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

Abstract

Purpose: Malnutrition is extensively prevalent amongst critically ill patients afflicted by ischemic stroke (IS). This study purpose was to evaluate the protein whey effect on inflammatory and antioxidant markers and functional prognosis in acute IS patients. Methods: out of 42 patients with acute IS who were referred to Imam Reza Educational Hospital, Tabriz, Iran, 40 patients participated in the study. Twenty-one patients as control group received the hospital routine formula, and 19 patients as intervention group received 20 g/daily of whey protein through oral gavage. Inflammation and oxidative stress indicators (e.g., albumin, malondialdehyde (MDA), total antioxidant capacity (TAC), interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), and high sensitivity C reactive protein (hs-CRP)and clinical variables included in were evaluated using National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) during admission and also 3 weeks after intervention. Results: Whey protein supplementation significantly decreased the NIHSS and mRS scores, TNF-α, IL-6, and hs-CRP by passing 3 weeks from intervention (P<0.05). However, whey formula had no significant effect on other markers including albumin, and MDA. The hs-CRP (P = 0.02) reduction was significantly higher in whey protein group in comparison with control group. Conclusion: Whey protein supplementation reduced inflammation markers in those patients with IS. However, these changes should be studied in larger-scale trials.

Effect of Oral Nutritional Supplementation on National Institute of Health Stroke Scale in Acute Ischemic Stroke

“…These results are relevant to the study conducted by Hashemilar et al, which reported no difference in stroke severity with NIHSS scores between the intervention group (−1.47 ± 1.87) and the control group (-2.05 ± 1.92) with p = 0.34 [7]. A similar result was also reported in the largest clinical trial to date, The Feed or Ordinary Diet (FOOD) trial, which examined the benefits of routine administration of oral nutritional supplementation in hospitalized stroke patients.…”

“…Several studies reported the benefit of ONS supporting daily calorie and nutritional intake, which was characterized by positive effects on functional aspects (e.g., increased motor strength), nutritional status (e.g., weight gain, achievement of daily calorie and protein targets), and clinical (e.g., reduced incidence of pressure ulcers, mortality, and shortened hospital stay) [6], [7]. Macronutrients such as protein in ONS can help reactivate neural protein synthesis, thereby increasing neuronal energy and neurotransmitter function [6].…”

Clinical Impact Potential of Supplemental Nutrients as Adjuncts of Therapy in High-Risk COVID-19 for Obese Patients

“…Adequate daily protein, especially whey and soy, intake have beneficial effects on the antioxidant defense system and host immunity (18). Among the various sources of protein, the whey protein has been recently recommended as a well-balanced and easy to digest amino acid and protein source with anabolic (19), anti-inflammatory (20), and immunomodulatory properties (21) as well as antiviral effects (22). Besides being an energy-rich part of the daily diet for balanced caloric intake, dietary fats, including fish oil and vegetable oils, provide a source for essential fatty acids as well as fat-soluble vitamins affecting metabolism and immunity.…”

Resistance Exercise and Whey Protein Supplementation Reduce Mechanical Allodynia and Spinal Microglia Activation After Acute Muscle Trauma in Rats

“…Although there was a reduction of IL-6 in the injured muscle, such decrease was found only in the group that underwent resistance exercise training combined with whey protein supplementation. However, it has already been reported that whey protein supplementation reduces pro-inflammatory cytokine IL-6 and tumor necrosis factor alpha (TNF-α) levels in patients with ischemic stroke, chronic obstructive pulmonary disease, and hypertension ( Lee et al, 2010 ; Sugawara et al, 2012 ; Hashemilar et al, 2020 ). In addition, an in vitro study found that the physiological concentrations of dairy whey protein normalize the TNF-α–induced pro-inflammatory gene expression in human endothelial cells ( Da Silva et al, 2017 ).…”

“…Although there is a study in the literature demonstrating this effect through exercise ( Dos Santos et al, 2019 ), it did not use resistance exercise; however, they did not use resistance exercise. It is known that during exercise, several neurotransmitters are released, that is, endocannabinoids, which may act on specific receptors in the spinal microglia, inhibiting their activation ( Hashemilar et al, 2020 ). Furthermore, whey protein supplementation may be associated with mTOR activation in the microglia, which may inhibit these cells ( Xie et al, 2014 ).…”