Inflammation and Malnutrition in Acute Ischemic Stroke
INFLAMMATION and malnutrition may work together to worsen outcomes in acute ischemic stroke.
Why This Relationship Matters
Acute ischemic stroke triggers systemic inflammation, metabolic stress, and immune dysregulation, while malnutrition is common after stroke and linked to poorer recovery. This narrative review highlighted a bidirectional relationship in which inflammation can drive nutritional decline, while malnutrition may further impair immune regulation and amplify inflammatory dysfunction. Together, these processes may contribute to worse neurological recovery, higher mortality risk, and more post-stroke complications.
How Inflammation Can Worsen Nutritional Status
The review described several pathways through which inflammation may promote malnutrition after acute ischemic stroke. Pro-inflammatory cytokines such as IL-1β, IL-6, and TNF-α can suppress appetite, disrupt neuroendocrine signaling, and contribute to anorexia. In parallel, inflammation may drive hypercatabolism, increase resting energy expenditure, accelerate muscle breakdown, and alter hepatic protein synthesis away from transport proteins and toward acute phase reactants. Gastrointestinal dysfunction and impaired absorption may further worsen nutritional status.
These mechanisms are clinically relevant because stroke survivors may already face dysphagia, reduced mobility, cognitive impairment, and decreased oral intake. The review emphasized that this combination can create a self-reinforcing cycle in which inflammation worsens malnutrition and malnutrition, in turn, sustains inflammatory stress.
Clinical Assessment and Early Nutrition Strategies
The authors noted there is no single gold standard for nutritional assessment in stroke care. Instead, they supported a multifaceted approach using validated screening and diagnostic tools alongside laboratory-based indices such as CONUT and PNI. Although serum albumin and prealbumin are commonly used, the review cautioned that acute phase responses can limit their value as standalone nutritional markers.
Early nutritional intervention was presented as a key clinical priority. Personalized dietary plans and enteral feeding, when needed, may reduce the consequences of inflammation-driven malnutrition, improve functional outcomes, and lower complication risk. The authors concluded that integrating nutritional assessment and management into standard stroke care protocols may support better recovery and long-term outcomes, while also identifying important areas for future research.
Reference
Golenia A et al. The interplay between inflammation and malnutrition in acute ischemic stroke: a narrative review. Nutrition Reviews. 2026;DOI:10.1093/nutrit/nuag040.
Featured Image: Solid photos on Adobe Stock.
