The Relationship Between Nutritional Status at the Time of Stroke on Adverse Outcomes: A Systematic Review and Meta-Analysis of Prospective Cohort Studies

Lorenzo de Paola, Tiberiu Pana, Ben Carter, Roy Soiza, Mohannad W. Kafri, John F Potter, Mamas A Mamas, Phyo Kyaw Myint* (Corresponding Author), Arnav Mehta

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)

Abstract

Context and Objective: The impact of existing malnutrition on stroke outcomes is poorly recognised and treated. Evidence was systematically reviewed and quantified by meta-analysis.
Methods: MEDLINE, EMBASE and Web of Science were searched from inception to 11
January 2021 and updated in July. Prospective cohort studies, in English, evaluating anthropometric and biomarkers of nutrition on stroke outcomes were included. Risk of bias was assessed using the Scottish Intercollegiate Guidelines Network checklist.

Results: Twenty-six studies (n=156,249) were eligible (follow-up: one month-14 years). Underweight patients had increased risk of long-term mortality (adjusted hazard ratio=1.65,1.41-1.95), whilst overweight (0.80,0.74-0.86) and obese patients (0.80,0.75-0.85) had decreased risk compared to normal weight. Odds of mortality decreased in those with high serum albumin (odds ratio=0.29,0.18-0.48) and increased with low serum albumin (odds ratio=3.46,1.78-6.74) compared to normal serum albumin (30-35g/L). Being malnourished compared to well-nourished, as assessed by the Subjective Global Assessment (SGA) or by a combination of anthropometric and biochemical markers increased all-cause mortality (odds ratio=2.38,1.85-3.06) and poor functional status (adjusted odds ratio=2.21,1.40-3.49).
Conclusion: Nutritional status at the time of stroke predicts adverse stroke outcomes.
Original languageEnglish
Pages (from-to)2275-2287
Number of pages13
JournalNutrition Reviews
Volume80
Issue number12
Early online date27 May 2022
DOIs
Publication statusPublished - 1 Dec 2022

Data Availability Statement

Supporting Information
The following Supporting Information is available through the online version of this article at the publisher’s website.
Figure S1 MEDLINE Search Strategy
Figure S2 Obesity and Post-Stroke Poor
Functional Status
Figure S3 Overweight and Post-Stroke Poor
Functional Status
Figure S4 Malnourished and Post-Stroke Poor
Functional Status
Figure S5 Sensitivity Analysis of Underweight and
Post-Stroke Long-Term Mortality
Figure S6 BMI and Post-Stroke Long-Term
Mortality Funnel Plot
Table S1 Critical Appraisal
Table S2 Studies not Included for Meta-Analysis
Table S3 Study Results
Table S4 PRISMA Checklist

Keywords

  • malnutrition
  • stroke and prognosis

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