Medicosnext
Geeta Karki
She holds a Bachelor’s degree in Nutrition and Dietetics from Tribhuvan University, Nepal, and a Master’s degree in Food Science for Nutrition from Mahidol University, Thailand. She specializes in enteral feed development and is committed to enhancing patient nutrition by applying food science principles to create optimized enteral formulas that meet individual nutritional needs. She has over three years of working experience in clinical practice and school nutrition. Her work is entirely focused in enteral nutrition and dysphagia, reflecting her core expertise and interest.
Stroke, the second leading global cause of death, is increasing in incidence and mortality, and ranks third in causing disability by DALYs. Nutrition plays a crucial role during stroke as well as during the recovery process following stroke. Nutrition intervention supports recovery of motor and cognitive function, mood, and everyday activities, while reducing the risk of complications and recurrent strokes. Timely and targeted nutritional care significantly improves rehabilitation outcomes.
Malnutrition in post-stroke patients
Malnutrition prevalence among stroke survivors varies widely, ranging from 49% to 62% in different studies. Malnutrition correlates with poor clinical and functional outcomes, including cognitive functions and disorders of consciousness, neurogenic vomiting, neurogenic dysphagia, gastrointestinal dysfunction in post-stroke patients. It also increases the risk of infections, pressure sores, and delayed healing, making early nutritional assessment and support a critical component of care.
Nutrient Deficiencies and Comorbid Conditions
Post-stroke patients often have low calcium, leading to reduced bone density, so calcium levels should be monitored during rehabilitation. Anemia is a risk factor for stroke and predicts poor outcomes. Patients are also prone to loss of muscle mass (sarcopenia), driven by age, inactivity, and malnutrition. About one-third have diabetes, requiring blood glucose control and lifestyle changes like weight loss, low-carb, and high-fiber diets for effective management.
Nutritional Assessment
Measuring body weight in immobilized stroke patients is a challenge, which makes it difficult to track nutritional changes and accurately assess the caloric needs. Alternative assessment methods include triceps skinfold thickness and mid-arm circumference. Moreover, hand grip strength using a dynamometer may be performed at the bedside as a functional test.
Biochemical tests along with clinical symptoms also help to predict nutritional status in post stroke patients along with anthropometric measurements. In addition, appropriate screening tools are advised to assess the nutritional status of patients.
Energy and Protein Needs in Rehabilitation
Calorie and protein needs often increase after a stroke, influenced by factors like age, gender, activity level, body composition, comorbidities, nutritional status, stroke severity, and rehabilitation intensity. Elderly individuals with chronic conditions may require less energy than healthy, active adults. Protein needs vary based on stress, renal/hepatic function, and demands of wound healing. For example, those with pressure ulcers need more protein, while those with kidney or liver issues need individualized plans. Protein adequacy is assessed through nitrogen balance i.e. negative balance suggests increased needs. Carbohydrates play a vital role in protein sparing; insufficient carbs lead to muscle breakdown, even with adequate protein, by promoting amino acid use for energy instead of repair.
Role of Micronutrients and Supplements
Nutritional supplements are often recommended during rehabilitation to meet the increased demand for bioactive compounds. Antioxidants and nutrients like polyphenols, PUFAs, vitamins A, C, D, B1, B6, B9, magnesium, and potassium support neural repair, immune function, and neurotransmitter synthesis. These are found in foods like leafy greens, berries, fish, liver, eggs, and whole grains. Trace minerals: zinc, magnesium, copper, iron, and selenium aid immune response and inflammation control, sourced from nuts, seeds, legumes, meats, and dairy. Deficiencies can hinder recovery and should be monitored and addressed.
Modes of Nutrition Support
When oral nutritional intake is insufficient or not possible, provided that the gastrointestinal tract is functional, enteral nutrition can be put into practice. Total parenteral nutrition can be administered if the gastrointestinal tract is non-functional and inaccessible. When oral diet is insufficient, oral nutritional supplementation can increase nutrient intake. The adequacy of any mode of feeding must be assessed by total volume and rate of delivery, tolerance checks including gastric residuals, abdominal distension, and diarrhea, electrolyte balance, and glucose test.
Feeding Challenges in Dysphagia
Dysphagia, common in stroke patients, is strongly linked to malnutrition. It is managed by modifying food texture, consistency, and viscosity to reduce aspiration risk and improve nutrient intake. Methods like chopping, blending, or tenderizing foods are customized to suit each individual’s swallowing ability. However, texture-modified diets often lack nutrients, increasing malnutrition risk. To address this, diets should be fortified or supplemented, and enteral nutrition can be provided if oral intake is compromised. Regular assessment of nutritional status and food intake is essential in managing dysphagia effectively.
Neuroprotective Dietary patterns
Adapting the nutritional balance and eating patterns to suit brain health is imperative. The Mediterranean Diet (MD) is one of such patterns which focuses on abundant quantities of different fruits and vegetables, legumes, whole grains, fish, low quantities of meat and dairy products. Dietary Approaches to Stop Hypertension (DASH) emphasizes fruits, vegetables, whole grains, nuts, seeds, moderate poultry and fish, restricted amounts of salt, sweets, and saturated fats. Stroke prevention and recovery have been demonstrated to benefit from both of these strategies. An intermingling of the MD and the DASH diet is the MIND (Mediterranean-DASH Intervention for Neurological Delay) diet makes the foods more nutrient-dense and lowers salt content. A number of studies associate MIND Diet with improvement in mental function, namely, memory and speed of processing. Overall, nutrition plays a crucial role during stroke as well as during the recovery process following stroke. Therefore, it is essential to prioritize nutrition as an indispensable component of post-stroke rehabilitation to improve long-term health outcomes and enhance quality of life.
Conclusion
Nutrition is a cornerstone of post-stroke rehabilitation. From preventing malnutrition to supporting neuroplasticity and functional recovery, dietary strategies must be prioritized alongside physical and cognitive therapies. Integrating individualized nutritional care into stroke rehabilitation programs can significantly enhance long-term outcomes and improve quality of life for survivors.
