Dietary Behaviors of Ambulatory Care Stroke Patients
Background: Diet plays an important role in the management of the chronic diseases that increase the risk of stroke. Health care providers may not adequately stress the need for dietary modification. Methods: A Nutrition History (NH) form was developed in a referral based ambulatory care stroke clinic to evaluate patients’ dietary habits. The form included a Fat Intake Scale (FIS), created and validated by the Northwest Lipid Clinic. An FIS score > 24 indicates the need for dietary modification. A person with a Body Mass Index (BMI) > 25 is considered overweight. Statistics are descriptive and non-parametric. Results: Of the 103 patients that completed the NH, 89% were Caucasian, 75% had a stroke or TIA, 48% were hyperlipidemic, 37% were hypertensive and 13% were diabetic. The body mass index (BMI) was 26 ± 6.6 (60% > 25). Among patients with stroke or TIA (n=77), 58% were hyperlipidemic, 45% were hypertensive and the BMI was 27 ± 7.2 (61% > 25). In hyperlipidemic patients with stroke or TIA (n=45), the BMI was 28 ± 7.7 (68% > 25) and the FIS score was 28 ± 6.1 (76% > 24); 66% of these patients had never been counseled by a Registered Dietitian (RD). Only 43% of hyperlipidemic patients with TIA or stroke were being treated with lipid-lowering agents; use did not differ as a function of age or gender. Among patients with hypertension, 68% used sodium when cooking and only 32% of reported eating five or more servings of fruits and vegetables a day; 71% of hypertensive patients had never been counseled by an RD. Persons with diabetes were more likely to have been counseled by an RD than persons without diabetes (p=0.032), but persons with hyperlipidemia, hypertension, overweight persons, and persons with TIA or stroke were not more likely to have been counseled by an RD than persons without those conditions. Conclusions: These data show that persons with hypertension and hyperlipidemia, especially those who have had TIA or stroke, are not fully engaged in the recommended dietary practices to help control their diseases. Furthermore, lipid-lowering agents appear to be underutilized. Greater attention to preventive measures, such as appropriate referral for nutrition counseling, needs to be incorporated into routine practice.