Nutrition for Brain Recovery After Ischemic Stroke

Abstract

In patients who undergo rehabilitation after ischemic stroke, nutrition strategies are adopted to provide tube-fed individuals with adequate nutrition and/or to avoid the body wasting responsible for poor functional outcome and prolonged stay in the hospital. Investigations have documented that nutrition interventions can enhance the recovery of neurocognitive function in individuals with ischemic stroke. Experimental studies have shown that protein synthesis is suppressed in the ischemic penumbra. In clinical studies on rehabilitation patients designed to study the effects of counteracting or limiting this reduction of protein synthesis by providing protein supplementation, patients receiving such supplementation had enhanced recovery of neurocognitive function. Cellular damage in cerebral ischemia is also partly caused by oxidative damage secondary to free radical formation and lipid peroxidation. Increased oxidative stress negatively affects a patient's life and functional prognosis. Some studies have documented that nutrition supplementation with B-group vitamins may mitigate oxidative damage after acute ischemic stroke. Experimental investigations have also shown that cerebral ischemia changes synaptic zinc release and that acute ischemia increases zinc release, aggravating neuronal injury. In clinical practice, patients with ischemic stroke were found to have a lower than recommended dietary intake of zinc. Patients in whom daily zinc intake was normalized had better recovery of neurological deficits than subjects given a placebo. The aim of this review is to highlight those brain metabolic alterations susceptible to nutrition correction in clinical practice. The mechanisms underlying the relationship between cerebral ischemia and nutrition metabolic conditions are discussed.

Swallowing rehabilitation with nutrition therapy improves clinical outcome in patients with dysphagia at an acute care hospital

“…Alix et al (15) showed that resting energy expenditure of the hospitalized elderly patients was 18.8 kcal/kg/day. Foley et al (16) reported that the average energy intakes of acute stroke patients ranged from 19.4-22.3 kcal/kg/day and Aquilani et al (17) recommended daily energy intakes !25 kcal/kg/day after acute ischemic stroke.…”

Malnutrition in Patients with Acute Stroke

“…In contrast, location or type of stroke, paresis of the dominant arm, socioeconomic status, and education were not significantly associated with malnutrition [8, 12]. Interestingly, deficiency of micronutrients such as B vitamins, vitamin D, antioxidant vitamins (A, C, and E), and zinc [2, 11] appears to contribute to vasculature changes in the brain; moreover, they appear to increase the risk of stroke and cognitive impairment in the elderly (Table 1). However, how these factors are causally interrelated remains poorly understood [11].…”

“…In 2008, a stroke prevalence of 7,000,000 patients has been estimated for the US with an average of one patient dying from stroke every 4 min [1]. Across European countries, stroke incidence varies between 100 and 700 events per 100,000 inhabitants [2]. The incidence of stroke is predicted to increase over the next 5–10 years by 12% in the general population and by 20% in low-income subjects [3].…”

“…Long-term disability represents the most frequent poststroke complication with 50% of patients suffering from hemiparesis and 30% being unable to walk without assistance creating an enormous socioeconomic burden [1, 2]. …”

Feeding the brain and nurturing the mind: Linking nutrition and the gut microbiota to brain development

“…This postinjury regenerative growth process may require metabolic and nutritional resources similar to those used during development (55,56). Thus, efforts to understand these needs in the developing brains of healthy and undernourished children may enhance our ability to treat an injured adult brain (57,58).…”