Background. The purpose of this study is to compare serum nutritional profiles in chronic stroke survivors to a representative sample of US Adults (NHANESIII) and determine whether these serum markers differed by race and impact physical function in stroke. Methods. Fasting serum samples were collected for analysis of lipids, uric acid, and albumin in 145 African American (AA) and 111 Caucasian (C) stroke survivors (age: 60 ± 1 years [mean ± SEM]). A six-minute walk was performed in a subset of stroke survivors (N = 134). Results. Triglycerides were higher and HDL-cholesterol and albumin lower in C than AA women stroke survivors (Ps < 0.05). Uric acid was lower in C than AA stroke survivors (P < 0.05). Compared to NHANESIII, HDL-cholesterol, albumin, and hemoglobin generally were lower (Ps < 0.05) and lipids were more favorable in stroke (Ps < 0.01). Uric acid was related to six-minute walk performance among a subset of stroke survivors (P < 0.05). Conclusion. In stroke, racial differences exist with regard to serum nutritional risk, but these differences are similar to that observed in the general population. Regardless of race, nutritional risk appears elevated above that of the general population with regard to many of the serum markers. As a modifiable biomarker, uric acid should be monitored closely as it may provide insight into the functional risk of stroke survivors. 1. Introduction Both suboptimal or excessive caloric intake and poor dietary quality affect nutritional risk and may hinder recovery from stroke. In as little as six months following discharge from an initial stroke incident, ~41% of survivors are at nutritional risk, based upon patient interviews regarding appetite, digestion, mobility, and swallowing difficulties [1]. Another study shows that 11% of stroke survivors with initial motor deficits and communication impairment still require feeding assistance six months after stroke [2]. Further, we have previously shown that well into the chronic phase of stroke recovery (>6 months), survivors are obese and have greater intramuscular fat relative to muscle area in their affected limb [3], indicating imbalanced dietary intake relative to energy expenditure. While these data suggest that poor caloric intake exists in chronic stroke, little data are currently available regarding diet quality in stroke. Difficulties with speech and cognition may interfere with obtaining accurate dietary records to assess dietary quality in those chronically disabled by stroke. However, several serum biomarkers commonly found on general comprehensive
References
[1]
A. Westergren, “Nutrition and its relation to mealtime preparation, eating, fatigue and mood among stroke survivors after discharge from hospital—a pilot study,” The Open Nursing Journal, vol. 2, pp. 15–20, 2008.
[2]
L. Perry, “Eating and dietary intake in communication-impaired stroke survivors: a cohort study from acute-stage hospital admission to 6 months post-stroke,” Clinical Nutrition, vol. 23, no. 6, pp. 1333–1343, 2004.
[3]
A. S. Ryan, C. L. Dobrovolny, G. V. Smith, K. H. Silver, and R. F. Macko, “Hemiparetic muscle atrophy and increased intramuscular fat in stroke patients,” Archives of Physical Medicine and Rehabilitation, vol. 83, no. 12, pp. 1703–1707, 2002.
[4]
H. E. Hinds, A. A. Johnson, M. C. Webb, and A. P. Graham, “Iron, folate, and vitamin B12 status in the elderly by gender and ethnicity,” Journal of the National Medical Association, vol. 103, no. 9-10, pp. 870–877, 2011.
[5]
A. Astrup, J. Dyerberg, P. Elwood et al., “The role of reducing intakes of saturated fat in the prevention of cardiovascular disease: where does the evidence stand in 2010?” The American Journal of Clinical Nutrition, vol. 93, no. 4, pp. 684–688, 2011.
[6]
F. B. Hu, “Are refined carbohydrates worse than saturated fat?” The American Journal of Clinical Nutrition, vol. 91, no. 6, pp. 1541–1542, 2010.
[7]
B. R. Don and G. Kaysen, “Serum albumin: relationship to inflammation and nutrition,” Seminars in Dialysis, vol. 17, no. 6, pp. 432–437, 2004.
[8]
E. P. de Oliveira and R. C. Burini, “High plasma uric acid concentration: causes and consequences,” Diabetology & Metabolic Syndrome, vol. 4, no. 1, article 12, 2012.
[9]
A. E. Thalacker-Mercer, C. A. Johnson, K. E. Yarasheski, N. S. Carnell, and W. W. Campbell, “Nutrient ingestion, protein intake, and sex, but not age, affect the albumin synthesis rate in humans,” The Journal of Nutrition, vol. 137, no. 7, pp. 1734–1740, 2007.
[10]
S. H. Pai, “Changes in serum lipid concentrations during iron depletion and after iron supplementation,” Annals of Clinical and Laboratory Science, vol. 31, no. 2, pp. 151–156, 2001.
[11]
H. K. Choi, S. Liu, and G. Curhan, “Intake of purine-rich foods, protein, and dairy products and relationship to serum levels of uric acid: the third national health and nutrition examination survey,” Arthritis and Rheumatism, vol. 52, no. 1, pp. 283–289, 2005.
[12]
B. W. J. H. Penninx, M. Pahor, M. Cesari et al., “Anemia is associated with disability and decreased physical performance and muscle strength in the elderly,” Journal of the American Geriatrics Society, vol. 52, no. 5, pp. 719–724, 2004.
[13]
B. W. Schalk, D. J. H. Deeg, B. W. Penninx, L. M. Bouter, and M. Visser, “Serum albumin and muscle strength: a longitudinal study in older men and women,” Journal of the American Geriatrics Society, vol. 53, no. 8, pp. 1331–1338, 2005.
[14]
C. Macchi, R. Molino-Lova, P. Polcaro et al., “Higher circulating levels of uric acid are prospectively associated with better muscle function in older persons,” Mechanisms of Ageing and Development, vol. 129, no. 9, pp. 522–527, 2008.
[15]
H. E. Hinson, S. L. Patterson, R. F. Macko, and A. P. Goldberg, “Reduced cardiovascular fitness and ambulatory function in Black and White stroke survivors,” Ethnicity and Disease, vol. 17, no. 4, pp. 682–685, 2007.
[16]
G. Boysen, J. L. Marott, M. Gr？nb？k, H. Hassanpour, and T. Truelsen, “Long-term survival after stroke: 30 years of follow-up in a cohort, the Copenhagen City Heart Study,” Neuroepidemiology, vol. 33, no. 3, pp. 254–260, 2009.
[17]
“Differences in disability among black and white stroke survivors—United States, 2000-2001,” Morbidity and Mortality Weekly Report, vol. 54, pp. 3–6, 2000.
[18]
S. E. Judd, O. M. Gutiérrez, P. K. Newby et al., “Dietary patterns are associated with incident stroke and contribute to excess risk of stroke in black americans,” Stroke, vol. 44, no. 12, pp. 3305–3311, 2013.
[19]
World Health Organization, Global Database on Body Mass Index: An Interactive Surveillance Tool for Monitoring Nutrition Transition, World Health Organization, 2014.
[20]
“Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report,” Circulation, vol. 106, pp. 3143–3421, 2002.
[21]
H. H. Billett, “Hemoglobin and hematocrit,” in Clinical Methods: The History, Physical, and Laboratory Examinations, H. K. Walker, W. D. Hall, and J. W. Hurst, Eds., Butterworth-Heinemann, Oxford, UK, 3rd edition, 2011.
[22]
M.-C. Corti, J. M. Guralnik, M. E. Salive, and J. D. Sorkin, “Serum albumin level and physical disability as predictors of mortality in older persons,” Journal of the American Medical Association, vol. 272, no. 13, pp. 1036–1042, 1994.
[23]
L. Sachs, K. L. Batra, and B. Zimmermann, “Medical implications of hyperuricemia,” Medicine and Health, Rhode Island, vol. 92, no. 11, pp. 353–355, 2009.
[24]
R. F. Macko, L. I. Katzel, A. Yataco et al., “Low-velocity graded treadmill stress testing in hemiparetic stroke patients,” Stroke, vol. 28, no. 5, pp. 988–992, 1997.
[25]
G. V. Smith, K. H. Silver, A. P. Goldberg, and R. F. Macko, ““Task-oriented” exercise improves hamstring strength and spastic reflexes in chronic stroke patients,” Stroke, vol. 30, no. 10, pp. 2112–2118, 1999.
[26]
National Health and Nutrition Examination Survey.
[27]
ACSM's Guidelines for Exercise Testing and Prescription, Lippincott Williams & Wilkins, Philadelphia, Pa, USA, 8th edition, 2010.
[28]
J. Wu, S. Chen, Y. Zhou, et al., “Non-high-density lipoprotein cholesterol on the risks of stroke: a result from the Kailuan study,” PLoS ONE, vol. 8, no. 9, Article ID e74634, 2013.
[29]
A. Mahmood, M. A. Sharif, M. N. Khan, and U. Z. Ali, “Comparison of serum lipid profile in ischaemic and haemorrhagic stroke,” Journal of the College of Physicians and Surgeons Pakistan, vol. 20, no. 5, pp. 317–320, 2010.
[30]
G. A. Nichols, S. Vupputuri, and A. G. Rosales, “Change in high-density lipoprotein cholesterol and risk of subsequent hospitalization for coronary artery disease or stroke among patients with type 2 diabetes mellitus,” The American Journal of Cardiology, vol. 108, no. 8, pp. 1124–1128, 2011.
[31]
J. Z. Willey, C. J. Rodriguez, R. F. Carlino, et al., “Race-ethnic differences in the association between lipid profile components and risk of myocardial infarction: the Northern Manhattan Study,” American Heart Journal, vol. 161, no. 5, pp. 886–892, 2011.
[32]
N. I. Khan, L. Naz, S. Mushtaq, L. Rukh, S. Ali, and Z. Hussain, “Ischemic stroke: prevalence of modifiable risk factors in male and female patients in Pakistan,” Pakistan Journal of Pharmaceutical Sciences, vol. 22, no. 1, pp. 62–67, 2009.
[33]
E. V. Kuklina, M. D. Carroll, K. M. Shaw, and R. Hirsch, “Trends in high LDL cholesterol, cholesterol-lowering medication use, and dietary saturated-fat intake: United States, 1976–2010,” NCHS Data Brief, no. 117, pp. 1–8, 2013.
[34]
C. G. Mihos, A. M. Pineda, and O. Santana, “Cardiovascular effects of statins, beyond lipid-lowering properties,” Pharmacological Research, vol. 88, pp. 12–19, 2014.
[35]
S. Oravec, Z. Krivo？íková, M. Krivo？ík et al., “Lipoprotein profile in patients who survive a stroke,” Neuroendocrinology Letters, vol. 32, no. 4, pp. 496–501, 2011.
[36]
M. Mehrpour, M. Khuzan, N. Najimi, M. R. Motamed, and S.-M. Fereshtehnejad, “Serum uric acid level in acute stroke patients,” Medical Journal of the Islamic Republic of Iran, vol. 26, no. 2, pp. 66–72, 2012.
[37]
K. Y. Wong, R. S. Macwalter, H. W. Fraser, I. Crombie, S. A. Ogston, and A. D. Struthers, “Urate predicts subsequent cardiac death in stroke survivors,” European Heart Journal, vol. 23, no. 10, pp. 788–793, 2002.
[38]
J. W. Maynard, M. A. McAdams-Demarco, A. Law, et al., “Racial differences in gout incidence in a population-based cohort: atherosclerosis risk in communities study,” American Journal of Epidemiology, vol. 179, no. 5, pp. 576–583, 2014.
[39]
R. C. S. Seet, K. Kasiman, J. Gruber et al., “Is uric acid protective or deleterious in acute ischemic stroke? A prospective cohort study,” Atherosclerosis, vol. 209, no. 1, pp. 215–219, 2010.
[40]
K. M. Beavers, D. P. Beavers, M. C. Serra, R. G. Bowden, and R. L. Wilson, “Low relative skeletal muscle mass indicative of sarcopenia is associated with elevations in serum uric acid levels: findings from NHANES III,” Journal of Nutrition, Health and Aging, vol. 13, no. 3, pp. 177–182, 2009.
[41]
E. P. de Oliveira, F. Moreto, L. V. D. A. Silveira, and R. C. Burini, “Dietary, anthropometric, and biochemical determinants of uric acid in free-living adults,” Nutrition Journal, vol. 12, no. 1, article 11, 2013.
[42]
H.-C. Huang, C.-H. Chang, T.-H. Lee et al., “Differential trajectory of functional recovery and determinants for first time stroke survivors by using a LCGA approach: a hospital based analysis over a 1-year period,” European Journal of Physical and Rehabilitation Medicine, vol. 49, no. 4, pp. 463–472, 2013.
[43]
C. M. Kim, J. J. Eng, D. L. MacIntyre, and A. S. Dawson, “Effects of isokinetic strength training on walking in persons with stroke: a double-blind controlled pilot study,” Journal of Stroke & Cerebrovascular Diseases, vol. 10, no. 6, pp. 265–273, 2001.
[44]
A. R. Luft, L. Forrester, R. F. Macko et al., “Brain activation of lower extremity movement in chronically impaired stroke survivors,” NeuroImage, vol. 26, no. 1, pp. 184–194, 2005.
