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Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): a multicentre randomised controlled trial
Open accessAbstract
Background Undernutrition is common in patients admitted with stroke. We aimed to establish whether the timing and route of enteral tube feeding after stroke affected patients' outcomes at 6 months. Methods The FOOD trials consist of three pragmatic multicentre randomised controlled trials, two of which included dysphagic stroke patients. In one trial, patients enrolled within 7 days of admission were randomly allocated to early enteral tube feeding or no tube feeding for more than 7 days (early versus avoid). In the other, patients were allocated percutaneous endoscopic gastrostomy (PEG) or nasogastric feeding. The primary outcome was death or poor outcome at 6 months. Analysis was by intention to treat. Findings Between Nov 1, 1996, and July 31, 2003, 859 patients were enrolled by 83 hospitals in 15 countries into the early versus avoid trial. Early tube feeding was associated with an absolute reduction in risk of death of 5.8% (95% CI -0.8 to 12.5, p=0.09) and a reduction in death or poor outcome of 1.2% (-4.2 to 6.6, p=0.7). In the PEG versus nasogastric tube trial, 321 patients were enrolled by 47 hospitals in 11 countries. PEG feeding was associated with an absolute increase in risk of death of 1.0% (-10.0 to 11.9, p=0.9) and an increased risk of death or poor outcome of 7.8% (0.0 to 15.5, p=0.05). Interpretation Early tube feeding might reduce case fatality, but at the expense of increasing the proportion surviving with poor outcome. Our data do not support a policy of early initiation of PEG feeding in dysphagic stroke patients.
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“Within the FOOD trial, which prospectively compared early versus delayed EN as well as PEG feeding with nasogastric feeding in dysphagic stroke patients, PEG feeding was associated with an increased risk of death or poor outcome of 7.8% (p=0.05)(165).”
From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [165]
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“In addition, in the FOOD trial, which was performed in patients with dysphagic stroke, early EN was associated with an absolute reduction in the risk of death of 5.8% (p=0.09)(165).”
From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [165]
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Cites
Interobserver agreement for the assessment of handicap in stroke patients
van Swieten, J. C., Koudstaal, P. J., Visser, M. C., Schouten, H. J., & van Gijn, J. (1988) · Stroke · doi:10.1161/01.str.19.5.604 · Cited by 6,512
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Research works printed but not linked: 17
- Unosson, 1994, Feeding dependence and nutritional status after acute stroke, Stroke, 25, 366, 10.1161/01.STR.25.2.366 · DOI
- Choi-Kwon, 1998, Nutritional status in acute stroke: undernutrition versus overnutrition in different stroke subtypes, Acta Neurol Scand, 98, 187, 10.1111/j.1600-0404.1998.tb07292.x · DOI
- Finestone, 1995, Malnutrition in stroke patients on the rehabilitation service and at follow up: prevalence and predictors, Arch Phys Med Rehabil, 76, 310, 10.1016/S0003-9993(95)80655-5 · DOI
- Axelsson, 1988, Nutritional status in patients with acute stroke, Acta Med Scand, 224, 217, 10.1111/j.0954-6820.1988.tb19364.x · DOI
- Gariballa, 1998, Influence of nutritional status on clinical outcome after acute stroke, Am J Clin Nutr, 68, 275, 10.1093/ajcn/68.2.275 · DOI
- Dávalos, 1996, Effect of malnutrition after acute stroke on clinical outcome, Stroke, 27, 1028, 10.1161/01.STR.27.6.1028 · DOI
- 2003, Poor nutritional status on admission predicts poor outcomes after stroke: observational data from the FOOD trial, Stroke, 34, 140
- Barer DH. The natural history and functional consequences of dysphagia after hemispheric stroke. J Neurol Neurosurg Psych 52: 236–41. · DOI
- Smithard, 1997, The natural history of dysphagia following a stroke, Dysphagia, 12, 188, 10.1007/PL00009535 · DOI
- Mann, 1999, Swallowing function after stroke. Prognosis and prognostic factors at 6 months, Stroke, 30, 744, 10.1161/01.STR.30.4.744 · DOI
- Norton, 1996, A randomised prospective comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding after acute dysphagic stroke, BMJ, 312, 13, 10.1136/bmj.312.7022.13 · DOI
- 2005, Routine oral nutritional supplementation for stroke patients in hospital (FOOD): a multicentre randomised controlled trial, Lancet, 365, 755, 10.1016/S0140-6736(05)17982-3 · DOI · Paper page
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Cited by
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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
Winstein, C. J., Stein, J., Arena, R., Bates, B., Cherney, L. R., Cramer, S. C., Deruyter, F., Eng, J. J., Fisher, B., Harvey, R. L., et al. (2016) · Stroke · doi:10.1161/str.0000000000000098 · Cited by 3,293
Medical Complications After Stroke: A Multicenter Study
Langhorne, P., Stott, D. J., Robertson, L., MacDonald, J., Jones, L., McAlpine, C., Dick, F., Taylor, G. S., & Murray, G. (2000) · Stroke · doi:10.1161/01.str.31.6.1223 · Cited by 1,196
Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines
ESICM Working Group on Gastrointestinal Function, Reintam Blaser, A., Starkopf, J., Alhazzani, W., Berger, M. M., Casaer, M. P., Deane, A. M., Fruhwald, S., Hiesmayr, M., Ichai, C., et al. (2017) · Intensive Care Medicine · doi:10.1007/s00134-016-4665-0 · Cited by 837
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
Metadata
- Authors
- Dennis, M. S., Lewis, S. C., & Warlow, C.
- Affiliations
- Western General Hospital (GB)
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2005-02
- Volume
- 365
- Issue
- 9461
- Pages
- 764-772
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W1685157389
- Cited by
- 562
- References
- 1
- Citations by year
- 2026: 22 · 2025: 24 · 2024: 17 · 2023: 15 · 2022: 27 · 2021: 23 · 2020: 23 · 2019: 25 · 2018: 25 · 2017: 26 · 2016: 22 · 2015: 28 · 2014: 33 · 2013: 30 · 2012: 25
- FWCI
- 121.01
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion, other-oa)
- Funders
- National Institute for Health and Care Research (96/29/01)
- Medical Research Council
- 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 › Physiology (medical) › Nutrition and Health in Aging
- Keywords
- enteral nutrition, early feeding, percutaneous endoscopic gastrostomy, nasogastric tube feeding, malnutrition, stroke mortality, functional outcome, feeding route
- MeSH terms
- Activities of Daily Living, Aged, Deglutition Disorders, Enteral Nutrition, Female, Gastrostomy, Humans, Intubation, Gastrointestinal, Male, Prognosis, Quality of Life, Time Factors, Treatment Outcome, Stroke, Malnutrition
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