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Title: Measuring nutritional status, hydration and body composition changes in acute stroke
Author: Kafri, Mohannad
Awarding Body: University of East Anglia
Current Institution: University of East Anglia
Date of Award: 2013
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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.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available