Assessment and treatment of nutritional status in stroke patients.

Stroke illness imposes a heavy and costly work load on hospital and community care services, and life after stroke can be a miserable affair for stroke patients and their carers. Nutritional factors may have an important role in acute stroke and its outcome. From the limited amount of research undertaken it has been shown that a significant number of patients with stroke are undernourished on admission and their nutritional status deteriorates further as an in-patient. This is especially so for those who are most dependent, in whom undernutrition is also associated with increasing morbidity and mortality. There is some evidence that nutritional supplementation may improve nutritional status and reduce morbidity and mortality. However most clinically available nutrition screening instruments lack sensitivity and specificity, and abnormal nutritional indicators may simply reflect effects of age, functional disability, or severe underlying disease. Therefore, causal relationship cannot be assumed without a sufficiently powerful intervention study which adequately adjusts for the effects of non-nutritional factors, such as the number and severity of comorbid conditions on clinical outcome. Meanwhile, doctors, nurses and members of the multidisciplinary team looking after stroke patients should be made aware of the likely impact of poor nutritional status on clinical outcome.