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BackgroundMalnutrition is common after stroke. Stroke patients often have a suboptimal energy intake, body weight and inadequate blood nutrient levels. Nutrient insufficiencies may not be detected, but their recognition is essential to provide adequate nutritional support after a stroke. This comprehensive summary of the literature is a collection of data on blood levels of a broad selection of nutrients involved in restoring cerebral blood flow and functional brain connectivity in stroke patients compared to controls.MethodsEmbase and MEDLINE were searched for studies published in English in the period 1980–2022. Studies including adult stroke subjects and controls whose blood samples were analyzed for docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), uridine, choline, folate, vitamin B6, vitamin B12, vitamin C, vitamin E, selenium, coenzyme Q10 (CoQ10), carnitine, arginine, or taurine were selected. If there were >3 reports (k) per nutrient, results were generated with an unadjusted and age-adjusted random-effects meta-analysis model. Risk of bias was evaluated for relevant domains from the ROBINS-I tool and with Egger's test.ResultsOne hundred five reports on blood nutrient levels were extracted from 56 eligible studies. Overall, meta-analyses showed lower blood levels of most nutrients in stroke patients compared to controls. The number of reports and the statistical significance for the unadjusted data were: folate (k = 27; p = 0.005), vitamin B12 (k = 23; p = 0.002), vitamin E (k = 11; p = 0.013), DHA (k = 7, p = 0.015), EPA (k = 7; p = 0.004), vitamin C (k = 6; p = 0.020), and selenium (k = 6; p = 0.018). No significant decreases were observed for vitamin B6 (k = 6; p = 0.52) and arginine (k = 4; p = 0.93). For other selected nutrients, there were insufficient reports to perform a meta-analysis. Available reports pointed toward lower (CoQ10, choline; k = 2), higher (taurine; k = 2), or unchanged (carnitine, uridine; k = 1) blood levels after stroke. In general, risk of bias was low.ConclusionOur findings indicate that nutrient insufficiencies occur for many nutrients that are involved in repair processes after stroke. The low blood levels of folate, vitamin B12, EPA, DHA, vitamin C, vitamin E, selenium, and possibly CoQ10 and choline, highlight the presence of a suboptimal nutritional status after stroke. The inclusion of targeted nutritional interventions to further support recovery should receive consideration in the multidisciplinary context of stroke rehabilitation.

BackgroundMalnutrition is common after stroke and can affect rehabilitation and healthcare costs. A comprehensive overview of stroke patients' nutritional condition from the hyperacute to the chronic phase is lacking. This systematic review aimed to investigate the prevalence of impaired nutritional condition (INC) across the continuum of care in specific phases after stroke.MethodsCAB ABSTRACTS, Embase, MEDLINE, were used to collect studies published between 01-01-1999 and 26-08-2020. Primary and secondary outcomes were prevalence of INC and prevalence of malnutrition, respectively. Exploratory outcomes were prevalence of INC at follow-up, nutritional examination methods, prevalence of dysphagia, stroke severity, adverse events, and continent-specific prevalence of INC. A random-effects meta-analysis model was used to estimate the phase-specific pooled prevalence of INC and malnutrition.ResultsThe dataset consisted of 78 study groups selected over a total of 1,244 identified records. The pooled prevalence of INC and malnutrition were 19% (95%CI:7–31) (N = 4) and 19% (95%CI:9–29) (N = 3), 34% (95%CI:25–43) (N = 34) and 26% (95%CI:18–35) (N = 29), 52% (95%CI:43–61) (N = 34) and 37% (95%CI:28–45) (N = 31), 21% (95%CI:12–31) (N = 3) and 11% (95%CI:0–24) (N = 3) and 72% (95%CI:41–100) (N = 3) and 30% (95%CI:0–76) (N = 2) in the hyperacute, acute, early subacute, late subacute, and chronic phase, respectively.ConclusionINC and malnutrition are highly prevalent in all stages of stroke care. Since malnutrition has been shown to negatively affect clinical outcomes, mortality, and overall healthcare expenditure in stroke survivors, it is essential to examine and monitor the nutritional status of stroke patients throughout their care journey to guide and plan, timely nutritional support and dietary modification.

Obesity is a common and multi-factorial condition. During the last years, different research has been done to clarify the complex mechanisms that occur in this disease. The excessive increase of the adipose tissue depots is the first clear signal of an impaired metabolism. Moreover, the endocannabinoid system (eCB), inflammation regulatory factors and weight control – through the diet – are strictly connected with the obesity development. The gut microbiota has been proposed as one suitable candidate to explain the intricacy of this scenario. Nevertheless, the latest findings are characterized by several conflicting theories that do not allow us to define the precise role of the gut microbiota. This review, through a critical analysis of the relevant literature, underlines the possibility of considering the gut microbiota as a “joining link” between obesity and the adipose tissue.