Malnutrition in Stroke Patients: Risk Factors, Assessment, and Management.

Abstract

Stroke is the fourth leading cause of death in the United States (1), and one of the major causes of disability generating a massive economic burden (2). Ischemic strokes account for 65–85% of stroke patients in the Western World, and the rest are hemorrhagic strokes which are more disabling (3). Only 10–20% of hemorrhagic stroke patients will recover functional independence (4). In order to improve neurological and cognitive functions of stroke patients, numerous rehabilitation interventions are implemented, including nutritional interventions, in attempt to overcome the metabolic consequences of stroke (5, 6). Even though malnutrition in stroke patients is under-recognized and undertreated, its prevalence on admission is estimated to be around 20% (7, 8). However, the prevalence of malnutrition after acute stroke varies widely ranging between 6.1% and 62% (9, 10). This wide range has been attributed to different timing of assessment, patients’ characteristics, and most importantly, nutrition assessment methods (10). Malnutrition before and after acute stroke is responsible for extended hospital stay, poorer functional outcome, and increased mortality rates at 3–6 months after stroke (11–13). The metabolic requirements and the resting energy expenditures (REE) depend on the type of stroke with subarachnoid hemorrhage (SAH) requiring the most caloric intake when compared to ischemic strokes and intracerebral hemorrhage (ICH). As a result, the hasty identification of malnutrition using body mass index (BMI) or anthroprometric measures or laboratory parameters after the acute event is fundamental to avoid poor outcomes (10, 14, 15). The type of feeding depends on the swallowing status of the stroke patient; if dysphagia is present, enteral nutrition (EN) through nasogastric tube (NGT) or percutaneous endoscopic gastrostomy/jejunostomy (PEG/J) is a preferred intervention to oral feeding (14). Although the exact day of initiation of feeding after an acute stroke event remains debatable, it is preferable to start feeding after the clinical stabilization of patients in order to reduce complication rates and improve overall recovery (16–18). The aim of this review article is to discuss the risk factors of malnutrition in stroke patients and its assessment, the metabolic requirements for each type of stroke, and the importance of early feeding using the appropriate feeding method. We reviewed all English papers on risk factors, assessment, and management of malnutrition in stroke patients using Google Scholar and Pubmed. Relevant studies are included in this review.