section name header

Evidence summaries

Interventions for Nutritional Support in Subacute Stroke

For stroke patients requiring long-term nutritional support (beyond 6 months), PEG feeding may result in fewer treatment failures and gastrointestinal bleeding and better feed delivery. Nutritional supplements are probably not effective to normally nourished patients. Level of evidence: "C"

A Cochrane review [Abstract]1 included 16 studies (1 trial included two separate comparisons) with 5829 patients. The studies assessed the effectiveness of interventions for nutritional and fluid supplementation, in patients with acute and subacute (within six months from onset) stroke.

  • Route of feeding (6 trials, n=559), recruitment from 4 to 30 days post stroke: percutaneous endoscopic gastrostomy (PEG) and nasogastric tube (NGT) feeding did not differ for case fatality or the composite outcome of death or dependency. PEG was associated with fewer treatment failures (OR 0.09; 95% CI 0.01 to 0.51; 3 trials, n = 72), gastrointestinal bleeding (OR 0.25; 95% CI 0.09 to 0.69; 1 trial, n = 321), higher feed delivery (MD 22.00; 95% CI 16.15 to 27.85; 1 trial, n = 30) and albumin concentration (MD 4.92 g/L; 95% CI 0.19 to 9.65; 3 trials, n = 63). Although looped NGT vs. conventional NGT feeding did not differ for end-of-trial case fatality or death or dependency, feed delivery was higher with looped NGT (MD 18.00%; 95% CI 6.66 to 29.34; 1 trial, n = 104).
  • Timing of feeding, comparing earlier (within 7 days) vs. later feeding (1 trial, n=859): there was no difference for case fatality, death or dependency, with early feeding vs. late feeding.
  • Fluid supplementation, comparing administering free water and thickened fluids with thickened fluids alone (1 trial, n=20): there was no difference for case fatality, or death or dependency, with fluid supplementation.
  • Nutritional supplementation (8 trials, n=4391 non-dysphagic patients): there was no difference for case fatality, death or dependency with nutritional supplementation. However, nutritional supplementation was associated with reduced pressure sores (OR 0.56; 95% CI 0.32 to 0.96; 2 trials, n = 4125), and, by definition, increased energy (MD 430.18 kcal/day; 95% CI 141.61 to 718.75; 3 trials, n = 174) and protein intake (MD 17.28 g/day; 95% CI 1.99 to 32.56; 3 trials, n = 174).

Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in interventions) and imprecise results (limited study size for several comparisons)

References

  • Geeganage C, Beavan J, Ellender S et al. Interventions for dysphagia and nutritional support in acute and subacute stroke. Cochrane Database Syst Rev 2012;10:CD000323. [PubMed]

Primary/Secondary Keywords