脳卒中後の体脂肪変化：系統的レビュー

脳卒中後の体脂肪変化に関する系統的レビューを紹介します。

Coralie English, Kerry Thoirs, Alison Coates, Alice Ryan, Julie Bernhardt. Changes in fat mass in stroke survivors: a systematic review. International Journal of Stroke, Article first published online: 18 MAY 2012 DOI: 10.1111/j.1747-4949.2012.00824.x

目的は、①脳卒中後に麻痺側と非麻痺側で体脂肪量の違いがあるか、②脳卒中後の時間経過で体脂肪量の変化があるかの2つです。メタ分析はDEXAで評価した10論文で行われています。

結果は、①下肢では麻痺側と非麻痺側で体脂肪量の違いはなく、上肢ではわずかに麻痺側で体脂肪量が多かったです（84g）。②脳卒中発症1ヶ月後と6ヶ月後では有意差なく、6ヶ月後と12ヶ月後では有意な増加ありでした（1935g）。

一般的に下肢より上肢のほうが麻痺が重いことが多いため、麻痺側上肢のみ体脂肪量が増加したのかもしれません。発症6ヶ月後までは機能訓練を頑張りますが、その後は機能訓練の量が少なくなりがちです。そのため、6ヶ月後以降に体脂肪量が増加するのかもしれません。

リハ栄養的には、十分な機能訓練を行っている時期（回復期リハ病棟入院中など）には、食事摂取量を増やすことが必要です。一方、機能訓練の量が減る時期（回復期リハ病棟退院後など）には、入院中より食事摂取量を少なくして、体脂肪量を増加させないことが重要だと考えます。るいそうなら別ですが。

Abstract
Background
Stroke survivors have less muscle mass in their paretic limbs compared with nonparetic limbs, which may or may not be accompanied by changes in regional and/or whole body fat mass. Aim To examine the current evidence regarding differences in regional fat mass between paretic and nonparetic limbs and changes in whole body fat mass over time in stroke survivors.

Methods
A systematic search of relevant databases. Studies measuring whole body or regional fat mass using dual-energy X-ray absorpiometry, computed tomography, or magnetic resonance imaging were included.

Results
Eleven trials were identified. Fat mass differences between paretic and nonparetic limbs and change in fat mass over time were not consistent. Meta-analyses were conducted using dual-energy X-ray absorpiometry-derived data from 10 trials (n = 324). There were no differences in fat mass between paretic and nonparetic legs (pooled mean difference 31·4 g, 95% confidence interval −33·9 to 96·6, P = 0·35), and slightly greater fat mass in the paretic arms compared with nonparetic arms (pooled mean difference 84·0 g, 95% confidence interval 30·7 to 137·3, P = 0·002). Whole body fat mass did not increase significantly between one-month and six-months poststroke (pooled mean difference 282·3 g, 95% confidence interval −824·4 to 1389, P = 0·62), but there was an increase between six- and 12 months poststroke (pooled mean difference 1935 g, 95% confidence interval 1031 to 2839, P < 0·001).

Conclusions
There were inconsistent findings regarding changes in fat mass after stroke. Large, well-designed studies are required to further investigate the impact of body composition changes on the health of stroke survivors.