Acute Stroke: Malnutrition and Post-stroke Outcomes

Pavankumar Kamat


November 25, 2021


  • Patients with acute stroke at risk of malnutrition had a higher risk of multiple adverse outcomes and a greater need for early support on discharge.

Why this matters

  • As part of quality improvement initiatives, the Royal College of Physicians recommends nutrition screening for all patients admitted with acute stroke.

Study design

  • A multicentre, registry-based cohort study included 2962 patients with acute stroke without pre-stroke disability, identified using data from the 4 hyperacute stroke units (HASUs; 2014-2016).

  • Nutrition status was evaluated using Malnutrition Universal Screening Tool to identify patients at risk of malnutrition.

  • Funding: None disclosed.

Key results

  • Overall, 25.8% of patients with acute stroke had an increased risk of malnutrition.

  • Compared with well-nourished patients, patients with acute stroke at risk of malnutrition had an increased risk of (adjusted OR [aOR]; 95% CI):

    • length of stay on the HASUs of >14 days (9.85; 7.28-11.50; P<.001);

    • disability on discharge (8.12; 6.63-9.95; P<.001);

    • worst level of consciousness in the first 7 days (score ≥1; 7.50; 6.07-9.26; P<.001);

    • mortality (5.17; 4.03-6.64; P<.001); and

    • pneumonia (5.11; 3.92-6.66; P<.001) and urinary tract infection (1.54; 1.12-2.00; P=.008) within 7 days of admission.

  • Patients with acute stroke at risk of malnutrition had a greater need for (aOR; 95% CI):

    • palliative care (12.33; 8.52-17.83; P<.001);

    • new care home discharge (3.07; 2.18-4.33; P<.001);

    • activities of daily living support (1.84; 1.45-2.33; P<.001);

    • planned joint care (1.45; 1.19-1.76; P<.001); and

    • discharge visits (1.38; 1.06-1.80; P=.018).


  • Observational design.


Fluck D, Fry CH, Gulli G, Affley B, Robin J, Kakar P, Sharma P, Han TS. Association of risk of malnutrition with adverse outcomes and early support on discharge in acute stroke patients without prestroke disability: A multicenter, registry-based cohort study. Nutr Clin Pract. 2021 Oct 19 [Epub ahead of print]. doi: 10.1002/ncp.10790. PMID: 34664741 

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.


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