What is the role of protein powder in stroke patients?

Role of Protein Powder in Stroke Patients

Protein powder supplementation should be provided only to stroke patients who are malnourished or at risk of malnutrition, not routinely to all stroke patients. 1

Nutritional Assessment and Screening

• All stroke patients should undergo nutritional screening within 24 hours of admission using validated tools such as the Malnutrition Universal Screening Tool (MUST) 2, 1
• Document baseline weight, recent weight changes, BMI, and dietary intake 2
• Assess for dysphagia before providing any oral nutrition, including protein supplements 2

Indications for Protein Supplementation

Recommended for:

• Stroke patients identified as malnourished or at risk of malnutrition 1
• Patients with dysphagia who can safely consume oral supplements 1

Not recommended for:

• Routine use in acute stroke patients without dysphagia who are adequately nourished 1

Evidence for Protein Supplementation in Stroke

• High-protein oral nutritional supplements (ONS) have shown positive effects on:

  • Improved functional independence measures 1
  • Better performance on 6-minute walking tests 1
  • Prevention of weight loss 1
  • Improved handgrip strength 1

• A small trial found that protein supplementation may enhance neurological recovery in subacute ischemic stroke patients, with improvements in NIH Stroke Scale scores correlating with increased protein intake 3

• Protein intake in stroke patients often falls below requirements (0.81-0.90 g/kg/day observed vs. 1 g/kg/day recommended) 4

Protein Supplement Specifications

When protein supplementation is indicated:

• Provide ONS with at least 400 kcal with 30% of energy as protein (approximately 30g protein) 1
• For high-protein ONS, use products with >20% of energy from protein 1
• Consider protein quality: replacing red meat protein with poultry, nuts, fish, or dairy protein sources may reduce stroke risk 5

Implementation Algorithm

1. Screening: Assess nutritional status within 24 hours of admission

   • If malnourished or at risk → proceed to step 2
   • If well-nourished → no protein supplementation needed

2. Swallowing Assessment:

   • If dysphagia present → consult speech therapist for appropriate texture modifications
   • If severe dysphagia → consider enteral nutrition

3. Protein Supplementation Plan:

   • For oral intake: High-protein ONS (>20% energy from protein)
   • For texture-modified diets: Appropriate consistency protein supplements
   • For enteral nutrition: Ensure adequate protein content (1-1.5 g/kg/day)

4. Monitoring:

   • Regular reassessment of nutritional status
   • Monitor for complications (aspiration, infections)
   • Track functional outcomes

Pitfalls and Caveats

• Malnutrition after stroke is associated with increased risk of infections, bedsores, and poor outcomes 6
• Texture-modified diets and thickened liquids may lead to reduced energy and fluid intake 1
• Protein supplementation alone may not address all nutritional deficiencies; consider comprehensive nutritional support
• Avoid delaying nutritional intervention, as protein-energy malnutrition after acute stroke is an independent risk factor for poor outcomes 6
• The largest trial (FOOD trial) showed no significant differences in mortality or functional outcomes with routine ONS, highlighting the importance of targeting supplementation to at-risk patients 1