Enteral tube feeding of patients with acute stroke: when does the risk of diarrhoea increase?

Abstract Background Malnutrition often occurs in acute stroke patients receiving enteral tube feeding (ETF). Unless malnutrition is improved, their clinical outcome is poor. However, strategies to improve malnutrition in these patients have not been established. Branched-chain amino acids (BCAA) may enhance protein synthesis and attenuate inflammation. Our study aimed to investigate whether a leucine enriched BCAA dietary supplement (LEBDs) could quickly increase serum levels of albumin (Alb) or transthyretin (TTR) and decrease high-sensitivity C-reactive protein (CRP) in the development of severe malnutrition within a few days after stroke onset compared to standard BCAA dietary supplement (SBDs). Methods We retrospectively included acute stroke patients who: 1) were admitted between August 2016 and July 2017; 2) underwent ETF for 7 days or longer after admission, and 3) underwent blood examination of Alb, TTR, and CRP on admission, the fifth day and the seventh day. We defined severe malnutrition as severe hypoproteinemia: decrease of TTR to less than 15 mg/dl on the 5th day. In LEBDs and SBDs groups, patients started to receive a dietary supplement containing leucine of 1.44 and 0. 72 g twice a day on the fifth day, respectively. We evaluated Alb (g/dl), TTR (mg/dl), and CRP (mg/dl) on admission, the fifth day, and the seventh day. Results Twenty-nine patients met our inclusion criteria:15 in LEBDs and 14 in SBDs. In LEBDs and SBDs groups, the median Alb was 3.5 and 3.3 g/dl, TTR was 12.7 and 10.7 mg/dl, and CRP was 1.02 and 0.673 mg/dl on admission, respectively. In LEBDs, the median Alb and TTR decreased to 2.6 g/dl and 11.9 mg/dl, and CRP increased to 5.337 mg/dl on the fifth day. On the 7th day, TTR increased, and CRP decreased, although Alb did not improve. In SBDs, the median Alb and TTR decreased to 2.6 g/dl and 9.7 mg/dl, and CRP increased to 4.077 mg/dl on the fifth day. On the 7th day, Alb, TTR, and CRP did not improve. Conclusion In acute stroke patients receiving leucine enriched BCAA dietary supplement, quick improvements in transthyretin and CRP were observed.

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Abstract WP359: Enteral Tube Feeding Propensity Score for Acute Stroke Patients

Stroke ◽

10.1161/str.49.suppl_1.wp359 ◽

2018 ◽

Vol 49 (Suppl_1) ◽

Author(s):

Luiz Dalfior ◽

Geovanna Veronezi Augusto ◽

Luiz Fernando Oliveira ◽

Maira Honorato ◽

Patricia Nunes ◽

...

Keyword(s):

Propensity Score ◽

Acute Stroke ◽

Tube Feeding ◽

Stroke Patients ◽

Enteral Tube Feeding

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Correction to: Quick and effective improvement of leucine enriched dietary supplement on malnutrition in acute stroke patients receiving enteral tube feeding

BMC Emergency Medicine ◽

10.1186/s12873-020-00393-0 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Takahisa Mori ◽

Kazuhiro Yoshioka

Keyword(s):

Acute Stroke ◽

Dietary Supplement ◽

Tube Feeding ◽

Stroke Patients ◽

Enteral Tube Feeding

An amendment to this paper has been published and can be accessed via the original article.

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A quick and improvement effect of leucine enriched dietary supplement on malnutrition in acute stroke patients receiving enteral tube feeding

10.21203/rs.3.rs-18349/v1 ◽

2020 ◽

Author(s):

Takahisa Mori ◽

Kazuhiro Yoshioka

Keyword(s):

Acute Stroke ◽

Dietary Supplement ◽

Early Stage ◽

Tube Feeding ◽

Calorie Intake ◽

Stroke Patients ◽

Enteral Tube Feeding ◽

Improvement Effect ◽

Enhance Protein Synthesis ◽

Branched Chain

Abstract Background:Malnutrition often occurs in acute stroke patients receiving enteral tube feeding (ETF). Unless malnutrition is improved, their clinical outcome is poor. However, strategies to improve malnutrition in these patients have not been established. Branched-chain amino acids (BCAA) may enhance protein synthesis and attenuate inflammation. Our study aimed to investigate whether a leucine enriched BCAA dietary supplement (LEBDs) could quickly improve a patient's nutritional status during the early stage of malnutrition. Methods:We retrospectively analyzed acute stroke patients who 1) were admitted between December 2016 and July 2017; 2) underwent ETF for seven days or longer after admission; 3) who underwent blood examination on admission, the 5th day, and seventh day; 4) in whom transthyretin (TTR) was less than 15 mg/dl on the 5th day, and 5) received LEBDs containing 1.44 g leucine per 200 kcal twice a day on the 5th day. We evaluated patients' features, serum albumin (Alb) (g/dl), transthyretin (TTR) (mg/dl), and high sensitive C-reactive protein (CRP) (mg/dl) on admission, the fifth day, and the seventh day. Results:Fifteen patients met our inclusion criteria. Their median age, body mass index (BMI), body weight (BW), serum blood glucose (BG), Alb, TTR, and CRP were 82 years, 21.8 kg/m2, 50 kg, 150 mg/dl, 3.5 g/dl, 12.7 mg/dl, and 1.02 mg/dl, respectively. Their median calorie intake was 1,200 kcal/day. On the 5th day, their median Alb and TTR decreased to 2.6 g/dl (p<0.0001) and 11.8 mg/dl (p<0.01), respectively, and their median CRP increased to 5.24 mg/dl (p<0.01). On the 7th day, TTR increased to 15.7 mg/dl (p<0.001), and CRP decreased to 4.77 mg/dl (p<0.05), whereas their median Alb was 2.6 g/dl (ns) and did not significantly change. ConclusionThe leucine enriched BCAA dietary supplement had a quick and improvement effect on the transthyretin and CRP level.

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