Thursday, January 22, 2009

Nutrition and Stroke Patients: Better Motor Function?

Here is a cool new study from the Journal Neurology looking at the impact of nutrition in stroke patients.

Not that long ago, we believed that the brain would not change in the older years of your life. Now based on the new research of "neuroplasticity" we know that is NOT true! The brain has an amazing ability to learn, even as we get older, as long as we keep learning new things such as cognitive functions and new movements!

Check out some older blog posts on:

Stroke of Insight

Movement and Brain Deterioration? New Study

Neuroplasticity and Human Athletic Performance

New Study
This study looked at the impact of nutrition in stroke patients. We know the brain can change, but can nutrition affect it? If I were a betting man, I would bet a "Heck ya!"

The "standard" supplement was Resource Standard (127 calories, 5 g protein, 36 mg vitamin C per dose), and the "intensive" supplement was Novasource 2.0 (240 calories, 11 g protein, 90 mg vitamin C per dose). Both preparations, made by Novartis Pharmaceuticals, were administered as 120-mL doses every 8 hours along with multivitamins with minerals, in addition to the normal diet.

Patients receiving intensive supplementation improved significantly more than their counterparts on measures of motor function. Score one for better nutrition!

"These differences were perceived clinically important by the patients, their families, and the physicians and other health care providers caring for them," Dr. Rabadi's team reports.

A higher percentage of patients in the intensive group returned home upon discharge (63% vs. 43%, p < 0.05). If you are or have a loved one that is a stroke victim, 20% is huge!

The authors speculate that the benefits of the high-protein, high-fat supplementation were primarily due to their effects on muscle, as evidenced by the lack of significant improvement on measures of cognition. Imagine that, higher protein and more fat are anabolic--go figure! Plus the downsides are basically non-existent and perhaps a slight fat gain at a high enough dose; and you can just got back at that point so it is really a non issue.

I am excited to see more in the "main stream" medical community looking at the impact of exercise and nutrition

Here is the abstract

Intensive nutritional supplements can improve outcomes in stroke rehabilitation
M. H. Rabadi, MD, MRCPI, P. L. Coar, RD, CDN, M. Lukin, MS, M. Lesser, PhD and J. P. Blass, MD, PhD

From the Stroke Service (M.H.R., P.L.C.), Burke Rehabilitation Hospital, an affiliate of Weill Medical College of Cornell University; Biostatistics Unit at the Feinstein Institute for Medical Research (M. Lukin, M. Lesser), North Shore–Long Island Jewish Health System; Departments of Public Health (M. Lesser) and Neurology and Neuroscience (J.P.B.), Weill Medical College of Cornell University; and Burke Medical Research Institute (J.P.B.), New York, NY.

Address correspondence and reprint requests to Dr Rabadi, VA Medical Center, 921 NE 13th Street, Oklahoma City, OK 73104

Objective: Poor nutrition is a common complication of strokes severe enough to require inpatient rehabilitation. We therefore tested whether intensive nutritional supplements given to undernourished patients from the time of their admission to a specialized stroke rehabilitation service would improve patient outcomes.

Methods: Randomized, prospective, double-blind, single center study comparing intensive nutritional supplementation to routine nutritional supplementation in 116 undernourished patients admitted to a stroke service. The analysis included the 90% of patients who were not lost to follow-up due to acute or subacute hospitalization (n = 102; 51 in each group). The nutritional supplements are commercially available and Food and Drug Administration approved. The primary outcome variable was change in total score on the Functional Independence Measure (FIM). The secondary outcome measurements included the FIM motor and cognitive subscores, length of stay (taken from day of admission), 2-minute and 6-minute timed walk tests measured at admission and on discharge, and discharge disposition (home/not home).

Results: Patients receiving intensive nutritional supplementation improved more than those on standard nutritional supplements on measures of motor function (total FIM, FIM motor subscore, 2-minute and 6-minute timed walk tests, all significant at p < 0.002). They did not, however, improve on measures of cognition (FIM cognition score). A higher proportion of patients who received the intensive nutritional supplementation went home compared to those on standard supplementation (p = 0.05).

Conclusion: Intensive nutritional supplementation, using readily available commercial preparations, improves motor recovery in previously undernourished patients receiving intensive in-patient rehabilitation after stroke.

GLOSSARY: F-M = Fugl-Myer; FIM = Functional Independence Measure; FOOD = Feed or Ordinary Diet; LOS = length of stay; NIHSS = NIH Stroke Scale.