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Premorbid nutrition and short term outcome of stroke: a multicentre study from India
  1. Jeyaraj Durai Pandian1,
  2. Rashmi Jyotsna2,
  3. Ruma Singh2,
  4. Padmavati N Sylaja3,
  5. Pamidimukkala Vijaya4,
  6. Madakasira Vasantha Padma5,
  7. Kolichana Venkateswaralu6,
  8. Sajith Sukumaran7,
  9. Kurupath Radhakrishnan7,
  10. Prabhakaran S Sarma8,
  11. Robert Mathew9,
  12. Yashpal Singh1
  1. 1Stroke Unit, Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
  2. 2Department of Dietetics, Christian Medical College, Ludhiana, Punjab, India
  3. 3Stroke Unit, Ananthapuri Hospitals and Research Centre, Thiruvananthapuram, Kerala, India
  4. 4Stroke Unit, Department of Neurology, Brain and Heart Centre, Guntur, Andhra Pradesh, India
  5. 5Department of Neurology, All India Institute for Medical Sciences, New Delhi, India
  6. 6Department of Neurology, Andhra Medical College, Vizagapatnam, Andhra Pradesh, India
  7. 7Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
  8. 8Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
  9. 9Department of Neurology, Government Medical College, Trivandrum, Kerala
  1. Correspondence to Professor J D Pandian, Department of Neurology, Head of Research, Betty Cowan Research and Innovation Centre, Christian Medical College and Hospital, Ludhiana, Punjab, India; jeyarajpandian{at}


Background Little is known about the impact of premorbid undernutrition on stroke outcome in developing countries.

Aim To study the impact of premorbid undernutrition status, measured by the Subjective Global Assessment (SGA) tool, on short term stroke outcome.

Methods First ever stroke patients admitted to six major hospitals in North and South India participated in this study from 1 March 2008 to 30 September 2009. The SGA tool was administered within 48 h of stroke onset, and 6 months premorbid nutritional status was rated as well nourished (A rating) and undernourished (B and C ratings) using this tool. Stroke outcome was assessed after 30 days using the modified Rankin scale (mRs), and a mRs score >3 was defined as a poor outcome. Statistical analyses were performed using SPSS Statistics V.17.0.

Results Of 477 patients enrolled, 448 patients were included in the analyses. Mean age was 58.1±13.7 years (range 16–96) and 281 (62.7%) patients were men. At admission, premorbid undernutrition was found in 121 (27.2%) patients. Older age (OR 4.99, CI 1.26 to 19.64, p=0.021), hypertension (OR 1.99, CI 1.04 to 3.79, p=0.037) and patients from Andhra Pradesh State (OR 1.87, CI 1.05 to 3.32, p=0.032) were predictors of undernutrition in multiple logistic regression analysis. Premorbid undernutrition (OR 1.99, CI 1.20 to 3.31, p=0.007) and length of hospital stay (OR 3.41, CI 1.91 to 6.06, p<0.0001) were the independent predictors of poor outcome in the multiple logistic regression model.

Conclusions High rates of premorbid undernutrition in stroke patients were found. Age, hypertension and patients from Andhra Pradesh State were predictors of premorbid undernutrition. Premorbid undernutrition was associated with poor stroke outcome. The results provide opportunities for primary prevention and improving stroke outcome.

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  • Funding CMC Neurology Intramural Research Fund.

  • Competing interests None.

  • Ethics approval The study was approved by the ethics committee in four centres and by the institutional research committee in two centres.

  • Provenance and peer review Not commissioned; externally peer reviewed.