Published Online
on May 15, 2003

A more recent version of this article appeared on June 1, 2003

This Article Full Text (PDF) All Versions of this Article: 34/6/1450    most recent 01.STR.0000074037.49197.8Cv1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Search for Related Content PubMed PubMed Citation Pubmed/NCBI databases Medline Plus Health Information Nutrition Nutrition for Seniors Stroke Related Collections Nutrition Other Stroke Treatment - Medical Other Stroke Rehabilitation, Stroke

Submitted on November 26, 2002
Accepted on January 21, 2003

Poor Nutritional Status on Admission Predicts Poor Outcomes After Stroke. Observational Data From the FOOD Trial

FOOD Trial Collaboration^*

^* To whom correspondence should be addressed. E-mail: msd{at}skull.dcn.ed.ac.uk.

Background and Purpose--Previous studies suggest that undernourished patients with acute stroke do badly. The data, however, are not robust. We aimed to reliably assess the importance of baseline nutritional status as an independent predictor of long-term outcome after stroke in a large prospective cohort enrolled in the Feed Or Ordinary Diet (FOOD) trial, a multicenter randomized trial evaluating various feeding policies.

Methods--Patients admitted to hospital with a recent stroke were enrolled in the FOOD trial. Data on nutritional status and other clinical predictors of outcome were collected at trial entry. At 6 months, the coordinating center collected data on survival and functional status (modified Rankin Scale). Outcome assessment was done by researchers blinded to baseline assessments and treatment allocation.

Results--Between November 1996 and November 2001, 3012 patients were enrolled, and 2955 (98%) were followed up. Of the 275 undernourished patients, 102 (37%) were dead by final follow-up compared with only 445 (20%) of 2194 patients of normal nutritional status (odds ratio [OR], 2.32; 95% CI, 1.78 to 3.02). After adjustment for age, prestroke functional state, and stroke severity, this relationship, although weakened, still held (OR, 1.82; 95% CI, 1.34 to 2.47). Undernourished patients were more likely to develop pneumonia, other infections, and gastrointestinal bleeding during their hospital admission than other patients.

Conclusions--These data provide reliable evidence that nutritional status early after stroke is independently associated with long-term outcome. It supports the rationale for the FOOD trial, which continues to recruit and aims to estimate the effect of different feeding regimes on outcome after stroke and thus determine whether the association observed in this study is likely to be causal.

Key words: clinical trials • nutrition • prognosis • stroke outcome

This article has been cited by other articles:

				N. Badjatia and M. S. V. Elkind Nutritional Support After Ischemic Stroke: More Food for Thought Arch Neurol, January 1, 2008; 65(1): 15 - 16. [Full Text] [PDF]

				S.-H. Yoo, J. S. Kim, S. U. Kwon, S.-C. Yun, J.-Y. Koh, and D.-W. Kang Undernutrition as a Predictor of Poor Clinical Outcomes in Acute Ischemic Stroke Patients Arch Neurol, January 1, 2008; 65(1): 39 - 43. [Abstract] [Full Text] [PDF]

				A. Ois, E. Cuadrado-Godia, J. Jimenez-Conde, M. Gomis, A. Rodriguez-Campello, J. E. Martinez-Rodriguez, E. Munteis, and J. Roquer Early Arterial Study in the Prediction of Mortality After Acute Ischemic Stroke Stroke, July 1, 2007; 38(7): 2085 - 2089. [Abstract] [Full Text] [PDF]

				S Singh and S Hamdy Dysphagia in stroke patients. Postgrad. Med. J., June 1, 2006; 82(968): 383 - 391. [Abstract] [Full Text] [PDF]

				M. Vargas, J. P. Horcajada, V. Obach, M. Revilla, A. Cervera, F. Torres, A. M. Planas, J. Mensa, and A. Chamorro Clinical Consequences of Infection in Patients With Acute Stroke: Is It Prime Time for Further Antibiotic Trials? Stroke, February 1, 2006; 37(2): 461 - 465. [Abstract] [Full Text] [PDF]

				H. Adams, R. Adams, G. Del Zoppo, and L. B. Goldstein Guidelines for the Early Management of Patients With Ischemic Stroke: 2005 Guidelines Update A Scientific Statement From the Stroke Council of the American Heart Association/American Stroke Association Stroke, April 1, 2005; 36(4): 916 - 923. [Full Text] [PDF]

				J. P. Davis, A. A. Wong, P. J. Schluter, R. D. Henderson, J. D. O'Sullivan, and S. J. Read Impact of Premorbid Undernutrition on Outcome in Stroke Patients Stroke, August 1, 2004; 35(8): 1930 - 1934. [Abstract] [Full Text] [PDF]

				T. Dziedzic, A. Slowik, E. A. Gryz, and A. Szczudlik Lower Serum Triglyceride Level Is Associated With Increased Stroke Severity Stroke, June 1, 2004; 35(6): e151 - e152. [Abstract] [Full Text] [PDF]

				S. Gariballa Editorial Comment: Protein-Energy Undernutrition and Acute Stroke Outcome Stroke, June 1, 2003; 34(6): 1455 - 1456. [Full Text] [PDF]