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(Stroke. 2004;35:1930.)
© 2004 American Heart Association, Inc.

Original Contributions

Impact of Premorbid Undernutrition on Outcome in Stroke Patients

James P. Davis, BComm, BNurs(Hons); Andrew A. Wong, MBBS; Philip J. Schluter, BSc(Hons), MSc, PhD; Robert D. Henderson, MBBS, FRACP; John D. O’Sullivan, MBBS, MD, FRACP Stephen J. Read, MBBS, PhD, FRACP

From the Stroke Unit (J.P.D., A.A.W., R.D.H., J.D.O., S.J.R.), Department of Neurology, Royal Brisbane Hospital, and the School of Population Health (P.J.S.), University of Queensland, Brisbane, Australia.

Correspondence to Dr Stephen Read, Stroke Unit, Department of Neurology, Level 7, Ned Hanlon Building, Royal Brisbane Hospital, PO Herston Qld 4029, Brisbane, Australia. E-mail Stephen_Read{at}health.qld.gov.au

Background and Purpose— To assess the prevalence of premorbid undernutrition and its impact on outcomes 1 month after stroke.

Methods— The study recruited from consecutive stroke admissions during a 10-month period. Premorbid nutritional status (using the subjective global assessment [SGA]), premorbid functioning (modified Rankin scale [MRS]), and stroke severity (National Institutes of Health Stroke Scale [NIHSS] score) were assessed at admission. The associations between premorbid nutritional status, poor outcome (defined as MRS 3), and mortality were examined before and after adjustment for confounding variables, including age, gender, stroke risk factors, stroke severity, and admission serum albumin.

Results— Thirty of 185 patients were assessed as having undernutrition at admission. Significant unadjusted associations were observed between undernutrition and poor outcome (odds ratio [OR], 3.4; 95% CI, 1.3 to 8.7; P=0.01), and mortality (OR, 3.1, 95% CI, 1.3 to 7.7; P=0.02) at 1 month. NIHSS, age, and premorbid MRS were also significantly associated with poor outcomes. After adjustment for these factors, the effect size of associations remained important but not significant (poor outcome: OR, 2.4; 95% CI, 0.7 to 9.0, P=0.18; mortality: OR, 3.2; 95% CI, 1.0 to 10.4, P=0.05).

Conclusions— Premorbid undernutrition, as assessed using the SGA, appears to be an independent predictor of poor stroke outcome. Stroke prevention strategies should target undernutrition in the population at risk for stroke to improve outcomes.

Key Words: stroke • outcome • diet

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