Ischemic stroke: the role of adipose and muscle tissue

Ischemic stroke (IS) is one of the leading causes of disability. Most cases of this disease are caused by modifiable metabolic risk factors associated with obesity. However, the effect of body composition on the functional status of patients who have suffered an IS has not been determined. Purpose of the study . To assess the effect of muscle and adipose tissue on the functional status and cognitive impairment in patients after IS. Material and methods . The study included 65 patients who had suffered an IS (age 62.9 ± 2.1 years) and 43 volunteers — the control group (age 63 ± 5 years). Depending on the severity of functional impairment after stroke (Modified Rankin Scale), the study group was divided into 2 subgroups. Subgroup 1 included 35 patients with no or mild limitations of life activities, and subgroup 2 included 30 patients with severe limitations. All patients underwent an assessment of daily activity (Barthel index), cognitive testing, anthropometric data and bioimpedancemetry parameters. Results . Compared with the control group, patients after IS showed an increase in parameters reflecting the state of adipose tissue, and the results of assessing cognitive functions and muscle mass were lower. In patients who had undergone IS, obesity was noted in 46% of cases, and a decrease in skeletal muscle mass was observed in 93%. In patients with obesity, the Barthel index values were lower than in those without it (90 ± 7 vs 95 ± 6, p = 0.005). The body mass index (BMI) and visceral fat area (VFA) values were higher in the presence of disability (31.8 ± 1.5 vs. 28.4 ± 1.9 kg/cm 2 ; p = 0.003; 177 [158;192] vs. 141 [122;156] cm 2 , p = 0.005). A threshold value of VFA (168.5 cm 2 ) was determined, the excess of which serves as a marker for identifying severe functional limitations. The results of assessing cognitive functions in patients were associated with the value of the skeletal muscle index (men r = 0.487, p = 0.001; women r = 0.596, p = 0.007). Conclusion . Visceral obesity accompanies more severe post-stroke limitations of life activities. Cognitive impairment in individuals who have suffered a stroke is associated with the state of muscle mass. An increase in the VFA from 168.5 cm 2 can serve as a marker of major functional limitations in patients who have suffered a stroke.