Amanat Sasan, Dordevic Aimee L, Brodtmann Amy, Cardoso Barbara R
Department of Nutrition, Dietetics and Food, Monash University, Victoria, Australia.
Department of Nutrition, Dietetics and Food, Monash University, Victoria, Australia; Victorian Heart Institute, Monash University, Victoria, Australia.
Adv Nutr. 2025 Jun;16(6):100440. doi: 10.1016/j.advnut.2025.100440. Epub 2025 May 10.
Poststroke cognitive decline is a major form of disability in stroke survivors. Although dietary interventions have shown potential in improving cognitive outcomes in stroke-free populations, their effects on stroke survivors remain unclear. This review aimed to evaluate associations between diet and cognitive function in stroke survivors. MEDLINE, Embase, Scopus, and CINHAL were searched for studies from inception to 16 December, 2024. Eligible articles were observational and interventional studies on adult stroke survivors that evaluated the association/effect of any nutritional exposure/intervention on cognitive performance and dementia risk. Studies were excluded when an intervention was combined with nonnutritional treatment. Random-effects meta-analysis was used for similar randomized clinical trials. This review included 20 clinical trials and 14 observational studies assessing the intake of energy and proteins and a variety of single nutrients, as well as dietary patterns, single foods, and phytochemicals. Meta-analyses revealed a positive effect of energy-protein supplementation on global cognition [standardized mean difference (SMD): 0.62; 95% confidence interval (CI): 0.15, 1.08; P = 0.009], and a negative effect of B-vitamins (folic acid, vitamin B6, and vitamin B12) (SMD: -0.40; 95% CI: -0.72, -0.08; P = 0.02). Adherence to the Mediterranean-Dietary Approaches to Stop Hypertension (DASH) Intervention for Neurodegenerative Delay and plant-based diets, as well as higher consumption of fruits, milk, coffee, vitamin E, and selenium, were related to better cognitive outcomes; no significant association was observed for adherence to DASH and Mediterranean diets and consumption of vitamins D and C. Butter and sugar intake and calcium supplementation were associated with negative cognitive outcomes. Mixed results were seen for omega (ω)-3, tea, and plant extracts. The available evidence indicates that energy-protein supplementation may benefit cognition after stroke, whereas B-vitamin supplementation has no effect. The substantial heterogeneity among studies hinders conclusions about other dietary strategies. This review was registered with PROSPERO as CRD42024541785.
中风后认知功能下降是中风幸存者残疾的主要形式。尽管饮食干预在改善未患中风人群的认知结果方面已显示出潜力，但其对中风幸存者的影响仍不明确。本综述旨在评估中风幸存者饮食与认知功能之间的关联。检索了MEDLINE、Embase、Scopus和CINHAL数据库，查找从数据库建立至2024年12月16日的研究。符合条件的文章为针对成年中风幸存者的观察性和干预性研究，这些研究评估了任何营养暴露/干预与认知表现和痴呆风险之间的关联/效果。当干预措施与非营养治疗相结合时，研究被排除。对类似的随机临床试验采用随机效应荟萃分析。本综述纳入了20项临床试验和14项观察性研究，这些研究评估了能量和蛋白质的摄入量以及多种单一营养素、饮食模式、单一食物和植物化学物质的摄入量。荟萃分析显示，能量 - 蛋白质补充剂对整体认知有积极影响[标准化均数差（SMD）：0.62；95%置信区间（CI）：0.15，1.08；P = 0.009]，而B族维生素（叶酸、维生素B6和维生素B12）有负面影响（SMD： - 0.40；95% CI： - 0.72， - 0.08；P = 0.02）。坚持地中海 - 终止高血压饮食方法（DASH）干预以延缓神经退行性变和采用植物性饮食，以及增加水果、牛奶、咖啡、维生素E和硒的摄入量，与更好的认知结果相关；未观察到坚持DASH饮食和地中海饮食以及维生素D和C的摄入量与认知结果之间存在显著关联。黄油和糖的摄入量以及钙补充剂与负面认知结果相关。对于ω - 3、茶和植物提取物，结果不一。现有证据表明，能量 - 蛋白质补充剂可能有益于中风后的认知，而B族维生素补充剂则无效果。研究之间存在的显著异质性阻碍了关于其他饮食策略的结论。本综述已在PROSPERO注册，注册号为CRD42024541785。
