Table 1.
The characteristics of included studies in this meta-analysis.
| Study ID | Country | Sample size | Stroke subtype | Age (mean ± SD, range) | Follow-up time | Interventions | Main outcomes |
|---|---|---|---|---|---|---|---|
| Aquilani R (2014) | Italy | 38 | Ischemic and hemorrhagic | 68 ± 13.2 71.3 ± 10 |
Discharge | Nutritional mixture supplement that provided 8 g of EAAs/d (4 g in the morning + 4 g in the afternoon diluted in half a glass of water), until discharge | Arterial amino acid concentrations and muscle amino acid arteriovenous difference. |
| Bellone JA (2019) | USA | 16 | Ischemic and hemorrhagic | 58.13 ± 13.62 59.63 ± 13.48 |
Discharge | Pomegranate (1 g of a concentrated blend of polyphenols, equivalent to levels in approximately 8 oz of juice (approximately 755 mg of gallic acid equivalents: profile includes ellagitannins, gallotannins, ellagic acid, and flavonoids)) supplement twice per day (morning and night) for 1 week. | Neuropsychological testing (primary outcome: Repeatable Battery for the Assessment of Neuropsychological Status) and functional independence scores |
| Boselli M (2012) | Italy | 136 | Ischemic and hemorrhagic | 62.7 ± 12.4 63.9 ± 17 |
60 days | Nutritional mixture supplement with 8 g of EAAs/day (4 g in the morning + 4 g in the afternoon diluted in half a glass of water), 60 days | The incidence of infections, Relationship Between Measured Variables and Functional Independence, Risk-Identifying Variables |
| Dennis MS (2005a) | Multi-countries | 4023 | NR | 78 ± 10 80 ± 7 |
6 months | Regular hospital diet plus oral nutritional supplements (360 mL at 6.27 kJ/mL and 62·5 g/L in protein every day), Until discharge | Death or poor outcome (modified Rankin scale [MRS] grade 3–5) |
| Dennis MS (2005b) | Multi-countries | 859 | NR | 76 ± 11 76 ± 11 |
6 months | Starting enteral tube feeding (via the clinician’s preferred tube) as soon as possible, for > 7 days |
Risk of death |
| Gariballa SE (1998) | UK | 42 | Ischemic | 78 ± 10 80 ± 7 |
2, 4, 12 weeks, discharge | Regular hospital diet plus a twice daily oral nutritional supplement of ≥ 400 mL containing 600 kcal, 4 weeks or until death or discharge | Energy and protein intakes, change in nutritional status, disability, infective complications, length of stay, and mortality |
| Ha L (2010) | Norway | 124 | Ischemic and hemorrhagic | 79.7 ± 6.8 78.5 ± 7.4 |
3 months | Individualized nutritional care using established oral energy- and protein rich feedings or enteral tube feeding, Until discharge | The percentage of patients with weight loss ≥ 5%; QoL, handgrip strength and length of hospital stay |
| Irisawa H (2020) | Japan | 179 | NR | 79.7 ± 11.5 | 4 weeks | NR | Muscle mass and the nutritional status, activities of daily living |
| Mizushima T (2020) | Japan | 668 | Ischemic | 74 ± 66-80 78 ± 72-84 |
90 days | NR | Transfer to acute care and death; 2-year mortality; FIM-motor effectiveness |
| Nishioka S (2017) | Japan | 264 | NR | 78.5 ± 7.5 78.3 ± 7.2 |
3 weeks | oral protein supplementation of 20 g/d for 21 d | the ability of participants; Achievement of full oral intake, malnutrition risk |
| Nishioka S (2020a) | Japan | 420 | Ischemic and hemorrhagic | 80.1 ± 8.0 77.2 ± 7.6 |
NR | NR | Recurrent stroke, prestroke ADL, Total FIM, Comorbidities, Disabilities |
| Nishioka S (2020b) | Japan | 113 | Ischemic and hemorrhagic | 77 (66.5–84) 77.5 (63.5–82) |
3 months | Protein 1.5 g/kg (= 24% energy), carbohydrate 3.12 g/kg (= 50% energy), carbohydrate–protein ratio 2.08, lipids 0.72 g/kg (= 26% energy) | Malnutrition, muscle mass and oral status, and swallowing function recovery |
| Nishiyama A (2019) | Japan | 290 | Ischemic and hemorrhagic | 76.5 ± 7.5 80.2 ± 7.8 |
3 weeks | 21 days of daily supplementation with a formula providing 20 g of protein and 250 kcal (carbohydrate 28.2 g, lipids 7 g in addition to the 20 g of protein) | ADL was evaluated using FIM, and nutritional status |
| Rabadi MH (2008) | United States | 116 | Ischemic and haemorrhagic | 75 ± 10.58 73.58 ± 13.02 |
Discharge | Intensive nutritional supplement every 8 h by mouth (120 ml, 240 calories, 11 g of proteins, 90 mg of vitamin C), Until discharge | Change in total score on the FIM, the FIM motor and cognitive subscores, length of stay, 2-minute and 6-minute timed walk tests |
| Yoshimura Y (2019) | Japan | 113 | Ischemic and hemorrhagic | 80.8 + 7.1 78.9 + 6.3 |
90 days | Early nasogastric nutrition using a solution with high nutritional content, 21 days | Physical function, appendicular muscle mass, muscle strength |
| Zheng T (2015) | China | 146 | Ischemic and hemorrhagic | 71.4 ± 9.3 71.8 ± 10.1 |
21 days | Either Nutrison fiber, Swiss High (RAE; 4.18–6.27 kJ/ml), or a solution with high nutrition content made by nutritionists and based on condition, body weight, and nutritional status. Energy requirements were in the range of 83.68–125.52 kJ/kg/day | Nutritional status, nosocomial infection, and mortality rates |
FIM = functional independence measurement, NR = no report, QoL = quality of life.