Research article: undernutrition & stroke outcome

Citation: Davis JP, Wong AA, Schluter PJ, Henderson RD, O'Sullivan JD, Read SJ. Impact of premorbid undernutrition on outcome in stroke patients. Stroke 2004;35:1930-1934.

Last week I was looking for information on nutrition risk screening in stroke patients -- specifically, evidence to support including a screening tool in our new acute stroke pathway. (Of course you can guess my bias.)  Google Scholar led me to David et al's article that reports on the prevalence and impact of malnutrition in a cohort of stroke patients. Here's the abstract:
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.

I extracted from the authors' thorough discussion this 4-item "take-home" message:

(1) The study found a significant crude association among premorbid nutritional status and mortality and poor outcome at one month. (2) After adjustment for factors such as age, premorbid dependence, and stroke, the associations were not statistically significant.  (3) This study measured premorbid undernutrition, which was the only modifiable risk factor to show an important effect on morbidity and mortality that approached statistical significance. (4)  "In keeping with previous studies, we also found older people, especially those with impaired functional capacity, and those living in aged care facilities to be more susceptible to undernutrition. These groups in particular need to be targeted by nutrition improvement strategies to limit the impact undernutrition has on stroke outcomes."

You can read the full text of the article here. If you aren't able to access it, please contact me.