Oral Nutritional Interventions for Stroke Recovery: A Systematic Review

Abstract

Context: Suboptimal nutritional status has been observed in stroke patients throughout the stroke recovery pathway, negatively impacting recovery and rehabilitation outcomes. Oral nutritional supplements (ONSs) can correct deficiencies and treat malnutrition and may support rehabilitation following a stroke.

Objectives: In this systematic review we aimed to synthesize evidence on the effects of oral nutritional interventions on functional, cognitive, and psychological outcomes of stroke rehabilitation, such as independence or activities of daily living (ADLs), muscle function, cognition, and mood.

Data sources: The search strategy and inclusion/exclusion criteria were established according to the participants, intervention, comparators, and outcome (PICO) framework. Two reviewers screened titles and abstracts using search terms related to stroke rehabilitation or recovery and nutritional supplementation using the databases Web of Sciences, PubMed, Google Scholar, and Scopus.

Data extraction: This review included randomized controlled trials (RCTs) that assessed the effects of oral nutritional interventions on rehabilitation outcomes in stroke patients. Details of the interventions and main outcomes were extracted independently by 2 researchers.

Data analysis: Twenty-four reports (comprising 23 studies) that met the inclusion/exclusion criteria were finally included in the review. The included studies were grouped according to the type of nutritional intervention, including protein-energy supplements, essential amino acids, vitamin D supplementation, and a heterogeneous group of interventions with different polyphenols and omega-3 supplements. Overall, this review reports mixed results for the effects of nutritional interventions on stroke survivors.

Conclusions: The evidence suggests that stroke patients with greater nutritional needs may benefit most from targeted interventions. Furthermore, protein-based ONS interventions were suggested to augment functional outcomes when supplemented alongside exercise rehabilitation, including a resistance training component. Further evidence is needed before these findings can be adopted into clinical guidance. Although there were some promising results for other non-protein-related interventions, there were also contradictory findings, with heterogeneity between studies and variability in interventions limiting the transferability of findings to recommendations for clinical practice.

Keywords: essential amino acids; nutritional interventions; omega 3; oral nutritional supplements (ONS); polyphenols; stroke recovery; stroke rehabilitation; vitamin D.