Nutritional Issues in Stroke Patients Anne Lamb Senior Dietitian RIE

Malnutrition Under recognised & under treated No universal accepted definition but here’s a working definition “a state of nutrition in which a deficiency or excess or imbalance of energy, protein and other nutrients causes measurable adverse effects on tissue/body structure and function and outcome” (Professor Elia 2003)

Incidence of Malnutrition On admission – 40% of hospital MoE in-patients are malnourished (McWhirter 2003) and 75% of those undernourished patients lost further weight during their stay Stroke patients – 12 – 49% undernourished O/A (with or without dyspahgia)

Consequences of nutritional depletion  muscle weakness  length of hospital stay  frequency of infection Poorer functional outcome

Nutritional Screening Aims to identify those at risk of malnutrition MUST – Malnutrition Universal Screening Tool used throughout Lothian BMI, weight change, acute disease score (ability to eat, medical condition, skin integrity)

Nutritional Screening Integral to numerous policies /key initiatives regarding nutritional care RCOP report Nutrition & Patients – A Doctor’s Responsibility (2002) recommends “nutritional screening of all patients be an integral part of clinical practice” NHS QIS standards Food, Fluid & Nutritional Care in Hospitals (2003) states screening be done within 48hrs of admission thereafter weekly

Nutritional care in stroke patients Ensure nutrition & hydration needs are met to prevent malnutrition and dehydration Support safe swallowing to prevent aspiration and choking

Who is more nutritionally at risk? Patients with dysphagia Patients with little or no intake for 7days Patients with disease related malnutrition Patients with increased requirements e.g. wounds infections

Nutritional Intervention Nutritional intervention can improve functional outcome target those with BMI< 20 and or unintentional wt loss (Stratton 2002) early intervention to limit nutritional depletion (Badjatia & Elkind)

Nutritional Intervention FOOD trial (Food or Ordinary diet) Should ONS be routine ? – No Early or late tube feeding? – Early may substantially reduce risk of dying NG or PEG? – in first few weeks feeding via NG rather than PEG results in better functional outcome

Meeting Nutritional & Fluid Requirements Oral diet • texture modified diet • fortified foods & snacks • nutritional supplements Enteral Combination of above Parenteral (rarely used)

Nutritional care – what can help? Weekly MUST – identify issues early Monitor food intake, be aware of food quality not just quantity Hydration Bowel function

Nutritional care – what can help? Communication with patients,family/carers re food & fluid preferences Assistance with feeding Protected mealtimes Encouragement – nutritional care needs team approach