1. Nutritional Issues in Stroke Patients
Anne Lamb
Senior Dietitian RIE

2. 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)

3. 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)

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

5. 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)

6. 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

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

8. 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

9. 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)

10. 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

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

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

13. 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