The relationship between nutritional status at the time of stroke on adverse outcomes: a systematic review and meta-analysis of prospective cohort studies

Abstract

Context and Objective:The impact of existing malnutrition on stroke outcomes is poorly recognised and treated. Evidence was systematically reviewed and quantified by meta-analysis. Methods: MEDLINE, EMBASE and Web of Science were searched from inception to 11 January 2021 and updated in July. Prospective cohort studies, in English, evaluating anthropometric and biomarkers of nutrition on stroke outcomes were included. Risk of bias was assessed using the Scottish Intercollegiate Guidelines Network checklist. Results: Twenty-six studies (n ¼ 156 249) were eligible (follow-up: One month-14 years). Underweight patients had increased risk of long-term mortality (adjusted hazard ratio ¼ 1.65,1.41-1.95), whilst overweight (0.80,0.74-0.86) and obese patients (0.80,0.75-0.85) had decreased risk compared to normal weight. Odds of mortality decreased in those with high serum albumin (odds ratio ¼ 0.29,0.18-0.48) and increased with low serum albumin (odds ratio ¼ 3.46,1.78-6.74) compared to normal serum albumin (30-35 g/ L). Being malnourished compared to well-nourished, as assessed by the Subjective Global Assessment (SGA) or by a combination of anthropometric and biochemical markers increased all-cause mortality (odds ratio ¼ 2.38,1.85-3.06) and poor functional status (adjusted odds ratio ¼ 2.21,1.40-3.49). Conclusion: Nutritional status at the time of stroke predicts adverse stroke outcomes.

Evident lower blood levels of multiple nutritional compounds and highly prevalent malnutrition in sub-acute stroke patients with or without dysphagia

“…The importance of nutritional management after stroke is well recognized by most relevant guidelines, which generally recommend early screening for dysphagia and malnutrition and the consideration of oral nutritional supplements for patients who are malnourished or at risk of malnourishment ( 50 – 55 ). These recommendations are supported by a recent meta-analysis concluding that impaired nutritional status on admission is associated with poor functional recovery and increased mortality ( 56 ). The lower levels of many nutritional compounds as found in current study may result in suboptimal substrate availability for numerous structural and functional recovery processes after stroke.…”

Clinical application of HALP score to predict early neurological deterioration in elderly acute cerebral infarction patients

“…Another important component of the HALP score, hemoglobin and albumin, is also strongly associated with stroke prognosis. Patients with anemia or hypoalbuminemia have a higher risk of stroke, cardiovascular disease and mortality [31,32] . Curtelin et al [33] reported that in low hemoglobin or further declined hemoglobin leads to worsening neurological function in AIS, speci cally probably because of lower hemoglobin levels with altered cerebral hemodynamics leading to worsen of ischemia and hypoxia.…”

Effect of abnormal body weight on mortality and functional recovery in adults after stroke: An umbrella review

“…Search terms across the included reviews were broadly similar with "body mass index" and "stroke" being widely used. Six of the included reviews reported on post-stroke mortality 2,[4][5][6]11,12 and five reported on post-stroke functional recovery. [2][3][4][5]12 All included reviews reported findings according to PRISMA guidelines.…”

“…[2][3][4] This phenomenon counterintuitively indicates that stroke survivors who are overweight have better mortality and functional outcomes following a stroke, compared to normal weight. [2][3][4][5] Although much of the literature has focused on the effects of being overweight on post-stroke outcomes, it is notable that people who are underweight (BMI < 18.5 kg/m 2 ) appear to be worse off compared to people of normal weight, with an increased risk of mortality 2,[4][5][6] and reduced functional capacity [2][3][4][5] after a stroke.…”

“…Several systematic reviews on this topic have reached conflicting conclusions. [2][3][4][5][6]11,12 Among these systematic reviews, heterogeneity among included studies, such as variable use of BMI cut-off points and differences in outcome measures, as well as reporting and methodological differences have likely contributed to contradictory findings. Inconsistent results from these systematic reviews are worthy of further investigation.…”