Is Antioxidant and n–3 Supplementation Able to Improve Functional Status in Poststroke Patients? Results from the Nutristroke Trial

Abstract

Background: To test whether supplementary antioxidants and n–3 fatty acids, alone or in combination, could improve functional status in stroke survivors. Methods: We performed a randomized, double-blind, placebo-controlled clinical trial in 72 stroke patients (47 males; age 65.3 ± 12.9 years) admitted to a rehabilitation hospital for sequelae of first-ever ischemic stroke, and divided them into 4 subgroups. Group 1 patients received daily oral antioxidants, group 2 received n–3 polyunsaturated fatty acids, group 3 both supplements, and group 4 placebo, all for 12 months. No difference at baseline was observed among groups in neurological severity or in disability. All measures were repeated after 6 and 12 months of treatment. All major clinical events were recorded. Results: At baseline, 25% of the patients had a low plasma vitamin status, and 48.5% was at risk of undernutrition. At the 1-year follow-up, we observed a trend for lower mortality (p = 0.060) in subgroups treated with n–3 fatty acids, but without significant differences in rehabilitation result status among groups. Conclusions: Malnutrition is widely observed in patients admitted to a rehabilitative hospital for stroke rehabilitation, and dietary supplementation, even if not able to improve rehabilitation results, is likely to reduce mortality at the 1-year follow-up.

Omega-3 Fatty Acids as a Putative Treatment for Traumatic Brain Injury

“…93 There is additional evidence in humans that dietary supplementation with omega-3 fatty acids improves functional recovery in subarachnoid hemorrhage and stroke. [94][95][96][97] The impact of omega-3 PUFAs on prevention and recovery from stroke remains an intense area of inquiry, though the association between consumption of fish and fish oils and decreased risk of cardiovascular disease was first noted over 50 years ago. 98 Higher consumption of fish and n-3 fatty acids is correlated with a reduced risk of thrombotic stroke, 99,100 thus omega-3 PUFAs, in particular DHA, are now being investigated as putative ''nutraceuticals'' for treatment of cerebral ischemia.…”

Dietary and Serum Omega-6/Omega-3 Fatty Acids Are Associated with Physical and Metabolic Function in Stroke Survivors

“…Despite studies identifying an association between acute poststroke plasma fatty acid profiles and stroke recurrence, dietary omega-3 supplementation trials in stroke survivors have been unsuccessful at reducing cardiovascular risk [15]. However, in stroke survivors receiving 250 mg/d of DHA and 250 mg/d of EPA orally for one year, a trend in greater improvements in functional status (i.e., activities of daily living and mobility disability) was observed [16]. Further, associations between reduction in serum omega-6/omega-3 and cholesterol-lowering and improvements in insulin sensitivity are observed in patients with cardiovascular disease following statin treatment [17].…”

Dietary Intake and Intervention in Chronic Stroke: Review of the Evidence

“…In survivors randomized to one year of a standard diet (participants were given meals providing up to 125% of daily needs and high nutritional density) plus a) antioxidants alone (290 mg vitamin E, 240 mg vitamin C, 150 mg polyphenols and 19 mg β-carotene) b) omega 3s alone (500 mg polyunsaturated fatty acids) c) antioxidants plus omega 3s, or d) placebo [50], no effects were observed with regard to group differences in neurological or functional status [50] at one year; however, when omega-3 groups were combined, a trend in better improvements in functional status (i.e., Barthel Index (assesses autonomy in activities of daily living) and Rivermead Mobility Index (quantifies mobility disability)) and lower mortality were observed in those supplemented with omega 3s. This suggests that omega 3 supplementation may result in improved functional outcomes during the chronic phase of stroke.…”