• Nutrition · Jan 2022

    Protein energy wasting-based nutritional assessment predicts outcomes of acute ischemic stroke and solves the epidemiologic paradox.

    • Li-Chun Ho, Hao-Kuang Wang, Lu-Ting Chiu, Hsi-Hao Wang, Yi-Che Lee, Shih-Yuan Hung, Yu Sun, Cheng-Yu Wei, Kai-Cheng Hsu, Yu-Wei Chen, Li-Ming Lien, Chung Y Hsu, and Taiwan Stroke Registry Investigators.
    • School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan; Division of General Medicine, Department of Internal Medicine, E-DA Hospital, Kaohsiung, Taiwan; Division of Nephrology, Department of Internal Medicine, E-DA Hospital, Kaohsiung, Taiwan. Electronic address: hoim7024@ms3.hinet.net.
    • Nutrition. 2022 Jan 1; 93: 111431.

    ObjectiveOverweight and hyperlipidemia, the two established risk factors for acute ischemic stroke, are paradoxically associated with favorable outcomes. The paradox may be resolved by the concept of protein energy wasting (PEW), in which total cholesterol level and body mass index are used as nutritional indexes for predicting outcomes of chronic kidney disease.MethodsAmong 12 271 people with acute ischemic stroke and chronic kidney disease, 2086 were defined as being at risk of PEW-with a body mass index <22 kg/m2 plus either a serum albumin level <38 g/L or a total cholesterol level <4.14 mmol/L (160 mg/dL) without the use of lipid-lowering drugs-and all the others were a control group. The hazards of PEW for mortality and functional outcomes were evaluated using propensity score matching and multivariate Cox regression analysis.ResultsBased on the propensity score, 2081 PEW participants were matched to the same number of non-PEW control participants. PEW was associated with a higher mortality risk at 3 mo (adjusted hazard ratio, 1.19; 95% confidence interval [CI], 1.02-1.42) and 1 y (adjusted hazard ratio, 1.33; 95% CI1.13-1.52). PEW was also associated with poor functional outcomes (modified Rankin Scale score >2) at 1 mo (adjusted odds ratio, 1.32; 95% CI, 1.08-1.61) and 3 mo (adjusted odds ratio, 1.27; 95% CI, 1.03-1.56).ConclusionsAccording to the PEW-based assessment system, a modest decrease in body mass index and total cholesterol levels suggests malnutrition and is associated with adverse outcomes of acute ischemic stroke.Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.

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