Nutrition after stroke.

Decisions about feeding are amongst the most difficult to face those managing stroke patients. About a fifth of patients with acute stroke are malnourished on admission to hospital. Moreover, patients' nutritional status often deteriorates thereafter because of increased metabolic demands which cannot be met due to feeding difficulties. Poor nutritional intake may result from: (i) reduced conscious level; (ii) an unsafe swallow (iii) arm or facial weakness; (iv) poor mobility; or (v) ill fitting dentures. Malnutrition is associated with poorer survival and functional outcomes, although these associations may not be causal. Patients often receive support with oral supplements or enteral tube feeding via nasogastric or percutaneous endoscopic gastrostomy. Although these probably improve nutritional parameters, it is unclear whether they improve patients' outcomes. Also the optimal timing, type and method of enteral feeding is uncertain. Large randomised trials are now in progress to identify the optimum feeding policies for stroke patients.