Nutrition intake early after stroke is poor: Investigating nutrition within an Enriched Environment

Ms Samantha Robertson1, Dr Rohan Grimley2,3, Dr Chris Anstey2,3, Dr Ingrid Rosbergen1,4

1Allied Health Medical Services, Sunshine Coast Hospital and Health Service, Birtinya, Australia, 2Sunshine Coast Clinical School, Griffith University , Birtinya, Australia, 3Department of Medicine, Sunshine Coast Hospital and Health Service, Birtinya, Australia, 4Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia

Background: Malnutrition is common after stroke. Nutrition intake and malnutrition were investigated within the novel intervention of an Enriched Environment (EE) in an acute stroke unit.

Methods: We performed a before-after study observing standard care (n=30) versus EE (n=30) participants.  Standard care participants ate meals at the bedside whilst EE participants were provided the opportunity of communal mealtimes at breakfast and lunch. Both groups received nutrition supplementation if indicated. Mealtime intake was observed and remaining daily intake calculated using food charts across 6 days per week. Nutrition requirements were calculated for total energy (ratio method) and protein (1g/kg) and proportion of requirements met (%).  Malnutrition was assessed using the Subjective Global Assessment (SGA) and admission and discharge body weights. Stepwise multivariable logistic regression was performed assessing predictors of nutrition outcomes adjusting for intervention group, age, gender, stroke type and severity, length of stay, admission weight, and dietary modification.

Results: Neither standard care (n=30, age 76.0 ±12.8) nor the EE group (n=30, age 76.7 ±12.1) met daily requirements for energy (70.7% ±16.8 vs. 70.7% ±17.3, p= 0.94) or protein (73.2% ±18.6 vs. 69.8% ±17.3, p= 0.70). Data was stratified into stroke severity showing a trend toward improved intake in moderate stroke patients (NIHSS 8-16) (Energy 63.7% ±13.7 vs. 76.8% ±15.2, p=0.55 and Protein 66.2% ±14.5 vs. 77.3% ±16.2, p=0.11). Mean body weight dropped (0.92kg standard care vs. 0.64kg EE) and malnutrition rates increased: standard care (3.3% to 26.6%) and EE (6.6% to 13.3%).  Predictors of malnutrition on discharge in logistic regression models were: length of stay (p<0.01), and protein (p<0.01) or energy intake (p<0.05).

Conclusion: Overall, acute stroke patients were not meeting nutrition requirements and losing body weight. The enriched environment had no effect on nutrition intake. Malnutrition was associated with lower energy and protein intakes and increased length of stay.


Samantha qualified as an Accredited Practicing Dietitian (APD) at Queensland University of Technology in Brisbane, Australia graduating with Honours. Samantha began her career working for the NHS in London, gaining experience in a broad range of areas and is now based at the Sunshine Coast University Hospital, specialising in acute stroke for the past 7 years. Samantha has an interest in research and has presented study results internationally in 2017 at the Stroke Society of Australasia (SSA) conference in New Zealand and also locally at the Sunshine Coast Hospital and Health Service (SCHHS) Research Days. Samantha was recently awarded a Runner Up prize at the Allied Health Translating Research into Practice (AHTRIP) 2018 Queensland State-wide program and received an Excellence in Patient Care award by the SCHHS Chief Executive in 2018. Samantha’s work has featured in local research reports, social media and Dietitian Association of Australia newsletters. Samantha is currently the Senior Stroke Dietitian at the Sunshine Coast University Hospital, Australia.


NAHC Conferences

2007, Hobart (7th NAHC)

2009, Canberra (8th NAHC)

2012, Canberra (9th NAHC)

2013, Brisbane (10th NAHC)

2015, Melbourne (11th NAHC)

2017, Sydney (12th NAHC)

2019, Brisbane (13th NAHC)

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