national-clinical-guidelines-for-stroke-fourth-edition

Nutrition and dietetics concise guide for stroke 2012
National clinical guideline for stroke
ongoing management plan for the provision
of adequate hydration and nutrition.
B All patients should be screened for
malnutrition and the risk of malnutrition at
the time of admission and at least weekly
thereafter. Screening should be undertaken by
trained staff using a structured assessment
such as the Malnutrition Universal Screen
Tool (MUST).
C All people with acute stroke should have their
hydration assessed on admission, reviewed
regularly and managed so that normal
hydration is maintained.
D People with suspected aspiration on specialist
assessment or who require tube feeding or
dietary modification for 3 days should be:
● reassessed and be considered for
instrumental examination (such as
videofluroscopy or fibre-optic endoscopic
evaluation of swallowing)
● referred for specialist nutritional
assessment.
E People with acute stroke who are unable to
take adequate nutrition and fluids orally
should be:
● considered for tube feeding with a
nasogastric tube within 24 hours of
admission
● considered for a nasal bridle tube or
gastrostomy if they are unable to tolerate a
nasogastric tube
● referred to an appropriately trained
healthcare professional for detailed
nutritional assessment, individualised
advice and monitoring.
F Nutritional support should be initiated for
people with stroke who are at risk of
malnutrition. This may include oral
nutritional supplements, specialist dietary
advice and/or tube feeding.
G People with dysphagia should be given food,
fluids and medications in a form that can be
swallowed without aspiration following
specialist assessment of swallowing.
[H] Routine oral nutritional supplements are not
recommended for people with acute stroke
who are adequately nourished on admission
and are able to take a full diet while in
hospital.
Lifestyle measures (5.3.1)
C All patients should be advised to eat the
optimum diet:
● eating five or more portions of fruit and
vegetables per day from a variety of
sources
● eating two portions of oily fish per week
(salmon, trout, herring, pilchards,
sardines, fresh tuna).
D All patients should be advised to reduce and
replace saturated fats in their diet with
polyunsaturated or monounsaturated fats by:
● using low-fat dairy products
● replacing butter, ghee and lard with
products based on vegetable and plant oils
● limiting red meat intake especially fatty
cuts and processed forms.
E Patients who are overweight or obese should
be offered advice and support to aid weight
loss, which may include diet, behavioural
therapy and physical activity.
F All patients, but especially people with
hypertension, should be advised to reduce
their salt intake by:
● not adding salt to food at the table
● using as little salt as possible in cooking
● avoiding high-salt foods, eg processed
meat products, such as ham and salami,
cheese, stock cubes, pre-prepared soups
and savoury snacks such as crisps and
salted nuts.
G Patients who drink alcohol should be advised
to keep within recognised safe drinking limits
of no more than three units per day for men
and two units per day for women.
H The following interventions have not been
shown to reduce stroke reoccurrence:
● vitamin B and folate supplementation
● vitamin E
● supplementation with calcium with or
without vitamin D.
142 © Royal College of Physicians 2012