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(Stroke. 1996;27:1028-1032.)
© 1996 American Heart Association, Inc.
Articles |
Effect of Malnutrition After Acute Stroke on Clinical Outcome
From the Departments of Neurology (A.D., S.S., A.M., D.G.), Endocrinology (W.R.), Gastroenterology (F.G.-H.), and Nursing (R.S.), Hospital Doctor Josep Trueta, Girona; and the Lipid and Cardiovascular Epidemiology Unit, Institut Municipal d'Investigació Mèdica de Barcelona (J.M.) (Spain).
Correspondence to Dr Antoni Dávalos, Section of Neurology, Hospital Doctor Josep Trueta, Ctra Francia s/n, 17007 Girona, Spain.
Background and Purpose Malnutrition has received little attention in acute stroke, although it represents a risk of decreased immunity and nosocomial infections. Our objectives were to determine the prevalence of malnutrition after 1 week of hospitalization in acute stroke and to establish its relation to the stress response and neurological outcome.
Methods The study included 104 patients with an acute stroke of less than 24 hours' duration. Nutritional parameters (triceps skinfold thickness, midarm muscle circumference, serum albumin, and calorimetry) were evaluated at admission and after 1 week. Stress response (free urinary cortisol) was measured daily during the first week. Neurological deficit was evaluated by the Canadian Stroke Scale. Clinical outcome was estimated by the Barthel Index 1 month after the acute stroke. Patients received an oral standard diet or polymeric enteral nutrition when they had swallowing difficulties.
Results Protein-energy malnutrition was observed in
16.3% of patients at inclusion and in 26.4% after the first week,
with a significant decrease in fat (P=.002) and visceral
protein compartments (P=.049). Malnourished patients showed
higher stress reaction and increased frequency of infections and
bedsores in comparison with the appropriately nourished group. Multiple
logistic regression analysis showed that malnutrition after 1
week (odds ratio, 3.5; 95% confidence interval, 1.2 to 10.2) and
elevated free urinary cortisol (odds ratio, 3.3; confidence interval,
1.05 to 10.2) increased the risk of poor outcome (death or Barthel
Index 
50 on the 30th day of follow-up) independently of age and
nutritional status at admission.
Conclusions Our findings suggest that protein-energy malnutrition after acute stroke is a risk factor for poor outcome. Early appropriate enteral caloric feeding did not prevent malnutrition during the first week of hospitalization.
Key Words: cortisol • diet • metabolism • stroke outcome
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