Exploring Malnutrition and Nutritional Deficiencies in Stroke Patients with or without dysphagia

Significance 

Stroke is a leading cause of death and disability worldwide, affecting millions of people each year. One of the most common complications associated with stroke is oropharyngeal dysphagia (OD), a swallowing disorder that affects up to 80% of stroke survivors. OD can hinder the ability to eat and drink, resulting in reduced nutritional intake and an increased risk of malnutrition. Malnutrition is a serious condition that can worsen stroke outcomes and increase mortality. Consequently, it is crucial to assess and treat nutritional impairment instroke patients, particularly those with OD. However, current methods of nutritional assessment often rely on screening tools or dietary records, which may not fully capture the extent of nutritional deficiencies and requirements in stroke patients. Furthermore, there is limited data available on the blood levels of specific nutritional compounds and metabolites relevant to stroke recovery, such as vitamins, minerals, antioxidants, and omega-3 fatty acids. These compounds may play a role in modulating inflammation, oxidative stress, neurogenesis, angiogenesis, and neuroplasticity after stroke. Therefore, a more comprehensive nutritional assessment that incorporates blood biomarkers and nutritional intake could offer better insight into the nutritional status and needs of stroke patients.

In a recent study published in the peer-reviewed journal Frontiers in Neurology, Dutch scientists from Danone Nutricia Research, including Dr. Nick van Wijk, Claudia van den Berg, MSc, Dr. Dina Ripken, and Dr. Mirian Lansink, collaborated with German clinicians from two rehabilitation centers in Germany, Dr. Bettina Studer, Prof. Dr. Mario Siebler, and Prof. Dr. Tobias Schmidt-Wilcke. The researchers hypothesized that malnutrition is prevalent in sub-acute stroke patients, especially those with OD, and that this is reflected in lower blood levels of multiple nutritional compounds compared to healthy reference subjects.

To test their hypothesis, the researchers conducted a comprehensive nutritional assessment in sub-acute ischemic stroke patients during inpatient rehabilitation between ≥2 and ≤12 weeks after they had a stroke, and compared them with age- and sex-matched healthy reference subjects. Their findings revealed that over half of the stroke patients were at risk of or had malnutrition, with a higher prevalence observed in patients with OD compared to those without. Additionally, the study identified that stroke patients have lower fasted blood levels of multiple nutritional compounds, essential for stroke recovery. Blood levels of vitamins B1, B2, B6, A, D, and E, selenium, choline, coenzyme Q10, albumin, pre-albumin, transferrin, docosahexaenoic acid, and eicosapentaenoic acid were all lower in stroke patients compared to healthy reference, regardless of the presence of OD. Remarkably, well-nourished stroke patients also had lower blood levels of these nutritional compounds, similar to malnourished patients. These lower blood levels were possibly due to disease-specific changes in metabolism and absorption of these nutrients. The researchers also noted that stroke patients had lower nutritional intake, poorer quality of life, and reduced ability to perform daily activities compared to the healthy reference subjects. Furthermore, these factors were more pronounced in patients with OD.

The study underscored the importance of conducting a comprehensive nutritional assessment in sub-acute stroke patients, possibly also utilizing cheap and accessible blood biomarkers, to identify and address specific nutritional deficiencies and requirements. The authors suggested that nutritional interventions targeting the lower blood levels of nutritional compounds may benefit sub-acute stroke patients, potentially improving their stroke outcomes. However, the study acknowledged the limitations of its cross-sectional design, which prevents causal inference or longitudinal follow-up. The researchers also recognized the potential influence of unknown confounding factors on the study’s results. Consequently, they called for further research to elucidate the mechanisms and consequences of lower blood levels of nutritional compounds in stroke patients and to evaluate the feasibility and effectiveness of nutritional interventions in this population. The study emphasized the necessity of a multidisciplinary approach to address the intricate interplay among malnutrition, OD, and stroke outcomes. By contributing to the growing body of evidence on the role of nutrition in stroke care and prevention, this study advances our understanding of these important issues.

In conclusion, Dr. Nick van Wijk and colleagues demonstrated a high prevalence of malnutrition and lower blood levels of multiple nutritional compounds in sub-acute stroke patients, which could negatively impact their stroke recovery. They emphasized the need for a comprehensive nutritional assessment and management in this population and called for further research to investigate the underlying mechanisms and consequences. The study highlighted the important role of nutrition in stroke care and stressed the significance of a multidisciplinary approach to address the complex interplay among malnutrition, OD, and stroke outcomes. In a statement to Medicine Innovates, Dr. Nick van Wijk said “The lower blood levels of numerous nutritional compounds in stroke patients as found in current study may result in suboptimal substrate availability for structural and functional recovery processes after stroke.”

Exploring Malnutrition and Nutritional Deficiencies in Stroke Patients with or without dysphagia - Medicine Innovates Exploring Malnutrition and Nutritional Deficiencies in Stroke Patients with or without dysphagia - Medicine Innovates

About the author

Nick van Wijk is an accomplished scientist with over 15 years of experience in the field of nutritional science and brain research. He holds a Ph.D. in Medical Sciences from Vrije Universiteit Amsterdam, where his thesis focused on the rationale for multi-nutrient intervention in Alzheimer’s disease.

Currently, Nick serves as a senior scientist in the medical and nutritional science team focusing on the development of next generation nutritional formulas for patients with neurological diseases and disease-related malnutrition.

linkedin.com/in/nick-van-wijk-22790028

Reference

van Wijk N, Studer B, van den Berg CA, Ripken D, Lansink M, Siebler M, Schmidt-Wilcke T. Evident lower blood levels of multiple nutritional compounds and highly prevalent malnutrition in sub-acute stroke patients with or without dysphagia. Frontiers in Neurology. 2023;13:2736.

Go To Frontiers in Neurology.