Nutrition and Stroke.

Nutrition and Stroke

Gariballa S, Blackwell Publishing, Oxford, 2004, 178 pages, $125.00, ISBN 1-4051-1120-8

Stroke is the third most common cause of death (behind heart disease and cancer) and a major cause of disability among adults in Australia. More than 48 000 strokes occur in Australia every year, with one stroke occurring on average every 11 minutes. With the ageing population this number will rise to 74 000 by the year 2017 at current rates. Stroke claimed 12 533 lives in 2002, accounting for approximately 10% of all deaths in Australia.

Research indicates that lifestyle factors, including diet, may be important in stroke prevention. Salah Gariballa's book Nutrition and Stroke--Prevention and Treatment examines how poor nutrition and diet not only influence the prevalence of stroke, but also affect the course and outcome, post stroke.

Salah Gariballa is a consultant at Barnsley General Hospital and Senior Clinical Lecturer at the Sheffield Institute for Studies on Ageing, University of Sheffield, UK. His MD and principal research interests are in nutritional aspects of ageing and age-related diseases. He is widely published in the area of nutrition and age-related diseases such as stroke, most recently protein-energy undernutrition and outcome after acute stroke--invited commentary on the International Multicentre FOOD Trial (Stroke).

The book comprises three sections: 'Nutrition and Ageing', 'Nutritional Risk Factors and Risk of Stroke' and 'Nutrition Factors Following Stroke'.

'Nutrition and Ageing' provides a thorough grounding in areas that would be familiar to many dietitians, especially those with experience in gerontology. Topics include ageing changes relevant to nutrition in elderly people, macro- and micronutrients in elderly people and diagnosing undernutrition in elderly people.

This general information brings together a large amount of well-referenced information in an easily readable format and sets the scene for section II--'Nutritional Factors and Risk of Stroke'. This section explores dietary factors in stroke prevention, including fruit and vegetable consumption, dietary sodium, calcium, magnesium, potassium, fibre, as well as fish and milk consumption, obesity, alcohol use, hyperhomocysteinaemia and maternal and foetal nutrition. Antioxidants and risk of ischaemic stroke, homocysteine and stroke and endothelial dysfunction and stroke round this section off.

Stroke patients are highly dependent on others for their nutritional requirements being met. Many are undernourished prior to admission and their nutritional status declines further while in hospital, with a subsequent increase in morbidity and mortality. Section III provides practitioners, whether they be dietitians, nurses, speech therapists or rehabilitation specialists, with valuable insights into potentially modifiable factors that influence undernutrition.

This section, 'Nutritional Factors Following Stroke', visits areas such as protein-energy undernutrition following stroke, nutritional status of special stroke groups, including patients with urinary incontinence and patients with swallowing difficulties. Urinary incontinence is associated with poor outcomes post stroke and may be at least partly due to modifiable risk factors such as undernutrition, dehydration and infections, and may be used as one criterion for selecting stroke patients for intensive treatment, according to Gariballa. This section also deals with nutritional support of elderly stroke patients and makes recommendations for future directions in stroke prevention and treatment.

With more than 500 references (31 pages) and a useful index, as well as informative subheadings and summaries at the end of each chapter, the book provides valuable information for those just beginning to work in the area of stroke as well as those with much experience. The book with its balance of public health and clinical nutrition would be a most welcome asset in any nutrition department, or for those with an interest in dealing with the epidemiology, prevention and treatment of cerebrovascular disease and stroke.

Rudi Bartl

Public Health/Community Nutritionist 

Northern Sydney Central Cost Area Health, Gosford

[c] 2006 Dietitians Association of Australia