Disability caused by stroke is usually attributed to brain damage, with little attention to the effector organ, the skeletal muscle. A study published in the Journal of Cachexia, Sarcopenia, and Muscle investigated the relationship between stroke and body deterioration. Physical training is the most promising way to delay or prevent the progression of cachexia and can be a therapeutic option.
Stroke is one of the major medical, socio-economic and health problems in the world. Increased global life expectancy and reduced acute post-stroke mortality rates contribute to increased costs in stroke treatment. About two-thirds of patients remain disabled after a stroke. Several clinical studies have shown an important role of body weight and nutritional status on functional outcome and mortality after stroke. Body weight loss after stroke is a common observation in acute and chronic stroke. However, detailed information on changes in body composition after a stroke is scarce.
A recent study involved 150 patients with mild to moderate ischemic stroke recruited within 48 hours of the event. Basic measurements included body weight, body composition by dual-energy X-ray absorptiometry, functional status by the National Institutes of Health Stroke Scale (NIHSS), modified Rankin scale and Barthel index, and muscle strength by grip testing. The measurements were repeated a year later.
Nadja Scherbakov, of the Center for Stroke Research at the Charité Medical University of Berlin, and author of the study, said: "Cachexia is observed in cancer and chronic diseases such as heart failure, chronic obstructive pulmonary disease, and obstructive kidney disease. This study was the first to prospectively investigate the development of cachexia in stroke patients.
The study examined changes in body weight and body composition in the year following an ischemic stroke and their association with disability. Researchers found that 21% of patients had developed cachexia a year later, i.e. they had lost at least 5% of their body weight. This resulted in the loss of 19% of their body fat and 6.5% of their muscle mass. In particular, this deterioration is equally verified in patients with and without paresis of the limbs.
Patients with cachexia had significantly less functional capacity and significantly less grip force than patients without cachexia. Patients with cachexia had significantly higher levels of inflammation than patients without cachexia. Patients with systemic inflammation had a five-fold higher risk of muscle loss, an 11% higher risk of weight loss, a 30% higher chance of reducing appetite, and a 6% higher risk of developing a strength deficit in the grip.
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Scherbakov N, Pietrock C, Sandek A, Ebner N, Valentova M, Springer J, Schefold JC, von Haehling S, Anker SD, Norman K, Haeusler KG, Doehner W. Body weight changes and incidence of cachexia after stroke. J Cachexia Sarcopenia Muscle. 2019 Jan 24.doi: 10.1002/jcsm.12400.