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Meta-Analysis
. 2024 Aug 15;8(8):CD014852.
doi: 10.1002/14651858.CD014852.pub2.

Nutritional therapy for reducing disability and improving activities of daily living in people after stroke

Kotomi Sakai  1   2 , Masachika Niimi  3 , Ryo Momosaki  4 , Eri Hoshino  2 , Daisuke Yoneoka  5 , Enri Nakayama  6 , Kaoru Masuoka  7 , Tomomi Maeda  8 , Nao Takahashi  8 , Nobuo Sakata  1   9
Affiliations
Meta-Analysis

Nutritional therapy for reducing disability and improving activities of daily living in people after stroke

Kotomi Sakai et al. Cochrane Database Syst Rev. .

Abstract

Background: Stroke patients often face disabilities that significantly interfere with their daily lives. Poor nutritional status is a common issue amongst these patients, and malnutrition can severely impact their functional recovery post-stroke. Therefore, nutritional therapy is crucial in managing stroke outcomes. However, its effects on disability, activities of daily living (ADL), and other critical outcomes have not been fully explored.

Objectives: To evaluate the effects of nutritional therapy on reducing disability and improving ADL in patients after stroke.

Search methods: We searched the trial registers of the Cochrane Stroke Group, CENTRAL, MEDLINE (from 1946), Embase (from 1974), CINAHL (from 1982), and AMED (from 1985) to 19 February 2024. We also searched trials and research registries (ClinicalTrials.gov, World Health Organization International Clinical Trials Registry Platform) and reference lists of articles.

Selection criteria: We included randomised controlled trials (RCTs) that compared nutritional therapy with placebo, usual care, or one type of nutritional therapy in people after stroke. Nutritional therapy was defined as the administration of supplemental nutrients, including energy, protein, amino acids, fatty acids, vitamins, and minerals, through oral, enteral, or parenteral methods. As a comparator, one type of nutritional therapy refers to all forms of nutritional therapies, excluding the specific nutritional therapy defined for use in the intervention group.

Data collection and analysis: We used Cochrane's Screen4Me workflow to assess the initial search results. Two review authors independently screened references that met the inclusion criteria, extracted data, and assessed the risk of bias and the certainty of the evidence using the GRADE approach. We calculated the mean difference (MD) or standardised mean difference (SMD) for continuous data and the odds ratio (OR) for dichotomous data, with 95% confidence intervals (CIs). We assessed heterogeneity using the I2 statistic. The primary outcomes were disability and ADL. We also assessed gait, nutritional status, all-cause mortality, quality of life, hand and leg muscle strength, cognitive function, physical performance, stroke recurrence, swallowing function, neurological impairment, and the development of complications (adverse events) as secondary outcomes.

Main results: We identified 52 eligible RCTs involving 11,926 participants. Thirty-six studies were conducted in the acute phase, 10 in the subacute phase, three in the acute and subacute phases, and three in the chronic phase. Twenty-three studies included patients with ischaemic stroke, three included patients with haemorrhagic stroke, three included patients with subarachnoid haemorrhage (SAH), and 23 included patients with ischaemic or haemorrhagic stroke including SAH. There were 25 types of nutritional supplements used as an intervention. The number of studies that assessed disability and ADL as outcomes were nine and 17, respectively. For the intervention using oral energy and protein supplements, which was a primary intervention in this review, six studies were included. The results for the seven outcomes focused on (disability, ADL, body weight change, all-cause mortality, gait speed, quality of life, and incidence of complications (adverse events)) were as follows: There was no evidence of a difference in reducing disability when 'good status' was defined as an mRS score of 0 to 2 (for 'good status': OR 0.97, 95% CI 0.86 to 1.10; 1 RCT, 4023 participants; low-certainty evidence). Oral energy and protein supplements may improve ADL as indicated by an increase in the FIM motor score, but the evidence is very uncertain (MD 8.74, 95% CI 5.93 to 11.54; 2 RCTs, 165 participants; very low-certainty evidence). Oral energy and protein supplements may increase body weight, but the evidence is very uncertain (MD 0.90, 95% CI 0.23 to 1.58; 3 RCTs, 205 participants; very low-certainty evidence). There was no evidence of a difference in reducing all-cause mortality (OR 0.57, 95% CI 0.14 to 2.28; 2 RCTs, 4065 participants; low-certainty evidence). For gait speed and quality of life, no study was identified. With regard to incidence of complications (adverse events), there was no evidence of a difference in the incidence of infections, including pneumonia, urinary tract infections, and septicaemia (OR 0.68, 95% CI 0.20 to 2.30; 1 RCT, 42 participants; very low-certainty evidence). The intervention was associated with an increased incidence of diarrhoea compared to usual care (OR 4.29, 95% CI 1.98 to 9.28; 1 RCT, 4023 participants; low-certainty evidence) and the occurrence of hyperglycaemia or hypoglycaemia (OR 15.6, 95% CI 4.84 to 50.23; 1 RCT, 4023 participants; low-certainty evidence).

Authors' conclusions: We are uncertain about the effect of nutritional therapy, including oral energy and protein supplements and other supplements identified in this review, on reducing disability and improving ADL in people after stroke. Various nutritional interventions were assessed for the outcomes in the included studies, and almost all studies had small sample sizes. This led to challenges in conducting meta-analyses and reduced the precision of the evidence. Moreover, most of the studies had issues with the risk of bias, especially in terms of the absence of blinding and unclear information. Regarding adverse events, the intervention with oral energy and protein supplements was associated with a higher number of adverse events, such as diarrhoea, hyperglycaemia, and hypoglycaemia, compared to usual care. However, the quality of the evidence was low. Given the low certainty of most of the evidence in our review, further research is needed. Future research should focus on targeted nutritional interventions to reduce disability and improve ADL based on a theoretical rationale in people after stroke and there is a need for improved methodology and reporting.

Trial registration: ClinicalTrials.gov NCT01810263 NCT02982668.

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Conflict of interest statement

  1. Kotomi Sakai: Published a review related to this topic in 2018 in the Journal of Nutrition, Health & Aging. Work as a researcher: Department of Research, Heisei Medical Welfare Group Research Institute. A researcher in the Division of Policy Evaluation, Department of Health Policy, Research Institute, National Center for Child Health and Development. Work as a health professional: speech‐language‐hearing therapist, Sakai Heisei Hospital.

  2. Masachika Niimi: Work as a health professional: medical doctor, Department of Rehabilitation Medicine, Nihon University School of Medicine. Any affiliation to an organisation (including not‐for‐profit) that has a declared opinion or position on the topic: member, The Japan Stroke Society.

  3. Ryo Momosaki: Work as a health professional: medical doctor, Department of Rehabilitation Medicine, Mie University Graduate School of Medicine.

  4. Eri Hoshino: Work as a researcher: Division of Policy Evaluation, Department of Health Policy, Research Institute, National Center for Child Health and Development.

  5. Daisuke Yoneoka: Work as a statistician: Infectious Disease Surveillance Center at the National Institute of Infectious Diseases.

  6. Enri Nakayama: Work as a health professional: dentist, Department of Dysphagia Rehabilitation, Nihon University School of Dentistry.

  7. Kaoru Masuoka: A Master of Public Health student: Graduate School of Public Health, St. Luke’s International University.

  8. Tomomi Maeda: Work as a researcher: Comprehensive Unit for Health Economic Evidence Review and Decision Support (CHEERS), Research Organization of Science and Technology, Ritsumeikan University.

  9. Nao Takahashi: A visiting researcher, Comprehensive Unit for Health Economic Evidence Review and Decision Support (CHEERS), Research Organization of Science and Technology, Ritsumeikan University.

  10. Nobuo Sakata: Works as a Director of the Heisei Medical Welfare Group Research Institute and a medical doctor at Setagaya Memorial Hospital. A researcher in the Department of Health Services Research, Faculty of Medicine, University of Tsukuba.

Figures

1
1
Risk of bias summary
2
2
Risk of bias graph
3
3
Prisma flow diagram
1.1
1.1. Analysis
Comparison 1: Oral nutritional supplements (energy and protein) versus no supplements, Outcome 1: Disability (modified Rankin Scale 0 to 2, good status) at follow‐up
1.2
1.2. Analysis
Comparison 1: Oral nutritional supplements (energy and protein) versus no supplements, Outcome 2: Activities of daily living (Functional Independence Measure, Motor score) at end of intervention phase
1.3
1.3. Analysis
Comparison 1: Oral nutritional supplements (energy and protein) versus no supplements, Outcome 3: Subgroup analysis – type of stroke: activities of daily living
1.4
1.4. Analysis
Comparison 1: Oral nutritional supplements (energy and protein) versus no supplements, Outcome 4: Neurological impairment (change in NIHSS score) during intervention phase
1.5
1.5. Analysis
Comparison 1: Oral nutritional supplements (energy and protein) versus no supplements, Outcome 5: Walking capacity (2‐minute walk test) at end of intervention phase
1.6
1.6. Analysis
Comparison 1: Oral nutritional supplements (energy and protein) versus no supplements, Outcome 6: Walking capacity (6‐minute walk test) at end of intervention phase
1.7
1.7. Analysis
Comparison 1: Oral nutritional supplements (energy and protein) versus no supplements, Outcome 7: Muscle strength (grip strength) at end of intervention phase
1.8
1.8. Analysis
Comparison 1: Oral nutritional supplements (energy and protein) versus no supplements, Outcome 8: Nutritional status change (body weight ) during intervention phase
1.9
1.9. Analysis
Comparison 1: Oral nutritional supplements (energy and protein) versus no supplements, Outcome 9: Subgroup analysis – type of stroke: nutritional status (body weight )
1.10
1.10. Analysis
Comparison 1: Oral nutritional supplements (energy and protein) versus no supplements, Outcome 10: Subgroup analysis – nutritional status at baseline: nutritional status (body weight )
1.11
1.11. Analysis
Comparison 1: Oral nutritional supplements (energy and protein) versus no supplements, Outcome 11: Nutritional status (triceps skinfold thickness) at end of intervention phase
1.12
1.12. Analysis
Comparison 1: Oral nutritional supplements (energy and protein) versus no supplements, Outcome 12: All‐cause mortality at follow‐up
1.13
1.13. Analysis
Comparison 1: Oral nutritional supplements (energy and protein) versus no supplements, Outcome 13: Subgroup analysis – type of stroke: all‐cause mortality
1.14
1.14. Analysis
Comparison 1: Oral nutritional supplements (energy and protein) versus no supplements, Outcome 14: Subgroup analysis – nutritional status at baseline: all‐cause mortality
1.15
1.15. Analysis
Comparison 1: Oral nutritional supplements (energy and protein) versus no supplements, Outcome 15: Stroke recurrence at end of intervention phase
1.16
1.16. Analysis
Comparison 1: Oral nutritional supplements (energy and protein) versus no supplements, Outcome 16: Change in cognitive function score (Mini‐Mental State Examination) during intervention phase
1.17
1.17. Analysis
Comparison 1: Oral nutritional supplements (energy and protein) versus no supplements, Outcome 17: Complication (pressure sores) during intervention phase
1.18
1.18. Analysis
Comparison 1: Oral nutritional supplements (energy and protein) versus no supplements, Outcome 18: Complications (infections: pneumonia, urinary tract, and septicaemias) during intervention phase
1.19
1.19. Analysis
Comparison 1: Oral nutritional supplements (energy and protein) versus no supplements, Outcome 19: Complication (pneumonia) during intervention phase
1.20
1.20. Analysis
Comparison 1: Oral nutritional supplements (energy and protein) versus no supplements, Outcome 20: Complication (urinary tract infection) during intervention phase
1.21
1.21. Analysis
Comparison 1: Oral nutritional supplements (energy and protein) versus no supplements, Outcome 21: Complication (hyper/hypoglycaemia) during intervention phase
1.22
1.22. Analysis
Comparison 1: Oral nutritional supplements (energy and protein) versus no supplements, Outcome 22: Complication (gastrointestinal haemorrhage) during intervention phase
1.23
1.23. Analysis
Comparison 1: Oral nutritional supplements (energy and protein) versus no supplements, Outcome 23: Complication (diarrhoea) during intervention phase
2.1
2.1. Analysis
Comparison 2: Oral nutritional supplements (vitamin D) versus no supplements, Outcome 1: Disability (modified Rankin Scale 0 to 2, good status) at end of intervention
2.2
2.2. Analysis
Comparison 2: Oral nutritional supplements (vitamin D) versus no supplements, Outcome 2: Activities of daily living (change in Barthel Index or Functional Independence Measure) at end of intervention phase
2.3
2.3. Analysis
Comparison 2: Oral nutritional supplements (vitamin D) versus no supplements, Outcome 3: Sensitivity analysis: Activities of daily living (change in Barthel Index or Functional Independence Measure) at end of intervention phase
2.4
2.4. Analysis
Comparison 2: Oral nutritional supplements (vitamin D) versus no supplements, Outcome 4: Subgroup analysis – type of stroke: activities of daily living (Barthel Index and Functional Independence Measure)
2.5
2.5. Analysis
Comparison 2: Oral nutritional supplements (vitamin D) versus no supplements, Outcome 5: Nutritional status (change in calf circumference) during intervention phase
2.6
2.6. Analysis
Comparison 2: Oral nutritional supplements (vitamin D) versus no supplements, Outcome 6: All‐cause mortality at end of intervention phase
2.7
2.7. Analysis
Comparison 2: Oral nutritional supplements (vitamin D) versus no supplements, Outcome 7: Muscle strength (change in grip strength) during intervention phase
3.1
3.1. Analysis
Comparison 3: Oral nutritional supplements (protein) versus no supplements, Outcome 1: Disability (modified Rankin Scale) at end of intervention phase
3.2
3.2. Analysis
Comparison 3: Oral nutritional supplements (protein) versus no supplements, Outcome 2: Walking capacity (6‐minute walk test) at end of intervention phase
3.3
3.3. Analysis
Comparison 3: Oral nutritional supplements (protein) versus no supplements, Outcome 3: Nutritional status (proportion of skeletal muscle atrophy) at end of intervention phase
3.4
3.4. Analysis
Comparison 3: Oral nutritional supplements (protein) versus no supplements, Outcome 4: Nutritional status (change in lean mass) during intervention phase
3.5
3.5. Analysis
Comparison 3: Oral nutritional supplements (protein) versus no supplements, Outcome 5: Quality of life (short‐form NeuroQoL measurement tool, fatigue) at end of follow‐up
3.6
3.6. Analysis
Comparison 3: Oral nutritional supplements (protein) versus no supplements, Outcome 6: Quality of life (short‐form NeuroQoL measurement tool, lower extremity mobility) at end of follow‐up
3.7
3.7. Analysis
Comparison 3: Oral nutritional supplements (protein) versus no supplements, Outcome 7: Quality of life (short‐form NeuroQoL measurement tool, cognition) at end of follow‐up
3.8
3.8. Analysis
Comparison 3: Oral nutritional supplements (protein) versus no supplements, Outcome 8: Physical performance (Fugl‐Meyer Assessment, lower extremity function) at end of intervention phase
3.9
3.9. Analysis
Comparison 3: Oral nutritional supplements (protein) versus no supplements, Outcome 9: Physical performance (Timed Up & Go test) at end of intervention phase
3.10
3.10. Analysis
Comparison 3: Oral nutritional supplements (protein) versus no supplements, Outcome 10: Physical performance (Berg Balance Scale) at end of intervention phase
3.11
3.11. Analysis
Comparison 3: Oral nutritional supplements (protein) versus no supplements, Outcome 11: Complication (pneumonia) during intervention phase
3.12
3.12. Analysis
Comparison 3: Oral nutritional supplements (protein) versus no supplements, Outcome 12: Complication (urinary tract infection) during intervention phase
3.13
3.13. Analysis
Comparison 3: Oral nutritional supplements (protein) versus no supplements, Outcome 13: Neurological impairment (change in NIHSS score) during intervention phase
4.1
4.1. Analysis
Comparison 4: Oral nutritional supplements (protein and vitamin D) versus no supplements, Outcome 1: Activities of daily living (Functional Independence Measure, Motor score) at end of intervention phase
4.2
4.2. Analysis
Comparison 4: Oral nutritional supplements (protein and vitamin D) versus no supplements, Outcome 2: Gait speed (10‐metre walk test) at end of intervention phase
4.3
4.3. Analysis
Comparison 4: Oral nutritional supplements (protein and vitamin D) versus no supplements, Outcome 3: Walking capacity (6‐minute walk test) at end of intervention phase
4.4
4.4. Analysis
Comparison 4: Oral nutritional supplements (protein and vitamin D) versus no supplements, Outcome 4: Nutritional status (skeletal muscle index) at end of intervention phase
4.5
4.5. Analysis
Comparison 4: Oral nutritional supplements (protein and vitamin D) versus no supplements, Outcome 5: Nutritional status (cross‐sectional area of total thigh muscle area: paretic side) at end of intervention phase
4.6
4.6. Analysis
Comparison 4: Oral nutritional supplements (protein and vitamin D) versus no supplements, Outcome 6: Nutritional status (cross‐sectional area of total thigh muscle area: non‐paretic side) at end of intervention phase
4.7
4.7. Analysis
Comparison 4: Oral nutritional supplements (protein and vitamin D) versus no supplements, Outcome 7: Nutritional status (cross‐sectional area of normal thigh muscle area: paretic side) at end of intervention phase
4.8
4.8. Analysis
Comparison 4: Oral nutritional supplements (protein and vitamin D) versus no supplements, Outcome 8: Nutritional status (cross‐sectional area of normal thigh muscle area: non‐paretic side) at end of intervention phase
4.9
4.9. Analysis
Comparison 4: Oral nutritional supplements (protein and vitamin D) versus no supplements, Outcome 9: Nutritional status (cross‐sectional area of thigh muscle area with fat infiltration: paretic side) at end of intervention phase
4.10
4.10. Analysis
Comparison 4: Oral nutritional supplements (protein and vitamin D) versus no supplements, Outcome 10: Nutritional status (cross‐sectional area of thigh muscle area with fat infiltration: non‐paretic side) at end of intervention phase
4.11
4.11. Analysis
Comparison 4: Oral nutritional supplements (protein and vitamin D) versus no supplements, Outcome 11: Nutritional status (body weight) at end of intervention phase
4.12
4.12. Analysis
Comparison 4: Oral nutritional supplements (protein and vitamin D) versus no supplements, Outcome 12: Muscle strength (grip strength, paretic side) at end of intervention phase
4.13
4.13. Analysis
Comparison 4: Oral nutritional supplements (protein and vitamin D) versus no supplements, Outcome 13: Muscle strength (grip strength, non‐paretic side) at end of intervention phase
4.14
4.14. Analysis
Comparison 4: Oral nutritional supplements (protein and vitamin D) versus no supplements, Outcome 14: Muscle strength (knee‐extensor strength, paretic side) at end of intervention phase
4.15
4.15. Analysis
Comparison 4: Oral nutritional supplements (protein and vitamin D) versus no supplements, Outcome 15: Muscle strength (knee‐extensor strength, non‐paretic side) at end of intervention phase
4.16
4.16. Analysis
Comparison 4: Oral nutritional supplements (protein and vitamin D) versus no supplements, Outcome 16: Physical performance (30‐second chair test) at end of intervention phase
4.17
4.17. Analysis
Comparison 4: Oral nutritional supplements (protein and vitamin D) versus no supplements, Outcome 17: Physical performance (Timed Up & Go test) at end of intervention phase
5.1
5.1. Analysis
Comparison 5: Oral nutritional supplements (vitamin C and vitamin D) versus no supplements, Outcome 1: Stroke recurrence at follow‐up
6.1
6.1. Analysis
Comparison 6: Oral nutritional supplements (zinc) versus no supplements, Outcome 1: Neurological impairment (NIHSS score) at end of intervention phase
6.2
6.2. Analysis
Comparison 6: Oral nutritional supplements (zinc) versus no supplements, Outcome 2: Nutritional status (body weight) at end of intervention phase
7.1
7.1. Analysis
Comparison 7: Oral nutritional supplements (fatty acids) versus no supplements, Outcome 1: Quality of life (SF‐36, physical component scale) at end of intervention phase
7.2
7.2. Analysis
Comparison 7: Oral nutritional supplements (fatty acids) versus no supplements, Outcome 2: Quality of life (SF‐36, mental component scale) at end of intervention phase
8.1
8.1. Analysis
Comparison 8: Early enteral nutrition versus control, Outcome 1: Disability: modified Rankin Scale (mRS 0 to 3, good status) at follow‐up
8.2
8.2. Analysis
Comparison 8: Early enteral nutrition versus control, Outcome 2: Activities of daily living (Barthel Index score) at end of intervention phase
8.3
8.3. Analysis
Comparison 8: Early enteral nutrition versus control, Outcome 3: Subgroup analysis – type of stroke: activities of daily living (Barthel Index score)
8.4
8.4. Analysis
Comparison 8: Early enteral nutrition versus control, Outcome 4: Activity of daily living (independent) at end of intervention phase
8.5
8.5. Analysis
Comparison 8: Early enteral nutrition versus control, Outcome 5: Neurological impairment (NIHSS score) at and of intervention phase
8.6
8.6. Analysis
Comparison 8: Early enteral nutrition versus control, Outcome 6: Subgroup analysis – type of stroke: neurological impairment (NIHSS)
8.7
8.7. Analysis
Comparison 8: Early enteral nutrition versus control, Outcome 7: Neurological improvement (NIHSS score, ≥ 90% decrease ) at and of intervention phase
8.8
8.8. Analysis
Comparison 8: Early enteral nutrition versus control, Outcome 8: Nutritional status (triceps skinfold thickness) at end of intervention phase
8.9
8.9. Analysis
Comparison 8: Early enteral nutrition versus control, Outcome 9: Subgroup analysis – type of stroke: nutritional status (triceps skinfold thickness)
8.10
8.10. Analysis
Comparison 8: Early enteral nutrition versus control, Outcome 10: Nutritional status (arm muscular circumference) at end of intervention phase
8.11
8.11. Analysis
Comparison 8: Early enteral nutrition versus control, Outcome 11: Subgroup analysis – type of stroke: nutritional status (arm muscular circumference)
8.12
8.12. Analysis
Comparison 8: Early enteral nutrition versus control, Outcome 12: Swallowing function (water swallow test score) at end of intervention phase
8.13
8.13. Analysis
Comparison 8: Early enteral nutrition versus control, Outcome 13: All‐cause mortality at follow‐up
8.14
8.14. Analysis
Comparison 8: Early enteral nutrition versus control, Outcome 14: Subgroup analysis – type of stroke: mortality
8.15
8.15. Analysis
Comparison 8: Early enteral nutrition versus control, Outcome 15: Stroke recurrence at follow‐up
8.16
8.16. Analysis
Comparison 8: Early enteral nutrition versus control, Outcome 16: Complication (pneumonia) during intervention phase
8.17
8.17. Analysis
Comparison 8: Early enteral nutrition versus control, Outcome 17: Subgroup analysis – type of stroke: pneumonia
8.18
8.18. Analysis
Comparison 8: Early enteral nutrition versus control, Outcome 18: Complication (urinary tract infection) during intervention phase
8.19
8.19. Analysis
Comparison 8: Early enteral nutrition versus control, Outcome 19: Subgroup analysis – type of stroke: urinary tract infection
8.20
8.20. Analysis
Comparison 8: Early enteral nutrition versus control, Outcome 20: Complication (intestinal infection) during intervention phase
8.21
8.21. Analysis
Comparison 8: Early enteral nutrition versus control, Outcome 21: Subgroup analysis – type of stroke: intestinal infection
8.22
8.22. Analysis
Comparison 8: Early enteral nutrition versus control, Outcome 22: Complication (sepsis) during intervention phase
8.23
8.23. Analysis
Comparison 8: Early enteral nutrition versus control, Outcome 23: Complication (pressure sores) during intervention phase
8.24
8.24. Analysis
Comparison 8: Early enteral nutrition versus control, Outcome 24: Complication (vomiting) during intervention phase
8.25
8.25. Analysis
Comparison 8: Early enteral nutrition versus control, Outcome 25: Complication (diarrhoea) during intervention phase
8.26
8.26. Analysis
Comparison 8: Early enteral nutrition versus control, Outcome 26: Complication (gastrointestinal haemorrhage) during intervention phase
8.27
8.27. Analysis
Comparison 8: Early enteral nutrition versus control, Outcome 27: Subgroup analysis – type of stroke: gastrointestinal haemorrhage
8.28
8.28. Analysis
Comparison 8: Early enteral nutrition versus control, Outcome 28: Complication (renal problems) during intervention phase
9.1
9.1. Analysis
Comparison 9: Enteral nutritional supplements (high energy and multi‐nutrients) versus no supplements, Outcome 1: Nutritional status (arm muscular circumference) at end of intervention phase
9.2
9.2. Analysis
Comparison 9: Enteral nutritional supplements (high energy and multi‐nutrients) versus no supplements, Outcome 2: Nutritional status (triceps skinfold thickness) at end of intervention phase
9.3
9.3. Analysis
Comparison 9: Enteral nutritional supplements (high energy and multi‐nutrients) versus no supplements, Outcome 3: Complication (pneumonia) during intervention phase
9.4
9.4. Analysis
Comparison 9: Enteral nutritional supplements (high energy and multi‐nutrients) versus no supplements, Outcome 4: Complication (urinary tract infection) during intervention phase
9.5
9.5. Analysis
Comparison 9: Enteral nutritional supplements (high energy and multi‐nutrients) versus no supplements, Outcome 5: Complication (intestinal infection) during intervention phase
9.6
9.6. Analysis
Comparison 9: Enteral nutritional supplements (high energy and multi‐nutrients) versus no supplements, Outcome 6: Complication (pressure sores) during intervention phase
10.1
10.1. Analysis
Comparison 10: Enteral nutritional supplements (energy) versus no supplements, Outcome 1: Activity of daily living (ADL score) at end of intervention phase
10.2
10.2. Analysis
Comparison 10: Enteral nutritional supplements (energy) versus no supplements, Outcome 2: Neurological impairment (NIHSS score) at end of intervention phase
10.3
10.3. Analysis
Comparison 10: Enteral nutritional supplements (energy) versus no supplements, Outcome 3: Subgroup analysis – type of stroke: NIHSS score
10.4
10.4. Analysis
Comparison 10: Enteral nutritional supplements (energy) versus no supplements, Outcome 4: Physical performance (Fugl‐Meyer Assessment score) at end of intervention phase
10.5
10.5. Analysis
Comparison 10: Enteral nutritional supplements (energy) versus no supplements, Outcome 5: Quality of life (SF‐36, Physiological Function score) at end of intervention phase
10.6
10.6. Analysis
Comparison 10: Enteral nutritional supplements (energy) versus no supplements, Outcome 6: Quality of life (SF‐36, Role Function score) at end of intervention phase
10.7
10.7. Analysis
Comparison 10: Enteral nutritional supplements (energy) versus no supplements, Outcome 7: Quality of life (SF‐36, Physical Pain score) at end of intervention phase
10.8
10.8. Analysis
Comparison 10: Enteral nutritional supplements (energy) versus no supplements, Outcome 8: Quality of life (SF‐36, General Health score) at end of intervention phase
10.9
10.9. Analysis
Comparison 10: Enteral nutritional supplements (energy) versus no supplements, Outcome 9: Quality of life (SF‐36, Mental Health score) at end of intervention phase
10.10
10.10. Analysis
Comparison 10: Enteral nutritional supplements (energy) versus no supplements, Outcome 10: Quality of life (SF‐36, Energy score) at end of intervention phase
10.11
10.11. Analysis
Comparison 10: Enteral nutritional supplements (energy) versus no supplements, Outcome 11: Quality of life (SF‐36, Social Function score) at end of intervention phase
10.12
10.12. Analysis
Comparison 10: Enteral nutritional supplements (energy) versus no supplements, Outcome 12: Quality of life (SF‐36, Emotional Function score) at end of intervention phase
10.13
10.13. Analysis
Comparison 10: Enteral nutritional supplements (energy) versus no supplements, Outcome 13: Complication (pneumonia) during intervention phase
10.14
10.14. Analysis
Comparison 10: Enteral nutritional supplements (energy) versus no supplements, Outcome 14: Complication (urinary tract infection) during intervention phase
10.15
10.15. Analysis
Comparison 10: Enteral nutritional supplements (energy) versus no supplements, Outcome 15: Complication (intestinal infection) during intervention phase
11.1
11.1. Analysis
Comparison 11: Enteral nutritional supplements (fatty acids) versus no supplements, Outcome 1: Complication (pressure sores) during intervention phase
12.1
12.1. Analysis
Comparison 12: Oral or enteral nutritional supplements (essential amino acids) versus no supplements, Outcome 1: Activities of daily living (Functional Independence Measure, total score) at end of intervention phase
12.2
12.2. Analysis
Comparison 12: Oral or enteral nutritional supplements (essential amino acids) versus no supplements, Outcome 2: Nutritional status (body weight) at end of intervention phase
12.3
12.3. Analysis
Comparison 12: Oral or enteral nutritional supplements (essential amino acids) versus no supplements, Outcome 3: Swallowing function (Dysphagia Outcome and Severity Scale score) at end of intervention phase
12.4
12.4. Analysis
Comparison 12: Oral or enteral nutritional supplements (essential amino acids) versus no supplements, Outcome 4: Swallowing function (improvement in Dysphagia Outcome and Severity Scale score) at end of intervention phase
13.1
13.1. Analysis
Comparison 13: Oral or enteral individualised nutritional therapy versus control, Outcome 1: Activities of daily living (Functional Independence Measure, motor score) at follow‐up
13.2
13.2. Analysis
Comparison 13: Oral or enteral individualised nutritional therapy versus control, Outcome 2: Nutritional status (change in body weight) during follow‐up or intervention phase
13.3
13.3. Analysis
Comparison 13: Oral or enteral individualised nutritional therapy versus control, Outcome 3: Subgroup analysis – nutritional status at baseline: change in body weight
13.4
13.4. Analysis
Comparison 13: Oral or enteral individualised nutritional therapy versus control, Outcome 4: Nutritional status (thigh circumference, paretic side) at follow‐up
13.5
13.5. Analysis
Comparison 13: Oral or enteral individualised nutritional therapy versus control, Outcome 5: Nutritional status (thigh circumference, non‐paretic side) at follow‐up
13.6
13.6. Analysis
Comparison 13: Oral or enteral individualised nutritional therapy versus control, Outcome 6: Nutritional status (calf circumference, paretic side) at follow‐up
13.7
13.7. Analysis
Comparison 13: Oral or enteral individualised nutritional therapy versus control, Outcome 7: Nutritional status (calf circumference, non‐paretic side) at follow‐up
13.8
13.8. Analysis
Comparison 13: Oral or enteral individualised nutritional therapy versus control, Outcome 8: Nutritional status (arm circumference, paretic side) at follow‐up
13.9
13.9. Analysis
Comparison 13: Oral or enteral individualised nutritional therapy versus control, Outcome 9: Nutritional status (arm circumference, non‐paretic side) at follow‐up
13.10
13.10. Analysis
Comparison 13: Oral or enteral individualised nutritional therapy versus control, Outcome 10: Nutritional status (arm circumference, dominant or non‐dominant arm) at end of intervention phase
13.11
13.11. Analysis
Comparison 13: Oral or enteral individualised nutritional therapy versus control, Outcome 11: Nutritional status (arm muscular circumference) at end of intervention phase
13.12
13.12. Analysis
Comparison 13: Oral or enteral individualised nutritional therapy versus control, Outcome 12: Nutritional status (triceps skinfold thickness) at end of intervention phase
13.13
13.13. Analysis
Comparison 13: Oral or enteral individualised nutritional therapy versus control, Outcome 13: Cognitive function (Functional Independence Measure, cognition score) at follow‐up
13.14
13.14. Analysis
Comparison 13: Oral or enteral individualised nutritional therapy versus control, Outcome 14: Quality of life (EQ‐5D questionnaire, improvement in mobility) at follow‐up
13.15
13.15. Analysis
Comparison 13: Oral or enteral individualised nutritional therapy versus control, Outcome 15: Quality of life (EQ‐5D questionnaire, improvement in self‐care) at follow‐up
13.16
13.16. Analysis
Comparison 13: Oral or enteral individualised nutritional therapy versus control, Outcome 16: Quality of life (EQ‐5D questionnaire, improvement in usual activities) at follow‐up
13.17
13.17. Analysis
Comparison 13: Oral or enteral individualised nutritional therapy versus control, Outcome 17: Quality of life (EQ‐5D questionnaire, improvement in pain/discomfort) at follow‐up
13.18
13.18. Analysis
Comparison 13: Oral or enteral individualised nutritional therapy versus control, Outcome 18: Quality of life (EQ‐5D questionnaire, improvement in anxiety/depression) at follow‐up
13.19
13.19. Analysis
Comparison 13: Oral or enteral individualised nutritional therapy versus control, Outcome 19: Muscle strength (change in grip strength) at follow‐up
13.20
13.20. Analysis
Comparison 13: Oral or enteral individualised nutritional therapy versus control, Outcome 20: All‐cause mortality at follow‐up
14.1
14.1. Analysis
Comparison 14: Early parenteral nutrition versus control, Outcome 1: Activity of daily living (independent) at end of intervention phase
14.2
14.2. Analysis
Comparison 14: Early parenteral nutrition versus control, Outcome 2: All‐cause mortality at follow‐up
14.3
14.3. Analysis
Comparison 14: Early parenteral nutrition versus control, Outcome 3: Complication (pneumonia) during intervention phase
14.4
14.4. Analysis
Comparison 14: Early parenteral nutrition versus control, Outcome 4: Complication (intestinal infection) during intervention phase
14.5
14.5. Analysis
Comparison 14: Early parenteral nutrition versus control, Outcome 5: Complication (sepsis) during intervention phase
15.1
15.1. Analysis
Comparison 15: Parenteral nutritional supplements (amino acids) versus no supplements, Outcome 1: Nutritional status (decreased nutritional status) during intervention phase
16.1
16.1. Analysis
Comparison 16: Parenteral (selenium, zinc, vitamin C, and vitamin B1) and enteral (vitamin E) supplements versus no supplements, Outcome 1: Complication (pneumonia) during intervention phase
17.1
17.1. Analysis
Comparison 17: Oral and parenteral supplements (fatty acids) versus no supplements, Outcome 1: Disability (Glasgow Outcome Scale Extended score 1 to 4, poor status) at follow‐up
17.2
17.2. Analysis
Comparison 17: Oral and parenteral supplements (fatty acids) versus no supplements, Outcome 2: Stroke recurrence at follow‐up
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Aquilani 2008a {published data only}
    1. Aquilani R, Scocchi M, Boschi F, Viglio S, Iadarola P, Pastoris O, et al. Effect of calorie-protein supplementation on the cognitive recovery of patients with subacute stroke. Nutritional Neuroscience 2008;11(5):235-40. - PubMed
Aquilani 2008b {published data only}
    1. Aquilani R, Scocchi M, Iadarola P, Franciscone P, Verri M, Boschi F, et al. Protein supplementation may enhance the spontaneous recovery of neurological alterations in patients with ischaemic stroke. Clinical Rehabilitation 2008;22:1042-50. - PubMed
Aquilani 2009 {published data only}
    1. Aquilani R, Baiardi P, Scocchi M, Iadarola P, Verri M, Sessarego P, et al. Normalization of zinc intake enhances neurological retrieval of patients suffering from ischemic strokes. Nutritional Neuroscience 2009;12(5):219–25. - PubMed
Aquilani 2014 {published data only}
    1. Aquilani R, Boselli M, D'Antona G, Baiardi P, Boschi F, Viglio S, et al. Unaffected arm muscle hypercatabolism in dysphagic subacute stroke patients: the effects of essential amino acid supplementation. BioMed Research International 2014;2014:964365. - PMC - PubMed
Aquilani 2015 {published data only}
    1. Aquilani R, Emilio B, Dossena M, Baiardi P, Testa A, Boschi F, et al. Correlation of deglutition in subacute ischemic stroke patients with peripheral blood adaptive immunity: essential amino acid improvement. International Journal of Immunopathology and Pharmacology 2015;28(4):576–83. - PubMed
Badjatia 2021 {published data only}
    1. Badjatia N, Sanchez S, Haymore J, Judd G, Motta M, Parikh G, et al. Impact of neuromuscular electrical stimulation and high protein supplementation on recovery after subarachnoid hemorrhage. Neurocritical Care (Conference: 17th Annual Meeting, Neurocritical Care Society) 2019;31(Suppl 1):1–341.
    1. Badjatia N, Sanchez S, Judd G, Hausladen R, Hering D, Motta M, et al. Neuromuscular electrical stimulation and high-protein supplementation after subarachnoid hemorrhage: a single-center phase 2 randomized clinical trial. Neurocritical Care 2021;35(1):46–55. - PMC - PubMed
Beeharry 2014 {published data only}
    1. Beeharry S, Petrova MV, Butrov AV, Storchai M. The role of high protein nutritional support on the nutritional status and in correcting hyper-catabolic syndrome in patients suffering from ischemic stroke. Clinical Nutrition 2014;33:S67.
Berger 2008 {published data only}
    1. Berger MM, Soguel L, Shenkin A, Revelly JP, Pinget C, Baines M, et al. Influence of early antioxidant supplements on clinical evolution and organ function in critically ill cardiac surgery, major trauma, and subarachnoid hemorrhage patients. Critical Care 2008;12(4):R101. - PMC - PubMed
Cheng 2019 {published data only}
    1. Cheng YH, Wei L, Chan WP, Hsu CY, Huang SW, Wang H, et al. Effects of protein supplementation on aerobic training-induced gains in cardiopulmonary fitness, muscle mass, and functional performance in chronic stroke: a randomized controlled pilot study. Clinical Nutrition 2020;39(9):2743-50. - PubMed
Daga 1997 {published data only}
    1. Daga MK, Madhuchhanda, Mishra TK, Mohan A. Lipid peroxide, beta-carotene and alpha-tocopherol in ischaemic stroke and effect of exogenous vitamin E supplementation on outcome. Journal of the Association of Physicians of India 1997;45(11):843–6. - PubMed
Dang 2018 {published data only}
    1. Dang Y, Zhang G. Effects of early enteral nutrition on sub-acute ischemic stroke via gut microbiota reconstruction: a randomized controlled trial. Journal of Gastroenterology and Hepatology 2018;33(Suppl 4):219.
Dang 2023 {published data only}
    1. Dang J, Li G, Wu Q, Pian G, Wang Z. Impacts of evidence-based nursing combined with enteral nutrition on nutritional status and quality of life in acute cerebral infarction patients: a randomized controlled trial. Perfusion 2023;Vol not reported:2676591231223910. [DOI: 10.1177/02676591231223910] - DOI - PubMed
Das 2021 {published data only}
    1. Das KC, Dube SK, Rath GP, Jena BR, Roy H, Bithal P, et al. Nutrition in stroke patients: comparison of indirect calorimetry vs. standard weight-based regimen. Anesthesia and Analgesia 2021;133(Suppl 2):956.
De Aguilar‐Nascimento 2011 {published data only}
    1. De Aguilar-Nascimento JE, Prado Silveira BR, Dock-Nascimento DB. Early enteral nutrition with whey protein or casein in elderly patients with acute ischemic stroke: a double-blind randomized trial. Nutrition 2011;27(4):440-4. - PubMed
Dennis 2005a {published data only}
    1. Dennis M, Lewis S, Cranswick G, Forbes J, FOOD Trial Collaboration. FOOD: a multicentre randomised trial evaluating feeding policies in patients admitted to hospital with a recent stroke. Health Technology Assessment 2006;10(2):1-120. - PubMed
    1. Dennis MS, Lewis SC, Warlow C. Routine oral nutritional supplementation for stroke patients in hospital (FOOD): a multicentre randomised controlled trial. Lancet 2005;365(9461):755-63. - PubMed
    1. Dennis MS. The FOOD trial 1 - results of a multicentre RCT comparing outcomes of stroke patients given routine oral nutritional supplements in addition to normal hospital diet with those given normal hospital diet alone. Stroke 2004;35(6):e200.
    1. Dennis MS. The FOOD trial 1 - results of a multicentre RCT evaluating the effects of routine oral nutritional supplements on hospitalised stroke patients. Cerebrovascular Diseases 2004;17(Suppl 5):39.
    1. Prosser-Loose EJ, Paterson PG. The FOOD Trial Collaboration: nutritional supplementation strategies and acute stroke outcome. Nutrition Reviews 2006;64(6):289-94. - PubMed
Dennis 2005b {published data only}
    1. Dennis MS, Lewis SC, Warlow C. Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): a multicentre randomised controlled trial. Lancet 2005;365(9461):764-72. - PubMed
    1. Dennis MS. The FOOD trial 2 - results of a multicentre RCT comparing early versus delayed enteral tube feeding after acute stroke. Cerebrovascular Diseases 2004;17(Suppl 5):39.
    1. Dennis MS. The FOOD trial 2 - results of a multicentre RCT comparing outcomes of dysphagic acute stroke patients fed early via an enteral tube with those where enteral feeding was avoided for at least a week. Stroke 2004;35(6):e286.
    1. Teasell R, Foley N. Results from the FOOD trial. Lancet Neurology 2005;4(5):267. - PubMed
Gao 2008 {published data only}
    1. Gao JX, Su YY. Effects of two enteral nutrition formulas with equal calorie and different carbohydrate on plasma glucose in acute stroke patients: a randomized controlled study. Chinese Journal of Clinical Nutrition 2008;4:209-15.
Garbagnati 2009 {published data only}
    1. Garbagnati F, Cairella G, De Martino A, Multari M, Scognamiglio U, Venturiero V, et al. Is antioxidant and n-3 supplementation able to improve functional status in poststroke patients? Results from the Nutristroke Trial. Cerebrovascular Diseases 2009;27(4):375–83. - PubMed
Gariballa 1998 {published data only}
    1. Gariballa SE, Parker SG, Taub N, Castleden CM. A randomized, controlled, a single-blind trial of nutritional supplementation after acute stroke. Journal of Parenteral and Enteral Nutrition 1998;22(5):315–9. - PubMed
Gupta 2016 {published data only}
    1. Gupta A, Prabhakar S, Modi M, Bhadada SK, Kalaivani M, Lal V, et al. Effect of vitamin D and calcium supplementation on ischaemic stroke outcome: a randomised controlled open-label trial. International Journal of Clinical Practice 2016;70(9):764–70. - PubMed
Ha 2010a {published data only}
    1. Ha L, Hauge T, Iversen PO. Individualised nutritional supplementation improves quality of life in elderly patients hospitalised with acute stroke; a randomised controlled trial. Stroke 2009;40(4):e237-e238.
    1. Ha L, Hauge T, Spenning AB, Iversen PO. Individual, nutritional support prevents undernutrition, increases muscle strength and improves QoL among elderly at nutritional risk hospitalized for acute stroke: a randomized, controlled trial. Clinical Nutrition 2010;29(5):567–73. - PubMed
    1. Iversen PO, Ha L, Blomhoff R, Hauge T, Veierød MB. Baseline oxidative defense and survival after 5-7 years among elderly stroke patients at nutritional risk: follow-up of a randomized, nutritional intervention trial. Clinical Nutrition 2015;34(4):775-8. - PubMed
Ha 2010b {published data only}
    1. Ha L, Hauge T, Iversen PO. Body composition in older acute stroke patients after treatment with individualized, nutritional supplementation while in hospital. BMC Geriatrics 2010;10:75. - PMC - PubMed
Hashemilar 2020 {published data only}
    1. Hashemilar M, Khalili M, Rezaeimanesh N, Sadeghi Hokmabadi E, Rasulzade S, Shamshirgaran SM, et al. Effect of whey protein supplementation on inflammatory and antioxidant markers, and clinical prognosis in acute ischemic stroke (TNS trial): a randomized, double blind, controlled, clinical trial. Advanced Pharmaceutical Bulletin 2020;10(1):135–40. - PMC - PubMed
Honaga 2022 {published data only}
    1. Honaga K, Mori N, Akimoto T, Tsujikawa M, Kawakami M, Okamoto T, et al. Investigation of the effect of nutritional supplementation with whey protein and vitamin D on muscle mass and muscle quality in subacute post-stroke rehabilitation patients: a randomized, single-blinded, placebo-controlled trial. Nutrients 14;3:685. - PMC - PubMed
Kadri 2020 {published data only}
    1. Kadri A, Sjahrir H, Juwita Sembiring R, Ichwan M. Combination of vitamin A and D supplementation for ischemic stroke: effects on interleukin-1s and clinical outcome. Medicinski Glasnik: official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina 2020;17(2):425–32. - PubMed
Kang 2023 {published data only}
    1. Kang T, Xue Y, Yang Q, Lei Q. Analysis of the effect of early nutritional support on clinical treatment and prognosis of emergency patients with severe intracerebral hemorrhage. Panminerva Medica 2023;65(3):424–5. - PubMed
Laviano 2011 {published data only}
    1. Laviano A, Aghilone F, Colagiovanni D, Fiandra F, Giambarresi R, Tordiglione P, et al. Metabolic and clinical effects of the supplementation of a functional mixture of amino acids in cerebral hemorrhage. Neurocritical Care 2011;14(1):44–9. - PubMed
Li 2008 {published data only}
    1. Li MY, Xia F, Su JH. Effect of enteral nutrition support on prognosis in patients with severe acute stroke. Journal of Clinical Neurology (China) 2008;21(3):171-3.
Li 2014 {published data only}
    1. Li Y, Pei Y, Sun M. Effects of early enteral nutrition support on the nutritional status and outcomes of patients with post-stroke dysphagia [Chinese]. Chinese Journal of Clinical Nutrition 2014;22(6):334-8.
Li 2016 {published data only}
    1. Li Y, Dai J, Zhang S, Li X-Z. Clinical value of early enteral nutrition support in patients with acute cerebral infarction accompanied with dysphagia. World Chinese Journal of Digestology 2016;24(4):618-22.
Mohan 2015 {published data only}
    1. Mohan R, Beeharry S, Petrova MV, Butrov AV. Correction of protein-energy malnutrition in mechanically ventilated patients suffering from severe ischemic stroke. Clinical Nutrition 2015;34:S33.
Momosaki 2019 {published data only}
    1. Momosaki R, Abo M, Urashima M. Vitamin D supplementation and post-stroke rehabilitation: a randomized, double-blind, placebo-controlled trial. Nutrients 11;6:1295. - PMC - PubMed
Ogawa 2021 {published data only}
    1. Ogawa K. Effect of enteral nutrition with eicosapentaenoic acids for prevention of bedsores in cerebrovascular disease patients. Clinical Nutrition ESPEN 2021;46:S763.
Otsuki 2020 {published and unpublished data}
    1. Otsuki I, Himuro N, Tatsumi H, Mori M, Niiya Y, Kumeta Y, et al. Individualized nutritional treatment for acute stroke patients with malnutrition risk improves functional independence measurement: a randomized controlled trial. Geriatrics & Gerontology International 2020;20(3):176–82. - PubMed
Ouyang 2003 {published data only}
    1. Ouyang HM, Wang XH, Song HQ. Applied research on early enteral nutrition in patiens with severe cerebral infarction. Chinese Journal of Clinical Rehabilitation 2003;7(28):3836-7.
Pan 2017 {published data only}
    1. Pan WH, Lai YH, Yeh WT, Chen JR, Jeng JS, Bai CH, et al. Intake of potassium-and magnesium-enriched salt improves functional outcome after stroke: a randomized, multicenter, double-blind controlled trial. American Journal of Clinical Nutrition 2017;106(5):1267–73. - PubMed
Poppitt 2009 {published data only}
    1. Poppitt SD, Howe CA, Lithander FE, Silvers KM, Lin RB, Croft J, et al. Effects of moderate-dose omega-3 fish oil on cardiovascular risk factors and mood after ischemic stroke: a randomized, controlled trial. Stroke 2009;40:11. - PubMed
Rabadi 2008 {published data only}
    1. Bergstrom N. Intensive nutritional supplementation improved functional outcome after stroke. Evidence-Based Nursing 2009;12:85. - PubMed
    1. Rabadi MH, Coar PL, Lukin M, Lesser M, Blass JP. Intensive nutritional supplements can improve outcomes in stroke rehabilitation. Neurology 2008;71(23):1856-61. - PubMed
Saito 2017 {published data only}
    1. Saito G, Zapata R, Rivera R, Zambrano H, Rojas D, Acevedo H, et al. Long-chain omega-3 fatty acids in aneurysmal subarachnoid hemorrhage: a randomized pilot trial of pharmaconutrition. Surgical Neurology International 2017;8:304. - PMC - PubMed
Sato 2022 {published data only}
    1. Sato C, Kamijo YI, Sakurai Y, Araki S, Sakata Y, Ishigame A, et al. Three-week exercise and protein intake immediately after exercise increases the 6-min walking distance with simultaneously improved plasma volume in patients with chronic cerebrovascular disease: a preliminary prospective study. BMC Sports Science, Medicine & Rehabilitation 2022;14(1):38. - PMC - PubMed
Tajiri 2008 {published data only}
    1. Tajiri H, Mori T, Iwata T, Miyazaki Y, Nakazaki M. Short-term clinical outcome following gastrointestinal tube feeding of immunonutritionoriented (IMPACT®) or protein-oriented food (PEMVest®) in acute stroke management [Japanese]. Japanese Journal of Stroke 2011;33(3):305-12. [DOI: ]
    1. Tajiri H, Mori T, Iwata T, Nakazaki M. Short-term clinical outcome following gastro-intestinal tube feeding by immunonutrition-oriented or protein-oriented food in acute stroke management. Preliminary results. International Journal of Stroke 2008;3 (Suppl 1):239.
Toole 2004 {published data only}
    1. Spence JD, Bang H, Chambless LE, Stampfer MJ. Vitamin intervention for stroke prevention trial. An efficacy analysis. Stroke; Journal of Cerebral Circulation 2005;36(11):2404-9. - PubMed
    1. Spence JD, Blake C, Landry A, Fenster A. Measurement of carotid plaque and effect of vitamin therapy for total homocysteine. Clinical Chemistry and Laboratory Medicine 2003;41(11):1498-504. - PubMed
    1. Spence JD, Howard VJ, Chambless LE, Malinow MR, Pettigrew LC, Stampfer M, et al. Vitamin intervention for stroke prevention (VISP) trial: rationale and design. Neuroepidemiology 2001;20(1):16-25. - PubMed
    1. Toole JF, Malinow MR, Chambless LE, Spence JD, Pettigrew LC, Howard VJ, et al. Lowering homocysteine in patients with ischemic stroke to prevent recurrent stroke, myocardial infarction, and death: the vitamin intervention for stroke prevention (VISP) randomized controlled trial. JAMA 291;5:565–75. - PubMed
Torrisi 2021 {published data only}
    1. Torrisi M, Bonanno L, Formica C, Arcadi FA, Cardile D, Cimino V, et al. The role of rehabilitation and vitamin D supplementation on motor and psychological outcomes in poststroke patients. Medicine 2021;100(45):e27747. - PMC - PubMed
Ullegaddi 2005a {published data only}
    1. Ullegaddi R, Powers HJ, Gariballa SE. Antioxidant supplementation enhances antioxidant capacity and mitigates oxidative damage following acute ischaemic stroke. European Journal of Clinical Nutrition 2005;59(12):1367–73. - PubMed
Ullegaddi 2005b {published data only}
    1. Gariballa S, Ullegaddi R. Riboflavin status in acute ischaemic stroke. European Journal of Clinical Nutrition 2007;61(10):1237-40. - PubMed
    1. Ullegaddi R, Powers HJ, Gariballa SE. Antioxidant supplementation with or without B-group vitamins after acute ischemic stroke: a randomized controlled trial. Journal of Parenteral and Enteral Nutrition 2006;30(2):2. - PubMed
Yoshimura 2019 {published and unpublished data}
    1. Yoshimura Y, Bise T, Shimazu S, Shiraishi A. A randomized-controlled trial of leucine-enriched amino-acid mixtures on muscle mass, strength, and physical performance in post-stroke patients with sarcopenia. Clinical Nutrition 2017;36:s198. - PubMed
    1. Yoshimura Y, Bise T, Shimazu S, Tanoue M, Tomioka Y, Araki M, et al. Effects of a leucine-enriched amino acid supplement on muscle mass, muscle strength, and physical function in post-stroke patients with sarcopenia: a randomized controlled trial. Nutrition 2019;58:1–6. - PubMed
Zhang 2004 {published data only}
    1. Zhang JJ, Dong WF, Gu SJ, Zhang J, Xuan HF, Xie RL. Clinical study on the early nutrition support in postoperative patients with critical hypertensive intracerebral hemorrhage [Chinese]. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue 2004;16(9):552-5. - PubMed
Zhang 2014 {published data only}
    1. Zhang L, Li Z, Luo B, Li Z, Lei Min, Jing Y. Effects of different intakes of protein on nutritional status in severe stroke patients [Chinese]. Wei Sheng Yan Jiu 2014;43(6):929-32. - PubMed
Zhao 2020 {published data only}
    1. Zhao S, Wang B, Geng S, Zhao X, Wang W, Xie L, et al. Impact of early enteral nutrition on nutritional indicators in patients with severe cerebrovascular disease [Chinese]. Chinese Journal of Clinical Nutrition 2020;28(4):232-7.
Zheng 2006 {published data only}
    1. Zheng TH, Wang SS, Chen ZL, Yang JD, Zhao HF, Cheng L, et al. The effect of early enteral nutrition support on immunological function in patients with acute stroke [Chinese]. Chinese Journal of Cerebrovascular Diseases 2006;3(8):356-60.
Zheng 2015 {published data only}
    1. Zheng T, Zhu X, Liang H, Huang H, Yang J, Wang S. Impact of early enteral nutrition on short term prognosis after acute stroke. Journal of Clinical Neuroscience 2015;22(9):1473-6. - PubMed
Zhou 2006 {published data only}
    1. Zhou CP, Su YY. Effect of the equal non-protein-calorie but different protein intake on enteral nutritional metabolism in 51 patients with severe stroke: a randomized controlled study [Chinese]. Chinese Journal of Clinical Nutrition 14;6:351-5.

References to studies excluded from this review

Cavalieri 2012 {published data only}https://doi.org/10.1111/j.1468-1331.2012.03887.x
    1. Cavalieri M, Chen C, Mok V, De Freitas GR, Homayoon N, Grazer A, et al. B-vitamins and cerebral small vessel disease: the VITATOPS MRI substudy. European Journal of Neurology 2012;19:25.
Ikeda 2020 {published data only}
    1. Ikeda T, Morotomi N, Kamono A, Ishimoto S, Miyazawa R, Kometani S, et al. The effects of timing of a leucine-enriched amino acid supplement on body composition and physical function in stroke patients: a randomized controlled trial. Nutrients 2020;12(7):1-9. - PMC - PubMed
Kang 2010 {published data only}
    1. Kang Y, Lee HS, Paik NJ, Kim WS, Yang M. Evaluation of enteral formulas for nutrition, health, and quality of life among stroke patients. Nutrition Research and Practice 2010;4(5):393-9. - PMC - PubMed
Liu 2015 {published data only}
    1. Liu X, Shi M, Xia F, Han J, Liu Z, Wang B, et al. The China Stroke Secondary Prevention Trial (CSSPT) protocol: a double-blinded, randomized, controlled trial of combined folic acid and B vitamins for secondary prevention of stroke. International Journal of Stroke 2015;10(2):264-8. - PubMed
Martin 2019 {published data only}
    1. Martin J, Murphy A, McNamara E, Wilton D, Martin L. Medical nutrition therapy to improve nutrition and fluid intake in patients with dysphagia. In: International Journal of Stroke. Vol. 14(1 Supplement). 2019:13.
Missaoui 2021 {published data only}
    1. Missaoui M, Hassine A, Naija S, Emna J, Ben Amor S. Effect of vitamin D supplementation on anxiety-depressive disorder at six months of stroke: a randomized clinical trial. European Journal of Neurology 2021;28(Suppl 1):864.
Nakamura 2011 {published data only}https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000006995
    1. UMIN000005915. Antioxidant nutrients enhanced diet effect on stroke study. https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R0000... (accessed prior to 24 July 2024).
Narasimhan 2017 {published data only}
    1. Narasimhan S, Balasubramanian P. Role of vitamin D in the outcome of ischemic stroke - a randomized controlled trial. India Journal of Clinical and Diagnostic Research 2017;11(2):CC06-CC10. - PMC - PubMed
NCT01810263 {published data only}
    1. NCT01810263. The efficacy of intensive nutritional supplement[s] in patient[s] with stroke. https://ClinicalTrials.gov/show/NCT01810263 (date first received 2012).
NCT02982668 {published data only}
    1. NCT02982668. Optimizing early enteral nutrition in severe stroke. https://ClinicalTrials.gov/show/NCT02982668 (date first received November 30, 2016).
Oonuma 2019 {published data only}
    1. Oonuma Y, Tanno Y, Chiba N, Mori T. Rapid improvement of malnutrition following treatment by leucine-enhanced branched chain amino acid in severe acute stroke patients fed with enteral nutrition. In: American Heart Association/American Stroke Association 2019 International Stroke Conference and State-of-the-Science Stroke Nursing Symposium 2019. Vol. 50 (Supplement 1). 2019:481.
Sato 2005a {published data only}
    1. Sato Y, Honda Y, Iwamoto J, Kanoko T, Satoh K. Effect of folate and mecobalamin on hip fractures in patients with stroke: a randomized controlled trial. Journal of the American Medical Association 2005;293(9):1082-8. - PubMed
Sato 2005b {published data only}
    1. Sato Y, Iwamoto J, Kanoko T, Satoh Kei. Low-dose vitamin D prevents muscular atrophy and reduces falls and hip fractures in women after stroke: a randomized controlled trial. Cerebrovascular Diseases 2005;20(3):187-92. - PubMed
Shen 2020 {published data only}
    1. Shen H, Zhan B. Effect of vitamin E on stroke-associated pneumonia. Journal of International Medical Research 2020;48(9):300060520949657. - PMC - PubMed
Solodov 2010 {published data only}
    1. Solodov AA, Petrikov SS, Titova YV, Zinkin VY, Krylov VV. Enteral nutrition with glutamin supplementation vs standard enteral formula in patients with intracranial hemorrhages. Intensive Care Medicine 2010;36(Suppl 2):S300.
Sugiyama 2005 {published data only}
    1. Sugiyama T, Tanaka H, Taguchi T, Sato Y, Iwamoto J, Kanoko T, et al. Folate and vitamin B12 for hip fracture prevention after stroke. Journal of the American Medical Association 2005;294(7):792. - PubMed
UMIN000019589 {published data only}https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000022615
    1. UMIN000019589. A randomized trial to evaluate the efficacy of branched-chain amino acid fortified supplements in post-stroke rehabilitation patients. https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R0000... (date received 2015).
UMIN000025075 {published data only}https://center6.umin.ac.jp/cgi-open-bin/icdr_e/ctr_view.cgi?recptno=R000028843
    1. UMIN000025075. Effects of early enteral nutrition in acute stroke patients: an open-label randomized study. https://center6.umin.ac.jp/cgi-open-bin/icdr_e/ctr_view.cgi?recptno=R000... (date received 2016).
Witham 2009 {published data only}
    1. Witham MD, Dove FJ, Sugden JA, Doney A, Struthers AD. Does vitamin D supplementation improve markers of vascular health in stroke patients? A randomised controlled trial. International Journal of Stroke 2009;4(Suppl 2):21.
Wuyanti 2005 {published data only}
    1. Wuyanti S, Sayogo S, Ahmad SA. The effect of high protein enteral nutrition on protein status in acute stroke patients. Medical Journal of Indonesia 2005;14(1):37-43.
Xia 2014 {published data only}
    1. Xia X-S, Li X, Wang L, Wang J-Z, Ma J-P, Wu C-J. Supplementation of folic acid and vitamin B12 reduces plasma levels of asymmetric dimethylarginine in patients with acute ischemic stroke. Journal of Clinical Neuroscience 2014;21(9):1586-90. - PubMed
Yousefian 2019 {published data only}
    1. Yousefian M, Sadegi SRGP, Sakaki M. Vitamin D supplements' effect on expediting the weaning process in patients with the stroke. Electronic Journal of General Medicine 2019;16(2):1-5.
Zavertailo 2010 {published data only}20919542
    1. Zavertailo LL, Semenkova GV, Leiderman IN. Effect of an original enteral feeding protocol on clinical outcome indicators in patients with acute cerebral damage of vascular and traumatic genesis. Anesteziologiia i Reanimatologiia 2010;4:35-8. - PubMed
Zhong 2014 {published data only}
    1. Zhong G-Y, Li Y-H, Ma L-P, Huang C-P. Early enteral nutrition and nursing care for prevention of complications of severe cerebrovascular diseases. World Chinese Journal of Digestology 2014;22(11):1612-15.

References to studies awaiting assessment

CTRI 2020/03/024293 {published data only}
    1. CTRI/2020/03/024293. Impact of MTHFR, MS and CBS genes polymorphisms and vitamin B6, B9 & B12 supplementations on hyperhomocysteinemia among ischemic stroke patients. https://trialsearch.who.int/Trial2.aspx?TrialID=CTRI/2020/03/024293 (date received 2020).
ISRCTN11086312 {published data only}
    1. ISRCTN11086312. Effect of vitamin D supplementation on the functional efficiency of patients after stroke. https://www.isrctn.com/ISRCTN11086312 (date received February 16, 2023).
NCT03637270 {published data only}
    1. NCT03637270. Incorporating supplementary protein into rehabilitative exercise (INSPIRE Trial) for patients with chronic stroke. https://clinicaltrials.gov/ct2/show/NCT03637270 (date received August 18, 2018).
NCT04295044 {published data only}
    1. NCT04295044. Effect of high protein diet in stroke patients with low muscle mass. https://clinicaltrials.gov/ct2/show/NCT04295044 (date received 2018).
NCT04459091 {published data only}
    1. NCT04459091. Effects of supplementation with amino essential acids on circulating albumin levels in patients with cerebral ictus in rehabilitation phase. https://clinicaltrials.gov/ct2/show/NCT04459091 (date received 2018).
UMIN000023954 {published data only}
    1. UMIN000023954. Efficacy of nutrition management for acute stroke patients with malnutrition risk: a randomized controlled study. https://rctportal.niph.go.jp/detail/um?trial_id=UMIN000023954# (date received 2016).

References to ongoing studies

CTRI/2023/11/060377 {published data only}
    1. CTRI/2023/11/060377. A study to know whether Vitamin D supplementation can improve the disability due to stroke in 90 days in patients with low levels of vitamin D in blood. https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=OTYwNDc=&Enc... (date received November 26, 2023).
DRKS00005577 {published data only}
    1. DRKS00005577. Effect of essential amino acids on muscle size and strength in patients with acute ischemic stroke during rehabilitation - AMINOS. https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00005577 (date received 2014).
    1. Scherbakov N, Ebner N, Sandek A, Meisel A, Haeusler KG, Von Haehling S, et al. Influence of essential amino acids on muscle mass and muscle strength in patients with cerebral stroke during early rehabilitation: protocol and rationale of a randomized clinical trial (AMINO-Stroke Study). BMC Neurology 2016;16:10. - PMC - PubMed
IRCT20190305042937N1 {published data only}
    1. IRCT20190305042937N1. Clinical trial comparison of the effect of folic acid and vitamin D supplementation in the prevention of cerebrovascular attacks in patients referred to Shahid Beheshti Hospital in 3 months. https://en.irct.ir/trial/40282 (date received 2019).
NCT02347995 {published data only}
    1. NCT02347995. Resistive training combined with nutritional therapy after stroke (REPS). https://www.clinicaltrials.gov/study/NCT02347995 (date received January 15, 2015).
NCT04259307 {published data only}
    1. NCT04259307. Effect of intensive nutritional support on functional recovery in subacute stroke patient. https://clinicaltrials.gov/ct2/show/NCT04259307 (date received February 4, 2020).
NCT04386525 {published data only}
    1. NCT04386525. The potential effect of omega3 supplement in fish oil on infarcted areas in the brain and improvement of neurological functions of ischemic stroke patients. https://clinicaltrials.gov/ct2/show/NCT04386525 (date received 2020).
NCT05474105 {published data only}
    1. NCT05474105. Multi-nutrient supplementation as a therapeutic intervention in ischaemic stroke (MUST-IS). https://classic.clinicaltrials.gov/ct2/show/NCT05474105 (date received July 26, 2022).
NCT05728229 {published data only}
    1. NCT05728229. Effects of nutrition on post stroke fatigue (NUTRE-S). https://classic.clinicaltrials.gov/ct2/show/NCT05728229 (date received February 15, 2023).
UMIN000035365 {published data only}
    1. UMIN000035365. Effects of medium-chain triglyceride on ghrelin activation, food intake, activity of daily living and muscle mass in older malnourished patients with stroke. https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&a... (date received 2018).

Additional references

Anderson 1995
    1. Anderson CS, Linto J, Stewart-Wynne EG. A population-based assessment of the impact and burden of caregiving for long-term stroke survivors. Stroke 1995;26(5):843-9. - PubMed
Aquilani 2011
    1. Aquilani R, Sessarego P, Iadarola P, Barbieri A, Boschi F. Nutrition for brain recovery after ischemic stroke: an added value to rehabilitation. Nutrition in Clinical Practice 2011;26(3):339-45. - PubMed
Atkins 2004
    1. Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, et al, GRADE Working Group. Grading quality of evidence and strength of recommendations. BMJ 2004;328(7454):1490. - PMC - PubMed
Barker 2015
    1. Barker-Collo S, Bennett DA, Krishnamurthi RV, Parmar P, Feigin VL, Naghavi M, et al. Sex differences in stroke incidence, prevalence, mortality and disability-adjusted life years: results from the Global Burden of Disease Study 2013. Neuroepidemiology 2015;45(3):203-14. - PMC - PubMed
Bath 2018
    1. Bath PM, Lee HS, Everton LF. Swallowing therapy for dysphagia in acute and subacute stroke. Cochrane Database of Systematic Reviews 2018, Issue 10. Art. No: CD000323. [DOI: 10.1002/14651858.CD000323.pub3] - DOI - PMC - PubMed
Beninato 2006
    1. Beninato M, Gill-Body KM, Salles S, Stark PC, Black-Schaffer RM, Stein J. Determination of the minimal clinically important difference in the FIM instrument in patients with stroke. Archives of Physical Medicine and Rehabilitation 2005;87(1):32–9. - PubMed
Bernhardt 2019
    1. Bernhardt J, Hayward KS, Dancause N, Lannin NA, Ward NS, Nudo RJ, et al. A stroke recovery trial development framework: consensus-based core recommendations from the Second Stroke Recovery and Rehabilitation Roundtable. Neurorehabilitation and Neural Repair 2019;33(11):959–69. - PubMed
Bonita 1988
    1. Bonita R, Beaglehole R. Recovery of motor function after stroke. Stroke 1988;19:1497-500. - PubMed
Boselli 2012
    1. Boselli M, Aquilani R, Baiardi P, Dioguardi FS, Guarnaschelli C, Achilli MP, et al. Supplementation of essential amino acids may reduce the occurrence of infections in rehabilitation patients with brain injury. Nutrition in Clinical Practice 2012;27:99–113. - PubMed
Bouziana 2011
    1. Bouziana SD, Tziomalos K. Malnutrition in patients with acute stroke. Journal of Nutrition and Metabolism 2011;2011:167898. - PMC - PubMed
Brott 1989
    1. Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke 1989;20(7):864-70. - PubMed
Burgos 2018
    1. Burgos R, Bretón I, Cereda E, Desport JC, Dziewas R, Genton L, et al. ESPEN guideline clinical nutrition in neurology. Clinical Nutrition 2018;37(1):354-96. - PubMed
Butland 1982
    1. Butland RJ, Pang J, Gross ER, Woodcock AA, Geddes DM. Two-, six-, and 12-minute walking tests in respiratory disease. British Medical Journal 1982;284(6329):1607–8. - PMC - PubMed
Chen 2019
    1. Chen N, Li Y, Fang J, Lu Q, He L. Risk factors for malnutrition in stroke patients: a meta-analysis. Clinical Nutrition 2019;38(1):127-35. - PubMed
Cieza 2021
    1. Cieza A, Causey K, Kamenov K, Hanson SW, Chatterji S, Vos T. Global estimates of the need for rehabilitation based on the global burden of disease study 2019: a systematic analysis for the global burden of disease study 2019. Lancet 2021;396(10267):2006-17. - PMC - PubMed
Collin 1988
    1. Collin C, Wade DT, Davies S, Horne V. The Barthel ADL Index: a reliability study. International Disability Studies 10;2:61–3. - PubMed
Covidence [Computer program]
    1. Covidence. Melbourne, Australia: Veritas Health Innovation, 2022. Available at covidence.org (accessed 1 March 2022).
Cruz 2019
    1. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al, Writing group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), and the extended group for EWGSOP2. Sarcopenia: revised European consensus on definition and diagnosis. Age and Ageing 2019;48(1):16-31. - PMC - PubMed
Daubail 2012
    1. Daubail B, Jacquin A, Guilland JC, Hervieu M, Osseby GV, Rouaud O, et al. Serum 25-hydroxyvitamin D predicts severity and prognosis in stroke patients. European Journal of Neurology 2013;20(1):57-61. - PubMed
Dennis 2005
    1. Dennis MS, Lewis SC, Warlow C, FOOD Trial Collaboration. Routine oral nutritional supplementation for stroke patients in hospital (FOOD): a multicentre randomised controlled trial. Lancet 2005;365(9461):755-63. - PubMed
Dávalos 1996
    1. Dávalos A, Ricart W, Gonzalez-Huix F, Soler S, Marrugat J, Molins A, et al. Effect of malnutrition after acute stroke on clinical outcome. Stroke 1996;27(6):1028-32. - PubMed
Egger 1997
    1. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997;315(7109):629-34. - PMC - PubMed
Foley 2009
    1. Foley NC, Salter KL, Robertson J, Teasell RW, Woodbury MG. Which reported estimate of the prevalence of malnutrition after stroke is valid? Stroke 2009;40(3):e66-74. - PubMed
FOOD Trial Collaboration 2003
    1. FOOD Trial Collaboration. Poor nutritional status on admission predicts poor outcomes after stroke: observational data from the FOOD trial. Stroke 2003;34(6):1450-6. - PubMed
Ford 2022
    1. Ford KL, Arends J, Atherton PJ, Engelen MPKJ, Gonçalves TJM, Laviano A, et al. The importance of protein sources to support muscle anabolism in cancer: an expert group opinion. Clinical Nutrition 2022;41(1):192–201. - PubMed
Fugl‐Meyer 1975
    1. Fugl-Meyer AR, Jääskö L, Leyman I, Olsson S, Steglind S. The post-stroke hemiplegic patient. 1. A method for evaluation of physical performance. Scandinavian Journal of Rehabilitation 1975;7(1):13-31. - PubMed
Gariballa 1998
    1. Gariballa SE, Parker SG, Taub N, Castleden CM. Influence of nutritional status on clinical outcome after acute stroke. American Journal of Clinical Nutrition 1998;68(2):275–81. - PubMed
GBD 2017 DALYs and HALE Collaborators 2018
    1. GBD 2017 DALYs and HALE Collaborators. Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease study 2017. Lancet 2018;392(10159):1859-922. - PMC - PubMed
Geeganage 2012
    1. Geeganage C, Beavan J, Ellender S, Bath PMW. Interventions for dysphagia and nutritional support in acute and subacute stroke. Cochrane Database of Systematic Reviews 2012, Issue 10. Art. No: CD000323. [DOI: 10.1002/14651858.CD000323.pub2] - DOI - PubMed
Gorelick 2019
    1. Gorelick PB. The global burden of stroke: persistent and disabling. Neurology 2019;18(5):417–8. - PubMed
GRADEpro GDT [Computer program]
    1. GRADEpro GDT. Version accessed on December 1, 2022. Hamilton (ON): McMaster University (developed by Evidence Prime), 2022. Available at gradepro.org.
Guralnik 1994
    1. Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. Journal of Gerontology 1994;49(2):M85–M94. - PubMed
Higgins 2003
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003;327(7414):557-60. - PMC - PubMed
Higgins 2011
    1. Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration 2011. Available from training.cochrane.org/handbook/archive/v5.1.
Higgins 2021
    1. Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 6.2 (updated February 2021). Cochrane 2021. Available from www.training.cochrane.org/handbook/archive/v6.2.
Higgins 2022
    1. Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.3 (updated August 2022). Cochrane 2022. Available from www.training.cochrane.org/handbook/archive/v6.3.
Hoffmann 2014
    1. Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ 2014;348:g1687. - PubMed
Japan Stroke Society 2019
    1. Japan Stroke Society. Japanese guidelines for the management of stroke 2015; 2019. jsts.gr.jp/img/guideline2015_tuiho2019_10.pdf (accessed 1 March 2022).
Kalra 2007
    1. Kalra L, Langhorne P. Facilitating recovery: evidence for organized stroke care. Journal of Rehabilitation Medicine 2007;39(2):97-102. - PubMed
Kalueff 2007
    1. Kalueff AV, Tuohimaa P. Neurosteroid hormone vitamin D and its utility in clinical nutrition. Current Opinion in Clinical Nutrition and Metabolic Care 2007;10(1):12–9. - PubMed
Katz 1970
    1. Katz S, Downs TD, Cash HR, Grotz RC. Progress in development of the index of ADL. Gerontologist 1970;10(1):20-30. - PubMed
Keith 1987
    1. Keith RA, Granger CV, Hamilton BB, Sherwin FS. The functional independence measure: a new tool for rehabilitation. Advances in Clinical Rehabilitation 1987;1:6–18. - PubMed
Khor 2014
    1. Khor SC, Abdul Karim N, Ngah WZ, Yusof YA, Makpol S. Vitamin E in sarcopenia: current evidence on its role in prevention and treatment. Oxidative Medicine and Cellular Longevity 2014;2014:914853. - PMC - PubMed
Knops 2013
    1. Knops M, Werner CG, Scherbakov N, Fiebach J, Dreier JP, Meisel A, et al. Investigation of changes in body composition, metabolic profile and skeletal muscle functional capacity in ischemic stroke patients: the rationale and design of the Body Size in Stroke Study (BoSSS). Journal of Cachexia, Sarcopenia and Muscle 2013;4(3):199–207. - PMC - PubMed
Kondrup 2003
    1. Kondrup J, Rasmussen HH, Hamberg O, Stanga Z. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clinical nutrition 2003;22(3):321-36. - PubMed
Lefebvre 2021
    1. Lefebvre C, Glanville J, Briscoe S, Littlewood A, Marshall C, Metzendorf M-I, et al. Technical Supplement to Chapter 4: Searching for and selecting studies. In: Higgins JPT, Thomas J, Chandler J, Cumpston MS, Li T, Page MJ, et al, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 6.2 (updated February 2021). Cochrane 2021. Available from www.training.cochrane.org/handbook/archive/v6.2.
Li 2020
    1. Li W, Yue T, Liu Y. New understanding of the pathogenesis and treatment of stroke-related sarcopenia. Biomedicine & Pharmacotherapy 2020;131:110721. - PubMed
Lieber 2018
    1. Lieber AC, Hong E, Putrino D, Nistal DA, Pan JS, Kellner CP. Nutrition, energy expenditure, dysphagia, and self-efficacy in stroke rehabilitation: a review of the literature. Brain Sciences 2018;8(12):218. - PMC - PubMed
Malafarina 2012
    1. Malafarina V, Uriz-Otano F, Iniesta R, Gil-Guerrero L. Effectiveness of nutritional supplementation on muscle mass in treatment of sarcopenia in old age: a systematic review. Journal of the American Medical Directors Association 2012;14(1):10–7. - PubMed
Marshall 2018
    1. Marshall IJ, Noel-Storr A, Kuiper J, Thomas J, Wallace BC. Machine learning for identifying randomized controlled trials: an evaluation and practitioner's guide. Research Synthesis Methods 2018;9(4):602-14. - PMC - PubMed
Martino 2005
    1. Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke 2005;36(12):2756-63. - PubMed
Matwee 2020
    1. Matwee LK, Alaverdashvili M, Muir GD, Farthing JP, Bater SA, Paterson PG. Preventing protein-energy malnutrition after cortical stroke enhances recovery of symmetry in forelimb use during spontaneous exploration. Applied Physiology, Nutrition, and Metabolism 2020;45(9):1015–21. - PubMed
Minhas 2022
    1. Minhas JS, Chithiramohan T, Wang X, Barnes SC, Clough RH, Kadicheeni M, et al. Oral antiplatelet therapy for acute ischaemic stroke. Cochrane Database of Systematic Reviews 2022, Issue 1. Art. No: CD000029. [DOI: 10.1002/14651858.CD000029.pub3] - DOI - PMC - PubMed
Nakamura 2020
    1. Nakamura S, Sato Y, Kobayashi T, Kaneko Y, Ito E, Soma T, et al. Vitamin D protects against immobilization-induced muscle atrophy via neural crest-derived cells in mice. Scientific Reports 10;1:12242. - PMC - PubMed
National Stroke Foundation 2017
    1. National Stroke Foundation. Clinical Guidelines for Stroke Management 2017. clinicalguidelines.gov.au/portal/2585/clinical-guidelines-stroke-managem... (accessed 1 March 2022).
NICE 2019
    1. National Institute for Health and Care Excellence (NICE). Stroke and transient ischaemic attack in over 16s: diagnosis and initial management, NICE guideline (NG128). www.nice.org.uk/guidance/ng128 (accessed 1 March 2022). - PubMed
Noel‐Storr 2020
    1. Noel-Storr AH, Dooley G, Wisniewski S, Glanville J, Thomas J, Cox S, et al. Cochrane centralised search service showed high sensitivity identifying randomized controlled trials: a retrospective analysis. Journal of Clinical Epidemiology 2020;127:142-50. - PubMed
Noel‐Storr 2021
    1. Noel-Storr A, Dooley G, Elliott J, Steele E, Shemilt I, Mavergames C, et al. An evaluation of Cochrane Crowd found that crowdsourcing produced accurate results in identifying randomized trials. Journal of Clinical Epidemiology 2021;133:130-9. - PubMed
O'Neil 1999
    1. O'Neil KH, Purdy M, Falk J, Gallo L. The dysphagia outcome and severity scale. Dysphagia 1999;14(3):139-45. - PubMed
Page 2021
    1. Page MJ, Moher D, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ 2021;372:n160. - PMC - PubMed
Peters 2008
    1. Peters JL, Sutton AJ, Jones DR, Abrams KR, Rushton L. Contour-enhanced meta-analysis funnel plots help distinguish publication bias from other causes of asymmetry. Journal of Clinical Epidemiology 2008;61(10):991-6. - PubMed
Powers 2019
    1. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019. Update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2019;50(12):e344-e418. - PubMed
Rabin 2001
    1. Rabin R, De Charro F. EQ-5D: a measure of health status from the EuroQol Group. Annals of Medicine 2001;33(5):337–43. - PubMed
RevMan Web 2023 [Computer program]
    1. Cochrane Collaboration Review Manager Web (RevManWeb). Version Version 4.23.0. Cochrane Collaboration, 2023. Available at revman.cochrane.org. (accessed 8 January 2023).
Rosenbek 1996
    1. Rosenbek JC, Robbins JA, Roecker EB. A penetration-aspiration scale. Dysphagia 1996;11:93–8. - PubMed
Scherbakov 2014
    1. Scherbakov N, Sandek A, Doehner W. Stroke-related sarcopenia: specific characteristics. Journal of the American Medical Directors Association 2015;16(4):272–6. - PubMed
Schünemann 2013
    1. Schünemann H, Brożek J, Guyatt G, Oxman A, editor(s). Handbook for grading the quality of evidence and the strength of recommendations using the GRADE approach (updated October 2013). GRADE Working Group, 2013. Available from gdt.gradepro.org/app/handbook/handbook.html (accessed 1 March 2022).
Su 2020
    1. Su Y, Yuki M, Otsuki M. Prevalence of stroke-related sarcopenia: a systematic review and meta-analysis. Journal of Stroke and Cerebrovascular Diseases 2020;29(9):105092. - PubMed
Thomas 2021
    1. Thomas J, McDonald S, Noel-Storr A, Shemilt I, Elliott J, Mavergames C, et al. Machine learning reduced workload with minimal risk of missing studies: development and evaluation of a randomized controlled trial classifier for Cochrane Reviews. Journal of Clinical Epidemiology 2021;133:140-51. - PMC - PubMed
Van Dronkelaar 2018
    1. Van Dronkelaar C, Van Velzen A, Abdelrazek M, Van der Steen A, Weijs PJM, Tieland M. Minerals and sarcopenia: the role of calcium, iron, magnesium, phosphorus, potassium, selenium, sodium, and zinc on muscle mass, muscle strength, and physical performance in older adults: a systematic review. Journal of the American Medical Directors Association 2018;19(1):6–11. - PubMed
Wan 2014
    1. Wan X, Wang W, Liu J, Tong T. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Medical Research Methodology 2014;14:135. - PMC - PubMed
Williams 1999
    1. Williams LS, Weinberger M, Harris LE, Clark DO, Biller J. Development of a stroke-specific quality of life scale. Stroke 1999;30(7):1362-9. - PubMed
Winstein 2016
    1. Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, et al. Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2016;47(6):e98-e169. - PubMed
Yoo 2008
    1. Yoo SH, Kim JS, Kwon SU, Yun SC, Koh JY, Kang DW. Undernutrition as a predictor of poor clinical outcomes in acute ischemic stroke patients. Archives of Neurology 2008;65(1):39–43. - PubMed

References to other published versions of this review

Sakai 2019
    1. Sakai K, Kinoshita S, Tsuboi M, Fukui R, Momosaki R, Wakabayashi H. Effects of nutrition therapy in older stroke patients undergoing rehabilitation: a systematic review and meta-analysis. Journal of Nutrition, Health & Aging 2019;23(1):21-6. - PubMed

Associated data