente el cambio en las cadenas de miosina con el enlentecimiento de la marcha de estos pacientes, demostrando así lo complejo del proceso asociado a la unión neuromuscular (63) . La sarcopenia relacionada con el ACV puede estar presente antes o después del evento isquémico, independiente del orden de los eventos la presencia de estas dos patologías se relaciona con peores resultados funcionales (64,65) , una mayor tendencia a la discapacidad, dependencia y menor masa muscular esquelética (66) . La prevalencia de la sarcopenia después del ACV es alta y varía ampliamente según los criterios diagnósticos utilizados, el punto de corte para la evaluación y el origen étnico (10,64) . ...
... En una revisión sistemática reciente se encontró que fue del 42% (16,8 a 60,3%), con heterogeneidad y variabilidad significativa en la definición de la enfermedad (68) , en este estudio el 91% de estudios se realizaron en el continente Asiático (68) , en un estudio japonés se encontró una prevalencia de 51% y se asoció con una alta frecuencia de alteraciones en la deglución (69) . En el único estudio realizado en Colombia se determinó en una población de pacientes con ACV isquémico reciente una prevalencia del 42,8% de sarcopenia probable y 14.2% de sarcopenia confirmada por bioimpedanciometría (66) . El factor de asociación más importante para el desarrollo de sarcopenia confirmada fue la duración del ACV (69) , y en el estudio de Inoue y colaboradores (68) se encontró que la sarcopenia se presentó en el 15% y 20% a los 10 y 30 días posteriores respectivamente al episodio agudo (68) . ...
Article
Full-text available
Introducción: El ataque cerebrovascular es la principal causa de discapacidad y una de las primeras causas de muerte a nivel mundial; su diagnóstico ha tenido una tendencia creciente. La presencia de sarcopenia ensombrece el pronóstico especialmente en patologías de naturaleza vascular como el ataque cerebrovascular. Puede ser útil identificar la presencia de sarcopenia en pacientes con ataque cerebrovascular especialmente en el enfoque terapéutico y de rehabilitación integral. Desarrollo: Tradicionalmente se ha asociado la presencia de factores de riesgo cardiovascular y de tipo ambiental con la probabilidad de padecer un ataque cerebrovascular, también se han identificado factores de buen y mal pronóstico funcional. Particularmente la prevalencia del ataque cerebrovascular es directamente proporcional con la edad de las personas, especialmente en mayores de 50 años, recientemente se ha descubierto a la sarcopenia como un síndrome clínico asociado indefectiblemente al proceso del envejecimiento que se caracteriza por la pérdida de fuerza, masa y desempeño muscular. En pacientes con sarcopenia y ataque cerebrovascular hay cambios biológicos secundarios en las fibras musculares que contribuyen al desacondicionamiento físico y a un proceso de plasticidad neuronal errático con un patrón de reinervación neural anómalo que conlleva a mayor discapacidad y dependencia asociada. Conclusiones: La sarcopenia tiene un efecto aditivo en la morbilidad de los pacientes, más de un tercio de los pacientes con ataque cerebrovascular presentan sarcopenia, condicionando la probabilidad de lograr independencia funcional, así a partir de la identificación y tratamiento de sarcopenia en los pacientes con ataque cerebrovascular se logran mejores resultados clínicos impactando sobre la calidad de vida de los pacientes.
Article
Full-text available
Objectives: The association between weak hand grip strength (HGS) and stroke recovery has been studied; however, few studies focused on the association of HGS with stroke prevalence and incidence. Methods: A prospective cohort baseline study of a nationally representative sample in Chinese adults aged 45 years and older in 2011 was followed up in 2015. 8871 participants without stroke at baseline were followed. The associations of HGS and its changes with stroke prevalence and incidence were investigated using logistic regression models and Cox proportional hazards regression models. Results: Association of HGS and stroke prevalence was significant. HGS weakness significantly increased risk of stroke incidence, with 89.3% higher risk when compared to normal HGS. During 35,263 person-years of follow-up, 112 stroke patients occurred. The four-year incidence rate ratio of stroke for participants with a HGS weakness was 2.15, compared to normal HGS participants. HGS changes in weakness/weakness from 2011 to 2015(D-HGS) and normal/weakness D-HGS had higher risks of stroke incidence when compared with those who had normal/normal D-HGS. Conclusions: HGS weakness and decline of HGS were associated with stroke incidence for adults aged 45 years and older in China.
Article
Full-text available
Objectives: Although the skeletal muscle is the main effector of disability in stroke, evidence on post-stroke skeletal muscle is scarce; especially, the prevalence of stroke-related sarcopenia remains unclear. Thus, we aimed to systematically search the prevalence of sarcopenia in stroke survivors and synthesize pooled estimates of overall prevalence of stroke-related sarcopenia and prevalence stratified by sex, country, time since stroke onset, and diagnostic criteria of sarcopenia. Methods: We performed systematic searches in the MEDLINE, CINAHL, Embase, and Cochrane Library databases. English-language searches to identify included studies were completed August 25, 2019. Meta-analysis of data collected from cross-sectional or observational studies which were reported the prevalence of sarcopenia among stroke participants. All statistical analyses were performed using R version 3.5.2. Results: A total of 855 articles were initially identified. Seven articles were included in this study. Total sample size across all included studies was 1695. Three studies were conducted in Japan, 2 in South Korea, 1 in Taiwan, and 1 in the U.S. Four included studies had a cross-sectional design, and 3 were retrospective cohort studies. Four and 3 studies included participants at <1 month and ≥6 months since stroke onset, respectively. The pooled prevalence estimate was 42% (95% confidence interval: 33%-52%), with a substantial heterogeneity (I2=91%). Conclusions and implications: Sarcopenia is frequently observed in stroke survivors, and a higher prevalence of sarcopenia is noted during the early phase after stroke. This study would be useful for researchers to design sarcopenia studies in this population. Further prospective longitudinal studies for sarcopenia and their prognostic outcomes in stroke survivors are urgently needed to propose appropriate physical and nutritional strategies in geriatric rehabilitation.
Article
Full-text available
Objective: To investigate the effect of decreased Skeletal Muscle Index (SMI) and hand grip strength on functional recovery in subacute ambulatory stroke patients. Methods: Subacute stroke patients who were referred to the rehabilitation center were recruited. Decreased SMI and hand grip strength were diagnosed according to the Asian Working Group on Sarcopenia. Diagnostic criteria were decreased SMI and decreased unaffected hand grip strength. SMI was measured by bioelectrical impedance analysis. Unaffected hand grip strength was measured with a hand dynamometer. Patients were divided into two groups, decreased group (DG) and not-decreased group (NDG), according to the presence of decreased SMI and hand grip strength. Both groups received conventional stroke rehabilitation for 3 weeks. All patients were evaluated at the baseline and at 3 weeks after treatment. Functional status was evaluated with 4-meter walk test (4MWT), 6-minute walk test (6MWT), Timed Up and Go test (TUG), and Modified Barthel Index (MBI). Results: Both groups showed improvement in 4MWT, TUG, and MBI. NDG showed improvement in 6MWT. Comparing improvements between the two groups, NDG showed more improvement in 6MWT and TUG than DG. Conclusion: The presence of decreased SMI and hand grip strength had negative effects on functional recovery in subacute ambulatory stroke patients.
Article
Full-text available
In the original version of the above paper there was an error in Table 3, which shows the recommended cut-off points for ASM/height² in women. The cut-off point was given as <6.0 kg/m², but the correct value is <5.5 kg/m². This has now been corrected online. The authors wish to apologise for this error.
Article
Full-text available
Introducción. Sarcopenia es la disminución de masa muscular asociado a reducción del rendimiento y función física, siendo predictor de desenlaces adversos en ancianos. Su diagnóstico requiere datos de composición corporal de población joven sana para establecer valores de referencia de baja masa muscular. Objetivo. Establecer puntos de corte provisionales para sarcopenia en ancianos Caldenses a partir de datos de composición muscular esquelética de jóvenes usando bioimpedancia eléctrica. Materiales y métodos. Se utilizaron datos de composición corporal de jóvenes sanos entre 18 y 35 años medidos por bioimpedancia eléctrica. Se derivaron de allí los datos de índice de masa muscular esquelética. Se aplicó la prueba de Kolmogorov Smirnov para evaluar normalidad de los datos y luego se estableció el promedio de índice de masa muscular con sus desviaciones estándar, tanto para hombres como para mujeres. Resultados. A partir de estos datos se estableció como baja masa muscular un índice de masa muscular esquelética 2 desviaciones estándar por debajo de la media del índice de masa muscular en jóvenes, correspondiendo en mujeres a un valor de 6,42 kg/m2 y en hombres de 8,39 kg/m2. Conclusión. Estos valores son similares a los propuestos por algunos autores asiáticos, lo que muestra que la población de esta región tiene características de composición corporal similares a la asiática. Este es el primer estudio que ofrece una descripción de composición corporal muscular esquelética en jóvenes colombianos, y aporta puntos de corte para diagnóstico de sarcopenia en ancianos en región centroandina.
Article
Objectives: The association between prestroke sarcopenia and functional outcomes in patients who have had a stroke has not, to our knowledge, been evaluated to date. We aimed to investigate the prevalence of prestroke sarcopenia, and determine whether prestroke sarcopenia is associated with functional outcomes in elderly patients who have suffered an acute stroke. Methods: We assessed prestroke sarcopenia in elderly patients with acute stroke using the SARC-F questionnaire. Patients were divided into two groups according to their SARC-F score: non-sarcopenia (SARC-F score <4) and prestroke sarcopenia (SARC-F score ≥4). The study endpoint was the modified Rankin Scale score at 3 mo after the stroke (0-3, good outcome; 4-6, poor outcome). The Mann-Whitney U-test, Pearson χ2 test, Fisher exact test, and logistic regression were used in the statistical analyses. Results: Of the 152 patients (81 men; median age [interquartile range]: 76 [11] y) enrolled, the prevalence rate of prestroke sarcopenia was 18% (27 patients). These 27 patients showed poor functional outcome at 3 mo after the stroke (50% versus 12%, prestroke sarcopenia versus nonsarcopenia; P < 0.001). After adjusting for variables, prestroke sarcopenia was an independent predictor of poor functional outcome at 3 mo after stroke (odds ratios: 7.39, 95% confidence interval: 1.47-37.21, P = 0.02). Conclusions: Prestroke sarcopenia is an independent predictor of functional outcome at 3 mo after a stroke. Our findings highlight the importance of detecting prestroke sarcopenia in elderly patients with acute stroke.
Article
The large and increasing burden of stroke in Latin American countries, and the need to meet the UN and WHO requirements for reducing the burden from non-communicable disorders (including stroke), brought together stroke experts and representatives of the Ministries of Health of 13 Latin American countries for the 1st Latin American Stroke Ministerial meeting in Gramado, Brazil, to discuss the problem and identify ways of cooperating to reduce the burden of stroke in the region. Discussions were focused on the regional and country-specifc activities associated with stroke prevention and treatment, including public stroke awareness, prevention strategies, delivery and organisation of care, clinical practice gaps, and unmet needs. The meeting culminated with the adoption of the special Gramado Declaration, signed by all Ministerial ofcials who attended the meeting. With agreed priorities for stroke prevention, treatment, and research, an opportunity now exists to translate this Declaration into an action plan to reduce the burden of stroke
Article
Epidemiological evidence suggests that the incidence of ischaemic stroke in young adults (18–50 years) has increased substantially. These patients have a long life expectancy after stroke, and the costs of long-term care pose huge challenges to health-care systems. Although the current recommendations for treatment of young and old (>50 years) patients with stroke are similar, the optimal management of young adult patients with stroke is unknown. They are usually not included in trials, and specific subanalyses limited to young adult patients with stroke are usually not done, owing to lower incidence of stroke and lower prevalence of vascular risk factors in young adults. Progress has been made in identifying patients with a considerable risk of stroke occurrence, such as those with patent foramen ovale. Future prevention studies might result in a decrease in the incidence of stroke and its sequelae in young adults. The development of guidelines specifically devoted to the management of stroke in young adults will be an important step in achieving this aim.
Article
Objective: The aim of this study was to investigate the association between grip strength on the unaffected side and post-stroke functional improvement. Design: A total of 127 patients with unilateral stroke were included in this study. Demographic data, clinical data on initial grip strength, initial National Institutes of Health Stroke Scale, admission and discharge Modified Barthel Index (MBI), and stroke profiles were retrospectively reviewed. Results: Univariate and multiple linear regression analyses were carried out to evaluate the predictive values of each variable. In the model for discharge MBI, age, initial National Institutes of Health Stroke Scale, grip strength on the unaffected side, lesion side, and admission MBI were shown to be independent predictors. Meanwhile, grip strength on the unaffected side, lesion side, and admission MBI had significant predictive values in the model for difference between admission and discharge MBI. Conclusion: The current study suggests for the first time that grip strength on the unaffected side is an independent predictor for short-term functional gain and outcome after stroke. This result may change post-stroke rehabilitation strategies to emphasize exercises to prevent loss of muscle strength. In addition, this implies the possibility of a relationship between sarcopenia and post-stroke function. Further research is needed to reveal the effect of sarcopenia on stroke patients and its mechanism.
Article
Background & aims: The aim of the study was to investigate the prevalence of stroke-related sarcopenia and its association with poor oral status in post-acute stroke patients. Methods: This cross-sectional study included 202 consecutive stroke patients who were admitted to convalescent rehabilitation wards in Japan. The Revised Oral Assessment Guide (ROAG) was used to assess oral status. Sarcopenia was defined as a loss of skeletal muscle mass index (SMI) with bioelectrical impedance and decreased muscle strength as measured by handgrip strength; cut-off values were adopted from the Asian Working Group for Sarcopenia. Univariate and multivariate analyses were applied to examine the associations between oral status, SMI, and HG. Results: Study participants included 107 males and 95 females with a mean age of 72 ± 12 years. According to the ROAG, 82.2% of participants had slight to severe oral problems (median score: 11 [9-14]). The prevalence of stroke-related sarcopenia was 53.5%. Both SMI (mean: 6.1 ± 1.3) and handgrip strength (median: 15 [7-25]) were significantly lower in the group with oral problems (SMI = 5.8 ± 1.2, handgrip strength = 12 [6-20]) compared to individuals without oral problems (SMI = 7.4 ± .8, handgrip strength = 27 [23-34]) (p < .001). The ROAG score was independently associated with SMI and handgrip strength, after adjusting for sex, age, stroke severity, activities of daily living, cognitive level, nutritional status, comorbidities, and time from stroke onset. Conclusions: Poor oral status was associated with sarcopenia, reduced muscle mass and strength in post-acute stroke patients. Poor oral status and stroke-related sarcopenia were very common among the patients in this study, suggesting that healthcare providers should monitor for oral sarcopenia in post-acute stroke patients.