Impact of early enteral nutrition on short term prognosis after acute stroke
Abstract
We hypothesized that early enteral nutritional support would improve the short term prognosis of acute stroke patients with dysphagia, demonstrated by lower malnutrition rates, lower complication rates, and lower National Institutes of Health Stroke Scale (NIHSS) scores at 90 days post stroke. Nutrition support is an essential element in the care of stroke patients and many studies have investigated the effect of specific nutritional elements on stroke patients. However, few studies have looked at the impact of complete enteral nutrition on Chinese patients with acute stroke. To investigate this, we conducted a randomized controlled trial of 146 patients with acute stroke and dysphagia, among whom 75 were supported with nasogastric nutrition and 71 received family managed nutrition after randomization. Nutritional status, nosocomial infection and mortality rates were recorded on day 21 of hospitalization. Neurological deficits were evaluated by the NIHSS activities of daily living Barthel index (ADLBI) and the modified Rankin scale (mRS) and compared between the two groups. We found that the nasogastric nutrition group had a better nutritional status and reduced nosocomial infection and mortality rates after 21 days compared with patients in the family managed nutrition group. In addition, the nasogastric nutrition group showed a lower score on the NIHSS than the control group. However, the differences in the scores of the ADLBI and the 90 day mRS between the groups were not…
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In the Zheng et al. RCT, patients were admitted to the stroke unit in the intervention group and to the regular ward in the control group, entailing a high risk of bias.
“However, patients were admitted to the stroke unit in the IG and to the regular ward in the CG, which entails a high risk of bias”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [108]
In the same RCT, the early EN group showed a better NIHSS score than the control group after 21 days (12.04±2.55 vs 10.78±2.69; p=0.008).
“Also, the IG showed a better NIHSS score than that of the CG after 21 days (12.04 ± 2.55) vs. 10.78 ± 2.69); p ¼ 0.008).”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [108]
In a RCT of patients with acute stroke and dysphagia, early EN started on first day compared with family managed nutrition significantly lowered infection rate (33.3% vs 52.1%, p=0.022).
“The infection rate in the IG was significantly lower than that in the CG (33.3% vs. 52.1%,p ¼ 0.022).”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [108]
Cites
Tanaka, K., Ishikawa, Y., Yokoyama, M., Origasa, H., Matsuzaki, M., Saito, Y., Matsuzawa, Y., Sasaki, J., Oikawa, S., Hishida, H., et al. (2008) · Stroke · doi:10.1161/strokeaha.107.509455 · Cited by 217 · see citing works
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ESPEN guidelines on nutritional support for polymorbid internal medicine patients
Gomes, F., Schuetz, P., Bounoure, L., Austin, P., Ballesteros-Pomar, M., Cederholm, T., Fletcher, J., Laviano, A., Norman, K., Poulia, K.-A., et al. (2018) · Clinical Nutrition · doi:10.1016/j.clnu.2017.06.025 · Cited by 363 · see citing works
ESPEN guideline on nutritional support for polymorbid medical inpatients
Wunderle, C., Gomes, F., Schuetz, P., Stumpf, F., Austin, P., Ballesteros-Pomar, M. D., Cederholm, T., Fletcher, J., Laviano, A., Norman, K., et al. (2023) · Clinical Nutrition · doi:10.1016/j.clnu.2023.06.023 · Cited by 105 · see citing works
“Zheng et al. [108] compared early EN (started on fi rst day, n ¼ 75) with “ family managed nutrition ” (n ¼ 71) in a RCT of patients with acute stroke and dysphagia.”
Sabatino, A., Fiaccadori, E., Barazzoni, R., Carrero, J. J., Cupisti, A., De Waele, E., Jonckheer, J., Cuerda, C., & Bischoff, S. C. (2024) · Clinical Nutrition · doi:10.1016/j.clnu.2024.08.002 · Cited by 40 · see citing works
Gressies, C., Kaegi-Braun, N., Gomes, F., & Schuetz, P. (2023) · Clinical Nutrition · doi:10.1016/j.clnu.2022.11.007 · Cited by 5 · see citing works
- Authors
- Zheng, T., Zhu, X., Liang, H., Huang, H., Yang, J., & Wang, S.
- Affiliations
- Shanghai First People's Hospital (CN)
- Corresponding author
- Wang, Shaoshi
- Venue
- Journal of Clinical Neuroscience
- Publisher
- Elsevier BV
- Published
- 2015-09
- Volume
- 22
- Issue
- 9
- Pages
- 1473-1476
- ISSN
- 0967-5868 (ISSN-L)
- OpenAlex
- W2152116438
- Cited by
- 50
- References
- 1
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 9 · 2023: 5 · 2022: 5 · 2021: 7 · 2020: 2 · 2019: 3 · 2018: 2 · 2017: 5 · 2016: 1
- FWCI
- 5.84
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Clinical Neuroscience (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › Speech and Hearing › Dysphagia Assessment and Management
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Keywords
- acute stroke, dysphagia, early enteral nutrition, nasogastric tube feeding, malnutrition, nosocomial infections, mortality, neurological deficit, NIHSS, Barthel Index, modified Rankin Scale, Chinese patients
- MeSH terms
- Aged, Aged, 80 and over, Cross Infection, Deglutition Disorders, Enteral Nutrition, Female, Hospitalization, Humans, Intubation, Gastrointestinal, Male, Middle Aged, Prognosis, United States, Stroke
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