Impact of premorbid undernutrition on outcome in stroke patients

Background and Purpose - To assess the prevalence of premorbid undernutrition and its impact on outcomes 1 month after stroke. Methods - The study recruited from consecutive stroke admissions during a 10-month period. Premorbid nutritional status ( using the subjective global assessment [SGA]), premorbid functioning ( modified Rankin scale [MRS]), and stroke severity ( National Institutes of Health Stroke Scale [NIHSS] score) were assessed at admission. The associations between premorbid nutritional status, poor outcome ( defined as MRS greater than or equal to 3), and mortality were examined before and after adjustment for confounding variables, including age, gender, stroke risk factors, stroke severity, and admission serum albumin. Results - Thirty of 185 patients were assessed as having undernutrition at admission. Significant unadjusted associations were observed between undernutrition and poor outcome (odds ratio [OR], 3.4; 95% CI, 1.3 to 8.7; P = 0.01), and mortality (OR, 3.1, 95% CI, 1.3 to 7.7; P = 0.02) at 1 month. NIHSS, age, and premorbid MRS were also significantly associated with poor outcomes. After adjustment for these factors, the effect size of associations remained important but not significant ( poor outcome: OR, 2.4; 95% CI, 0.7 to 9.0, P = 0.18; mortality: OR, 3.2; 95% CI, 1.0 to 10.4, P = 0.05). Conclusions - Premorbid undernutrition, as assessed using the SGA, appears to be an independent predictor of poor stroke outcome. Stroke prevention strategies should target undernutrition in the population at risk for stroke to improve outcomes.