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Kolanu ND, Ahmed S, Kerimkulova MK, Stańczak M, Aguirre Vera GDJ, Shaikh N, Addula AR, Cheran M, Chilla SP, Oliveira Souza Lima SR, Shehryar A, Rehman A. Influence of Nutritional Interventions on Functional Outcomes in Stroke Rehabilitation: A Systematic Review. Cureus 2024; 16:e53711. [PMID: 38455777 PMCID: PMC10918289 DOI: 10.7759/cureus.53711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 03/09/2024] Open
Abstract
Stroke, a major cause of disability worldwide, necessitates comprehensive rehabilitation, with nutrition playing a pivotal role in recovery. Our systematic review assesses the impact of nutritional interventions on stroke survivors' rehabilitation. Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically searched PubMed, Embase, Web of Science, and Scopus, using keywords related to stroke rehabilitation and nutrition. Studies were selected based on criteria emphasizing dietary interventions and their effect on functional recovery in stroke patients. The review involved detailed data extraction and synthesis, covering study design, participant characteristics, interventions, and outcomes. Five studies met our inclusion criteria, encompassing longitudinal and prospective studies, retrospective cohorts, and randomized controlled trials. These studies highlighted the importance of early nutritional assessment, particularly for sarcopenic patients, and the role of energy and protein intake soon after a stroke. Findings indicated high nutritional risk correlated with poorer functional outcomes and increased inflammation. Tailored dietary support appeared beneficial for muscle mass maintenance and overall functional recovery, especially in older patients. Our review emphasizes the critical role of nutritional interventions in stroke rehabilitation. It suggests that personalized nutritional strategies can positively impact functional recovery, notably in older and nutritionally vulnerable stroke survivors. These insights underscore the necessity of integrating dietary assessments and interventions into standard stroke rehabilitation protocols, advocating a holistic approach to patient care.
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Affiliation(s)
| | - Sheraz Ahmed
- Medicine, Islamic International Medical College, Islamabad, PAK
| | | | - Mikołaj Stańczak
- Medicine, Kharkiv Institute of Medicine and Biomedical Sciences, Kharkiv, UKR
| | | | | | | | - Meher Cheran
- Internal Medicine, American International Medical University, Chicago, USA
| | - Srikar P Chilla
- Medicine, CARE Hospitals, Hyderabad, IND
- School of Health Sciences, University of East London, London, GBR
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Cong WJ, Liu ZP, Liang YX, Ye SL, Cai ZM, Chen HM, Liao CW, Lin QL, Feng RQ, Zhou XD, Wu YZ, Sun LQ, Huang XR, Zhang MM, Huang GQ, Zhu BL. Predictive Value of Nutritional Risk for All-Cause Death and Functional Outcomes in Chinese Elderly Patients with Acute Stroke: A 3-Year Follow-Up Study. Clin Interv Aging 2024; 19:109-118. [PMID: 38250175 PMCID: PMC10800106 DOI: 10.2147/cia.s447038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 01/09/2024] [Indexed: 01/23/2024] Open
Abstract
Purpose To explore the predictive value of nutritional risk for all-cause death and functional outcomes among elderly acute stroke patients. Patients and Methods A total of 479 elderly acute stroke patients were enrolled in this study. The nutritional risk of patients was screened by the GNRI and NRS-2002. The primary outcome was all-cause death, and the secondary outcome was poor prognosis defined as a modified Rankin Scale (mRS) score ≥3. Results Based on the NRS-2002, patients with nutritional risk had a higher risk of all-cause death at 3 months (adjusted OR: 3.642, 95% CI 1.046~12.689) and at 3 years (adjusted OR: 2.266, 95% CI 1.259~4.076) and a higher risk of adverse functional outcomes at 3 months (adjusted OR: 2.748, 95% CI 1.518~4.972. Based on the GNRI, compared to those without nutritional risk, patients with mild malnutrition also had a higher risk of all-cause death at 3 months (adjusted OR: 7.186, 95% CI 1.550~33.315) and at 3 years (adjusted OR: 2.255, 95% CI 1.211~4.199) and a higher risk of adverse functional outcomes at 3 months (adjusted OR: 1.947, 95% CI 1.030~3.680), so patients with moderate and severe malnutrition had a higher risk of all-cause death at 3 months (adjusted OR: 6.535, 95% CI 1.380~30.945) and at 3 years (adjusted OR: 2.498, 95% CI 1.301~4.799) and a higher risk of adverse functional outcomes at 3 months (adjusted OR: 2.213, 95% CI 1.144~4.279). Conclusion Nutritional risk increases the risk of poor short-term and long-term outcomes in elderly patients with acute stroke. For elderly stroke patients, we should pay attention to early nutritional risk screening, and effective intervention should be provided to improve the prognosis of such patients.
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Affiliation(s)
- Wen-Jie Cong
- Department of Acupuncture and Physiotherapy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Zhi-Peng Liu
- The First Clinical School, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Yi-Xin Liang
- The First Clinical School, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Sheng-Lie Ye
- The First Clinical School, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Zhong-Ming Cai
- The First Clinical School, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Hao-Man Chen
- The First Clinical School, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Cheng-Wei Liao
- The First Clinical School, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Qun-Li Lin
- Department of Neurology, Yongjia People's Hospital, Wenzhou, Zhejiang, People's Republic of China
| | - Ren-Qian Feng
- The First Clinical School, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Xu-Dong Zhou
- Department of Neurology, Pingyang People's Hospital, Wenzhou, Zhejiang, People's Republic of China
| | - Yan-Zhi Wu
- The First Clinical School, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Le-Qiu Sun
- Department of Neurology, Affiliated Yueqing Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Xue-Rong Huang
- Department of Neurology, Ruian People's Hospital, Wenzhou, Zhejiang, People's Republic of China
| | - Man-Man Zhang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University Wenzhou Zhejiang People's Republic of China
| | - Gui-Qian Huang
- School of Mental Health, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Bei-Lei Zhu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University Wenzhou Zhejiang People's Republic of China
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Guerrini A, Siotto M, Germanotta M, Cipollini V, Cortellini L, Pavan A, Insalaco S, Khazrai YM, Aprile I. Muscle quality improvement in subacute post-stroke patients after rehabilitation: Usefulness of segmental phase angle from bioelectrical impedance analysis. Clin Nutr 2024; 43:224-231. [PMID: 38096627 DOI: 10.1016/j.clnu.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/27/2023] [Accepted: 12/01/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND & AIMS During stroke rehabilitation, the whole-body Phase Angle (PhA) from Bioelectrical Impedance Analysis (BIA) is measured to assess whole-body muscle quality, which reflects cellular integrity and function. The segmental BIA is a valuable method for assessing the body composition of specific body segments, such as the arms, legs, and hemisoma. After a stroke insult, patients frequently experience hemiparesis, and segmental PhA from segmental BIA appears to be an appropriate parameter for examining the muscle quality of affected and unaffected limbs separately. This study aims to investigate whether segmental PhA is more informative than whole-body PhA in (a) assessing the deterioration of muscle quality in post-stroke patients and (b) monitoring its recovery following rehabilitative treatment. METHODS This longitudinal study recruited subacute post-stroke patients who were admitted to our rehabilitation center. At admission, demographic, anamnestic, and clinical information, such as the presence of comorbidities, were recorded. BIA was used to evaluate the whole-body PhA and segmental PhA of the affected and unaffected hemisoma, arms, and legs at admission (T0) and after a six-week rehabilitation program (T1). The modified Barthel Index (mBI), Fugl-Meyer Assessment for the Upper Extremity (FMA-UE), and Motricity Index of the Upper (MI-UE) and Lower (MI-LE) Extremities were evaluated at T0 and T1 to determine the patient's Activity of Daily Living (ADL) performance, upper limb motor performance, and upper and lower limb muscle strength, respectively. RESULTS We evaluated segmental and whole-body BIA in 70 subacute post-stroke patients (women n = 34, ischemic n = 56, mean age 70 ± 11) at T0 and T1. Whole-body PhA values of the patients were below the normal range. Considering segmental data, the affected hemisoma, arm, and leg had considerably lower PhA values as compared to the unaffected body segments. Furthermore, at T1, the PhA values of all affected body segments improved, while those of the unaffected ones and whole-body PhA did not. At both T0 and T1, the segmental PhA values of the affected body segments showed to be related with all clinical outcome measures, while whole-body PhA correlated only with mBI. CONCLUSIONS This study emphasizes the significance of measuring segmental PhA in hemiparetic subacute stroke patients undergoing rehabilitation treatment. Segmental PhA is a more accurate parameter to evaluate rehabilitation treatment in patients with hemiparesis because it can distinguish affected from unaffected body segments, hence facilitating accurate monitoring of muscle quality improvements resulting from a rehabilitation program.
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Affiliation(s)
- Alessandro Guerrini
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143, Florence, Italy; Department of Science and Technology for Humans and the Environment, Università Campus Bio-Medico di Roma, Rome, Italy.
| | | | - Marco Germanotta
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143, Florence, Italy.
| | | | - Laura Cortellini
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143, Florence, Italy.
| | - Arianna Pavan
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143, Florence, Italy.
| | - Sabina Insalaco
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143, Florence, Italy.
| | - Yeganeh Manon Khazrai
- Department of Science and Technology for Humans and the Environment, Università Campus Bio-Medico di Roma, Rome, Italy.
| | - Irene Aprile
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143, Florence, Italy.
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Sato Y, Yoshimura Y, Abe T, Nagano F, Matsumoto A. Hospital-associated sarcopenia and the preventive effect of high energy intake along with intensive rehabilitation in patients with acute stroke. Nutrition 2023; 116:112181. [PMID: 37678013 DOI: 10.1016/j.nut.2023.112181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 07/23/2023] [Accepted: 07/25/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVES Hospital-associated sarcopenia is prevalent and associated with poor outcomes in acutely admitted patients. Prevention of developing sarcopenia during hospitalization is an important factor in stroke management. Therefore, this study aimed to investigate whether energy intake and rehabilitation duration contribute to the prevention of hospital-associated sarcopenia in patients with acute stroke. METHODS Patients with acute stroke were included in this study. Energy intake during the first week of hospitalization was classified as "high" or "low" based on the reported cutoff value. Rehabilitation time during hospitalization was classified as "intense" or "mild" based on the median. The four groups were compared based on the combinations of high or low energy intake and intense or mild rehabilitation. The primary outcome was the development of sarcopenia during hospitalization. The secondary outcome was the Functional Independence Measure motor item gain during hospitalization. Multivariate analysis was performed with the primary or secondary outcome as the dependent variable and the effect of each group on the outcome was examined. RESULTS A total of 112 participants (mean age = 70.6 y; 63 men) were included in the study. Multivariate analysis found that high × intense (odds ratio = 0.113; P = 0.041) was independently associated with the development of sarcopenia during hospitalization (i.e., hospital-related sarcopenia). High × intense (β = 0.395; P < 0.001) was independently associated with the gain of Functional Independence Measure motor items. CONCLUSIONS In patients with acute stroke, the combination of high energy intake and adequate rehabilitation time is associated with prevention of hospital-associated sarcopenia.
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Affiliation(s)
- Yoichi Sato
- Department of Rehabilitation, Uonuma Kikan Hospital, Niigata, Japan
| | - Yoshihiro Yoshimura
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan.
| | - Takafumi Abe
- Department of Rehabilitation, Uonuma Kikan Hospital, Niigata, Japan
| | - Fumihiko Nagano
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Ayaka Matsumoto
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
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Di Vincenzo O, Pagano E, Cervone M, Natale R, Morena A, Esposito A, Pasanisi F, Scalfi L. High Nutritional Risk Is Associated with Poor Functional Status and Prognostic Biomarkers in Stroke Patients at Admission to a Rehabilitation Unit. Nutrients 2023; 15:4144. [PMID: 37836427 PMCID: PMC10574786 DOI: 10.3390/nu15194144] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
Considering that malnutrition (undernutrition) is common in stroke patients and may negatively impact body function, the aim of this study was to determine the relationship between nutritional risk and functional status in stroke patients at admission to a rehabilitation unit. Nutritional risk was assessed using the Geriatric Nutritional Risk Index (GNRI), the Prognostic Nutritional Index (PNI) and the Controlling Nutritional Status (CONUT) score. Functional status was assessed using the Barthel Index, the modified Rankin Scale, the Trunk Control Test and the Sitting Balance Scale, and cognitive function was assessed using the Short Portable Mental Status Questionnaire. C-reactive protein, fibrinogen and D-dimer were also evaluated as established prognostic biomarkers. Stroke patients (n = 245; age 69.7 ± 12.8 years; 47%, women; 82% ischemic stroke) at admission to a rehabilitation unit were included in this study. A high prevalence of nutritional risk was detected with each tool and was found to be greater using the GNRI and in patients aged ≥75 years. Multiple logistic regression analysis showed that age and dysphagia were independent predictors of high nutritional risk. High risk groups performed worse on all functional tests compared to the low-risk groups (p < 0.05). Nutritional risk with each tool was associated with functional and cognitive statuses (with the highest correlation being with the Trunk Control Test). Significant associations were also found with C-reactive protein, fibrinogen and D-dimer. In conclusion, a high nutritional risk, as evaluated with the GNRI, the PNI and the CONUT score, was detected in stroke patients at admission to a rehabilitation unit. High nutritional risk was associated with functional status and with predictors of clinical outcomes (and specifically in older patients).
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Affiliation(s)
- Olivia Di Vincenzo
- Department of Public Health, School of Medicine, Federico II University, via Sergio Pansini 5, 80131 Naples, Italy;
| | - Ermenegilda Pagano
- Casa di Cura Santa Maria del Pozzo Hospital, via Pomigliano 40, Somma Vesuviana, 80049 Naples, Italy; (E.P.); (M.C.); (A.E.)
| | - Mariarosaria Cervone
- Casa di Cura Santa Maria del Pozzo Hospital, via Pomigliano 40, Somma Vesuviana, 80049 Naples, Italy; (E.P.); (M.C.); (A.E.)
| | - Raffaele Natale
- Department of Clinical Medicine and Surgery, School of Medicine, Federico II University, via Sergio Pansini 5, 80131 Naples, Italy; (R.N.); (A.M.); (F.P.)
| | - Annadora Morena
- Department of Clinical Medicine and Surgery, School of Medicine, Federico II University, via Sergio Pansini 5, 80131 Naples, Italy; (R.N.); (A.M.); (F.P.)
| | - Alessandra Esposito
- Casa di Cura Santa Maria del Pozzo Hospital, via Pomigliano 40, Somma Vesuviana, 80049 Naples, Italy; (E.P.); (M.C.); (A.E.)
| | - Fabrizio Pasanisi
- Department of Clinical Medicine and Surgery, School of Medicine, Federico II University, via Sergio Pansini 5, 80131 Naples, Italy; (R.N.); (A.M.); (F.P.)
| | - Luca Scalfi
- Department of Public Health, School of Medicine, Federico II University, via Sergio Pansini 5, 80131 Naples, Italy;
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Gao Z, Chen H. Advances in the beneficial effects of nutrition on stroke-related Sarcopenia: A narrative review. Medicine (Baltimore) 2023; 102:e34048. [PMID: 37327307 PMCID: PMC10270533 DOI: 10.1097/md.0000000000034048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/30/2023] [Indexed: 06/18/2023] Open
Abstract
Stroke is one of the most common causes of disability in adults. Sarcopenia is a syndrome characterized by progressive systemic muscle loss and functional decline. The decrease in skeletal muscle mass and muscle function throughout the body after stroke cannot be explained by neurological motor disorders due to brain injury alone, it is considered to be a secondary sarcopenia known as stroke-related sarcopenia. Mounting evidences showed that stroke-related sarcopenia might promote the occurrence and development of sarcopenia through various pathogenesis such as muscle atrophy, dysphagia, inflammation, and malnutrition, etc. At present, the main indicators used to assess malnutrition in patients with stroke-related sarcopenia include temporalis muscle thickness, calf circumference, phase angle, geriatric nutritional risk index and mini-nutritional assessment short-form, etc. Currently, there is no particularly effective method to curb its progression, but supplementation with essential amino acids, whey protein combined with vitamin D, high energy diet, avoiding Polypharmacy, as well as increasing physical activity level and reducing sedentary lifestyle may improve the malnutrition status of stroke patients, and increase the muscle mass and skeletal muscle index, further delay or even prevent the development of stroke-related sarcopenia. This article reviews the latest research progress on the characteristics, epidemiology, pathogenesis and the role of nutrition in stroke-related sarcopenia, so as to provide reference for the clinical treatment and rehabilitation of stroke-related sarcopenia.
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Affiliation(s)
- Zhiqiang Gao
- School of Public Health, Hubei University of Medicine, Shiyan, China
| | - Hongxia Chen
- Institute of Biomedical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, China
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Siotto M, Aprile I. Nutrition in Post-Stroke Subjects during Rehabilitation. Nutrients 2023; 15:2056. [PMID: 37432198 DOI: 10.3390/nu15092056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 04/21/2023] [Indexed: 07/12/2023] Open
Abstract
Correct and appropriate nutrition after a stroke insult appears to exert an essential influence on, and play a key role in, the recovery of patients [...].
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Affiliation(s)
| | - Irene Aprile
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Florence, Italy
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The Assessment of the Risk of Malnutrition (Undernutrition) in Stroke Patients. Nutrients 2023; 15:nu15030683. [PMID: 36771390 PMCID: PMC9921740 DOI: 10.3390/nu15030683] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
Malnutrition is common in stroke patients, as it is associated with neurological and cognitive impairment as well as clinical outcomes. Nutritional screening is a process with which to categorize the risk of malnutrition (i.e., nutritional risk) based on validated tools/procedures, which need to be rapid, simple, cost-effective, and reliable in the clinical setting. This review focuses on the tools/procedures used in stroke patients to assess nutritional risk, with a particular focus on their relationships with patients' clinical characteristics and outcomes. Different screening tools/procedures have been used in stroke patients, which have shown varying prevalence in terms of nutritional risk (higher in rehabilitation units) and significant relationships with clinical outcomes in the short- and long term, such as infection, disability, and mortality. Indeed, there have been few attempts to compare the usefulness and reliability of the different tools/procedures. More evidence is needed to identify appropriate approaches to assessing nutritional risk among stroke patients in the acute and sub-acute phase of disease or during rehabilitation; to evaluate the impact of nutritional treatment on the risk of malnutrition during hospital stay or rehabilitation unit; and to include nutritional screening in well-defined nutritional care protocols.
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Influence of Oxidative Stress and Inflammation on Nutritional Status and Neural Plasticity: New Perspectives on Post-Stroke Neurorehabilitative Outcome. Nutrients 2022; 15:nu15010108. [PMID: 36615766 PMCID: PMC9823808 DOI: 10.3390/nu15010108] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/13/2022] [Accepted: 12/18/2022] [Indexed: 12/28/2022] Open
Abstract
Beyond brain deficits caused by strokes, the effectiveness of neurorehabilitation is strongly influenced by the baseline clinical features of stroke patients, including a patient's current nutritional status. Malnutrition, either as a pre-stroke existing condition or occurring because of ischemic injury, predisposes patients to poor rehabilitation outcomes. On the other hand, a proper nutritional status compliant with the specific needs required by the process of brain recovery plays a key role in post-stroke rehabilitative outcome favoring neuroplasticity mechanisms. Oxidative stress and inflammation play a role in stroke-associated malnutrition, as well as in the cascade of ischemic events in the brain area, where ischemic damage leads to neuronal death and brain infarction, and, via cell-to-cell signaling, the alteration of neuroplasticity processes underlying functional recovery induced by multidisciplinary rehabilitative treatment. Nutrition strategies based on food components with oxidative and anti-inflammatory properties may help to reverse or stop malnutrition and may be a prerequisite for supporting the ability of neuronal plasticity to result in satisfactory rehabilitative outcome in stroke patients. To expand nutritional recommendations for functional rehabilitation recovery, studies considering the evolution of nutritional status changes in post-stroke patients over time are required. The assessment of nutritional status must be included as a routine tool in rehabilitation settings for the integrated care of stroke-patients.
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