Feeding dependence and nutritional status after acute stroke.

Unosson, Mitra; Ek, Anna‐Christina; Bjurulf, Per; Schenck, H von; Larsson, Jörgen

doi:10.1161/01.str.25.2.366

Cited by 103 publications

(87 citation statements)

References 26 publications

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“…A decline in body fat in both the dependent and independent groups nine weeks after admission was found, indicating consumption of energy stores. In contrast, the change of body cell mass between admission and after 9 weeks was significantly greater in the dependent patients compared with the independent (Unosson et al, 1994). Immobilized individuals lose muscle mass irrespective of nutritional intake because of reduced synthesis of proteins, while the rate of breakdown of proteins is unchanged (Schonheyder et al, 1954).…”

Section: Strokementioning

confidence: 79%

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Body Composition in Disabilities of Central Nervous System

Dionyssiotis¹

2012

Dual Energy X-Ray Absorptiometry

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Section: Strokementioning

confidence: 79%

“…During the recovery period the stroke patients seemed to break down body fat to compensate for energy needs, independent of their functional condition. However, change of body cell mass appeared to relate to the patients' functional condition after stroke (Unosson et al, 1994).…”

Section: Strokementioning

confidence: 94%

Body Composition in Disabilities of Central Nervous System

Dionyssiotis¹

2012

Dual Energy X-Ray Absorptiometry

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“…[1][2][3][4][5][6][7] To compound the problem, up to half of stroke patients in hospital have dysphagia, which precludes safe oral nutrition for the first few days and can persist for long periods. [8][9][10] Surveys of feeding practice after stroke have recorded much variation between hospitals in the UK, especially in the timing of the start of enteral tube feeding and whether a nasogastric or percutaneous endoscopic gastrostomy (PEG) tube is used.…”

Section: Introductionmentioning

confidence: 99%

“…If the timing or route of enteral tube feeding does affect outcome, the present variation in practice means that large numbers of patients are being denied best treatment. In the FOOD trials, which included two pragmatic randomised trials of dysphagic patients, we aimed to answer two main questions: (1) does early initiation of enteral tube feeding improve outcomes (early versus avoid trial); and (2) does enteral tube feeding via PEG rather than nastrogastric tube improve outcomes (PEG versus nasogastric trial)?…”

Section: Introductionmentioning

confidence: 99%

Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): a multicentre randomised controlled trial

2005

The Lancet

333

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SummaryBackground Undernutrition is common in patients admitted with stroke. We aimed to establish whether the timing and route of enteral tube feeding after stroke affected patients' outcomes at 6 months. MethodsThe FOOD trials consist of three pragmatic multicentre randomised controlled trials, two of which included dysphagic stroke patients. In one trial, patients enrolled within 7 days of admission were randomly allocated to early enteral tube feeding or no tube feeding for more than 7 days (early versus avoid). In the other, patients were allocated percutaneous endoscopic gastrostomy (PEG) or nasogastric feeding. The primary outcome was death or poor outcome at 6 months. Analysis was by intention to treat.Findings Between Nov 1, 1996, and July 31, 2003, 859 patients were enrolled by 83 hospitals in 15 countries into the early versus avoid trial. Early tube feeding was associated with an absolute reduction in risk of death of 5·8% (95% CI -0·8 to 12·5, p=0·09) and a reduction in death or poor outcome of 1·2% (-4·2 to 6·6, p=0·7). In the PEG versus nasogastric tube trial, 321 patients were enrolled by 47 hospitals in 11 countries. PEG feeding was associated with an absolute increase in risk of death of 1·0% (-10·0 to 11·9, p=0·9) and an increased risk of death or poor outcome of 7·8% (0·0 to 15·5, p=0·05).Interpretation Early tube feeding might reduce case fatality, but at the expense of increasing the proportion surviving with poor outcome. Our data do not support a policy of early initiation of PEG feeding in dysphagic stroke patients.

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“…[1][2][3][4][5] Given that many factors could have influenced the precision of the estimates such as differences in patient characteristics and method and timing of nutritional assessment, it is impossible to know which estimate(s) most closely approximate the truth. Establishing a patient's true nutritional state can be a daunting task because there is not a universally accepted definition of malnutrition or a gold standard for nutritional assessment.…”

mentioning

confidence: 99%

Which Reported Estimate of the Prevalence of Malnutrition After Stroke Is Valid?

Foley

Salter²,

Robertson³

et al. 2009

Stroke

167

101

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Background and Purpose-The reported prevalence of malnutrition after stroke varies widely, whereas it remains unclear which of the estimates is most accurate. The aim of this review was to explore possible sources of this heterogeneity among studies and to evaluate whether the nutritional assessment techniques used were valid. Methods-A literature search was conducted to identify all studies in which the nutritional state of patients was assessed after inpatient admission for stroke. The percentages of patients identified as malnourished in each study and method of nutritional assessment are reported. For the purposes of this study, an assessment technique was considered valid if at least one form of validity had been demonstrated previously through psychometric evaluation. Results-Eighteen studies meeting inclusion criteria were identified. The reported frequency of malnutrition ranged from 6.1% to 62%. Seventeen different methods of nutritional assessment were used. Four trials used previously validated assessment methods: Subjective Global Assessment, "an informal assessment," and Mini Nutritional Assessment. The nutritional assessment methods used in the remaining studies used had not been validated previously. Conclusions-The

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Feeding dependence and nutritional status after acute stroke.

Cited by 103 publications

References 26 publications

Body Composition in Disabilities of Central Nervous System

Body Composition in Disabilities of Central Nervous System

Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): a multicentre randomised controlled trial

Which Reported Estimate of the Prevalence of Malnutrition After Stroke Is Valid?

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