Shinta Nishioka, RD, Hidekazu Sugawara, MD, PhD, Masako Takayama, RD, MS, Maki Urushihara, RD, Misuzu Watanabe, RD, Yumiko Kiriya, RD, Keiko Shintani, RD,
Hiromi Nakagomi, RD, Noriko Kageyama, RD, Takatsugu Okamoto, MD, PhD, Satoshi Sumita, MD, PhD, Masaaki Fujita, MD, PhD, Shigeki Hashimoto, MD, Makoto Ishikawa, MD, PhD, Eiki Tsushima, RPT, PhD, Akira Ogawa, MD, PhD
Jpn J Compr Rehabil Sci 9: 3-10, 2018
Objective: To investigate the relationship between the
frequency of nutritional monitoring, and both weight
gain and functional recovery in underweight, tube-fed
stroke patients.
Methods: Data for tube-fed stroke patients aged ->40
with an (age-dependent) body mass index (BMI) of
either <18.5, <20.0, or <21.5 kg/m2 were extracted from
two studies included in the gAlgorithm for Post-stroke
Patients to improve oral intake Level (APPLE)h study,
conducted at five Kaifukuki (convalescent) rehabilitation
wards in Japan. The outcome measurements were
compared between the wards participating in either
weekly (WM), or monthly (MM) nutritional monitoring
protocols by dietitians. Primary outcomes were a change
in BMI, and functional independence measure (FIM) at
discharge.
Results: There were 37 WM patients (18 women; mean
age, 77 years) and 29 MM patients (19 women; mean
age, 78 years) with no differences in stroke subtype,
BMI, functional independence measure (FIM) and
swallowing function. At discharge, WM patients
showed a significantly higher BMI gain compared to
MM patients (+0.2 kg/m2 vs. -0.5 kg/m2, p = 0.009). A
greater proportion of WM patients than that of MM
patients achieved full oral intake (81.1% vs. 44.8%, p =
0.002). WM was independently correlated with BMI
change and discharge FIM on multivariable analyses.
Conclusions: Nutritional monitoring and planning
recommendation at least once a week by dietitians
may correlate with positive BMI change and better
functions in tube-fed stroke patients.
Key words: convalescent rehabilitation wards, enteral nutrition, stroke patients, malnutrition, nutritional monitoring