Changes in nutritional status, risk factors and food intake in stroke subjects: cohort study analysis of non-communicable disease risk factors
Abstract
Background: Stroke is a major cause of death and disability worldwide, affecting 15 million people annually. In Indonesia, the prevalence is 10.9%. Major risk factors include high blood pressure, obesity, inactivity, poor diet, and smoking. Objective: This study aims to analyze long-term trends in risk factors, nutritional status, and food intake among stroke patients from 2011-2021, assessing their impact on stroke incidence. Methods: Data from a longitudinal cohort study of 5,329 subjects, including 215 stroke patients, were analyzed using Microsoft Excel 2019 and SAS software. ANOVA was used to assess annual changes in risk factors, nutritional status, and food intake. Survival analysis was conducted with SAS PROC LIFETEST and PROC LIFEREG. Results: The cohort was primarily female (62.8%), aged 60 or older (57.2%), senior high school education (25.6%), civil servants (30.7%), and low income (57.2%). Significant changes were noted in BMI (p=0.037), fasting blood glucose (FBG) (p=0.001), HDL (p=0.049), abdominal circumference, smoking habits, physical activity (p<0.001), protein intake (p=0.026), and intake of energy, fat, carbohydrates, and sodium (p<0.001). Factors significantly associated with stroke included age, FBG, postprandial glucose, smoking (p<0.0001), LDL (p=0.0380), HDL (p=0.0126), physical activity (p=0.0455), energy intake (p=0.0002), fat intake (p=0.0007), and sodium intake (p=0.0012). Conclusions: The study highlights significant changes in nutritional status, glucose levels, HDL cholesterol, physical activity, and smoking habits. These factors, along with age, cholesterol levels, and dietary intake, impact stroke incidence, underscoring the need for comprehensive stroke prevention strategies.Downloads
References
WHO. Stroke, Cerebrovascular accident. WHO [Internet]. 2023. Cited 2024 Mar 10. Available from: https://www.emro.who.int/health-topics/stroke-cerebrovascular-accident/index.html
Kemenkes. Hasil Riset Kesehatan Dasar Riskesdas) 2018. Jakarta: Direktorat Jenderal Bina Gizi dan KIA; 2018.
Boehme AK, Esenwa C, Elkind MSV. Stroke Risk Factors, Genetics, and Prevention. Circ Res. 2017;120(3):472–95.
National Heart. STROKE Causes and Risk Factors. National Heart, Lung, and Blood Institute. National Heart [Internet] 2023. cited 2023 Dec Available from: https://www.nhlbi.nih.gov/health/stroke/causes
Riyadina W, Sudikno, et al. Laporan Akhir Penelitian Studi Kohor Faktor Risiko Penyakit Tidak Menular Dan Tumbuh Kembang Anak Tahun 2018. Jakarta:Kementrian Kesehatan; 2018.
Mishra SR, Chung HF, Waller M, Dobson AJ, Greenwood DC, Cade JE, et al. Association between reproductive life span and incident nonfatal cardiovascular disease: a pooled analysis of individual patient data from 12 studies. JAMA Cardiol. 2020;5:1410–8.
Parikh NI, Gonzalez JM, Anderson CAM, Judd SE, Rexrode KM, Hlatky MA, et al. American Heart Association Council on Epidemiology and Prevention; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; and the Stroke Council. Adverse pregnancy outcomes and cardiovascular disease risk: unique opportunities for cardiovascular disease prevention in women: a scientific statement from the American Heart Association. Circulation. 2021;143:902–16.
Indria MD, Rachmi E, Hutahaean YO. Age-Associated with Worsening of Neurological Deficits in Ischemic Stroke Patients in Abdoel Wahab Sjahranie Regional Hospital, Samarinda. JUXTA: Jurnal Ilmiah Mahasiswa Kedokteran Universitas Airlangga. 2024;15(1):34–40.
American Stroke Association. Stroke Risk Factors Not Within Your Control. American Stroke Association. 2021.
Azzahra V, Ronoatmodjo S. Faktor-Faktor yang Berhubungan dengan Kejadian Stroke pada Penduduk Usia >15 Tahun di Provinsi Daerah Istimewa Yogyakarta (Analisis Riskesdas 2018). Jurnal Epidemiologi Kesehatan Indonesia. 2022;6(2):91–6.
Mosenzon O, Cheng AY, Rabinstein AA, Sacco S. Diabetes and Stroke: What Are the Connections? J Stroke. 2023;25(1):26–38.
Yawoot N, Govitrapong P, Tocharus C, Tocharus J. Ischemic stroke, obesity, and the anti-inflammatory role of melatonin. Biofactors. 2021;47(1):41–58.
Di Vincenzo O, Luisi MLE, Alicante P, Ballarin G, Biffi B, Gheri CF, et al. The Assessment of the Risk of Malnutrition (Undernutrition) in Stroke Patients. Nutrients. 2023;15(3):683.
Sato M, Ido Y, Yoshimura Y, Mutai H. Relationship of malnutrition during hospitalization with functional recovery and postdischarge destination in elderly stroke patients. J Stroke Cerebrovasc Dis. 2019;28:1866–72.
Li JJ, Tan JX, Zhu FY, Wu Z, Ruan HF, Li ZR, et al. Comparisons of Stroke Knowledge and Health Behaviors in Patients With Hypertensive Stroke at Different Recurrence Risk Strata: The Comprehensive Reminder System Based on the Health Belief Model Study. J Cardiovasc Nurs. 2022;37(2):184–91.
Ghozy S, Zayan AH, El-Qushayri AE, Parker KE, Varney J, Kallmes KM. Physical activity level and stroke risk in US population: A matched case-control study of 102,578 individuals. Ann Clin Transl Neurol. 2022;9(3):264–75.
Madsen TE, Samaei M, Pikula A, Yu AYX, Carcel C, Millsaps E. Sex Differences in Physical Activity and Incident Stroke: A Systematic Review. Clin Ther. 2022;44(4):586–611.
Kim Y, Lai B, Mehta T, Thirumalai M, Padalabalanarayanan S, Rimmer JH. Exercise Training Guidelines for Multiple Sclerosis, Stroke, and Parkinson Disease: Rapid Review and Synthesis. Am J Phys Med Rehabil. 2019;98(7):613–21.
Kang SM, Kim SH, Han KD, Paik NJ, Kim WS. Physical activity after ischemic stroke and its association with adverse outcomes: A nationwide population-based cohort study. Top Stroke Rehabil. 2020;28:170–80.
Pan, Biqi, Jin, Xiao, Jun, Liu. The relationship between smoking and stroke: A meta-analysis. Medicine. 2019;98(12).
Parmar MP, Kaur M, Bhavanam S, Mulaka GSR, Ishfaq L, Vempati R. A Systematic Review of the Effects of Smoking on the Cardiovascular System and General Health. Cureus. 2023;24:15.
Pappan N, Awosika AO, Rehman A. Dyslipidemia. Treasure Island (FL): StatPearls Publishing. 2024.
Junita, Ernawati. Hubungan Rasio Kolesterol Total-HDL Dan Rasio Lingkar Pinggang-Panggul Dengan Stroke Di Rsud Raden Mattaher Jambi Tahun 2016. Jurnal Bahana Kesehatan Masyarakat. Bahana of Journal Public Health. 2019;3(1).
Chainika K, Neeraj KS, Sasanka C, Vipin S, Anil, Sharma Reena VS, et al. Mechanistic insights into the oxidized low-density lipoprotein-induced atherosclerosis. Oxidative Medicine and Cellular Longevity. Oxidative Medicine and Cellular Longevity. 2020;2020.
Ma C, Gurol ME, Huang Z, Lichtenstein AH, Wang X, Wang Y. Low-density lipoprotein cholesterol and risk of intracerebral hemorrhage: A prospective study. Neurology. 2019;93(5).
Balgis B, Sumardiyono S, Handayani S. Hubungan Antara Prevalensin Hipertensi, Prevalensi DM dengan Prevalensi Stroke di Indonesia. Jurnal Kesehatan Masyarakat. 2022;10(2):379–84.
Mongkau LK, Langi FLFG, Kalesaran AFC. Studi Ekologi Prevalensi Diabetes Melitus Dengan Stroke. Jurnal Kesehatan Masyarakat. 2022;6(2):1156–62.
Huff T, Boyd B, Jialal I. Physiology, Cholesterol. Treasure Island (FL): StatPearls Publishing. 2024.
Ferrari F, Moretti A, Villa RF. Hyperglycemia in acute ischemic stroke: physiopathological and therapeutic complexity. Neural Regen Res. 2022;17:292–9.
Masitha D, Nugrohowati AK, Candra A, Subagio HW, Murbawani EA. Kejadian Disfagia, Kesesuaian Diet, Dan Kejadian Malnutrisi Pada Pasien Stroke Usia Muda Di Rsup Dr Kariadi Semarang. Journal of Nutrition and Health. 2021;9(1).
Hopper L, Martin N, Jimoh OF, Kirk C, Foster E, Abdelhamid AS. Reduction in saturated fat intake for cardiovascular disease. Cochrane Database Syst Rev. 2020;5(5).
Grillo A, Salvi L, Coruzzi P, Salvi P, Parati G. Sodium Intake and Hypertension. Nutrients. 2019;11(9):1970.
Kemenkes. Pedoman gizi seimbang. Jakarta: Direktorat Jenderal Bina Gizi dan KIA; 2014.
Submitted
Copyright (c) 2024 Engelien Milannia Gigir, Dadang Sukandar, Sri Anna Marliyati
![Creative Commons License](http://i.creativecommons.org/l/by/4.0/88x31.png)
This work is licensed under a Creative Commons Attribution 4.0 International License.
World Nutrition Journal is an open acces journal and under the licence of