Malnutrition in Patients with Acute Stroke

Table 1

Micronutrients and mechanisms through which their deficiencies induce cerebrovascular alterations and increase the risk of stroke.

Micronutrient	Mechanism
Folic acid
Cofactor in homocysteine metabolism	Hyperhomocysteinemia (potentially atherogenic)
B vitamins
(i) B6 and B12: cofactors in homocysteine metabolism	(i) Hyperhomocysteinemia (potentially atherogenic)
(ii) Potentially antioxidants	(ii) Oxidative stress
Vitamin D
(i) Controls parathormone levels	(i) Secondary hyperparathyroidism:
(ii) Suppresses cholesterol uptake by the macrophages and foam cell formation	– Insulin resistance and pancreatic b-cell dysfunction→type 2 diabetes mellitus
	– Activation of the rennin-angiotensin-aldosterone system→hypertension
(iii) Increases the size of high-density lipoprotein particles	– Stimulation of systemic and vascular inflammation→atherogenesis
	(ii) Atherogenesis
Vitamins A, C, and E
Antioxidants	Oxidative stress
Zinc
(i) Activates brain protein synthesis	(i) Neurocognitive impairment
(ii) Controls newly formed synapses	(ii) Impaired neurotransmission
(iii) Cofactor of superoxide dismutase	(iii) Oxidative stress