Low body mass index negatively affects muscle mass and intramuscular fat of chronic stroke survivors.

Naoki Akazawa,Naomi Okawa,Kimiyuki Tamura,Kazuhiro Harada,Hideki Moriyama,Jennifer Dearborn-Tomazos

doi:10.1371/journal.pone.0211145

Naoki Akazawa, Naomi Okawa + Show 4 more

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https://doi.org/10.1371/journal.pone.0211145

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Abstract

ObjectiveRelationship between secondary changes in skeletal muscle and body weight in chronic stroke survivors has not yet been carefully examined. The objective of this study was to clarify the relationships between muscle mass, intramuscular fat, and body weight in chronic stroke survivors.MethodsSeventy-two chronic stroke survivors participated in this study. Transverse ultrasound images were acquired using B-mode ultrasound imaging. Quadriceps muscle mass and intramuscular fat were assessed based on muscle thickness and echo intensity, respectively. We used a stepwise multiple regression analysis to identify the factors that were independently associated with the body mass index. We entered quadriceps thickness and echo intensity of the paretic and non-paretic sides into another stepwise multiple regression model to avoid multicollinearity. Age, sex, type of stroke, time since stroke, thigh length, number of medications, and an updated Charlson comorbidity index were included as the independent variables.ResultsThe quadriceps thickness and echo intensity of the paretic and non-paretic sides were significantly independently associated with the body mass index: quadriceps thickness of the paretic side, β = 0.52; quadriceps thickness of the non-paretic side, β = 0.55; quadriceps echo intensity of the paretic side, β = −0.35; quadriceps echo intensity of the non-paretic side, β = −0.27).ConclusionsOur results suggest that low body mass index is associated with loss of muscle mass and increased intramuscular fat on both the paretic and non-paretic sides of chronic stroke survivors. Further studies examining whether appropriate weight management, along with targeted rehabilitation programs aimed at increasing muscle mass and decreasing intramuscular fat, achieves good outcomes in chronic stroke survivors are warranted.

Highlights

Skeletal muscle is the main effector organ of disability in stroke survivors, and chronic stroke survivors often experience secondary changes in their skeletal muscles, including decreases in muscle mass and increases in intramuscular fat [1,2,3,4,5,6]
Our results suggest that low body mass index is associated with loss of muscle mass and increased intramuscular fat on both the paretic and non-paretic sides of chronic stroke survivors
Further studies examining whether appropriate weight management, along with targeted rehabilitation programs aimed at increasing muscle mass and decreasing intramuscular fat, achieves good outcomes in chronic stroke survivors are warranted

Summary

Introduction

Skeletal muscle is the main effector organ of disability in stroke survivors, and chronic stroke survivors often experience secondary changes in their skeletal muscles, including decreases in muscle mass and increases in intramuscular fat [1,2,3,4,5,6]. The survival rate and degree of improvement in the ability to perform activities of daily living (ADL) after stroke are higher in obese stroke survivors than in those who are underweight [13,14,15,16,17,18,19,20]. A previous study [21] reported that a decrease of body weight in convalescent older stroke survivors is related to decreased ability to perform ADL These findings suggest that preventing weight loss may be essential for good outcomes. In support of this hypothesis is the finding that underweight chronic stroke survivors display decreased muscle mass and increased intramuscular fat [7].

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