Nutritional support as an integral part of the management of a patient with stroke in the acute stage of the disease and at the stage of rehabilitation

This article reveals the features and consequences of nutritional deficiency for the condition of stroke patients, shows the importance of nutritional support both in the acute stage of the disease and at the stage of rehabilitation. One of the factors that worsen the rehabilitation potential after a stroke is nutritional deficiency, which increases the risk of adverse outcomes in patients with stroke, and therefore nutrition should be the focus of attention of specialists involved in rehabilitation treatment. Nutritional deficiency has the following negative impact directly on the process of recovery of a patient after a stroke: a decrease in the degree of recovery of motor functions, a decrease in the degree of recovery of cognitive functions, a low level of social adaptation, a low level of quality of life. 50% of stroke patients are malnourished upon admission to rehabilitation centers. Conducting parenteral nutrition for more than three days is fraught with serious complications due to the lack of a stimulating effect of food. Whenever possible, the choice of nutritional support should lean towards enteral nutrition. Enteral nutrition during the recovery period of a stroke is aimed at solving the problems of preventing the development of malnutrition and complications caused by this malnutrition, therapeutic nutrition is a component of therapy in order to improve its tolerance, has a psychologically beneficial effect – accelerating socialization and the possibility of returning to normal nutrition. The article presents the features and principles of the implementation of various methods of nutrition in patients who have had a stroke. Particular attention is paid to the method of siping nutrition, carried out at the stage of rehabilitation, the main criteria for choosing the optimal mixture for such nutrition are given, the effectiveness of using a nutrient mixture for this purpose, which most fully meets all the requirements for such mixtures presented in the article, is substantiated.

1. Compher C., Chittams J., Sammarco T. Greater protein and energy intake may be associated with improved mortality in higher risk critically ill patients: a multicenter, multinational observational study // Crit Care Med. 2017; 45: 156-163. DOI: 10.1097/CCM.0000000000002083.

2. Nicolo M., Heyland D. K., Chittams J., Sammarco T., Compher C. Clinical Outcomes Related to Protein Delivery in a Critically Ill Population: A Multicenter, Multinational Observation Study // JPEN J Parenter Enteral Nutr. 2016; 40 (1): 45-51. DOI: 10.1177/0148607115583675.

3. Bendavid I., Zusman O., Kagan I., Theilla M., Cohen J., Singer P. Early

4. Administration of Protein in Critically Ill Patients: A Retrospective Cohort Study // Nutrients. 2019; 11 (1). pii: E106. DOI: 10.3390/nu11010106.

5. FOOD Trial Collaboration. Poor nutritional status on admission predicts poor outcomes after stroke: observational data from the FOOD trial // Stroke. 2003; 34 (6): 1450– 1456. DOI: 10.1161/01.STR.0000074037.49197.8C.

6. Bouziana S. D., Tziomalos K. Malnutrition in patients with acute stroke. J Nutr Metab. 2011; 2011:167898. DOI: 10.1155/2011/167898. Epub 2011 Dec 27. PMID: 22254136; PMCID: PMC3255318.

7. Rabadi M. H., Coar P. L., Lukin M., Lesser M., Blass J. P. Intensive nutritional supplements can improve outcomes in stroke rehabilitation // Neurology. 2008; 71 (23): 1856-1861.

8. Kamayeva O. V., Monro P., Burakova Z. F. i soavt. Multidisciplinary approach in the management and early rehabilitation of neurological patients: Methodological guide. Part 2. Nursing issues / Pod red. A. A. Skoromtsa. SPb., 2003. P. 41.

9. Kondrup J., Rasmussen H. H., Hamberg O., Stanga Z. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials // Clin Nutr. 2003; 22 (3): 321-336.

10. Kaiser M. J., Bauer J. M., Ramsch C., et al. MNA International Group. Validation of the Mini Nutritional Assessment short-form (MNA-SF): a practical tool for identification of nutritional status // Journal of Nutrition Health Aging. 2009; 13: 782-788.

11. Singer P., et al. ESPEN guideline on clinical nutrition in the intensive care unit // Clinical nutrition. 2019; 1 (38): 48-79.

12. Abe T., et al. Low muscle mass is associated with walking function in patients with acute ischemic stroke // Journal of Stroke and Cerebrovascular Diseases. 2020; 11 (29): 105259.

13. Puthucheary Z. A., et al. Acute skeletal muscle wasting in critical illness // Jama. 2013; 15 (310): 1591-1600.

14. Nagano F., et al. Muscle mass gain is positively associated with functional recovery in patients with sarcopenia after stroke // Journal of Stroke and Cerebrovascular Diseases. 2020; 9 (29): 105017.

15. Zusman O., et al. Resting energy expenditure, calorie and protein consumption in critically ill patients: a retrospective cohort study // Critical care. 2016; 1 (20): 1-8.

16. Aquilani R., Sessarego P., Iadarola P., Barbieri A., Boschi F. Nutrition for Brain Recovery After Ischemic Stroke: An Added Value to Rehabilitation // Nutr Clin Pract. 2011; 26: 339-345.

17. Huijts M., Duits A., Staals J., van Oostenbrugge R. J. Association of vitamin B12 deficiency with fatigue and depression after lacunar stroke // PLoS One.

18. ; 7 (1): e30519. DOI: 10.1371/journal.pone.0030519. Epub 2012 Jan 20. PMID: 22276208; PMCID: PMC3262813.

19. Gariballa S. E., Parker S. G., Taub N., Castleden C. M. A randomized, controlled, a single-blind trial of nutritional supplementation after acute stroke // JPEN J Parenter Enteral Nutr. 1998; 22 (5): 315-319. DOI: 10.1177/0148607198022005315. PMID: 9739036105259.