Stroke is a public health problem of the first order. In developed countries is one of the leading causes of death, along with
cardiovascular disease and
cancer. In addition,
stroke is the leading cause of permanent disability in adulthood. Many of the patients who survive do so with significant sequelae that limit them in their
activities of daily living. Most
strokes (80-85%) are due to
ischemia, while the rest are hemorrhagic. We have identified many modifiable risk factors, some with an important relationship with dietary factors or comorbidities in wich the diet has a significant impact. The incidence of
malnutrition in
stroke patients is not well known, but most likely impacts on patient prognosis. Furthermore, the nutritional status of patients admitted for
stroke often deteriorates during hospitalization. It is necessary to perform a nutritional assessment of the patient in the early hours of admission, to determine both the nutritional status and the presence of
dysphagia.
Dysphagia, through alteration of the safety and efficacy of swallowing, is a complication that has an implication for
nutritional support, and must be treated to prevent
aspiration pneumonia, which is the leading cause of mortality in the
stroke patient.
Nutritional support should begin in the early hours. In patients with no or mild
dysphagia that can be controlled by modifying the texture of the diet, they will start oral diet and oral nutritional supplementation will be used if the patient does not meet their nutritional requirements. There is no evidence to support the use of nutritional supplements routinely. Patients with severe
dysphagia, or decreased level of consciousness will require
enteral nutrition. Current evidence indicates that early nutrition should be initiated through a nasogastric tube, with any advantages of early feeding
gastrostomy.
Gastrostomy will be planned when the
enteral nutrition support will be expected for long-term (4 weeks). Much evidence points to the importance of
glycemic control during hospitalization for
stroke.
Hyperglycemia at diagnosis and during the first hours of admission impact on patient prognosis. The goal of
glycemic control necessary to modify this bad prognosis without adding risk by iatrogenic
hypoglycemia is still matter of debate.