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. 1998 Jul;74(873):395–399. doi: 10.1136/pgmj.74.873.395

Assessment and treatment of nutritional status in stroke patients.

S E Gariballa 1, A J Sinclair 1
PMCID: PMC2360970  PMID: 9799909

Abstract

Stroke illness imposes a heavy and costly work load on hospital and community care services, and life after stroke can be a miserable affair for stroke patients and their carers. Nutritional factors may have an important role in acute stroke and its outcome. From the limited amount of research undertaken it has been shown that a significant number of patients with stroke are undernourished on admission and their nutritional status deteriorates further as an in-patient. This is especially so for those who are most dependent, in whom undernutrition is also associated with increasing morbidity and mortality. There is some evidence that nutritional supplementation may improve nutritional status and reduce morbidity and mortality. However most clinically available nutrition screening instruments lack sensitivity and specificity, and abnormal nutritional indicators may simply reflect effects of age, functional disability, or severe underlying disease. Therefore, causal relationship cannot be assumed without a sufficiently powerful intervention study which adequately adjusts for the effects of non-nutritional factors, such as the number and severity of comorbid conditions on clinical outcome. Meanwhile, doctors, nurses and members of the multidisciplinary team looking after stroke patients should be made aware of the likely impact of poor nutritional status on clinical outcome.

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Selected References

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  1. Allison M. C., Morris A. J., Park R. H., Mills P. R. Percutaneous endoscopic gastrostomy tube feeding may improve outcome of late rehabilitation following stroke. J R Soc Med. 1992 Mar;85(3):147–149. [PMC free article] [PubMed] [Google Scholar]
  2. Aptaker R. L., Roth E. J., Reichhardt G., Duerden M. E., Levy C. E. Serum albumin level as a predictor of geriatric stroke rehabilitation outcome. Arch Phys Med Rehabil. 1994 Jan;75(1):80–84. [PubMed] [Google Scholar]
  3. Axelsson K., Asplund K., Norberg A., Alafuzoff I. Nutritional status in patients with acute stroke. Acta Med Scand. 1988;224(3):217–224. doi: 10.1111/j.0954-6820.1988.tb19364.x. [DOI] [PubMed] [Google Scholar]
  4. Axelsson K., Asplund K., Norberg A., Eriksson S. Eating problems and nutritional status during hospital stay of patients with severe stroke. J Am Diet Assoc. 1989 Aug;89(8):1092–1096. [PubMed] [Google Scholar]
  5. Axelsson K., Norberg A., Asplund K. Eating after a stroke--towards an integrated view. Int J Nurs Stud. 1984;21(2):93–99. doi: 10.1016/0020-7489(84)90050-6. [DOI] [PubMed] [Google Scholar]
  6. Bastow M. D., Rawlings J., Allison S. P. Benefits of supplementary tube feeding after fractured neck of femur: a randomised controlled trial. Br Med J (Clin Res Ed) 1983 Nov 26;287(6405):1589–1592. [PMC free article] [PubMed] [Google Scholar]
  7. Buzby G. P., Mullen J. L., Matthews D. C., Hobbs C. L., Rosato E. F. Prognostic nutritional index in gastrointestinal surgery. Am J Surg. 1980 Jan;139(1):160–167. doi: 10.1016/0002-9610(80)90246-9. [DOI] [PubMed] [Google Scholar]
  8. Delmi M., Rapin C. H., Bengoa J. M., Delmas P. D., Vasey H., Bonjour J. P. Dietary supplementation in elderly patients with fractured neck of the femur. Lancet. 1990 Apr 28;335(8696):1013–1016. doi: 10.1016/0140-6736(90)91073-j. [DOI] [PubMed] [Google Scholar]
  9. Dávalos A., Ricart W., Gonzalez-Huix F., Soler S., Marrugat J., Molins A., Suñer R., Genís D. Effect of malnutrition after acute stroke on clinical outcome. Stroke. 1996 Jun;27(6):1028–1032. doi: 10.1161/01.str.27.6.1028. [DOI] [PubMed] [Google Scholar]
  10. Evans E., Stock A. L. Dietary intakes of geriatirc patients in hospital. Nutr Metab. 1971;13(1):21–35. doi: 10.1159/000175315. [DOI] [PubMed] [Google Scholar]
  11. Gordon C., Hewer R. L., Wade D. T. Dysphagia in acute stroke. Br Med J (Clin Res Ed) 1987 Aug 15;295(6595):411–414. doi: 10.1136/bmj.295.6595.411. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Klidjian A. M., Archer T. J., Foster K. J., Karran S. J. Detection of dangerous malnutrition. JPEN J Parenter Enteral Nutr. 1982 Mar-Apr;6(2):119–121. doi: 10.1177/0148607182006002119. [DOI] [PubMed] [Google Scholar]
  13. Larsson J., Unosson M., Ek A. C., Nilsson L., Thorslund S., Bjurulf P. Effect of dietary supplement on nutritional status and clinical outcome in 501 geriatric patients--a randomised study. Clin Nutr. 1990 Aug;9(4):179–184. doi: 10.1016/0261-5614(90)90017-m. [DOI] [PubMed] [Google Scholar]
  14. Mitchell C. O., Lipschitz D. A. Detection of protein-calorie malnutrition in the elderly. Am J Clin Nutr. 1982 Feb;35(2):398–406. doi: 10.1093/ajcn/35.2.398. [DOI] [PubMed] [Google Scholar]
  15. Norton B., Homer-Ward M., Donnelly M. T., Long R. G., Holmes G. K. A randomised prospective comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding after acute dysphagic stroke. BMJ. 1996 Jan 6;312(7022):13–16. doi: 10.1136/bmj.312.7022.13. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Nyswonger G. D., Helmchen R. H. Early enteral nutrition and length of stay in stroke patients. J Neurosci Nurs. 1992 Aug;24(4):220–223. doi: 10.1097/01376517-199208000-00009. [DOI] [PubMed] [Google Scholar]
  17. Souba W. W. Nutritional support. N Engl J Med. 1997 Jan 2;336(1):41–48. doi: 10.1056/NEJM199701023360107. [DOI] [PubMed] [Google Scholar]
  18. Sullivan D. H., Walls R. C. Impact of nutritional status on morbidity in a population of geriatric rehabilitation patients. J Am Geriatr Soc. 1994 May;42(5):471–477. doi: 10.1111/j.1532-5415.1994.tb04966.x. [DOI] [PubMed] [Google Scholar]
  19. Unosson M., Ek A. C., Bjurulf P., von Schenck H., Larsson J. Feeding dependence and nutritional status after acute stroke. Stroke. 1994 Feb;25(2):366–371. doi: 10.1161/01.str.25.2.366. [DOI] [PubMed] [Google Scholar]
  20. Wade D. T. Stroke: rehabilitation and long-term care. Lancet. 1992 Mar 28;339(8796):791–793. doi: 10.1016/0140-6736(92)91906-o. [DOI] [PubMed] [Google Scholar]
  21. Wanklyn P., Cox N., Belfield P. Outcome in patients who require a gastrostomy after stroke. Age Ageing. 1995 Nov;24(6):510–514. doi: 10.1093/ageing/24.6.510. [DOI] [PubMed] [Google Scholar]
  22. Young B., Ott L., Twyman D., Norton J., Rapp R., Tibbs P., Haack D., Brivins B., Dempsey R. The effect of nutritional support on outcome from severe head injury. J Neurosurg. 1987 Nov;67(5):668–676. doi: 10.3171/jns.1987.67.5.0668. [DOI] [PubMed] [Google Scholar]

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