Working Group

The “Nutrition and Stroke” Working Group started in 2003 and was confirmed by the SINU Board in 2016 with the following main objectives:

• participation in the development of the ISO-SPREAD Guidelines in collaboration with other scientific societies
• development of a document about the role of nutrition in the prevention of stroke

Key words: Primary and secondary prevention; Risk factors; Nutrition in the acute phase; Post-acute nutrition care (rehabilitation)

Working group: Pasquale Strazzullo (coordinator), Giulia Cairella (vice-coordinator), Barbara Biffi, Marialaura Bonaccio, Alessandro Casini, Francesca Garbagnati, Gianfranco Gensini, Rosalba Giacco, Licia Iacoviello, Maria Luisa Luisi, Alessandro Pinto, Domenico Rendina, Antonino Sage, Paola Sabino, Isabella Savini, Luca Scalfi, Umberto Scognamiglio

Distribution of TASKS FOR THE DEVELOPMENT OF ISO-SPREAD GUIDELINES

WORK ORGANIZATION FOR THE GUIDELINE REVISION 2016

An exhaustive search about the topic was initially carried out on the available databases and for relevant abstracts the manuscripts were recovered, thanks to the collaboration of Elisa Grifoni (prof. Gensini group), Giulia Cairella, Francesca Garbagnati and Paola Sabino.

Both the abstracts and then full papers have been archived for general use in the special NUTRI-STROKE folder of Dropbox.

The studies considered relevant are: RCT, prospective cohort studies, meta-analysis, case-control studies, well-conducted clinical or experimental studies on humans. First of all, studies with stroke as end point were considered relevant (e.g. association between obesity or salt consumption and stroke risk); secondly, studies relating to associations between nutritional factors and risk factors for stroke (e.g. association between sodium or potassium consumption and high blood pressure) were considered relevant.

For each study considered relevant, a summary descriptive form in ENGLISH (“Study description form”) was completed. A second form relating to the quality assessment of the work (“Quality check-list”) has been attached to the descriptive file in the same electronic file. The gradually filled in forms have been inserted in a specific sub-directory of the NUTRI-STROKE folder on Dropbox.

Each Task manager (or group of managers) has prepared an Excel file (“List of Relevant Studies”) with the indication for each relevant work of: Task Manager ID, first author name, first 10 words of the work title, complete reference, annotation on different columns of the various areas treated (rehabilitation, prevention, etc. ..). The file was also placed within the specific sub-directory on Dropbox.

METHODOLOGY FOR EVALUATION OF STUDIES, AS WELL AS THE DEGREE OF EVIDENCE AND THE STRENGTH OF THE RECOMMENDATIONS

The Working Group conformed the literature search to the guidelines preliminarily identified by the Coordinating Committee at the beginning of 2015. Basically, the SIGN quality check-list was used for the single study (different according to of the type of study). For what concerns the overall evaluation of the evidence from the studies about each topic (e.g. salt consumption and stroke risk), the SIGN graduation from 1 — to 4 was assigned according to the type, number and the quality of studies. Finally, concerning the strength of the recommendation derived for each topic, the Clinical Evidence (CE) methodology was used, according to the following classification:

• Beneficial
• Likely to be beneficial
• Unknown effectiveness
• Unlikely to be beneficial
• Likely to be ineffective or harmful

It was also established that, in the presence of good meta-analyses, it was possible to fill only one form for the whole meta-analysis and, in addition, for some of the main studies included.

At the end of the evaluation of the relevant works available about each topic, the manager of the specific Task proceeded to fill out a “Considered Judgment” on a preliminary basis (based on the SIGN and Clinical Evidence methodology), that was then subject to collective discussion and approval within the Working group.

The latest ISO-SPREAD Guidelines (8th ed.), with the contribution of the “Nutrition and Stroke” SINU Working Group, were published at the end of 2016 and are accessible here.

After publication, some members of the Working Group were engaged in a systematic review on Nutrition and Stroke focused on the primary prevention of cerebral stroke, with the coordination of Licia Iacoviello and the collaboration of Marialaura Bonaccio (acquired by the Working Group).

The document was published in 2018 in the “Nutrition, Metabolism and Cardiovascular Disease” Journal and is accessible here.

Currently, the Group is again committed to providing the contribution of SINU to the future edition of the ISO-SPREAD guidelines.

Publications:

• Linee Guida SPREAD edizioni dal 2003 al 2016 nelle sezioni dei cap 6, 7, 11 e 14 (fattori di rischio e prevenzione nutrizionale dell’ictus, fase acuta e riabilitazione nutrizionale)
• otilio G, Berni Canani R, Barba G, Branca F, Cairella G, Dilaghi B, Fieschi C, Garbagnati F, Gentile MG, Gensini GF, Gualtieri A, Inzitari D, La Massa M, Luisi ML, Mancia G, Marcelli M, Masini ML, Mastrilli F, Paolucci S, Pratesi L, Rubba P, Sacchetti ML, Salvia A, Scalfi L, Scognamiglio U, Siani A, Strazzullo P; Italian Working Group on Nutrition and Stroke Prevention. Nutritional recommendations for the prevention of ischemic stroke. Nutr Metab Cardiovasc Dis. 2004 Apr;14(2):115-20
• Strazzullo P, Scalfi L, Branca F, Cairella G, Garbagnati F, Siani A, Barba G, Rubba P, Mancia G. Nutrition and prevention of ischemic stroke: present knowledge, limitations and future perspectives. Nutr Metab Cardiovasc Dis. 2004 Apr;14(2):97-114
• G. Cairella, L. Scalfi, R. Berni Canani et al. Nutritional management of stroke patient. RINPE 2004; 22: 205-226
• Rotilio G, Berni Canani R, Branca F, Cairella G, Fieschi C, Garbagnati F, et al. Nutritional recommendations for stroke patients. RINPE 2004; 22: 227-36
• Iacoviello L, Bonaccio M, Cairella G, Catani MV, Costanzo S, D’Elia L, Giacco R, Rendina D, Sabino P, Savini I, Strazzullo P; Working Group for Nutrition and Stroke. Diet and primary prevention of stroke: Systematic review and dietary recommendations by the ad hoc Working Group of the Italian Society of Human Nutrition. Nutr Metab Cardiovasc Dis. 2018 Apr;28(4):309-334