Association between malnutrition and long-term mortality in older adults with ischemic stroke

Kang Yuan; Shuanggen Zhu; Huaiming Wang; Jingjing Chen; Xiaohao Zhang; Pengfei Xu; Yi Xie; Xinyi Zhu; Wusheng Zhu; Wen Sun; Gelin Xu; Xinfeng Liu

doi:10.1016/j.clnu.2021.04.018

Association between malnutrition and long-term mortality in older adults with ischemic stroke

Clin Nutr. 2021 May;40(5):2535-2542. doi: 10.1016/j.clnu.2021.04.018. Epub 2021 Apr 21.

Authors

Kang Yuan¹, Shuanggen Zhu², Huaiming Wang³, Jingjing Chen¹, Xiaohao Zhang⁴, Pengfei Xu⁵, Yi Xie⁴, Xinyi Zhu⁴, Wusheng Zhu⁶, Wen Sun⁷, Gelin Xu⁶, Xinfeng Liu⁸

Affiliations

¹ Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, 210002, China.
² Department of Neurology, Affiliated Longhua People's Hospital, Southern Medical University (Longhua People's Hospital), Shenzhen, 51800, Guangzhou, China.
³ Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China; Department of Neurology, The 80th Group Army Hospital of the People's Liberation Army, Weifang, Shandong, 261021, China.
⁴ Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China.
⁵ Stroke Center & Department of Neurology, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230001, Anhui, China.
⁶ Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, 210002, China; Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China; Department of Neurology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, 210002, China.
⁷ Stroke Center & Department of Neurology, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230001, Anhui, China. Electronic address: [email protected].
⁸ Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, 210002, China; Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China; Stroke Center & Department of Neurology, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230001, Anhui, China; Department of Neurology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, 210002, China. Electronic address: [email protected].

PMID: 33932800
DOI: 10.1016/j.clnu.2021.04.018

Abstract

Background & aims: Malnutrition is associated with poor prognosis of different diseases. This study aimed to investigate the association of malnutrition with long-term mortality of older adults with ischemic stroke in China.

Methods: We selected patients aged ≥65 years with first-ever ischemic stroke from the Nanjing Stroke Registry Program. Malnutrition was defined according to the controlling nutritional status score (CONUT), the geriatric nutritional risk index (GNRI), and the prognostic nutritional index score (PNI), respectively. Multivariable Cox proportional hazards regressions and competing risk regressions were performed to explore the relationship between malnutrition and the risk of mortality in older adults with ischemic stroke.

Results: Among 1065 enrolled patients, 60.5%, 46.7%, and 30.6% of patients were malnourished according to CONUT, GNRI, and PNI score. During a median follow-up of 4.74 (3.73-5.82) years, 205 (19.2%) patients died. In multivariate analysis, malnutrition (severe risk versus normal nutrition) was associated with significantly increased risk for mortality by the CONUT (adjusted hazard ratio [HR] 4.615, 95% confidence interval [CI] 1.373-15.514, P = 0.013), GNRI (adjusted HR 3.641, 95% CI 1.924-6.891, P < 0.001), and PNI score (adjusted HR 1.587, 95% CI, 1.096-2.297, P = 0.014). Furthermore, adding the malnutrition indexes to models modestly improved the predictive ability of mortality.

Conclusions: Our study indicated that malnutrition was highly prevalent in older Chinese adults with ischemic stroke and associated with increased mortality. Further research is required to evaluate the efficacy of nutritional management in these patients.

Keywords: China; Elderly; Ischemic stroke; Malnutrition; Mortality.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Female
Humans
Ischemic Stroke / mortality*
Male
Malnutrition / complications*
Risk Factors
Time Factors