Brain Neurorehabil.  2015 Mar;8(1):53-58. 10.12786/bn.2015.8.1.53.

Nutritional Status of Patients with Brain Disorder during the First Six Months

• Park YG
• Yoon YH
• Jung KJ
• Choi JH

• KMID: 1788517
• DOI: http://doi.org/10.12786/bn.2015.8.1.53

Abstract

OBJECTIVE
Patients with brain disorder manifest hypermetabolism, increased energy expenditure, and increased protein loss. Nutritional support can prevent loss of immunocompetence, and can decrease morbidity and mortality associated with brain disorder. Thus, we aimed to determine the nutritional status by measuring body mass index (BMI) in patients with brain disorder during the first 6 months and identify factors related to malnutrition in this study. METHOD: We enrolled 244 patients from January 2008 to December 2009. The patients were classified into two groups: BMI under 18.5 were categorized as malnourished, while BMI over 18.5 as not malnourished. Extracted data includes demographic characteristics, type of brain disorder, functional independence measure (FIM) and Korea mini-mental status exam (K-MMSE) scores, history of diabetes mellitus (DM), and laboratory data. Feeding method was classified into oral and enteral tube feeding.
RESULTS
The prevalence of malnourished patients was 13.1% (32 out of 244 patients). There was significant difference of total lymphocyte count (TLC) between the two groups. And there was no significant difference of correlation in other parameters. Analysis of feeding method showed that 11.4% of oral feeding patients were malnourished, compared to 17.4% of tube feeding patients who were categorized as malnourished. The tube feeding group tends to be more malnourished.
CONCLUSION
The results of this study can be a guide for active rehabilitation of patients with brain disorder, and further studies regarding functional outcome and complications related to early nutritional status is needed.

Keyword

nutritional status; stroke; traumatic brain injuries

MeSH Terms

Body Mass Index
Brain Diseases*
Brain Injuries
Diabetes Mellitus
Energy Metabolism
Enteral Nutrition
Feeding Methods
Humans
Immunocompetence
Korea
Lymphocyte Count
Malnutrition
Mortality
Nutritional Status*
Nutritional Support
Prevalence
Rehabilitation
Stroke

Figure

• 

  Fig. 1 FIM and MMSE scores of Malnourished and Non-Malnourished Patients. (A) FIM scores and (B) MMSE scores of Patients. FIM: functional independence measure, K-MMSE: Korea mini-mental status exam.

Reference

1. Pepe JL, Barba CA. The metabolic response to acute traumatic brain injury and implications for nutritional support. J Head Trauma Rehabil. 1999; 14:462–474.

2. Dennis M. Nutrition after stroke. Br Med Bull. 2000; 56:466–475.

3. Palmer Jeffrey B, Monahan Denise M, Matsuo Koichiro. Rehabilitation of Patients with Swallowing Disorders. In : Palmer Jeffrey B, Monahan Denise M, Matsuo Koichiro, editors. Physical medicine and rehabilitation. Philadelphia: 2006. p. 602–604.

4. Sitzmann JV. Nutritional support of the dysphagic patient: methods, risks, and complications of therapy. JPEN J Parenter Enteral Nutr. 1990; 14:60–63.

5. Cook AM, Peppard A, Magnuson B. Nutrition considerations in traumatic brain injury. Nutr Clin Pract. 2008; 23:608–620.

6. Krakau K, Hansson A, Karlsson T, de Boussard CN, Tengvar C, Borg J. Nutritional treatment of patients with severe traumatic brain injury during the first six months after injury. Nutrition. 2007; 23:308–317.

7. Miller MD, Thomas JM, Cameron ID, Chen JS, Sambrook PN, March LM, Cumming RG, Lord SR. BMI: a simple, rapid and clinically meaningful index of under-nutrition in the oldest old? Br J Nutr. 2009; 101:1300–1305.

8. Volpato S, Romagnoni F, Soattin L, Ble A, Leoci V, Bollini C, Fellin R, Zuliani G. Body mass index, body cell mass, and 4-year all-cause mortality risk in older nursing home residents. J Am Geriatr Soc. 2004; 52:886–891.

9. Flacker JM, Kiely DK. Mortality-related factors and 1-year survival in nursing home residents. J Am Geriatr Soc. 2003; 51:213–221.

10. Charlton KE, Kolbe-Alexander TL, Nel JH. Development of a novel nutrition screening tool for use in elderly South Africans. Public Health Nutr. 2005; 8:468–479.

11. Vellas B, Guigoz Y, Garry PJ, Nourhashemi F, Bennahum D, Lauque S, Albarede JL. The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition. 1999; 15:116–122.

12. Marco M, Fulvia V, Roberto M, Fulvio M, Alberto C. Biochemical Markers of Nutrition and Bone Mineral Density in the Elderly. Gerontology. 2003; 49:50–54.

13. Foley NC, Martin RE, Salter KL, Teasell RW. A review of the relationship between dysphagia and malnutrition following stroke. J Rehabil Med. 2009; 41:707–713.

14. Axelsson K, Asplund K, Norberg A, Eriksson S. Eating problems and nutritional status during hospital stay of patients with severe stroke. J Am Diet Assoc. 1989; 89:1092–1096.