Nutritional status in patients with moderate to severe brain injury admitted to sub- acute rehabilitation

Introduction Brain injury increases metabolic and catabolic responses initiated by injured tissue, perfusion deficits, infection and release of hormones. Body Mass Index (BMI) and biochemistry insufficiently describes nutritional status after brain injury. Bioelectrical impedance analysis (BIA) is an additional tool to estimate body composition but so far unused in patients with brain injury. Aim: To describe the nutritional status in patients admitted for subacute neurorehabilitation after acquired moderate to severe brain injury. Method: This prospective, descriptive cohort study included patients consecutively admitted to a neurorehabilitation hospital (n=92). Measures of malnutrition were fat-free mass index (FFMI), weight loss, BMI, fat mass index (FMI), muscle strength and Biochemical markers according to recommended standards. Malnutrition was compared between admission and after 4 weeks using McNemars test. Findings From admission to after 4 weeks of rehabilitation, low FFMI FFMI (< 14.6 kg/m2 in women and < 16.7 kg/m2 in men) decreased from 17 to 11%, weight loss >5% compared to habitual weight decreased significantly from 56 to 40%, whereas low BMI (<18.5 kg/m2) did not change after 4 weeks of rehabilitation. The biochemical nutritional markers and proportion of patients with low muscle strength (54%), low FMI (3%), high BMI (44%), and high FMI (19%) did not change significantly after 4 weeks of rehabilitation. Conclusion FFMI and weight loss improved whereas BMI and biochemistry were unchanged after 4 weeks of rehabilitation. FFMI may be a sensitive indicator of nutritional changes during subacute neurorehabilitation.