skip to main content

Relationship between skeletal muscle mass index and length of stay in stroke patient

1Doctoral Program in Medical and Health Science, Faculty of Medicine, Universitas Diponegoro, Central Java, Indonesia

2Clinical Nutrition Department, Faculty of Medicine, Universitas Diponegoro, Semarang, Central Java, Indonesia

3Medical Staff Committee, Neurology, Dr. Kariadi General Hospital, Semarang, Central Java, Indonesia

4 Neurology Department, Faculty of Medicine, Universitas Diponegoro, Semarang, Central Java, Indonesia

View all affiliations
Received: 3 Jul 2025; Revised: 22 Nov 2025; Accepted: 31 Dec 2025; Available online: 4 Feb 2026; Published: 30 Jun 2026.

Citation Format:
Abstract

Background: Sarcopenia is a syndrome characterized by progressive condition and generalized loss of skeletal muscle mass and strength. It is associated with poor prognosis and increased length of stay in stroke patients. Skeletal Muscle Mass Index (SMI) is an important parameter for assessing skeletal muscle mass and the clinical outcomes of stroke patients.

Objective: to examine the relationship between SMI and length of stay in stroke patient.

Materials and Methods: Cross-sectional observational analytical research was conducted at Dr. Kariadi Semarang Hospital from June 2024 to March 2025 in hospitalized stroke patients aged >18 years. Body composition, including skeletal muscle mass, is measured using BIA. Data were analyzed by Independent t-test, Pearson Correlation and Double Linear Regression.

Results: The average length of stay among the 78 individuals (43 males and 35 females) was 11 days. The SMI levels were normal, indicating no sarcopenia.

Conclusion: Skeletal Muscle Mass Index (SMI) was significantly related (p<0.05) with length of stay in stroke patients; the higher the SMI score, the shorter the duration of hospital stay.

 

Note: This article has supplementary file(s).

Fulltext View|Download |  common.other
Correlation between skeletal muscle mass index and length of stay in stroke patient
Subject
Type Other
  Download (110KB)    Indexing metadata
Keywords: length of stay; sarcopenia; skeletal muscle mass index; stroke

Article Metrics:

  1. Scherbakov N, von Haehling S, Anker SD D, U DW. Stroke induced sarcopenia: muscle wasting and disability after stroke. Int J Cardiol. 2013;170:89–94. https://doi.org/10.1016/j.ijcard.2013.10.031
  2. Rodgers H, Price C. Stroke unit care, inpatient rehabilitation and early supported discharge. Clin Med (Northfield Il). 2017;17(2):173–7. https://doi.org/10.7861/clinmedicine.17-2-173
  3. Ovbiagele B NHM. Stroke epidemiology: advancing our understanding of disease mecha nism and therapy. Neurotherapeutics. 2011;8:319–29. https://doi.org/10.1007/s13311-011-0053-1
  4. Scherbakov N, Sandek A DW. Stroke-related sarcopenia: specific characteristics. J Am Med Dir Assoc. 2015;16:272–276. https://doi.org/10.1016/j.jamda.2014.12.007
  5. Ohyama, K.; Watanabe, M.; Nosaki, Y.; Hara, T.; Iwai, K.; Mokuno K. Correlation Between Skeletal Muscle Mass Deficit and Poor Functional Outcome in Patients with Acute Ischemic Stroke. J Stroke Cerebrovasc Dis. 2020;29:104623. https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.104623
  6. Matsushita, T.; Nishioka, S.; Taguchi, S.; Yamanouchi A. Sarcopenia as a Predictor of Activities of Daily Living Capability in Stroke Patients Undergoing Rehabilitation. Geriatr Gerontol Int. 2019;19:1124–1128. https://doi.org/10.1111/ggi.13780
  7. Fielding RA, Vellas B, Evans WJ et al. Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International Working Group for Sarcopenia. J Am Med Dir Assoc. 2011;12:249–256. https://doi.org/10.1016/j.jamda.2011.01.003
  8. Cruz-Jentoft, A.J.; Bahat, G.; Bauer, J.; Boirie, Y.; Bruyère, O.; Cederholm, T.; Cooper, C.; Landi, F.; Rolland, Y.; Sayer AA. et al. Sarcopenia: Revised European Consensus on Definition and Diagnosis. Age Ageing. 2019;48:16–31. https://doi.org/10.1093/ageing/afz046
  9. Bianchi L, Ferrucci L, Cherubini A, Maggio M B, dinelli S, Savino E et al. The predictive value of the EWGSOP definition of sarcopenia: results from the InCHIANTI Study. J Gerontol A Biol Sci Med Sci. 2016;71:259–64. https://doi.org/10.1093/gerona/glv129
  10. Su Y, Yuki M OM. Prevalence of stroke-related sarcopenia: a systematic review and meta-analysis. J Stroke Cerebrovasc Dis. 2020;29:105092. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105092
  11. Petermann-Rocha F, Balntzi V, Gray SR et al. Global prevalence of sarcopenia and severe sarcopenia: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle. 2022;13:86–99. https://doi.org/10.1002/jcsm.12783
  12. Batsis JA, Mackenzie TA, Bartels SJ et al. Diagnostic accuracy of body mass index to identify obesity in older adults: NHANES 1999 2004. Int J Obes. 2016;40:761–7. https://doi.org/10.1038/ijo.2015.243
  13. Nakanishi, N.; Okura, K.; Okamura, M.; Nawata, K.; Shinohara, A.; Tanaka, K.; Katayama S. Measuring and Monitoring Skeletal Muscle Mass after Stroke: A Review of Current Methods and Clinical Applications. J Stroke Cerebrovasc Dis. 2021;30:105736. https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.105736
  14. Kim, S.; Won CW. Sex-Different Changes of Body Composition in Aging: A Systemic Review. Arch Gerontol Geriatr. 2022;102:104711. https://doi.org/10.1016/j.archger.2022.104711
  15. Yoshimura Y, Wakabayashi H, Bise T et al. Sarcopenia is associated with worse recovery of physical function and dysphagia and a lower rate of home discharge in Japanese hospitalized adults undergoing convalescent rehabilitation. Nutrition. 2019;61:111–8. https://doi.org/10.1016/j.nut.2018.11.005
  16. Shiraishi A, Yoshimura Y, Wakabayashi H TY. Prevalence of stroke-related sarcopenia and its as sociation with poor oral status in post-acute stroke patients: implications for oral sarcopenia. Clin Nutr. 2018;37:204–7. https://doi.org/10.1016/j.clnu.2016.12.002
  17. Nozoe M, Kubo H, Yamamoto M et al. Muscle weakness is more strongly associated with functional outcomes in patients with stroke than sarcopenia or muscle wasting: an observational study. Aging Clin Exp Res. 2024;36:4. https://doi.org/10.1007/s40520-023-02672-9
  18. Abe T, Iwata K, Yoshimura Y et al. Low Muscle Mass is Associated with Walking Function in Patients with Acute Ischemic Stroke. J Stroke Cerebrovasc Dis. 2020;29(11):105259. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105259
  19. Abe T, Yoshimura Y, Imai R, Yoneoka Y, Tsubaki A SY. Impact of Phase Angle on Physical Function in Patients with Acute Stroke. J Stroke Cerebrovasc Dis. 2021;30(9):105941. https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.105941
  20. Kyle, U.G.; Bosaeus, I.; De Lorenzo, A.D.; Deurenberg, P.; Elia, M.; Gómez, J.M.; Heitmann, B.L.; Kent-Smith, L.; Melchior JC., Pirlich M. et al. Bioelectrical Impedance Analysis—Part I: Review of Principles and Methods. Clin Nutr. 2004;23:1226–1243. https://doi.org/10.1016/j.clnu.2004.06.004
  21. Abe, T.; Yoshimua, Y.; Imai, R.; Sato Y. A Combined Assessment Method of Phase Angle and Skeletal Muscle Index to Better Predict Functional Recovery after Acute Stroke. J Nutr Heal Aging. 2022;26:445–451. https://doi.org/10.1007/s12603-022-1777-9
  22. Guerrini A, Siotto M, Germanotta M, Schirru M, Pavan A, Cipollini V, et al. Body Cell Mass from Bioelectrical Impedance Analysis in Patients with Stroke Undergoing Rehabilitation. Appl Sci. 2023;13(6). https://doi.org/10.3390/app13063965
  23. M D, AT M. Is bioelectrical impedance accurate for use in large epidemiological studies. Nutr J. 2008;7:26–33. https://doi.org/10.1186/1475-2891-7-26
  24. Keller, K. and Engelhardt M. Strength and muscle mass loss with aging process. Age and strength loss. Muscles Ligaments Tendons J. 2014;3(4):346–50. https://doi.org/10.32098/mltj.04.2013.17
  25. Taufiq, Syam ari fahrial, Lesmana c rinaldi, Suwarto S. Perbedaan Hasil Pemeriksaan Bio Electric Impedance Analysis antara Status Nutrisi Baik dan Malnutrisi pada Penderita Penyakit Gastrointestinal dan Hati yang Dirawat Inap di RSCM Tahun 2013. J Penyakit Dalam Indones. 2014;1(2):108–13. https://doi.org/10.32098/mltj.04.2013.17
  26. Kogan E, Twyman K, Heap J, Milentijevic D, Lin JH, Alberts M. Assessing stroke severity using electronic health record data: a machine learning approach. BMC Med Inf Decis Mak. 2020;(20):8. https://doi.org/10.1186/s12911-019-1010-x
  27. Somerford PJ, Lee AH YK. Ischemic stroke hospital stay and discharge destination. Ann Epidemiol. 2004;14:773–777. https://doi.org/10.1016/j.annepidem.2004.02.003
  28. Walter-Kroker A, Kroker A, Mattiucci-Guehlke M, Glaab T. A practical guide to bioelectrical impedance analysis using the example of chronic obstructive pulmonary disease. Nutr J. 2011;10:35. https://doi.org/10.1186/1475-2891-10-35
  29. Gonzalez MC HS. Bioelectrical imped ance analysis for diagnosing sarcopenia and cachexia: what are we really estimating? J Cachexia Sarcopenia Muscle. 2017;8:187–9. https://doi.org/10.1002/jcsm.12159
  30. Kim SJ, Yu EH, Min JH, Shin YI, Ko HY KS. Segmental bioelectrical impedance analysis of the body composition of affected and unaffected limbs after hemiparetic stroke. Am J Phys Med Rehabil. 2020;99:830–6. https://doi.org/10.1097/PHM.0000000000001434
  31. Korzilius JW, Oppenheimer SE, Roos NM de, Wanten GJA, Zweers H. Having breakfast has no clinically relevant effect on bioelectrical impedance measurements in healthy adults. Nutr J. 2023;22:55. https://doi.org/10.1186/s12937-023-00882-5
  32. Zuo X, Li X, Tang K, Zhao R, Wu M, Wang Y et al. Sarcopenia and cardiovascular diseases: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle. 2023;14(3):1183–98. https://doi.org/10.1002/jcsm.13221
  33. Lee H, Lee IH, Heo J, Baik M, Park H, Lee HS et al. Impact of sarcopenia on functional outcomes among patients with mild acute ischemic stroke and transient ischemic attack: a retrospective study. Front Neurol. 2022;13:841945. https://doi.org/10.3389/fneur.2022.841945
  34. Luo L, Shen X, Fang S, Wan T, Liu P, Li P et al. Sarcopenia as a risk factor of progression-free survival in patients with metastases: a systematic review and meta-analysis. BMC Cancer. 2023;23(1):127. https://doi.org/10.1186/s12885-023-10582-2
  35. Chang KV, Wu WT, Huang KC, Han DS. Segmental body composition transitions in stroke patients: Trunks are different from extremities and strokes are as important as hemiparesis. Clin Nutr. 2020;39(6):1968–73. https://doi.org/10.1016/j.clnu.2019.08.024
  36. Irisawa H, Nakamura T, Chiba Y, Hirota M, Hoshiai H, Mizushima T. Factors influencing changes in body composition and nutritional status in patients with hyperacute stroke: prospective study. Front Nutr. 2025;12. https://doi.org/10.3389/fnut.2025.1548796
  37. Suryadinata RV, Subagio HW, Khairuddin, Darmonoss, Christianto F. Analysis of the Impact of Muscle Mass Changes in Stroke Patients. Pharmacogn J . 2024;16(6):1359–64. https://doi.org/10.5530/pj.2024.16.219
  38. Mir MA, Al-Baradie RS, Alhussainawi MD. Pathophysiology of Strokes. In: Mir MA, editor. Recent Advances in Stroke Therapeutics. Nova Science Publishers, Inc.; 2014. p. 1–54
  39. Stroke Unit Trialists’ Collaboration. Organised inpatient (stroke unit) care for stroke [Internet]. Vol. 9, Cochrane Database of Systematic Reviews. London: John Wiley & Sons, Ltd.; 2013 [cited 2025 Apr 21]. Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000197.pub3/full
  40. Hunnicutt JL GC. Skeletal muscle changes following stroke: a systematic review and com parison to healthy individuals. Top Stroke Rehabil. 2017;24:463–71. https://doi.org/10.1080/10749357.2017.1292720
  41. Jang A, Bae CH, Han SJ, Bae H. Association Between Length of Stay in the Intensive Care Unit and Sarcopenia Among Hemiplegic Stroke Patients. Ann Rehabil Med. 2021;45(1):49–56. https://doi.org/10.5535/arm.20111
  42. Akahoshi T, Yasuda M, Momii K, Kubota K SY, Kaku N et al. Sarcopenia is a predictive factor for pro longed intensive care unit stays in high-energy blunt trauma patients. Acute Med Surg. 2016;3:326–31. https://doi.org/10.1002/ams2.195
  43. Chen LK, Woo J, Assantachai P et al. Asian Working Group for Sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment. J Am Med Dir Assoc. 2020;21(3):300–7. https://doi.org/10.1016/j.jamda.2019.12.012
  44. Ogawa, T.; Suenaga M. Elderly Patients after Stroke Increase Skeletal Muscle Mass by Exercise Therapy in Rehabilitation Wards. J Stroke Cerebrovasc Dis. 2021;30:105958. https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.105958
  45. Honma K, Honda Y, Nagase M, Nakao Y, Sota K, Naoki Sasanuma MI, et al. Pre-stroke patient characteristics that influence skeletal muscle quality: A cross-sectional study. Geriatr Gerontol Int. 2025;25:213–219. https://doi.org/10.1111/ggi.15060
  46. Arsava EM, Gungor L, Sirin H, Sorgun MH, Aykac O, Batur Caglayan HZ, et al. Muscle mass as a modifier of stress response in acute ischemic stroke patients. Sci Rep. 2024;14(1):1–7. https://doi.org/10.1038/s41598-024-60829-6
  47. Kim KY, Jung S, Cho E Bin, Yang TW, Kim SJ, Kim H, et al. The impact of reduced skeletal muscle mass at stroke onset on 3-month functional outcomes in acute ischemic stroke patients. PLoS One [Internet]. 2025;20(1):1–13. Available from: https://doi.org/10.1371/journal.pone.0313368
  48. Azzollini V, Dalise S, Chisari C. How Does Stroke Affect Skeletal Muscle? State of the Art and Rehabilitation Perspective. Front Neurol. 2021;12:797559. https://doi.org/10.3389/fneur.2021.797559
  49. Mas MF, González J, Frontera WR. Stroke and sarcopenia. Curr Phys Med Rehabil Rep. 2020;8(4):452–460. https://doi.org/10.1007/s40141-020-00284-2
  50. Knight RL, H D, Saunders, Mead G. Maximal muscle power after stroke: a systematic review. Clin Pr. 2014;11(2):183–191. https://doi.org/10.2217/cpr.13.97
  51. Hajar N, Tatius B, Basuki R, Fatharani LF, Adhyatma GP, Kurniawan DA, et al. Lingkar Betis Berhubungan dengan Kebugaran Kardiorespirasi Pada Mahasiswa Kedokteran: Sebuah Studi Potong Lintang. In: Prosiding KONGRES XV & HUT KE – 52 PAAI 2023 - 4th LUMMENS: “The Role of Gut-Brain Axis in Indonesian Human Development.” Semarang: Universitas Muhammadiyah Semarang; 2023. p. 1–6
  52. Satya AD, Lusiana NT, Hastuti J. Hubungan Kekuatan Genggam Tangan dengan Massa Otot dan Indeks Massa Tubuh (IMT) pada Usia Dewasa di Daerah Istimewa Yogyakarta. Universitas Gadjah Mada; 2023
  53. Irfan Darfika Lubis DMP. Hubungan antara Kekuatan Genggaman Tangan dengan Indeks Massa Tubuh pada Mahasiswa Fakultas Kedokteran Universitas Muhammadiyah Sumatera Utara. J Kedokt Anat. 2021;4(2). https://doi.org/10.30596/amj.v4i2.6514
  54. Trussardi Fayh AP de SI. Comparison of revised EWGSOP2 criteria of sarcopenia in patients with cancer using different parameters of muscle mass. PLoS One. 2021;16:e0257446. https://doi.org/10.1371/journal.pone.0257446
  55. Grili PP da F, Marim MFR, Comério ACC, Petarli GB, da Cruz GF, Marques-Rocha JL, et al. Calf circumference as a predictor of skeletal muscle mass in postmenopausal women. Clin Nutr Open Sci. 2022;43:20–7. https://doi.org/10.1016/j.nutos.2022.04.002
  56. RW. B. Muscle strength: clinical and prognostic value of hand-grip dynamometry. Curr Opin Clin Nutr Metab Care. 2015;18:465e70. https://doi.org/10.1097/MCO.0000000000000202
  57. Lopes AJ SNR. Hand grip strength in healthy young and older Brazilian adults. Kinesiology. 2017;49:208e16. https://doi.org/10.26582/k.49.2.5
  58. Kawakami R, Miyachi M, Sawada SS, Torii S, Midorikawa T, Tanisawa K et al. Cut-offs for calf circumference as a screening tool for low muscle mass: WASEDA’S Health Study. Geriatr Gerontol Int. 2020;20:943e50. https://doi.org/10.1111/ggi.14025
  59. Kawakami R, Murakami H, Sanada K, Tanaka N, Sawada SS, Tabata I et al. Calf circumference as a surrogate marker of muscle mass for diagnosing sarcopenia in Japanese men and women. Geriatr Gerontol Int. 2014;15:969e76. https://doi.org/10.1111/ggi.12377
  60. Nishioka S, Yamanouchi A, Matsushita T, Nishioka E, Mori N, Taguchi S. Validity of calf circumference for estimating skeletal muscle mass for Asian patients after stroke. Nutrition. 2021;82:111028. https://doi.org/10.1016/j.nut.2020.111028
  61. Stock R, Thrane G, Askim T, Anke A, Mork PJ. Development of Grip Strength During The First Year After Stroke. J Rehabil Med. 2019;51(4). https://doi.org/10.2340/16501977-2530
  62. Rashid K, Mukhtar T, Ali A, Inam R, Naureen S, Waheed H. Impact of Hand Grip Strength on Functional Independence and Arm Motor Performance in Stroke Survivors. J Heal Rehabil Res. 2024;4(1). https://doi.org/10.61919/jhrr.v4i1.498
  63. AA D, A D, JMA K, LF OO, C N, A M, et al. Factors influencing the longer hospital stays for acute stroke patients in a tertiary hospital in Burkina Faso. J Rehabil Res Pr. 2021;2(1):21–8. https://doi.org/10.46439/rehabilitation.2.011
  64. Dikbaş ŞK, Aslan IK. Factors Affecting Length of Stay in a Stroke Unit After Intravenous Thrombolytic Therapy: A Retrospective Study. Bosphorus Med J. 2024;11(1):15–22. https://doi.org/10.14744/bmj.2024.37450
  65. Nirmalasari N, Nofiyanto M, Hidayati RW. Lama Hari Rawat Pasien Stroke. J Terpadu Ilmu Kesehat. 2020;9(2):117–268. https://doi.org/10.37341/interest.v9i2.196
  66. Arboix A, Massons J, García-Eroles L, Targa C OM, E. C. Clinical predictors of prolonged hospital stay after acute stroke: Relevance of medical complications. Int J Clin Med. 2012;3(6):24547. https://doi.org/10.4236/ijcm.2012.36090
  67. P. A. Prediction of length of stay for stroke patients. Acta Neurol Scand. 2007;116:15–9. https://doi.org/10.1111/j.1600-0404.2006.00756.x
  68. Shang J, Zhang Z, Ma S, Peng H, Hou L, Yang F, et al. A Nomogram Incorporating Intracranial Atherosclerosis Score for Predicting Early Neurological Deterioration in Minor Stroke Patients With Type 2 Diabetes Mellitus. Diabetes, Metab Syndr Obes . 2025;18(February):491–506. https://doi.org/10.2147/DMSO.S494980
  69. Setiati FA and S. Correlation between hand grip strength and nutritional status in elderly patients. In: IOP Publishing, editor. The 2nd Physics and Technologies in Medicine and Dentistry Symposium. Jakarta: IOP Conf. Series: Journal of Physics: Conf. Series 1073; 2018. p. 1–9. https://doi.org/10.1088/1742-6596/1073/4/042032
  70. Jacobs A Van, Coltman A, Gomez-Perez SL, Bienia B, Bienia JSS, Peterson SJ. The Prevalence of Low CT-Measured Skeletal Muscle Index and Handgrip Strength in a General Medical Population. Nutr Clin Pract. 2022;37:102–9. https://doi.org/10.1002/ncp.10660
  71. Li H, Zheng Y, Zhang Y, Zhang X LW, Y ZW and Z. Handgrip strength and body mass index exhibit good predictive value for sarcopenia in patients on peritoneal dialysis. Front Nutr. 2024;11:1470669. https://doi.org/10.3389/fnut.2024.1470669
  72. Siregar FPB, Irawati L, MYH E, Fasrini UU, Abdiana A, Wahid I. Relationship Between Body Mass Index and Handgrip Strength in Elderly at PSTW Sabai Nan Aluih. J Biomedika dan Kesehat. 2024;7(3):312–21. https://doi.org/10.18051/JBiomedKes.2024.v7.312-321

Last update:

No citation recorded.

Last update: 2026-02-28 10:32:32

No citation recorded.