NEW YORK (Reuters Health) – Patients who are undernourished after experiencing an acute stroke benefit from intensive protein and energy supplementation during inpatient rehabilitation, according to results of a pilot study conducted at the Burke Rehabilitation Hospital in New York and reported in the December 2 issue of Neurology.

Dr. M. H. Rabadi, currently at the VA Medical Center in Oklahoma City, and co-investigators conducted a prospective, double-blind trial comparing intensive and routine nutritional supplementation in 102 undernourished patients admitted within 4 weeks of an acute stroke. All had unintentionally lost at least 2.5% of their body weight.

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: total Functional Independence Measure (FIM) score, 31.5 vs 22.9; FIM motor subscore, 24.5 vs 16.7; change in 2-minute walk test, 102 vs 44 feet; and change in 6-minute walk test, 299 vs 170 feet (p < 0.001 for all).

“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 < 0.050).

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.

“The data reflect real life practice,” they state, “the results of which can be incorporated into routine clinical care of patients with stroke admitted to rehabilitation units.”

Although editorialists from Massachusetts General Hospital in Boston comment that the trial “demonstrates the importance optimizing all aspects of management in the recovery phase of stroke,” they question the generalizability of the findings.

Drs. Karen L. Furie and Peter J. Kelly contend that “the results need to be replicated in multicenter trials balanced for stroke subtype and severity, and adequately powered to examine subgroups based on age, nutritional status, and stroke severity.”

Reference:
Neurology 2008;71:1852-1853,1856-1861.