Individual, nutritional support prevents undernutrition, increases muscle strength and improves QoL among elderly at nutritional risk hospitalized for acute stroke: A randomized, controlled trial
Abstract
Background & aims Undernutrition after an acute stroke increases the risk of poor outcome. We wanted to examine the effect of individualized, nutritional support on weight loss and functional outcomes in stroke patients. Methods Acute stroke patients at nutritional risk were randomized to either individualized, nutritional care or routine care while in hospital. Patients in the intervention group received an individualized treatment plan aiming to prevent weight loss. In accordance with routine care, the controls did not have such a treatment plan. Patients were reviewed at follow-up after three months. Primary outcome measure was the percentage of patients with weight loss ≥5%. Secondary outcomes measures were quality of life (QoL), handgrip strength and length of hospital stay. This trial is registered with ClinicalTrials.gov, number NCT00163007. Results At follow-up, 20.7% of the intervention group (n = 58) lost ≥5% weight compared with 36.4% in the control group (n = 66) (P = 0.055). The intervention group had a significantly higher increase in QoL score (P = 0.009) and in handgrip strength (P = 0.002). There was no difference in length of hospital stay. Conclusions Individualized, nutritional treatment strategy can prevent clinically significant weight loss and improve QoL in elderly acute stroke patients at nutritional risk.
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Three RCTs of low to acceptable quality in older hospitalized patients at nutritional risk with various diagnoses or after acute stroke reported positive effects on energy and protein intake, body weight, complications, antibiotic use, readmissions, and functional measures.
“Three RCTs of low to acceptable quality investigated the effects of comprehensive individualized nutritional interventions in older hospitalized patients at nutritional risk with various diagnoses (43,44) or after acute stroke (45), and reported positive effects on energy and protein intake (43,44), BW (44,45), complications, antibiotic use, readmissions (44) and functional measures (44,45).”
From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [45]
All three RCTs showed benefits concerning quality of life in the group receiving individual nutritional care compared to usual care.
“Additionally, all three studies showed benefits concerning the quality of life in the group receiving individual nutritional J o u r n a l P r e -p r o o f care compared to the group with usual care (43)(44)(45).”
From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [45]
No effect was found regarding length of hospital stay in the three RCTs of comprehensive individualized nutritional interventions.
“No effect was found regarding the length of hospital stay (44,45).”
From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [45]
Five RCTs, all performed in the hospital setting, were identified providing evidence for comprehensive individualized nutritional interventions in older persons with malnutrition or at risk of malnutrition.
“Five RCTs (all performed in the hospital setting) were identified providing evidence for comprehensive individualized nutritional interventions in older persons with malnutrition or at risk of malnutrition (43)(44)(45)(46)(47).”
From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [45]
Cites
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Kernan, W. N., Ovbiagele, B., Black, H. R., Bravata, D. M., Chimowitz, M. I., Ezekowitz, M. D., Fang, M. C., Fisher, M., Furie, K. L., Heck, D. V., et al. (2014) · Stroke · doi:10.1161/str.0000000000000024 · Cited by 5,170 · see citing works
ESPEN practical guideline: Clinical nutrition and hydration in geriatrics
Volkert, D., Beck, A. M., Cederholm, T., Cruz-Jentoft, A., Hooper, L., Kiesswetter, E., Maggio, M., Raynaud-Simon, A., Sieber, C., Sobotka, L., et al. (2022) · Clinical Nutrition · doi:10.1016/j.clnu.2022.01.024 · Cited by 516 · see citing works
Nutrition and Sarcopenia: A Review of the Evidence and Implications for Preventive Strategies
Robinson, S., Cooper, C., & Aihie Sayer, A. (2012) · Journal of Aging Research · doi:10.1155/2012/510801 · Cited by 256 · see citing works
- Authors
- Ha, L., Hauge, T., Spenning, A. B., & Iversen, P. O.
- Affiliations
- Østfold Hospital Trust (NO)
- Oslo University Hospital (NO)
- Corresponding author
- Ha, Lisa
- ORCID
- Iversen, Per Ole
- Venue
- Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2010-10
- Volume
- 29
- Issue
- 5
- Pages
- 567-573
- ISSN
- 0261-5614 (ISSN-L)
- OpenAlex
- W2066933875
- Cited by
- 153
- References
- 1
- Citations by year
- 2026: 8 · 2025: 4 · 2024: 9 · 2023: 5 · 2022: 14 · 2021: 10 · 2020: 12 · 2019: 14 · 2018: 11 · 2017: 5 · 2016: 6 · 2015: 11 · 2014: 11 · 2013: 18 · 2012: 9
- FWCI
- 7.14
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Sykehuset Østfold
- Topics
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Health Professions › Speech and Hearing › Dysphagia Assessment and Management
- Keywords
- acute stroke, malnutrition, nutritional support, weight loss prevention, grip strength, quality of life, elderly patients, hospitalized stroke patients, nutritional risk
- MeSH terms
- Aged, Aged, 80 and over, Female, Hospitals, Humans, Male, Nutritional Status, Quality of Life, Weight Loss, Nutrition Assessment, Treatment Outcome, Nutritional Support, Stroke, Malnutrition, Muscle Strength, Elder Nutritional Physiological Phenomena
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