Table 1.
Nutritional considerations for the prevention of metabolic, physical, and psychological dysfunction in adult chronic stroke survivors.
| Nutritional consideration | Dietary Reference Intake (United States and Canada) [25, 26]/Dietary Guidelines for Americans (United States) [27] | UL (United States and Canada) [25, 26] | Indicator of nutritional risk | Potential role in the prevention of metabolic, physical, and psychological dysfunction |
|---|---|---|---|---|
| Energy and macronutrient balance | ||||
|
| ||||
| Energy |
Dietary guidelines Males: 2,000–3,000 kcals/d, depending upon age and activity level Females: 1,600–2,400 kcals/d, depending upon age and activity level |
ND |
Serum albumin Reference range: 3.5–5.0 g/dL Increased risk: <3.2 g/dL Serum prealbumin Reference range: 15–35 mg/dL Increased risk: <15 mg/dL |
(i) Sarcopenic obesity prevention (a) Maintenance of muscle mass (b) Prevention of excessive adipose tissue accumulation |
| (i) Carbohydrates |
RDA (AMDR) Both sexes: 130 g/d (45–65%) |
ND, but <10% of daily calories should come from added sugars | ||
| (ii) Protein |
RDA (AMDR) Both sexes: 0.8 g/kg/d (10–35%) |
ND | ||
| (iii) Fat |
AMDR Both sexes: 20–35% |
ND, but <10% of daily calories should come from saturated fat | ||
|
| ||||
| Other nutrients | ||||
|
| ||||
| B-vitamins | ||||
|
| ||||
| (i) Folate |
RDA Both sexes: 400 μg/d |
1000 μg/d |
Serum folate Reference range: 6–20 ng/ml Deficiency: <3 ng/ml Red blood cell folate: Reference range: 140–628 ng/mL Deficiency: <100 ng/ml |
|
| (ii) Vitamin B6 |
RDA Both sexes: 19–50 y: 1.3 mg/d Males: 51+ y: 1.7 mg/d Females: 51+ y: 1.5 mg/d |
100 mg/d |
Plasma pyridoxal 5-phosphate Reference range: 11–302 nmol/L Deficiency: <10 nmol/L |
(i) Physical dysfunction prevention (ii) Depressive symptom prevention (iii) Cognitive impairment prevention (a) Reduced homocysteine |
| (iii) Vitamin B12 |
RDA Both sexes: 2.4 μg/da |
ND |
Serum B12 Reference range: 500–900 pg/mL Deficiency: <200 pg/mL |
|
| Vitamin D |
RDA Both sexes: 19–70 y: 15 μg/d 70+ y: 20 μg/d |
100 μg/d |
Serum 25(OH)D Reference range: 30–100 ng/mL Insufficiency: 20–30 ng/mL Deficiency: <20 ng/mL |
(i) Fracture prevention (ii) Depressive symptom prevention |
| Vitamin K |
AI Males: 120 μg/d Females: 90 μg/d |
ND |
Plasma phylloquinone Reference range: 0.25–2.67 nmol/L Insufficiency/Deficiency: ND (<0.2 nmol/L considered “low”) |
(i) Fracture prevention |
| Omega 3 |
AI (α-linolenic acid) Males: 1.6 g/d Females: 1.1 g/d |
ND |
Omega 3 index ([sum of 3 omega 3 fatty acids ÷ total phospholipid fatty acids] × 100) Reference range: 1.4–4.9% Increased Risk: <3.2% Omega 6/omega 3 (sum of 6 omega 6 fatty acids ÷ sum of 3 omega 3 fatty acids) Reference range: 5.7–21.3 Increased risk: >5 |
(i) Physical dysfunction prevention (a) Maintenance of muscle mass (b) Reduced inflammation and oxidative stress (ii) Depressive symptom prevention (iii) Cognitive impairment prevention |
RDA = Recommended Dietary Allowance, AI = Adequate Intake, UL = Tolerable Upper Intake Level, AMDR = Acceptable Macronutrient Distribution Range, and ND = not determinable. aBecause older people may malabsorb food-bound B12, it is advisable to meet RDA through foods fortified with vitamin B12 or supplements containing B12.