Dietary Intake and Intervention in Chronic Stroke: Review of the Evidence

Abstract

Despite evidence for a role of nutrition in the development of metabolic dysfunction, physical deconditioning, and psychological dysfunction common post-stroke, very little is known about the dietary habits and nutritional needs of chronic (>6 months) stroke survivors. This review summarizes the available evidence regarding dietary intake adequacy in chronic stroke survivors. It appears that a combination of screening methods, including food record, laboratory and malnutrition screening tools assessments may be beneficial to assess the dietary intake adequacy of stroke survivors. We also review the evidence suggesting the need for dietary modification by summarizing the strongest evidence (i.e., randomized controlled trial data) supporting and refuting the impact of nutritional interventions on clinical outcomes post-stroke. Data suggest that the B vitamins, omega 3s and vitamin D have promising effects on recovery post-stroke; however, to date, study limitations make drawing definitive conclusions regarding the impact of nutritional supplementation difficult. Further research is needed to provide insight on the ideal supplement dose and duration and about how different rehabilitation therapies (i.e., nutritional supplements, medications, exercise and caloric restriction) may interact to affect recovery. A better understanding of the role of nutrition during chronic stroke is needed as this information may one day help to individualize rehabilitation approaches to optimize patient outcomes.

The Importance of Assessing Nutritional Status to Ensure Optimal Recovery during the Chronic Phase of Stroke

“…Clinicians should consider the careful evaluation of dietary intake, especially among those with eating disabilities and preexisting malnutrition, in order to identity individuals at increased nutritional risk. A recent review summarizes the promising effects of nutritional modification, including oral intake retraining and alteration of dining conditions, behavior modification (i.e., reducing alcohol and fat intake and increasing fruit and vegetable intake), and supplementation on secondary stroke prevention, physical functioning, depression, and cognitive function in chronic stroke survivors [ 77 ]. Thus, the identification of suboptimal nutrient intake may allow for early intervention to maximize nutritional status, aid recovery and rehabilitation, and prevent further complications after stroke.…”

Evidence Surrounding Dietary Behavior Interventions in Community-Dwelling Stroke Survivors: A Scoping Review

“…In contrast, published reviews have examined post-stroke nutritional status, nutritional supplementation, and nutritional insufficiency in response to swallowing difficulties, particularly among survivors in acute care and survivors within 6 months poststroke. [12][13][14][15] However, those findings do not generalize to communitydwelling survivors without swallowing difficulties and survivors more than 6 months post-stroke. Thus, there is an obvious knowledge gap regarding dietary behavior intervention and dietary outcomes among community-dwelling stroke survivors.…”