Malnutrition Increases the Incidence of Death, Cardiovascular Events, and Infections in Patients with Stroke after Rehabilitation

Aim The Geriatric Nutritional Risk Index (GNRI) can predict nutritional risk. However, just a few studies have validated the optimal cut‐off value of GNRI for nutrition screening in older patients. Hence, this study aimed to determine the optimal value of GNRI to screen the risk of malnutrition among older patients. Methods This retrospective cross‐sectional study was carried out with 5867 consecutive older adult patients who were admitted to an academic hospital in Japan. Receiver operating characteristic curve analyses were carried out to obtain the optimal cut‐off value of GNRI, and the results were compared against the Mini Nutritional Assessment – Short Form and Malnutrition Universal Screening Tool. The validation of the obtained cut‐off value was examined on the concordance rate of malnutrition diagnosis based on the European Society of Clinical Nutrition and Metabolism criteria. Results The mean age of the patients was 76.0 ± 7.0 years. The optimal cut‐off value of GNRI for Mini Nutritional Assessment – Short Form ≤11 points was 95.92 (area under the curve 0.827 [0.817–0.838], P < 0.001), and that for Malnutrition Universal Screening Tool ≥1 point was 95.95 (area under the curve 0.788 [0.776–0.799], P < 0.001). By adapting GNRI <96 points as an initial screening cut‐off in the European Society of Clinical Nutrition and Metabolism‐defined malnutrition process, the concordance rates of comparisons were 98.5% and 98.5% for Mini Nutritional Assessment – Short Form‐based and MUST‐based diagnosis, respectively. Conclusions The study showed GNRI <96 points as the optimal cut‐off value for nutritional screening. GNRI might be one of the easy‐to‐use tools for nutritional screening and for diagnosing malnutrition in older adults. Geriatr Gerontol Int 2020; 20: 811–816.

Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

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Determining the optimal value of the Geriatric Nutritional Risk Index to screen older patients with malnutrition risk: A study at a university hospital in Japan

Ishida

Maeda

Nonogaki

et al. 2020

“…Malnutrition affects clinical outcomes in stroke patients. In previous studies, malnutrition of stroke patients was associated with a poor prognosis, [1][2][3][4] increased incidence of infections, cardiovascular events and pressure ulcers, 1,2,4,5 extended hospitalization periods, 1,3,5 and increased risk of requiring long-term care. 2 Furthermore, in our studies, stroke patients with malnutrition had poor activities of daily living (ADL) improvement.…”

Section: Introductionmentioning

confidence: 99%

Nutritional intake is associated with activities of daily living and complications in older inpatients with stroke

Kokura

Wakabayashi

Nishioka³

et al. 2018

“…The main goals for acute stroke treatment and rehabilitation are to reduce mortality and disabilities, and to increase independence in the activities of daily living (ADL) . In stroke patients, malnutrition is a common problem that has been associated with poor outcome an increase in the number of cardiovascular events, infections, and hospitalization days and cost and poor improvement in ADL . Stroke patients might be malnourished due to dysphagia, reduced level of consciousness and cognitive dysfunction .…”

Section: Introductionmentioning

confidence: 99%

Individualized nutritional treatment for acute stroke patients with malnutrition risk improves functional independence measurement: A randomized controlled trial

Otsuki

Himuro

Tatsumi

et al. 2019

Aim The aim of the present study was to investigate the effects of individualized nutritional treatment on the activities of daily living of acute stroke patients. Methods This was a randomized controlled study. The eligibility criteria were acute stroke, age >65 years and the presence of malnutrition risk. Between September 2016 and December 2017, 128 patients were assigned to either the standard or intensive group (individualized nutritional treatment). The intensive group received energy that was calculated using the Harris–Benedict equation. The main outcome measures were the total functional independence measurement gain from the time of assignment to the time of discharge from the recovery hospital or at 3 months after the stroke onset, and motor and cognitive functional independence measurement gains. Results Compared with the standard group, the intensive group had significantly higher median energy intake (P < 0.001); significantly greater functional independence measurement gains in the total score (42 vs. 22; P = 0.02) and motor subscore (P = 0.01), but similar cognitive subscore. Conclusion Individualized nutritional treatment improved the activities of daily living of older acute stroke patients with malnutrition risk. Geriatr Gerontol Int 2019; ••: ••–••.