FOOD Trials: Implications for Dietetic Practice

Earlier I posted a brief description of and links to the FOOD Trials, a series of three large, multi-centre, randomized controlled studies that attempted to answer questions about feeding stroke patients.

Here, in the researchers own words, are how the trial results can be applied to practice:

Study 1: Can oral supplementation improve stroke outcome?

On the basis of our results and our surveys of UK practice, it seems likely that patients who are judged to be undernourished on admission or who have deteriorating nutritional status in hospital will be offered oral nutritional supplements.....However, our data do not support use of routine supplementation of hospital diet for unselected stroke patients who are mainly well nourished on admission (The Lancet, Vol 365 February 26, 2005 p. 762).

Studies 2 & 3: Do timing and/or route of enteral feeding affect stroke outcome at 6 months?

Our data would suggest that to reduce case fatality, unless there is a strong indication to delay enteral tube feeding (such indications would have excluded such patients from the FOOD trial), dysphagic stroke patients should be offered enteral tube feeding via a nasogastric tube within the first few days of admission. Also, for enteral feeding within the first 2 or 3 weeks, nasogastric feeding should be the chosen route unless there is a strong practical reason to choose PEG feeding (eg, the patient cannot tolerate a nasogastric tube) (The Lancet, Vol 365 February 26, 2005 p. 771).

The authors also state:

Early tube feeding might reduce case fatality, but at the expense of increasing the proportion surviving with poor outcome. Our data do not support a policy of early initiation of PEG feeding in dysphagic stroke patients (The Lancet, Vol 365 February 26, 2005 p. 764).