Background Undernutrition is common in patients admitted with stroke. We aimed to establish whether the timing and route of enteral tube feeding after stroke affected patients’outcomes at 6 months. Methods The FOOD t...Background Undernutrition is common in patients admitted with stroke. We aimed to establish whether the timing and route of enteral tube feeding after stroke affected patients’outcomes at 6 months. Methods The FOOD trials consist of thre e pragmatic multicentre randomized controlled trials, two of which included dysp hagic stroke patients. In one trial, patients enrolled within 7 days of admissio n were randomly allocated to early enteral tube feeding or no tube feeding for m ore than 7 days (early versus avoid). In the other, patients were allocated perc utaneous endoscopic gastrostomy (PEG) or nasogastric feeding. The primary outcom e was death or poor outcome at 6 months. Analysis was by intention to treat.Find ings Between Nov 1, 1996, and July 31, 2003, 859 patients were enrolled by 83 ho spitals in 15 countries into the early versus avoid trial. Early tube feeding wa s associated with an absolute reduction in risk of death of 5.8%(95%CI -0.8 t o 12.5, p=0.09) and a reduction in death or poor outcome of 1.2%(-4.2 to 6.6, p=0.7). In the PEG versus nasogastric tube trial, 321 patients were enrolled by 47 hospitals in 11 countries. PEG feeding was associated with an absolute increa se in risk of death of 1.0%(-10.0 to 11.9, p=0.9) and an increased risk of dea th or poor outcome of 7.8%(0.0 to 15.5, p=0.05). Interpretation Early tube feed ing might reduce case fatality, but at the expense of increasing the proportion surviving with poor outcome. Our data do not support a policy of early initiatio n of PEG feeding in dysphagic stroke patients.展开更多
Background Undernutrition is common in hospital patients with stroke, can deve lop or worsen in hospital, and is associated with poor outcomes. We aimed to est ablish whether routine oral nutritional supplements impro...Background Undernutrition is common in hospital patients with stroke, can deve lop or worsen in hospital, and is associated with poor outcomes. We aimed to est ablish whether routine oral nutritional supplements improve outcome after stroke . Methods The FOOD trials are a family of three pragmatic, multicentre, randomis ed controlled trials.We measured the outcomes of stroke patients who could swall ow and who were randomly allocated normal hospital diet or normal hospital diet plus oral nutritional supplements until hospital discharge. The primary outcome was death or poor outcome (modified Rankin scale [MRS] grade 3-5), 6 months aft er enrolment, measured unaware of treatment allocation. Analysis was by intentio n to treat. Findings Between Nov 1, 1996, and July 31, 2003, 4023 patients were enrolled by 125 hospitals in 15 countries. Only 314 (8%) patients were judged t o be undernourished at baseline. Vital status and MRS at the end of the trial we re known for 4012 and 4004 patients, respectively. Supplemented diet was associa ted with an absolute reduction in risk of death of 0.7%(95%CI-1.4 to 2.7) and an increased risk of death or poor outcome of 0.7%(-2.3 to 3.8). Interpretati on We could not confirm the anticipated 4%absolute benefit for death or poor ou tcome from routine oral nutritional supplements for mainly well nourished stroke patients in hospital. Our results would be compatible with a 1%or 2%absolute benefit or harm from oral supplements. These results do not support a policy of routine oral supplementation after stroke.展开更多
文摘Background Undernutrition is common in patients admitted with stroke. We aimed to establish whether the timing and route of enteral tube feeding after stroke affected patients’outcomes at 6 months. Methods The FOOD trials consist of thre e pragmatic multicentre randomized controlled trials, two of which included dysp hagic stroke patients. In one trial, patients enrolled within 7 days of admissio n were randomly allocated to early enteral tube feeding or no tube feeding for m ore than 7 days (early versus avoid). In the other, patients were allocated perc utaneous endoscopic gastrostomy (PEG) or nasogastric feeding. The primary outcom e was death or poor outcome at 6 months. Analysis was by intention to treat.Find ings Between Nov 1, 1996, and July 31, 2003, 859 patients were enrolled by 83 ho spitals in 15 countries into the early versus avoid trial. Early tube feeding wa s associated with an absolute reduction in risk of death of 5.8%(95%CI -0.8 t o 12.5, p=0.09) and a reduction in death or poor outcome of 1.2%(-4.2 to 6.6, p=0.7). In the PEG versus nasogastric tube trial, 321 patients were enrolled by 47 hospitals in 11 countries. PEG feeding was associated with an absolute increa se in risk of death of 1.0%(-10.0 to 11.9, p=0.9) and an increased risk of dea th or poor outcome of 7.8%(0.0 to 15.5, p=0.05). Interpretation Early tube feed ing might reduce case fatality, but at the expense of increasing the proportion surviving with poor outcome. Our data do not support a policy of early initiatio n of PEG feeding in dysphagic stroke patients.
文摘Background Undernutrition is common in hospital patients with stroke, can deve lop or worsen in hospital, and is associated with poor outcomes. We aimed to est ablish whether routine oral nutritional supplements improve outcome after stroke . Methods The FOOD trials are a family of three pragmatic, multicentre, randomis ed controlled trials.We measured the outcomes of stroke patients who could swall ow and who were randomly allocated normal hospital diet or normal hospital diet plus oral nutritional supplements until hospital discharge. The primary outcome was death or poor outcome (modified Rankin scale [MRS] grade 3-5), 6 months aft er enrolment, measured unaware of treatment allocation. Analysis was by intentio n to treat. Findings Between Nov 1, 1996, and July 31, 2003, 4023 patients were enrolled by 125 hospitals in 15 countries. Only 314 (8%) patients were judged t o be undernourished at baseline. Vital status and MRS at the end of the trial we re known for 4012 and 4004 patients, respectively. Supplemented diet was associa ted with an absolute reduction in risk of death of 0.7%(95%CI-1.4 to 2.7) and an increased risk of death or poor outcome of 0.7%(-2.3 to 3.8). Interpretati on We could not confirm the anticipated 4%absolute benefit for death or poor ou tcome from routine oral nutritional supplements for mainly well nourished stroke patients in hospital. Our results would be compatible with a 1%or 2%absolute benefit or harm from oral supplements. These results do not support a policy of routine oral supplementation after stroke.
