The Food Trial Collaboration: Routine oral nutritional supplementation for stroke patients in hospital (FOOD): a multicenter randomized controlled trial. Lancet 2005;365(9461):755-63.
The FOOD Trial Collaboration: Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): a multicenter randomized controlled trial. Lancet 2005;365(9461):764-72.
After a stroke, patients often receive nutritional supplements. The authors tested several approaches to timing and use of supplemental and enteral feeding. In one trial, patients with stroke who could swallow were randomly allocated to receive normal hospital diet or normal diet plus oral nutrition supplements until hospital discharge. In a second trial, patients who were enrolled within several days of admission received either early enteral tube feeding or no tube feeding for more than 7 days. In the third trial, patients received either percutaneous endoscopic gastrostomy (PEG) or nasogastric feeding. Patients were prospectively followed to determine poor outcome or death at 6 months. Between 1996 and 2003, in 125 hospitals in 15 countries, 4,023 patients were enrolled in the first trial. In 3,709 patients (92%) who were judged to be well nourished on admission, supplemented diet was associated with an insignificant 0.7% reduction in death risk and 0.7% increased risk of death or poor outcome at 6 months. In the second trial, in 859 patients, early tube feeding was associated with a 5.8% reduced death risk (p = 0.09) and a 1.2% reduced risk of death or poor outcome (p = .7). In the PEG versus nasogastric tube trial, 321 patients were enrolled in 47 hospitals in 11 countries. Percutaneous endoscopic gastrostomy feeding was associated with an insignificant 1% increased risk of death (p = 0.9), but with a significant 7.8% increased risk of death or poor outcome (p = 0.05). These data do not support the routine use of oral supplementation after stroke or the early use of PEG and feeding tubes. Whatever slight reduction in fatality from early tube feeding might occur would be offset by increased survival with a poor outcome.