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Intensive Nutritional Supplementation After Stroke Improves Patient Outcomes: Presented at ANA

By Jacquelyn Beals

WASHINGTON, DC -- October 11, 2007 -- Stroke patients who receive intensive nutritional supplementation during in-patient rehabilitation achieve greater functional independence and are more likely to go home from hospital than patients on a routine nutritional supplement, according to research presented here at the American Neurological Association (ANA) 132nd Annual Meeting.

Acute stroke is frequently associated with poor nutrition. Causes include difficulty swallowing and/or feeding, depression, and pre-existing motor and cognitive deficits.

Meheroz H. Rabadi, MD, MRCPI, Co-Director, Stroke Service, Burke Rehabilitation Hospital, Weill Medical College of Cornell University, New York, New York, United States, presented the results of a randomised, double-blind, prospective study of 102 malnourished stroke patients at one institution.

Patients enrolled in the study were successive admissions to the stroke service that met inclusion criteria and granted informed consent. Exclusion criteria were prior history of alcohol abuse, kidney and liver disease, and malabsorption, medical instability, terminal illness, or participation in other therapeutic trials.

Of 102 subjects, 51 received the intensive nutritional supplementation and 51 received the routine nutritional regimen. Both supplements are commercially available and approved by the US Food and Drug Administration. Study subjects received the routine hospital diet with additional multi-vitamins and minerals and were randomised to one of the following supplementation regimens:

· Resource Standard 120 mL (127 calories, 5 g protein) every 8 hours by mouth;
· Novasource 2.0 (now called Resource 2.0) 120 mL (240 calories, 11 g protein) every 8 hours by mouth.

Novasource contains about double the calories and protein, and four times as much fat as Resource Standard. Both supplements were given throughout the rehabilitation period, but were not continued after discharge.

To assess patients' improvement, the researchers used the Functional Independence Measure (FIM) administered at the patient's admission and discharge. Other evaluative measures were length of stay, whether the patient returned home or to another facility, and the 2- and 6-minute timed walk measured by a physical therapist.

Patients receiving the intensive supplement improved significantly more than those on routine nutritional supplementation in the following measures: total FIM score (P =.001); motor FIM subscore (P =.001); 2-min walk (P <.001); 6-min walk (P <.001); discharge: home or not-home (P =.05).

Dr. Rabadi pointed out the striking increase in walking distances for patients on the intensive supplementation versus routine supplementation -- 85 ft vs149 ft in the 2-minute walk, respectively; 263 ft vs 396 ft in the 6-minute walk, respectively.

There was no significant difference between the improvement in cognitive FIM sub-scores for the two groups (P =.80).

For patients who are malnourished after acute strokes, intensive nutritional supplementation during the rehabilitation period contributes to recovery of motor function.


[Presentation title: Intensive Nutritional Supplements Can Improve Outcomes in Stroke Rehabilitation. Abstract M-131]

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