Body Composition Alterations in Patients with Chronic Stroke: A Cross-Sectional Study

Changes in body composition, including a decrease in muscle and bone mass, are common with ageing 1,2 .In individuals with stroke, significant skeletal muscle loss has been well documented, particularly on the hemiparetic side.However, declines in muscle mass and strength have also been observed in the non-paretic limbs 3 .In addition to muscle atrophy resulting from neuronal deafferentation, other contributing factors include catabolic-anabolic imbalance, systemic inflammatory activation and local metabolic alterations within the muscles 4-7 .Moreover, physical inactivity, fatigue, deconditioning and poor nutrition further exacerbate these changes 4,6 .Studies have shown that stroke survivors have a higher prevalence of sarcopenia compared to age-, sex-race-and BMI-matched controls 8 .Muscle loss is also associated with osteoporosis 9 .Alongside the decline in muscle mass, bone mineral content (BMC) also declines significantly.In some patients with stroke, bone loss in the paretic arm during the first year post-stroke can be equivalent to more than 20 years of bone loss in healthy individuals of the same age 10 .Ramnemark et al. found that BMC on the paretic side significantly decreased within the first year post-stroke, beginning as early as 4-month follow-up, whereas changes in lean mass were relatively minor 11 .This bone loss may result from several factors including muscle weakness, reduced bone loading, limited mobility, poor nutrition, iatrogenic influences and decreased sunlight exposure 12 .A reduction in bone mass, particularly to osteoporotic levels, significantly increases fracture risk 13 .Stroke survivors are estimated to have a 1.2 to 1.7 fold increased risk of hip fracture compared to the general population [14][15][16] .In contrast to the loss of muscle and bone mass, fat mass tends to increase following a stroke 17,18 .Contributing mechanisms may include impaired glucose metabolism, immobilization, and fatty infiltration of disused muscles 19 .