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Article

Physical Activity and Diet Quality Modify the Association between Comorbidity and Disability among Stroke Patients

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Rehabilitation Department, Hanoi Medical University, Hanoi 115-20, Vietnam
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Rehabilitation Center, Bach Mai Hospital, Hanoi 115-19, Vietnam
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Rehabilitation Department, Viet Duc University Hospital, Hanoi 110-17, Vietnam
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Department of Infectious Diseases, Vietnam Military Medical University, Hanoi 121-08, Vietnam
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Division of Military Science, Military Hospital 103, Hanoi 121-08, Vietnam
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Director Office, Military Hospital 103, Hanoi 121-08, Vietnam
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Department of Trauma and Orthopedic Surgery, Vietnam Military Medical University, Hanoi 121-08, Vietnam
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Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong 042-12, Vietnam
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President Office, Hai Phong University of Medicine and Pharmacy, Hai Phong 042-12, Vietnam
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Department of Internal Medicine, Haiphong University of Medicine and Pharmacy, Hai Phong 042-12, Vietnam
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Cardiovascular Department, Viet Tiep Friendship Hospital, Hai Phong 047-08, Vietnam
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Director Office, Thai Nguyen National Hospital, Thai Nguyen City 241-24, Vietnam
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President Office, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen City 241-17, Vietnam
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Department of Neurology, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen City 241-17, Vietnam
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Department of Clinical Pharmacy, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen City 241-17, Vietnam
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Department of Internal Medicine, University of Medicine and Pharmacy, Hue University, Thua Thien Hue 491-20, Vietnam
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Health Management Training Institute, University of Medicine and Pharmacy, Hue University, Thua Thien Hue 491-20, Vietnam
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Department of Health Economics, Corvinus University of Budapest, 1093 Budapest, Hungary
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Director Office, Thu Duc City Hospital, Ho Chi Minh City 713-11, Vietnam
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Director Office, Thu Duc City Health Center, Ho Chi Minh City 713-10, Vietnam
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Faculty of Health, Mekong University, Vinh Long 852-16, Vietnam
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Department of Health Promotion, Faculty of Social and Behavioral Sciences, Hanoi University of Public Health, Hanoi 119-10, Vietnam
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School of Nutrition and Health Sciences, Taipei Medical University, Taipei 110-31, Taiwan
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Nutrition Research Center, Taipei Medical University Hospital, Taipei 110-31, Taiwan
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Research Center of Geriatric Nutrition, Taipei Medical University, Taipei 110-31, Taiwan
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Master Program in Global Health and Development, College of Public Health, Taipei Medical University, Taipei 110-31, Taiwan
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Author to whom correspondence should be addressed.
Academic Editor: Yoshihiro Yoshimura
Nutrients 2021, 13(5), 1641; https://doi.org/10.3390/nu13051641
Received: 15 April 2021 / Revised: 11 May 2021 / Accepted: 12 May 2021 / Published: 13 May 2021
(This article belongs to the Special Issue Recent Advances in Clinical Nutrition in Stroke Rehabilitation)
Background: Comorbidity is common and causes poor stroke outcomes. We aimed to examine the modifying impacts of physical activity (PA) and diet quality on the association between comorbidity and disability in stroke patients. Methods: A cross-sectional study was conducted on 951 stable stroke patients in Vietnam from December 2019 to December 2020. The survey questionnaires were administered to assess patients’ characteristics, clinical parameters (e.g., Charlson Comorbidity Index items), health-related behaviors (e.g., PA using the International Physical Activity Questionnaire- short version), health literacy, diet quality (using the Dietary Approaches to Stop Hypertension Quality (DASH-Q) questionnaire), and disability (using the World Health Organization Disability Assessment Schedule II (WHODAS II)). Linear regression models were used to analyze the associations and interactions. Results: The proportion of comorbidity was 49.9% (475/951). The scores of DASH-Q and WHODAS II were 29.2 ± 11.8, 32.3 ± 13.5, respectively. Patients with comorbidity had a higher score of disability (regression coefficient, B, 8.24; 95% confidence interval, 95%CI, 6.66, 9.83; p < 0.001) as compared with those without comorbidity. Patients with comorbidity and higher tertiles of PA (B, −4.65 to −5.48; p < 0.05), and a higher DASH-Q score (B, −0.32; p < 0.001) had a lower disability score, as compared with those without comorbidity and the lowest tertile of PA, and the lowest score of DASH-Q, respectively. Conclusions: Physical activity and diet quality significantly modified the negative impact of comorbidity on disability in stroke patients. Strategic approaches are required to promote physical activity and healthy diet which further improve stroke rehabilitation outcomes. View Full-Text
Keywords: stroke patient; Charlson Comorbidity Index; World Health Organization Disability Assessment Schedule II; international physical activity questionnaire; Dietary Approaches to Stop Hypertension Quality; health literacy; International Classification of Diseases; health-related behaviors; Vietnam stroke patient; Charlson Comorbidity Index; World Health Organization Disability Assessment Schedule II; international physical activity questionnaire; Dietary Approaches to Stop Hypertension Quality; health literacy; International Classification of Diseases; health-related behaviors; Vietnam
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MDPI and ACS Style

Nguyen, L.T.K.; Do, B.N.; Vu, D.N.; Pham, K.M.; Vu, M.-T.; Nguyen, H.C.; Tran, T.V.; Le, H.P.; Nguyen, T.T.P.; Nguyen, Q.M.; Tran, C.Q.; Nguyen, K.T.; Yang, S.-H.; Chao, J.C.-J.; Van Duong, T. Physical Activity and Diet Quality Modify the Association between Comorbidity and Disability among Stroke Patients. Nutrients 2021, 13, 1641. https://doi.org/10.3390/nu13051641

AMA Style

Nguyen LTK, Do BN, Vu DN, Pham KM, Vu M-T, Nguyen HC, Tran TV, Le HP, Nguyen TTP, Nguyen QM, Tran CQ, Nguyen KT, Yang S-H, Chao JC-J, Van Duong T. Physical Activity and Diet Quality Modify the Association between Comorbidity and Disability among Stroke Patients. Nutrients. 2021; 13(5):1641. https://doi.org/10.3390/nu13051641

Chicago/Turabian Style

Nguyen, Lien T.K., Binh N. Do, Dinh N. Vu, Khue M. Pham, Manh-Tan Vu, Hoang C. Nguyen, Tuan V. Tran, Hoang P. Le, Thao T.P. Nguyen, Quan M. Nguyen, Cuong Q. Tran, Kien T. Nguyen, Shwu-Huey Yang, Jane C.-J. Chao, and Tuyen Van Duong. 2021. "Physical Activity and Diet Quality Modify the Association between Comorbidity and Disability among Stroke Patients" Nutrients 13, no. 5: 1641. https://doi.org/10.3390/nu13051641

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