World Stroke Day 2020: The importance of medical nutrition in stroke recovery and rehabilitation

October 29 marks World Stroke Day, an important occasion for Danone and its partners to strengthen their commitment to the stroke community through support of medical nutrition solutions in the recovery and care of stroke patients.

Poland. Patient and Carer Interview. Patient suffered a Stroke. Nutrison.

October 29 marks World Stroke Day, an important occasion for Danone and its partners to strengthen their commitment to the stroke community through support of medical nutrition solutions in the recovery and care of stroke patients.

With 1 in 4 people suffering a stroke in their lifetime1, it is the second leading cause of death and the third leading cause of disability worldwide.  By 2050, a third of the world population will be over the age of 50, and as the risk of stroke doubles each decade thereafter, more and more stroke patients are going to need nutritional support2.

Role of nutrition along the post-stroke journey

After a stroke, common complications such as swallowing problems, malnutrition, reduced muscle mass, pressure injuries and decreased immune response can impact patient outcomes. These include reduced speed and degree of recovery, increased hospital length of stay, greater healthcare costs and increased disability and mortality.

  • Dysphagia: up to 78% of people who suffer a stroke each year are affected by difficulty swallowing foods and liquids3. These swallowing problems can bring on anxiety around mealtimes and make life more difficult for stroke survivors and carers. Dysphagia can also increase the risk of malnutrition and negatively affect the speed and degree of recovery liquids. Dietary adjustments can be made by changing the texture and consistency of food and drinks, making them easier to swallow and therefore reducing the risk of accidental inhalation, which may result in serious lung infection. In case of severe swallowing difficulties (“nothing per mouth”), patients will need to receive their nutrition via a nasogastric tube.
  • Malnutrition: around half of people with dysphagia are malnourished or at risk4, and the prevalence rises with increased length of hospitalization by up to 62%5. This in turn can compromise recovery after stroke and lead to development of additional complications. Medical nutrition can support patients in gaining weight and strength by providing them with nutritional and energy intake requirements they need to support their recovery and stave off stroke-related complications.
  • Sarcopenia: Some pre- and post-stroke factors, such as older age, physical inactivity, and poor nutritional status, are well known to cause muscle wasting after stroke, increasing the risk of adverse outcomes such as physical disability, poor quality of life and death6-7. Muscle loss can be managed by physical therapy in combination with nutritional interventions, such as provision of essential amino acids, leucine, whey protein and vitamin D to help restore muscle mass and strength in stroke patients8.
  • Pressure injuries: malnourished stroke patients are at risk of developing injuries to the skin, especially over bony areas, which can cause serious clinical consequences and increase in morbidity and mortality9-10. Effective pressure injury support relies on good hygiene, regular pressure relief, timely wound care and nutrition to support the immune system in the healing process. Such nutrition plays an important role in stimulating tissue repair11, enhancing collagen synthesis, increasing skin tensile strength and improving immune function.
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Better care for stroke patients

Guidelines recommend that patients who have had a stroke are treated in a specialized stroke unit by a dedicated team. In turn, treatment and screening for complications should be initiated as quickly as possible after onset of symptoms, but this does not always happen. Earlier this year, Nutricia joined the Angels Initiative to contribute to better care for stroke patients, especially those who have swallowing difficulty The Angels Initiative optimize the quality of care for stroke centres across the world, and already works with over 4000 such units and almost 50 000 doctors, nurses and emergency medicine professionals worldwide. registered in the initiative worldwide.

With Nutricia’s support, the Angels Initiative now incorporates education modules, guidelines and methodologies for dysphagia screening and nutritional management, co-created with neurologists, nurses, speech and language therapists, chefs and carers. So far, Nutricia and the Angels Initiative have held education webinars in ten countries including Spain, Italy, Portugal, Poland, Czech Republic, Hungary, Ukraine, Russia, Argentina and Brazil.

  1.     https://www.webmd.com/stroke/news/20181220/1-in-4-people-over-25-will-be-hit-by-stroke#1
  2.     UN, Dept Economic & Social Affairs, Population Division. World Population Prospects 2019, custom data acquired via website; [Dysphagia] Martino R et al. Stroke 2005; 36: 2756–63; [Malnutrition] Foley NC, et al. J Rehabil Med. 2009;41:707–13.
  3.     Felt, P. Nutritional management of dysphagia in the healthcare setting; Healthcare Caterers International. 2006;1: 11-43.
  4.     Felt, P. Nutritional management of dysphagia in the healthcare setting; Healthcare Caterers International. 2006;1: 11-43.
  5.     Ruxton et al, Nutrition Communications 2013 4. Sun JH, et al. ATM. 2014; Aug; 2(8): 80.
  6.     Delmonico MJ, et al. Alternative definitions of sarcopenia, lower extremity performance, and functional impairment with aging in older men and women. J Am Geriatr Soc. 2007;55:769–74.
  7.     Morley JE, Argiles JM, Evans WJ, et al. J Am Med Dir Assoc 2010;11:391e396.
  8.     Morley JE, Argiles JM, Evans WJ, et al. J Am Med Dir Assoc 2010;11:391e396.
  9.     Degenholtz H et al. Gerontologist. 2008;48(5):584.
  10.     Allman R et al. Advances in Wound Care.
  11.     Stechmiller & Cowan, 2005.

Stroke and Dysphagia

Globally, 15 million people suffer from a stroke. Up to 78% of those patients have dysphagia

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Bringing Haute Cuisine to Dysphagia Cooking

Nutricia initiated the Chefs’ Council: a unique partnership of dysphagia experts, as well as world-class chefs

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