Negative Impact of Comorbidity on Health-Related Quality of Life Among Patients With Stroke as Modified by Good Diet Quality

Thu T M Pham; Manh-Tan Vu; Thuc C Luong; Khue M Pham; Lien T K Nguyen; Minh H Nguyen; Binh N Do; Hoang C Nguyen; Tuan V Tran; Thao T P Nguyen; Hoang P Le; Cuong Q Tran; Kien T Nguyen; Shwu-Huey Yang; Chaur-Jong Hu; Chyi-Huey Bai; Tuyen Van Duong

doi:10.3389/fmed.2022.836027

Negative Impact of Comorbidity on Health-Related Quality of Life Among Patients With Stroke as Modified by Good Diet Quality

Front Med (Lausanne). 2022 May 6:9:836027. doi: 10.3389/fmed.2022.836027. eCollection 2022.

Authors

Thu T M Pham^{1

2}, Manh-Tan Vu^{3

4}, Thuc C Luong^{5

6}, Khue M Pham^{2

7}, Lien T K Nguyen^{8

9

10}, Minh H Nguyen¹¹, Binh N Do^{12

13}, Hoang C Nguyen^{14

15}, Tuan V Tran^{16

17}, Thao T P Nguyen¹⁸, Hoang P Le¹⁹, Cuong Q Tran^{20

21}, Kien T Nguyen²², Shwu-Huey Yang^{23

24

25}, Chaur-Jong Hu^{26

27}, Chyi-Huey Bai^{1

11

28}, Tuyen Van Duong²³

Affiliations

¹ School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan.
² Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam.
³ Department of Internal Medicine, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam.
⁴ Cardiovascular Department, Viet Tiep Friendship Hospital, Hai Phong, Vietnam.
⁵ Director Office, Military Hospital 103, Hanoi, Vietnam.
⁶ Cardiovascular Center, Department of Cardiology, Military Hospital 103, Hanoi, Vietnam.
⁷ President Office, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam.
⁸ Rehabilitation Department, Hanoi Medical University, Hanoi, Vietnam.
⁹ Rehabilitation Center, Bach Mai Hospital, Hanoi, Vietnam.
¹⁰ Rehabilitation Department, Viet Duc University Hospital, Hanoi, Vietnam.
¹¹ International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
¹² Department of Infectious Diseases, Vietnam Military Medical University, Hanoi, Vietnam.
¹³ Division of Military Science, Military Hospital 103, Hanoi, Vietnam.
¹⁴ Director Office, Thai Nguyen National Hospital, Thái Nguyên, Vietnam.
¹⁵ President Office, Thai Nguyen University of Medicine and Pharmacy, Thái Nguyên, Vietnam.
¹⁶ Department of Neurology, Thai Nguyen University of Medicine and Pharmacy, Thái Nguyên, Vietnam.
¹⁷ Department of Clinical Pharmacy, Thai Nguyen University of Medicine and Pharmacy, Thái Nguyên, Vietnam.
¹⁸ Health Personnel Training Institute, University of Medicine and Pharmacy, Hue University, Hue, Vietnam.
¹⁹ Department of Internal Medicine, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam.
²⁰ Director Office, Thu Duc City Health Center, Ho Chi Minh City, Vietnam.
²¹ Faculty of Health Sciences, Mekong University, Vl̃nh Long, Vietnam.
²² Department of Health Promotion, Faculty of Social and Behavioral Sciences, Hanoi University of Public Health, Hanoi, Vietnam.
²³ School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan.
²⁴ Nutrition Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
²⁵ Research Center of Geriatric Nutrition, Taipei Medical University, Taipei, Taiwan.
²⁶ Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
²⁷ Department of Neurology, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan.
²⁸ Department of Public Health, College of Medicine, Taipei Medical University, Taipei, Taiwan.

Abstract

Background: Comorbidity, along with aging, affects stroke-induced health-related quality of life (HRQoL). We examined the potential role of diet quality in modifying the association between comorbidity and HRQoL in patients with stroke.

Methods: A cross-sectional study was conducted on 951 patients with stroke from December 2019 to December 2020 across Vietnam. Comorbidity was assessed using the Charlson Comorbidity Index (CCI) items and classified into two groups (none vs. one or more). Diet quality was evaluated using the Dietary Approaches to Stop Hypertension Quality (DASH-Q) questionnaire, and HRQoL was measured using the RAND-36, with a higher score indicating better diet quality or HRQoL, respectively. Besides, socio-demographics, health-related behaviors (e.g., physical activity, smoking, and drinking), disability (using WHODAS 2.0), and health literacy were also assessed. Linear regression analysis was utilized to explore the associations and interactions.

Results: The proportion of patients with stroke aged ≥65 years and having comorbidity were 53.7 and 49.9%, respectively. The HRQoL scores were 44.4 ± 17.4. The diet quality was associated with higher HRQoL score (regression coefficient, B, 0.14; (95% confidence interval, 95% CI, 0.04, 0.23; p = 0.004), whereas comorbidity was associated with lower HRQoL score (B, -7.36; 95% CI, -9.50, -5.23; p < 0.001). In interaction analysis, compared to patients without comorbidity and having the lowest DASH-Q score, those with comorbidity and higher DASH-Q score had a higher HRQoL score (B, 0.21; 95% CI, 0.03, 0.39; p = 0.021).

Conclusion: The findings showed that good diet quality could modify the adverse impact of comorbidity on HRQoL in patients with stroke. Diet quality should be considered as a strategic intervention to improve the HRQoL of patients with stroke, especially those with comorbidity, and to promote healthier aging.

Keywords: aging; comorbidity; diet; health-related quality of life; modification; stroke.