Body composition after stroke

Abstract

The aim of this study was to compare the body composition, including lean tissue mass, fat tissue mass, and bone mineral content, of the paretic leg with that of the nonaffected leg in patients with stroke and to evaluate the effects of time since stroke, spasticity, and motor recovery on the body composition specifically within the first year after stroke. Thirty-five stroke patients with mean age and standard deviation of 62.69+/-9.54 years were included in the study. A full physical examination including Brunnstrom motor recovery and modified Ashworth spasticity scale was performed. Fat tissue mass (grams), lean tissue mass (grams), and bone mineral content (grams) of both the paretic and nonaffected lower extremities were obtained from the total body scans determined by using dual-energy X-ray absorptiometry (Lunar DPX-PRO). Lean tissue mass and bone mineral content of the paretic side were found to be significantly lower than those of the nonaffected side (P<0.05). A significant correlation was found between the lean tissue mass and bone mineral content of both the paretic and nonaffected legs after adjusting for age and weight (P=0.000, r=0.679; P=0.000, r=0.634, respectively). Bone mineral content and lean tissue mass of both the paretic and nonaffected sides showed a significant negative correlation with time since stroke in patients with stroke for < or =1 year (P<0.05). A higher lean tissue mass and bone mineral content were found in patients with moderate to high spasticity in comparison with patients with low or no spasticity (P<0.05). Stroke causes loss of lean tissue mass and bone mineral content prominently in the paretic side. The loss increases with increasing time since stroke. Spasticity seems to help in preventing the loss of bone mineral content and lean tissue mass.

Guidelines for Adult Stroke Rehabilitation and Recovery

“…[242][243][244] Although declines in BMD and lean tissue mass can occur in both limbs, changes on the paretic side are more profound. BMD can decrease by >10% in <1 year in the paretic lower limb.…”

Factors That Influence Muscle Weakness Following Stroke and Their Clinical Implications: A Critical Review

“…18 After stroke, no changes in fat mass were found with DEXA imaging, despite a decline in paretic lean muscle mass. 27,31,35 Two other studies found increased fat mass using DEXA imaging, 28,30 but found no change in paretic lean muscle mass. Perhaps the DEXA was not sensitive enough in these last two studies to detect changes in lean muscle mass.…”

“…At 1 month post stroke, no change in lean muscle mass was found in the paretic leg or arm with DEXA imaging, 28 but by 2-4 months a decrease in lean muscle mass was evident in the paretic leg and arm muscles with both DEXA and CT imaging. 28,29,34 In the chronic phase (>6 months after stroke), a decrease in lean muscle mass on the paretic side relative to the non-paretic side was found with both DEXA and CT imaging, 27,31,33,35 meaning that many people with stroke are living with long-term effects of decreased muscle mass in the paretic muscles. A decrease in lean muscle mass with an increase in non-contractile tissue, including fat mass, is common with ageing.…”

“…27,29,31,[33][34][35] The studies reviewed found that the change in pennation angle differed for the muscles of the upper and lower extremities, increasing in the former and decreasing in the latter. [39][40][41] Only three studies were identified that examined changes in pennation angle, which makes it difficult to draw conclusions as to whether the differences in pennation angle are related to the function of the muscles (differences in patterns of use between gastrocnemius in the leg and brachialis in the arm) or to their structural composition.…”

Mechanical Factors and Bone Health: Effects of Weightlessness and Neurologic Injury

“…Although some have observed spasticity having a beneficial effect on extremity lean muscle mass and bone density [37], others have not [35, 36], reporting instead that muscle weakness and increased muscle spasticity were associated independently with decreased cortical thickness and density [35]. …”