Prevalence and Associated Factors of Coexistence of Malnutrition and Sarcopenia in Geriatric Rehabilitation.

Malnutrition and sarcopenia often coexist in rehabilitation patients, although they are often overlooked and undertreated in clinical practice. This cross-sectional study aimed to clarify the prevalence of the coexistence of malnutrition and sarcopenia (Co-MS) and its associated factors in convalescent rehabilitation wards in Japan. Consecutive patients aged ≥ 65 years in convalescent rehabilitation wards between November 2018 and October 2020 were included. Malnutrition and sarcopenia were determined by the Global Leadership Initiative on Malnutrition (GLIM) criteria and the Asian Working Group for Sarcopenia (AWGS 2019) criteria, respectively. Patients who presented both with malnutrition and sarcopenia were classified as Co-MS. Potentially associated factors included age, sex, days from onset to admission of rehabilitation wards, reason for admission, pre-morbid functional dependency, comorbidity, activities of daily living, swallowing ability, and oral function and hygiene. The prevalence of malnutrition, sarcopenia, and Co-MS was calculated. Binary logistic regression analyses were performed to compute odds ratios (ORs) and the 95% confidence interval (CI) of possible associated factors for each condition. Overall, 601 patients were eligible for the analysis (median 80 years old, 355 female patients, 70% cerebrovascular disease). Co-MS, malnutrition, and sarcopenia were found in 23.5%, 29.0%, and 62.4% of the enrolled patients, respectively. After adjustment, onset-admission interval (OR = 1.04; 95% CI = 1.02 to 1.06), hospital-associated deconditioning (OR = 4.62; 95% CI = 1.13 to 18.8), and swallowing ability (Food Intake LEVEL Scale) (OR = 0.83; 95% CI = 0.73 to 0.93) were identified as independent explanatory factors of Co-MS. In conclusion, Co-MS was prevalent in geriatric rehabilitation patients; thus, healthcare professionals should be aware of the associated factors to detect the geriatric rehabilitation patients who are at risk of both malnutrition and sarcopenia, and to provide appropriate treatments.

Validity of calf circumference for estimating skeletal muscle mass for Asian patients after stroke.

OBJECTIVES: The aims of this study was to determine the optimal cutoff values of non-paretic calf circumference (CC) that are indicative of low skeletal muscle mass and examine the association between a low CC and rehabilitation outcomes. METHODS: This was a retrospective cohort study that included 628 patients in convalescent rehabilitation wards in Japan. Patients in post-stroke rehabilitation who were ≥20 y of age were included. We examined the agreement between CC on the non-paretic side and a low skeletal muscle mass index (SMI) measured by bioelectrical impedance analysis. We also confirmed the correlation between sarcopenia defined by CC and handgrip strength, and sarcopenia according to Asian Working Group for Sarcopenia (AWGS) 2019 criteria. Functional Independent Measure (FIM) at discharge and discharge to home outcomes were compared between patients with a high CC and those with a low CC. RESULTS: Of the 628 patients included in the study, 408 (170 women; mean age, 72 y) were analyzed. The optimal cutoff values of CC were 33 cm for men (sensitivity and specificity, 0.798 and 0.840, respectively) and 32 cm for women (0.847 and 0.818, respectively). The sensitivity and specificity of CC-based sarcopenia against the AWGS criteria were 0.752 and 1.000 for men and 0.800 and 1.000 for women, respectively. Patients with a low CC had a significantly lower FIM and proportion of home discharge than those with a high CC. CONCLUSIONS: The optimal cutoff values of non-paretic CC for a low SMI were 33 cm for male and 32 cm for female Asian stroke rehabilitation patients. Sarcopenia can be defined using CC instead of SMI.

Nutritional Improvement Correlates with Recovery of Activities of Daily Living among Malnourished Elderly Stroke Patients in the Convalescent Stage: A Cross-Sectional Study.

BACKGROUND: Whether nutritional improvement correlates with functional recovery in convalescent stroke patients is unclear. OBJECTIVE: This study was conducted to examine the relationship between nutritional improvement and recovery of activities of daily living among malnourished elderly stroke patients in the convalescent stage. DESIGN: This study used a cross-sectional study design. PARTICIPANTS/SETTING: One hundred seventy-eight malnourished stroke patients aged 65 years and older from convalescent rehabilitation wards in Japan between April 2012 and December 2014 were included in the analyses. MAIN OUTCOME MEASURES: The participants were classified into three groups according to the Mini Nutritional Assessment Short-Form (MNA-SF) score at discharge (0 to 7 as no improvement, 8 to 11 as lesser improvement, and 12 to 14 as greater improvement). The primary outcome was functional independence measure (FIM) efficiency (FIM gain/length of hospital stay). The secondary outcomes were FIM gain and discharge outcome. STATISTICAL ANALYSIS: One-way analysis of variance, χ(2) test, and Kruskal-Wallis test were performed for univariate analysis. Linear regression analysis was used to adjust for covariates such as age, sex, length of hospital stay, FIM (motor and cognitive) on admission, and lower-order items of MNA-SF. Binomial logistic analysis for discharge outcome (home/others) was performed to adjust for covariates such as age, sex, and FIM. RESULTS: Study participants included 85 men and 93 women with a mean age of 77 years. Based on MNA-SF, 16 were classified as no improvement, 113 as lesser improvement, and 49 as greater improvement. The median FIM efficiency and length of hospital stay were 0.27 points/day and 151.5 days, respectively. The greater improvement group had significantly higher FIM efficiency than the other groups (P<0.001). Home discharge rate was also higher in the GI group (P=0.014). Linear regression analysis for FIM efficiency indicated that mobility, neuropsychological problems, and weight loss, which were lower-order items of MNA-SF at discharge, were independent explanatory variables (R(2)=0.373; P<0.001). CONCLUSIONS: These findings suggest that nutritional improvement such as maintenance of body weight is associated with the efficient recovery of activities of daily living among malnourished elderly convalescent stroke patients.

Obese Japanese Patients with Stroke Have Higher Functional Recovery in Convalescent Rehabilitation Wards: A Retrospective Cohort Study.

BACKGROUND: A protective effect of excessive body mass index (BMI) on mortality or functional outcome in patients with stroke is not well established in the Asian population. This study aimed to explore whether obese patients with stroke have advantages for functional improvement in Japanese rehabilitation wards. METHOD: This retrospective cohort study included consecutive patients with stroke admitted and discharged from convalescent rehabilitation wards between 2011 and 2015. Demographic data, BMI, Functional Independence Measure (FIM) score, and nutritional status were analyzed. Participants were classified into 4 groups according to BMI (underweight <18.5 kg/m(2), standard 18.5-<23 kg/m(2), overweight 23-<27.5 kg/m(2), obese ≥27.5 kg/m(2)). The primary outcome was the FIM gain, and the secondary outcome was the FIM score at discharge. Multiple regression analysis was performed to analyze the relationship between BMI and functional recovery. RESULTS: In total, 897 participants (males 484, females 413; mean age 71.6 years) were analyzed and classified as underweight (134), standard (432), overweight (277), and obese (54). The median FIM gain and the FIM score at discharge were 30 and 114, respectively. The FIM gain in the obese group was significantly higher than those in the other groups. Multiple regression analysis revealed that obesity was independently correlated with the FIM gain, and those at discharge after adjusting for confounders such as age, gender, and FIM score on admission. CONCLUSIONS: Obese Japanese convalescent patients with stroke may have some advantages for functional recovery in rehabilitation wards.

Functional conservation of wheat orthologs of maize rough sheath1 and rough sheath2 genes.

Maize rough sheath2 (RS2) and Arabidopsis ASYMMETRIC LEAVES1 (AS1) both encode a Myb transcription factor and repress Knotted1-type homeobox (KNOX) genes. The RS2/AS1-KNOX relationship is functionally conserved between maize and Arabidopsis. Here, we cloned wheat orthologs of RS2/AS1 and of a maize rough sheath1 (rs1) KNOX gene and named them WRS2 and WRS1, respectively. WRS1 mRNA was detected at leaf insertion points of the vegetative shoot meristem but was missing in differentiating floral organs. Conversely, WRS2 transcripts accumulated in initiating and developing floral organs. Transgenic tobacco plants expressing WRS1 showed morphological alterations typically observed due to expression of other KNOX genes. WRS2 with a deletion of the Myb domain could interact with NtPHAN to form a heterodimer, and expression of the truncated WRS2 gene conferred a dominant-negative phenotype similar to that expected and induced ectopic expression of an endogenous KNOX gene. Moreover, WRS2 expression alleviated morphological alterations in tobacco plants expressing the wheat KNOX gene. Therefore, the WRS2 gene product represses KNOX expression. These results indicate that the WRS2-KNOX relationship plays a fundamentally important role in lateral organ initiation and differentiation of meristems in wheat development. The antagonistic relationship between WRS2 and KNOX around meristematic tissues has been functionally conserved during wheat evolution.