Jurnal Kedokteran Dan Kesehatan Indonesia: Association Between Malnutrition and Stroke
Jurnal Kedokteran Dan Kesehatan Indonesia: Association Between Malnutrition and Stroke
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yang diperoleh dianalisis secara komputerisasi 22.9 kg/m2. Furthermore, low cholesterol
dan diuji dengan analisis univariat yang kemudian levels are also thought to increase the risk of
dilanjutkan dengan analisis bivariat dengan uji chi- hemorrhagic stroke.3
square.
The condition of malnutrition laboratory
Hasil: Pada penelitian ini gambaran jenis kelamin
menunjukkan sebagian besar adalah pasien is also indicated by the low total lymphocyte
laki-laki sebesar 119 (56,7%), sedangkan pasien level in the blood. Calculation of TLC is obtained
perempuan sebesar 91 (43,3%). Rentang usia from the percentage of lymphocytes in percent,
paling banyak pada penelitian ini ada di usia 60- then multiplied by the number of leukocytes
69 tahun dan di atas 70 tahun, masing-masing (White Blood Count) and the multiplication
sebanyak 64 (30,5%). Faktor risiko yang sering result is divided by 100.4 Previous researchers by
terjadi adalah hipertensi dengan jumlah 131 pasien
(62,4%). Pada analisis statistik didapatkan bahwa
Chandra et al. 1991 found a significant correlation
hipertensi menunjukkan hubungan signifikan (RP: between malnutrition and TLC <1200 cells/mm3
4,85, 95%CI: 2,62-8,97, p: 0,000) dan merupakan and between severe malnutrition and TLC <900
variabel terkuat yang berhubungan dengan cells/mm3. Malnutrition is associated with a
kejadian stroke. Malnutrisi secara statistik tidak decrease in body mass, including thymus gland
memiliki hubungan yang signifikan terhadap atrophy causing lymphopenia.5 The mechanism
kejadian stroke (RP: 0,80, 95%CI: 0,32-2,00, p:
of lymphocyte reduction in malnutrition up to
0,644).
Kesimpulan: Malnutrisi secara umum tidak the present has not been clearly described, but
menunjukkan hubungan yang signifikan terhadap it is thought to be associated with atrophy of the
stroke. Hipertensi merupakan faktor risiko thymus gland and interleukin.
independen terjadinya stroke. Undernutrition increases the risk of
cerebrovascular disease. Lack of substances such
INTRODUCTION as vitamins may impact on brain blood vessels.6
Stroke is a focal (or global) brain disorder Solenski (2007) wrote that the relationship
caused by vascular disorders, with clinical between nutrition and cerebrovascular disease
symptoms that takes place 24 hours or more.1 was in the lack of intake of vitamins B12, B6B12,
The morbidity and mortality rates of this disease folic acid leading to hyperhomocysteinemia and
are quite high. The incidence of stroke tends to blood cell formation disorders.7
increase annually. Epidemiological data show This study aims to determine the relationship
that stroke is the second cause leading death of malnutrition assessed according to the
in the world after heart disease In countries parameters of Total Lymphocyte Count (TLC)
with low capita income, stroke is the sixth cause to stroke.
of death, whereas, in countries with moderate
and high capita income, it is the second leading METHODS
cause of death.1 This study was conducted for three months
Malnutrition in a person's body will cause (July-September 2014) in Neural Unit and
various health problems. It can lead to anaemia, Medical Record Section of Bethesda Hospital
reduce the body's resistance to disease, and even Yogyakarta. This studyobtained ethical research
cause death. Also, malnutrition in children can approval from the Medical Research Ethics
lead to blindness and failure to thrive.2 Commission of the Faculty of Medicine, Duta
There several studies showing that people Wacana Christian University with no 061/C.10/
with malnutrition have a higher risk of stroke. FK/UKDW/VI/2014.This study useda cross-
Body Mass Index (BMI). Women with the sectional method, and research data was taken
nutritional status that is less or thin with body through the patient's medical record.
mass index (body mass index / BMI) <20 kg/ The inclusion criteria in this study are all
m2 have a higher risk ofa hemorrhagic stroke male and female stroke patients diagnosed by a
compared to other women with a BMI of 20.0– neurologist, and aged more or equal to 40 years.
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Exclusion criteria in this study are previous consisting of 105 patients with the case of both
stroke patients, patients who have leukemia, infarct and ischemic stroke diagnosis and 105
patients with a history of chemotherapy and control patients with the non-cerebrovascular
chronic diseases such as aplastic anaemia, diagnosis. Patients with a stroke diagnosis
myelodysplasia syndrome, HIV-AIDS, systemic (ischemic or hemorrhagic) are clinically
lupus erythematosus (SLE) determined, and a picture of infarction or
In the control group, the inclusion criteria are cerebral haemorrhage is obtained on the CT
all patients in the nerve poly suffering from non- scan results recorded in the medical record. This
cerebrovascular disease and aged more or equal study uses a cross-sectional method
to 40 years. Then, exclusion criteria are patients The data is taken using the data retrieval
who have leukemia, patients with a history of form. The dependent variable in this study is
chemotherapy and chronic diseases such as stroke, and the independent variable in this
aplastic anemia, myelodysplasia syndrome, HIV- study is the value of Total Lymphocyte Count
AIDS, systemic lupus erythematosus (SLE). (TLC) for assessment of malnutrition while
From the inclusion criteria, 210 research confounding variables include patient age,
subjects were meeting the research criteria, gender, education level, history of hypertension,
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hypercholesterolemia, LDL levels and a history 30.5% respectively). The main risk factor found
of diabetes mellitus. in the study is hypertension (131 patients/
The data from medical records obtainedare 62.4%).
analysed by computerisation and tested by a Based on the results of the analysis using
univariate analysis which is then continued Chi-square there are two variables that show
with bivariate analysis with chi-square test and a significant relationship to stroke (p:, 0.05).
multivariate with logistic regression test. Both of these factors are hypertension (OR:
4.85, 95% CI: 2.62-8.97, p: 0,000) and low
RESULTS education (elementary school education, OR:
The subjects of this study are mainly males 0.18, 95% CI: 0.05 -0.60, p: 0.005). The other
(119 people / 56.7%) graduating from senior variables such as gender, age, diabetes mellitus,
high schools the last education (33.3%). The hypercholesterolemia, high LDL history and TLC
subjects of this study are mainly in the age range do not have a statistically significant association
of 60-69 years and over 70 years (64 people / with stroke.
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of previous research supports the results of Wang et al., (2013). The situation of overnutrition
this study that found a statistically significant (obesity) is an independent risk factor for stroke,
relationship between hypertension and stroke while the condition of undernutrition has a low
with RP 4.85 (95% CI: 2.62-8.97) and p=0.000. potential for stroke
Hypertension is the most influential risk factor There is no meaningful relationship between
for stroke and is an independent factor because low TLC levels and stroke in this study probably
it has a value of p=0,000. due to the occurrence of an inflammatory process
Education is one of the factors that indirectly which is a risk factor for atherosclerosis in
play a role in stroke. It is someone’s effort to stroke patients. Acute and chronic inflammatory
obtainmore information and knowledge that processes cause an increase in lymphocyte and
will affect his health behaviour. The results of leukocyte levels in stroke patients. Therefore,
this study indicated that the majority of stroke assessing malnutrition using low TLC parameters
patients graduated fromsenior high school in stroke patients is not appropriate to use. This
education as the previous education (33.3%). seems to be a deficiency in this study. The use
The results of the bivariate analysis showed of BMI parameters with stroke is more relevant
that the last education especially elementary to find out the relationship between nutritional
school (Rp. 0.18, 95% CI: 0.05-0.60, p: 0.005) status and stroke because the parameters of BMI
had a statistically significant relationship are not related to the components of blood cells
with stroke. Notoatmodjo (2007) in his paper such as lymphocytes and leukocytes which tend
revealed that education was one of the factors to increase in stroke.
that indirectly played a role in stroke because it Malnutrition cannot be a risk factor alone to
was as someone’s effort to obtain information cause a stroke. Malnutrition conditions need to
and knowledge expected in the future would be supported by other independent risk factors
change health behaviour to be better. Someone such as hypertension to increase the risk of
with a higher level of education is expected to stroke. Lack of intake of vitamins B12, B6 and
be able to understand health information and folic acid can lead to hyperhomocysteinemia.
apply it in daily life. Hyperhomocysteinemia conditions can increase
Gunarsa et al. (2011) showed that there was the risk of stroke. Vitamin C deficiency can
a significant relationship between malnutrition increase the broken blood vessels. If the blood
and TLC levels (TLC <1,200 cells/mm3). Severe vessels in the brain have ruptured, there will be
malnutrition shows TLC <900 cells/mm3.12 In a stroke condition in patients.6
this study malnutrition conditions (indicated
by low TLC levels) did not show a significant CONCLUSION
relationship with stroke which is different from Based on the results of this study it can be
the research of Kurth et al. (2005) showing that concluded that there is no relationship between
women in the thin BMI category or included in Total Lymphocyte Count and stroke.
the possible undernutrition category (<20 kg This study was conducted to determine the
/ m2) are at higher risk of hemorrhagic stroke relationship of malnutrition with stroke assessed
than women with a BMI of 20.0 - 22.9 kg / m2. by the parameter Total Lymphocyte Count (TLC)
Also, low cholesterol levels are also thought to that has never been done in previous studies.
be associated with the increase of hemorrhagic Further research can be done with different
stroke.3 research methods, for example by cohort
The results of this study appear to be in methods and with more sample sizes. Unrelated
line with the research of Bazzano et al. (2011) risk factors can also be continued.
which showed that both men and women with
undernutrition (low BMI) have a low potential CONFLICT OF INTEREST
for stroke.13 The same thingwas confirmed by None declare.
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