A patient who arrives in hospital with an acute ischemic stroke, and is undernourished, is more likely to remain undernourished during his/her hospital stay and have worse clinical outcomes, compared to an acute ischemic stroke patient who is not undernourished, according to an article in Archives of Neurology (JAMA/Archives), January issue.
The researchers explain “Although undernutrition [a deficiency in overall calories or one or more nutrients] is common in medical, geriatric and stroke patients, its treatment has received little attention. Because undernutrition may influence clinical outcomes, it is important to assess nutritional status and treat undernutrition particularly during acute stage of stroke.”
Sung-Hee Yoo, R.N., M.S., University of Ulsan College of Medicine, Seoul, South Korea, and team looked at 131 acute ischemic stroke patients who had had their nutritional status assessed within 24 hours of being hospitalized, and then again seven days later. They assessed patients’ complications immediately following admission to hospital, and did so continuously until they were discharged from hospital or moved to a rehabilitation unit. Three months later their clinical outcomes were measured.
They found that 12.2% (16 in total) of the patients were undernourished when hospitalized, while 19.8% (26 in total) were undernourished seven days later. There was a significant link between undernutrition at the moment of hospitalization and continued undernutrition one week later and complications following the stroke. Undernutrition one week after being admitted to hospital was linked to poorer outcomes three months later.
The researchers write “These results suggest that patients undernourished at admission do not recover well with general hospital diets and are more likely to have post-stroke complications and that undernourished patients during hospitalization are more likely to develop poor functional outcomes.”
They concluded that strategic nutritional support, particularly in patients with baseline undernutrition, may improve clinical outcomes after acute ischemic stroke.
Accompanying Editorial
Neeraj Badjatia, M.D., and Mitchell S. V. Elkind, M.D., M.S., Columbia University Medical Center, New York, wrote in an accompanying editorial “The undernourished state may represent another modifiable physiological risk factor, like hyperglycemia and fever, that when actively treated leads to improved outcomes. This article is the latest in a series of studies representing current thinking about the potential value of nutritional support for stroke patients in the acute care setting,” they continue. “Providing adequate caloric intake early in the course after ischemic stroke may now be seen as a therapeutic intervention used to minimize disease severity, reduce complications and favorably affect patient outcomes. In the end, factors related to overall amount, content, route and timing may determine whether nutritional support improves outcomes or is ineffective.”
“Undernutrition as a Predictor of Poor Clinical Outcomes in Acute Ischemic Stroke Patients”
Sung-Hee Yoo, RN, MS; Jong S. Kim, MD, PhD; Sun U. Kwon, MD, PhD; Sung-Cheol Yun, PhD; Jae-Young Koh, MD, PhD; Dong-Wha Kang, MD, PhD
Arch Neurol. 2008;65(1):39-43.
Editorial
“Nutritional Support After Ischemic Stroke – More Food for Thought”
Neeraj Badjatia, M.D., Mitchell S. V. Elkind, M.D., M.S.,
Arch Neurol. 2008;65(1):15-16.
Written by – Christian Nordqvist