脳卒中入院患者の栄養状態とリハのアウトカム

脳卒中の入院患者の食事摂取量、栄養状態とリハのアウトカムを調査した論文を紹介します。

W. F. R. Nip, L. Perry, S. McLaren, A. Mackenzie. Dietary intake, nutritional status and rehabilitation outcomes of stroke patients in hospital. Journal of Human Nutrition and Dietetics DOI: 10.1111/j.1365-277X.2011.01173.x

脳卒中急性期で入院した100人を対象に、入院後2週間以内に、MNA、身体計測、食事摂取量、リハのアウトカム（Barthel Indexとその改善率）を調査しています。また38人は退院前に再調査しています。

1日推定エネルギー必要量以上に摂取している方は10％でした。また、退院時には33％の患者が1日推定エネルギー必要量の50％以下の摂取でした。入院後2週間以内で7％、退院時で13％が低栄養と判断されました。若年で、入院時Barthel Indexが低値でエネルギー摂取量が多いと、Barthel Indexの改善率が有意に高いという結果でした。

このくらいの臨床研究であれば、臨床を行いながらでも十分実現可能です。日本の学会発表でもこのレベルの臨床研究であれば少なからずあります。問題はその後、英語論文という形として残していないことですね。英語論文は厳しくても、せめて学会発表したものは日本語論文にしなければいけませんね。最近、痛感しています。

Abstract
Background:  Nutrition affects rehabilitation through its influence on physical and mental functioning, although little attention has been paid to effects on rehabilitation outcomes. The present study aimed to describe nutritional status and food consumption in stroke patients within 2 weeks of hospital admission and before discharge, as well as to investigate the effects of nutritional and dietary factors on rehabilitation outcomes.

Methods:  One hundred patients from a consecutive cohort admitted to a metropolitan hospital with acute stroke were recruited and assessed by a single researcher, with 38 reassessed at discharge. Nutritional status was assessed using Mini-Nutritional Assessment and anthropometric indices and dietary intake was assessed by 1-day weighed dietary records. Rehabilitation outcomes were changes in Barthel index scores and the rehabilitation efficiency index.

Results:  Few (n = 9; 10%) consumed ≥100% of the estimated average requirement (EAR) for energy within 2 weeks of admission and 13 (33%) had energy intakes <50% of EAR before discharge. A small but increasing proportion (7% at admission, 13% at discharge) were identified as being malnourished across the inpatient stay. Younger age, lower Barthel index and a higher energy intake in the early stages of admission predicted the extent and rate of restoration of functional abilities by discharge (F = 7.503, P = 0.001; F = 14.558, P < 0.001).

Conclusions:  Given a general finding of nutritional deterioration identified for these patients, as well as the identification of energy intake as a modifiable influence on the extent and rate of recovery, there is clearly scope for the multidisciplinary development of nutritional support for stroke patients to improve rehabilitation outcomes.