title: High Nutritional-Related Risk on Admission Predicts Less Improvement of Functional Independence Measure in Geriatric Stroke Patients: A Retrospective Cohort Study.
abstract: BACKGROUND
  The aim of the present study was to establish whether high nutritional-related risk on admission predicts less improvement of Functional Independence Measure (FIM) in geriatric stroke patients.
  
  
  METHODS
  We performed a retrospective cohort study of patients admitted for stroke at 5 major hospitals in the Noto district of Japan from July 2009 to June 2013. Patients were divided into 2 groups according to Geriatric Nutritional Risk Index (GNRI) at admission. Patient characteristics were compared between the low GNRI (<92) and high GNRI (≥92) groups. We assessed nutritional status using GNRI and activities of daily living using the FIM.
  
  
  RESULTS
  A total of 540 participants (mean age, 80 years; interquartile range, 75-85 years) were included in the present study. Patients were admitted because of cerebral infarction (394 patients), intracerebral hemorrhage (123 patients), and subarachnoid hemorrhage (23 patients). Univariate analysis of FIM gain demonstrated significant differences between groups. Multivariate analysis of FIM gain adjusting for confounding factors demonstrated age (β = -.139; 95% confidence interval [CI] = -.629 to -.140), cerebral infarction (β = -.264; 95% CI = -12.956 to -6.729), National Institutes of Health Stroke Scale (β = -.180; 95% CI = -.688 to -.248), and GNRI score (β = .089; 95% CI = .010-.347) as independent factors associated with FIM gain (P < .05 for all).
  
  
  CONCLUSIONS
  GNRI at admission may independently predict FIM gain. Poor nutritional status is a predictor of lower FIM improvement in geriatric stroke patients.
authors.affiliation: Department of Clinical Nutrition, Keiju Medical Center, Nanao City, Ishikawa, Japan; Noto Liaison Council for Cerebral Stroke, Nanao City, Ishikawa, Japan. Electronic address: yojikokura@hotmail.com.
authors.forename: Yoji
authors.initials: Y
authors.lastname: Kokura
authors.affiliation: Department of Nutrition and Dysphagia Rehabilitation, Tamana Regional Health Medical Center, Tamana, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Maeda
authors.affiliation: Department of Rehabilitation Medicine, Yokohama City University Medical Center, Yokohama, Kanagawa Prefecture, Japan.
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Wakabayashi
authors.affiliation: Department of Clinical Nutrition and Food Services, Nagasaki Rehabilitation Hospital, Nagasaki, Nagasaki Prefecture, Japan.
authors.forename: Shinta
authors.initials: S
authors.lastname: Nishioka
authors.affiliation: Noto Liaison Council for Cerebral Stroke, Nanao City, Ishikawa, Japan; Department of Neurosurgery, Keiju Medical Center, Nanao City, Ishikawa, Japan.
authors.forename: Sotaro
authors.initials: S
authors.lastname: Higashi
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D002544:Cerebral Infarction / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D016009:Chi-Square Distribution; D004185:Disability Evaluation; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D007564:Japan; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D015596:Nutrition Assessment; D009752:Nutritional Status; D010343:Patient Admission; D011237:Predictive Value of Tests; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D000071939:Stroke Rehabilitation; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome
keywords: Functional Independence Measure; Geriatric Nutritional Risk Index; Nutritional status; activities of daily living; stroke