急性期脳卒中患者への個別の栄養サポート

急性期脳卒中患者への個別の栄養サポートの効果をみたランダム化比較試験の論文を紹介します。

Ha L, et al: Individual, nutritional support prevents undernutrition, increases muscle strength and improves QoL among elderly at nutritional risk hospitalized for acute stroke: a randomized, controlled trial. Clin Nutr. 2010; 29(5):567-73.

栄養リスクのある急性期脳卒中患者を対象に、個別の栄養サポート群と通常の栄養サポート群を比較して、 5％以上の体重減少は20.7% vs. 36.4% (P = 0.055)と前者で低い傾向でした。また、QOL (P = 0.009) と握力 (P = 0.002)は前者で有意に高いという結果でした。

これより栄養リスクのある急性期脳卒中患者では、個別の栄養サポートが栄養障害の予防とQOLの改善に有効といえます。拡大解釈ですが、NSTの介入も栄養リスクのある急性期脳卒中患者では有効かもしれません。

体重がむしろ減少してほしい肥満の脳卒中患者も少なからずいますが、今回はあくまで体重が減少してほしくない脳卒中患者に関する研究です。

Abstract
BACKGROUND & AIMS: Undernutrition after an acute stroke increases the risk of poor outcome. We wanted to examine the effect of individualized, nutritional support on weight loss and functional outcomes in stroke patients.

METHODS: Acute stroke patients at nutritional risk were randomized to either individualized, nutritional care or routine care while in hospital. Patients in the intervention group received an individualized treatment plan aiming to prevent weight loss. In accordance with routine care, the controls did not have such a treatment plan. Patients were reviewed at follow-up after three months. Primary outcome measure was the percentage of patients with weight loss ≥5%. Secondary outcomes measures were quality of life (QoL), handgrip strength and length of hospital stay. This trial is registered with ClinicalTrials.gov, number NCT00163007.

RESULTS: At follow-up, 20.7% of the intervention group (n = 58) lost ≥5% weight compared with 36.4% in the control group (n = 66) (P = 0.055). The intervention group had a significantly higher increase in QoL score (P = 0.009) and in handgrip strength (P = 0.002). There was no difference in length of hospital stay.

CONCLUSIONS: Individualized, nutritional treatment strategy can prevent clinically significant weight loss and improve QoL in elderly acute stroke patients at nutritional risk.