Undernourished Stroke Patients May Have More Complications, Worse Outcomes

Patients who are undernourished when they enter the hospital with an acute ischemic stroke—the most common type of stroke, in which blood flow to the brain is blocked—are likely to remain undernourished in the hospital and may have worse clinical outcomes, according to a report in the January issue of Archives of Neurology, one of the JAMA/Archives journals.1

“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,” the authors write as background information in the article. “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., and colleagues at the University of Ulsan College of Medicine, Seoul, Korea, studied 131 acute ischemic stroke patients who underwent assessments of their nutritional status within 24 hours of hospital admission and again one week after their symptoms began. Complications were assessed immediately after admission to the hospital and continuously until patients left the hospital or transferred to a rehabilitation unit. Clinical outcomes were measured three months later.

Of the patients, 16 (12.2 percent) were insufficiently nourished when they were admitted to the hospital and 26 (19.8 percent) were undernourished after one week. Undernutrition at hospital admission was associated with undernutrition one week later and complications following the stroke, while undernutrition at one week predicted poor outcomes after three months.

“These results suggest that patients undernourished at admission do not recover well with general hospital diets and are more likely to have poststroke complications and that undernourished patients during hospitalization are more likely to develop poor functional outcomes,” the authors write.

“Strategic nutritional support, particularly in patients with baseline undernutrition, may improve clinical outcomes after acute ischemic stroke,” they conclude.

“The undernourished state may represent another modifiable physiological risk factor, like hyperglycemia and fever, that when actively treated leads to improved outcomes,” write Neeraj Badjatia, M.D., and Mitchell S. V. Elkind, M.D., M.S., of the Columbia University Medical Center, New York, in an accompanying editorial.2

“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.”

1. Arch Neurol. 2008; 65[1]:39-43. 

2. Arch Neurol. 2008; 65[1]:15-16.