Determinants of in-hospital muscle loss in acute ischemic stroke – Results of the Muscle Assessment in Stroke Study (MASS)

Gungor L., Arsava E. M., Güler A., Togay Işıkay C., Aykaç Ö., Batur Çağlayan H. Z., ...Daha Fazla

Clinical Nutrition, cilt.42, sa.3, ss.431-439, 2023 (SCI-Expanded) identifier identifier identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 42 Sayı: 3
  • Basım Tarihi: 2023
  • Doi Numarası: 10.1016/j.clnu.2023.01.017
  • Dergi Adı: Clinical Nutrition
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, PASCAL, CAB Abstracts, CINAHL, EMBASE, Food Science & Technology Abstracts, MEDLINE, Veterinary Science Database
  • Sayfa Sayıları: ss.431-439
  • Anahtar Kelimeler: Stroke, Computed tomography, Muscle mass, Nutritional gap, Neuro-intensive care, CRITICALLY-ILL, WEAKNESS, SARCOPENIA, NUTRITION, THICKNESS, ATROPHY, TRIAL, FAT
  • Eskişehir Osmangazi Üniversitesi Adresli: Evet

Özet

Background & aims: There is a change in the mass and composition of paretic and non-paretic skeletal muscles in the chronic phase of stroke. The multi-center, prospective, and observational Muscle Assessment in Stroke Study (MASS) was performed to evaluate the degree of muscle loss during the in-hospital acute stroke setting and determine factors contributing to this loss. Methods: Acute dysphagic ischemic stroke patients (n = 107) admitted to neuro-intensive care units were evaluated by computed tomography on days 1 and 14 after admission to determine the cross-sectional muscle area (CSMA) at the level of the mid-humerus, mid-thigh, and third lumbar vertebra. The percentage change in CSMA and variables associated with this change were evaluated by univariate and multivariate analyses. Results: There were significant reductions in CSMA in all the muscle groups analyzed; the most prominent change was observed in the arms (both: 14.2 ± 10.7%; paretic: 17.7 ± 11.6%; non-paretic: 10.1 ± 12.5%), followed by the muscles in the legs (both: 12.4 ± 8.7%; paretic: 12.9 ± 9.9%; non-paretic: 12.0 ± 9.3%) and L3-vertebra level (5.6 ± 9.8%) (P < 0.001 for all). Higher calorie (r = −0.378, P < 0.001) or protein (r = −0.352, P < 0.001) intake was negatively associated with the decrease in CSMA of upper extremities. A substantial protein (≥0.4 g/kg/d) or calorie (≥5 kcal/kg/d) gap between targeted or actual intake was related to a larger decrease in CSMA in all the anatomic regions (P ≤ 0.05 for all). Other significant predictors of muscle loss included history of diabetes mellitus, male sex, higher BMI, in-hospital infections, and the necessity for invasive mechanical ventilation. Conclusions: There is a considerable degree of loss in the global muscle mass in acute ischemic stroke patients over a two-week period. Along with several factors, falling significantly behind the daily protein or calorie targets was related to the decrease in the muscle area. Trial registration information: clinicaltrials.gov identifier NCT03825419.