The Importance of Assessing Nutritional Status to Ensure Optimal Recovery during the Chronic Phase of Stroke

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/	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. older people may malabsorb food-bound B12, it is advisable to meet RDA through foods fortified with vitamin B12 or supplements containing B12.