Study Impact of Nutritional Supplementary Treatment of Undernourished Stroke Patient on Functional Outcome Measures
Condition: Stroke
MeSH terms: Stroke; Malnutrition
Study type: Interventional

Summary: 
      Undernutrition after stroke is frequent and is due to cognitive impairment, visuospatial
      perceptive deficits, hemiparesis, depression and dysphagia. The impact of intensive
      nutritional supplementation on functional outcome measures in undernourished stroke patient
      has not been studied.
    

Detailed description: 
      The World Health Organization defines malnutrition as "the cellular imbalance between supply
      of nutrients and energy and the body's demand for them to ensure growth, maintenance, and
      specific functions". The prevalence of malnutrition in acute stroke patients varies from 8%-
      34%. It has been showed that after an acute stroke malnutrition was present in 16.3% patients
      on hospital admission, which increased to 26.4% after one week and 35% after two weeks of
      hospitalization. They also showed that 41% of malnourished stroke patients had poor outcome,
      based on the presence of urinary or respiratory infection, pressure sores, increased
      mortality rates, greater neurological deficit and longer length of stay, compared to 14% of
      malnourished patients who had a better outcome3. Prevalence studies of malnutrition in stroke
      patients admitted to an acute rehabilitation hospital has varied from 49% to 60%. This high
      prevalence of undernutrition in post stroke patients is due to: inadequate intake, poor
      nutritional status prior to their stroke onset, age, immobility with increased muscle
      wasting, high level of dependency, increased energy demands during the recovery period,
      depression, and dysphagia. In dysphagic stroke patients this is due to impaired chewing and
      swallowing from bulbar muscle weakness, and decreased sensation during mastication with oral
      accumulation of solid food resulting in inadequate nutrient intake. Cognitive, perceptual,
      visual field deficits and motor apraxia all do contribute to impaired self feeding ability
      and consequently increase the risk for undernutrition in this population.

      Undernutrition has been identified as the most modifiable factor associated with poor
      functional outcome and increase length of stay. Potter et al in a systematic review of
      nutritional supplementation in adults suggested that routine nutritional supplementation
      improved weight and anthropometry, both of which are validated measures of nutritional
      status; as well as improved functional outcomes. Oral sip feedings has been shown to improve
      nutritional intake in non-dysphagic patients and improve clinical outcome. Potter et al, in
      their trial of 381 poorly nourished patients found that high energy and protein oral
      supplements administered as a medication pass was associated with significantly better energy
      intake and weight gain, along with a reduction in mortality and an improvement in functional
      outcome. Thus increased energy and protein is justified in acute post stroke nutritionally
      compromised patients to improve outcome and decrease mortality.

      Oral nutritional supplements have the advantage of the ease of administration irrespective of
      oral or enteral feeding route, aseptic packaging ensuring patient safety, ability to be
      administered in different consistencies, reproducibility due to pre-measured formulas, and
      are established products approved as part of hospital formulary.

      Undernutrition assessment and treatment after an acute stroke remains a problem in the
      hospital setting. We therefore decided to: 1) evaluate what impact aggressive nutritional
      supplementation in addition to their intake of regular diet has on functional outcome
      measures; and 2) is there an association between dysphagia and nutritional status
      post-stroke.
    

Intervention name(s): Nutritional Supplementation
Intervention type(s): Drug
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: Single
Primary purpose: Treatment
Keywords: Stroke-Nutritional Supplementation-Functional Recovery