Measuring Nutritional Status, Hydration and Body Composition Changes in Acute Stroke

Kafri, Mohannad (2013) Measuring Nutritional Status, Hydration and Body Composition Changes in Acute Stroke. Doctoral thesis, University of East Anglia.

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Background: Dysphagia and cognitive problems, both common after stoke, may affect
dietary intake increasing the risk of malnutrition. Malnutrition has adverse effects on
body composition especially in conditions that escalate the stress response in the body
and may be associated with immobility such as stroke.
Study objective: The objective of my study was to understand the prognosis of
malnutrition on post cardiovascular disease (CV) outcomes, understand body
composition changes after stroke assessed using multi-frequency bioelectrical
impedance analysis (MF-BIA) methods, examine the utility of MF-BIA in diagnosing
dehydration in stroke patients, and validate MF-BIA selected body composition
estimates against the reference method Dual X-ray absorptiometry (DEXA).
Methodology: To understand the prognosis of malnutrition on post CVD outcomes I
carried out a systematic review and meta-analysis examining the association between
selected markers of malnutrition on outcomes. The systematic review is presented in
Chapter 2 of this thesis. Chapter 3 presents an observational longitudinal study that
describes body composition changes after ischaemic stroke and their prognosis on
outcomes. Ischaemic stroke patients admitted to an acute unit were prospectively
recruited between January-July 2011. Body composition variables (BioScan 920-2,
Maltron International Ltd, Essex, United Kingdom) were measured on admission and
discharge. Results were descriptively presented stratified by type of feeding regimen,
type of stroke and stroke severity. Validated follow up questionnaire were sent to
participants by post to understand body composition changes association with their
health and quality of life.
In chapter 4 the diagnostic accuracy of MF-BIA BioScan 920-2 in diagnosing
dehydration after stroke was examined for several diagnostic cut offs of current and
impending dehydration. In chapter 5 external validation of MF-BIA BioScan 920-2 fat
free mass and fat mass estimates against reference method DEXA was examined using
ten participants data. Bland and Altman analysis for understanding the agreement
between two methods of clinical measurement was carried out.
Results: Undernutrition (assessed using nutrition assessment tools) were associated
with mortality post cardiovascular event. Other findings are presented in Chapter 2.
Fat free mass loss, and fat mass gain, protein mass loss, muscle mass loss, and body cell
mass loss were observed in patients on modified diet (soft/mashed diet, pureed diet, nilby-
mouth feeding regimen). Sample size was small to generalize a conclusion on the
association between body composition changes in acute stay and outcomes. MF-BIA
BioScan 920-2 did not show diagnostic accuracy in diagnosing dehydration in stroke
patients. MF-BIA BioScan 920-2 fat free mass and fat mass estimates were in
agreement with their corresponding estimate from the reference methods DEXA.
Conclusion: My study was novel as it provided new information with regard to body
composition changes in acute stroke while utilizing new validated equipment in
estimating body composition component of fat free mass and fat mass. My study also
aimed to investigate new non-invasive methods to diagnose dehydration in stroke
patients. It contributed new knowledge that can be useful in future research, sample
size calculation, and can help researchers in the field to determine minimally clinically
significant differences for similar research and targeted intervention clinical trials.

Item Type: Thesis (Doctoral)
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User: Users 2259 not found.
Date Deposited: 12 Mar 2014 17:21
Last Modified: 12 Mar 2014 17:21


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