The FOOD trial - Feeding policy for patients with stroke
Lancet 2005; 365: 755-63
Lancet 2005; 365: 764-72
The Stroke Association funded a successful pilot study, and went on to partly fund the FOOD (Feed Or Ordinary Diet) trials in collaboration with NHS R&D, the Scottish Executive and Chest, Heart and Stroke Scotland. The trials are the largest ever multicentre international trials researching feeding policy for patients with stroke. Lead by Professor Martin Dennis (Professor of Stroke Medicine, Edinburgh) the trials aimed to identify the best way of feeding stroke patients by establishing which methods lead to a better chance of recovery.
Trial 1
Nutritional supplements may be given to stroke patients alongside the hospital diet, providing additional protein and energy. However, hospital practice varies considerably, and patients may be overfed or undernourished as a result. 4023 patients from 125 hospitals in 15 countries were monitored to determine whether patients' outcomes at 6 months after stroke could be improved by adding nutritional supplements to the standard hospital diet. However, no significant improvement was found, and it was concluded that supplements should only be routinely administered to undernourished patients and patients with deteriorating nutritional status. This would also save vital resources for those who needed them.
Trial 2
Patients experiencing swallowing difficulties (dysphagia), may require tube feeding. Although early tube feeding may be nutritionally beneficial, there can be complications. 859 patients from 83 hospitals in 15 countries were monitored to establish whether early tube feeding resulted in better outcomes for patients. Fatality was reduced by nearly 6% in patients who received early tube feeding, when compared with patients where early feeding was avoided. However, early tube feeding was associated with future disability, with patients being heavily dependent on others for the activities of daily living. Professor Dennis and colleagues concluded that although the number of deaths may be reduced when tube feeding is initiated early, the number of survivors with severe disability may be increased.
Trial 3
The type of feeding tube used varies substantially in UK hospitals. Nasogastric tubes reach the stomach via the nose, and percutaneous endoscopic gastronomy (PEG) tubes are surgically inserted into the stomach through the abdominal wall. The best route of feeding is unclear, which may result in ineffective treatment. 321 patients from 47 hospitals in 11 countries were examined to determine which route of tube feeding leads to better outcomes at 6 months following stroke. Nasogastric tube feeding was found to be safer, and it is suggested that this method is used in patients who require tube feeding within the first 2 or 3 weeks after stroke. Fatality and poor outcome was significantly higher for patients who were fed via PEG tube. It was suggested that PEG feeding should be reserved for patients who cannot be fed via a nasogastric tube, or where tube feeding is prolonged.
Press Release 29.06.05 - Early tube feeding reduces deaths in stroke patients with swallowing difficulties
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