Changes in skeletal muscle mass index and fat mass index during rehabilitation for traumatic brain injury and stroke measured by bioelectrical impedance analysis.

Although malnutrition may negatively impact the outcomes of rehabilitation and increase the cost of care, there are still no valid nutritional assessment methods appropriate for specific groups of patients undergoing rehabilitation. This study aimed to determine if a multifrequency bioelectrical impedance is suitable for monitoring the changes in body composition of brain-injured patients for whom individualized nutritional goals were set during rehabilitation. Fat mass index (FMI) and skeletal muscle mass index (SMMI) were examined by Seca mBCA515 or portable Seca mBCA525 device within 48 h of admission and before discharge in 11 traumatic brain injury (TBI) and 11 stroke patients with admission Nutritional Risk Screening 2002 scores ≥2. The changes in outcomes and plausible interactions were examined between the admission values and the values estimated for the 18th day (minimum length of stay in the sample) using a repeated measure mixed-sample analysis of covariance. In patients with low FMI at admission (mainly younger, TBI patients, with longer ICU stay), there was no change over time whereas, in those with high admission FMI (older, stroke patients, with shorter ICU stay), a decrease was observed (significant interaction F(1,19) = 9.224 P  = 0.007 Part. η² = 0.327). The SMMI significantly increased over time (F(1,19) = 5.202 P  = 0.034 Part. η² = 0.215) independently of gender, age, days spent in ICU and cause of brain injury. Our results suggest that bioelectrical impedance analysis is feasible and informative for monitoring the changes in body composition during rehabilitation, which also requires consideration of demographic and pre-rehabilitation characteristics.

Possibility of bioimpedance-based nutritional status assessment in rehabilitation / A tápláltsági állapot bioimpedancia-alapú meghatározásának lehetosége a rehabilitációban

Introduction: We do not have a diagnostic method for malnutrition yet that can monitor the nutritional status of patients in rehabilitation institutions and its changes in an objective, accurate, reproducible way. Objective: The aim of this study was to determine the risk of malnutrition in patients at the National Institute for Medical Rehabilitation of Hungary completing with bioimpedance-based body composition in order to develop adequate nutrition therapy. Method: The Nutritional Risk Screening 2002 questionnaire was used. Body composition analysis was determined by the multifrequency bioimpedance-based seca mBCA 525 device. Results: The association between the risk of malnutrition measured by a validated screening method of 41 patients was weaker with fat-free mass index (r = -0.487, p = 0.001) and skeletal muscle mass (r = -0.476, p = 0.002) than with body mass index (r = -0.662, p<0.001). It was not correlated with fat mass. Strong correlations of body mass index with body composition were significantly weakened in the case of brain injuries. A strong correlation between skeletal muscle and fat mass was observed in all cases. Body mass index correlated with extracellular and total body water ratio only in the case of brain injuries. The extracellular and total body water ratio presented a strong correlation with the phase angle in each case (r = -0.711, p<0.001). Phase angle showed the strongest correlations with fat-free mass index (r = 0.638, p<0.001), skeletal muscle (r = 0.544, p<0.001) and fat mass (r = 0.588, p<0.001) in the case of brain-injured patients. Conclusion: Malnutrition screening tools are not sensitive enough for patient groups of rehabilitation institutions, and with body mass index, less risky patients can be screened out than with body composition analysis. Combining screening with bioimpedance-based body composition analysis is a suitable method for rehabilitation hospitals.

[Malnutrition risk screening in inpatient rehabilitation]. / Alultápláltságkockázat-szurés a rehabilitációs fekvobeteg-ellátásban.

Introduction: There are no satisfying data about the difficulties of nutritional therapy during rehabilitation, but malnutrition and secondary sarcopenia increase the number of complications. Aim: The aim of this cross-sectional study was measuring of patients' malnutrition risk in the National Institute for Medical Rehabilitation of Hungary. Method: Malnutrition Universal Screening Tool was used in this study. Results: 44% of the patients had a risk of malnutrition (n = 331; average age: 59 years), 19% of the patients presented moderate risk and 25% had high risk of malnutrition. The sample consisted of 176 males and 155 females (53%/47%). The interquartile range of body mass index of patients was between 22-29.9 kg/m2 (s = 6.36). Comparison of units showed that the Brain Injury Rehabilitation Unit has the most malnutrition-risked patients (62.5%, 25 patients). Conclusions: Malnutrition screening tools are not sensitive enough in the case of special patient groups of rehabilitation, therefore a combined screening method is needed. Orv Hetil. 2020; 161(1): 11-16.