Early Enteral Nutrition and Short-Term Laboratory Dynamics in Acute Stroke With Dysphagia: Hemorheology, Inflammatory Cytokines, and Intestinal Barrier Biomarkers
Enteral Nutrition, Stroke & Dysphagia: Microcirculation and Cytokines
Abstract
Background:To examine whether enteral nutrition support modulates blood microcirculation, stress-related cytokines, and nutrition/metabolism biochemical indices in patients with acute cerebral stroke (CS) complicated by swallowing disorders (SD), and to explore possible biochemical links among these changes.
Methods:This retrospective cohort study included 126 patients with acute CS complicated by SD admitted to our hospital from August 2022 to August 2025. According to the intervention plan, patients were assigned to an observation group (68 cases; enteral nutrition support) or a control group (58 cases; routine fluid replacement therapy). Fasting venous blood was collected before intervention (T0), at 7 days (T1), and at 14 days (T2). Hemorheological parameters and red blood cell functional indices were measured with an automatic hemorheology analyzer; stress cytokines, inflammatory mediators, and intestinal barrier–related indicators were quantified by enzyme-linked immunosorbent assay; nutrition metabolism–related indices were determined using an automatic biochemical analyzer.
Results:In the observation group, hemorheological parameters improved progressively after intervention. Compared with T0, whole-blood high-shear viscosity (W-Vis-H), whole-blood low-shear viscosity (W-Vis-L), and fibrinogen were lower at T1 and further reduced at T2, while the red blood cell deformation index (RDI) increased (P<0.05). Stress cytokines, inflammatory mediators, and intestinal barrier indicators declined in parallel. By T2, tumor necrosis factor-α, interleukin-6, high-sensitivity C-reactive protein, and endotoxin each decreased by more than 35% versus T0 (P<0.05). Nutrition metabolism indices increased gradually: prealbumin (PA) and transferrin (TRF) increased at T1, and six indicators (including albumin [ALB] and hemoglobin [Hb]) showed statistically significant improvements at T2 (P<0.05). No significant changes were observed in these indices at any time point in the control group (P>0.05). Between-group comparisons showed more favorable values in the observation group at T1 and T2 (P<0.05).
Conclusion:In patients with acute CS complicated by SD, enteral nutrition support was associated with short-term stabilization of biochemical homeostasis, including improved microcirculation-related hemorheology, suppression of excessive inflammatory/stress responses, and reinforcement of nutritional reserves.
References
2. Tan KS, Pandian JD, Liu L, Toyoda K, Leung TWH, Uchiyama S, et al. Stroke in Asia. Cerebrovasc Dis Extra. 2024;14(1):58-75.
3. Labeit B, Michou E, Trapl-Grundschober M, Suntrup-Krueger S, Muhle P, Bath PM, et al. Dysphagia after stroke: research advances in treatment interventions. The Lancet Neurology. 2024;23(4):418-28.
4. Farpour S, Asadi-Shekaari M, Borhani Haghighi A, Farpour HR. Improving Swallowing Function and Ability in Post Stroke Dysphagia: A Randomized Clinical Trial. Dysphagia. 2023;38(1):330-9.
5. D'Netto P, Rumbach A, Dunn K, Finch E. Clinical Predictors of Dysphagia Recovery After Stroke: A Systematic Review. Dysphagia. 2023;38(1):1-22.
6. Li X, Wu M, Zhang J, Yu D, Wang Y, Su Y, et al. Post-stroke dysphagia: Neurological regulation and recovery strategies. Biosci Trends. 2025;19(1):31-52.
7. Szabo TP, Muhelyi V, Beres-Molnar AK, Kovacs A, Balogh Z, Folyovich A. [Dysphagiafelmeresek akut stroke-ban]. Ideggyogy Sz. 2021;74(7-08):235-48.
8. Labeit B, Muhle P, Dziewas R, Suntrup-Krueger S. [Diagnostics and treatment of post-stroke dysphagia]. Nervenarzt. 2023;94(8):676-83.
9. Zhang Q, Shi Y, Cheng J, Chen Y, Wang J, Wang X, et al. Impact of rTMS and iTBS on Cerebral Hemodynamics and Swallowing in Unilateral Stroke: Insights from fNIRS. Med Sci Monit. 2025;31:e944521.
10. Rigual R, Fuentes B, Diez-Tejedor E. Management of acute ischemic stroke. Med Clin (Barc). 2023;161(11):485-92.
11. McCarty EB, Chao TN. Dysphagia and Swallowing Disorders. The Medical clinics of North America. 2021;105(5):939-54.
12. Kang X, Liu L. Effect of nutritional intervention combined with vitamin D on glucose metabolism, sex hormones and inflammatory factors in patients with polycystic ovary syndrome. J Med Biochem. 2025;44(3):595-602.
13. Wu D, Su S, Zha X, Wei Y, Yang G, Huang Q, et al. Glutamine promotes O-GlcNAcylation of G6PD and inhibits AGR2 S-glutathionylation to maintain the intestinal mucus barrier in burned septic mice. Redox biology. 2023;59:102581.
14. Huo Q, Yue T, Li W, Wang X, Dong Y, Wu X, et al. Time-restricted feeding prevents ionizing radiation-induced hematopoietic stem cell damage by inhibiting NOX-4/ROS/p38 MAPK pathway. Int Immunopharmacol. 2024;130:111695.
15. Stumpf F, Keller B, Gressies C, Schuetz P. Inflammation and Nutrition: Friend or Foe? Nutrients. 2023;15(5).
16. Wunderle C, Stumpf F, Schuetz P. Inflammation and response to nutrition interventions. JPEN Journal of parenteral and enteral nutrition. 2024;48(1):27-36.
17. Abdelsalam RM, Hamam HW, Eissa NM, El-Sahar AE, Essam RM. Empagliflozin Dampens Doxorubicin-Induced Chemobrain in Rats: The Possible Involvement of Oxidative Stress and PI3K/Akt/mTOR/NF-kappaB/TNF-alpha Signaling Pathways. Molecular neurobiology. 2025;62(3):3480-92.
18. Hariz A, Bhattacharya PT. Megaloblastic Anemia. StatPearls. Treasure Island (FL) ineligible companies. Disclosure: Priyanka Bhattacharya declares no relevant financial relationships with ineligible companies.2025.
19. Xu P, Chen C, Zhang Y, Dzieciatkowska M, Brown BC, Zhang W, et al. Erythrocyte transglutaminase-2 combats hypoxia and chronic kidney disease by promoting oxygen delivery and carnitine homeostasis. Cell Metab. 2022;34(2):299-316 e6.
20. Zhang X, Wang X, Huang L, Zhou C, Qian B, Luo Z, et al. Effects of statins on sarcopenia with focus on mechanistic insights and future perspectives. Front Pharmacol. 2025;16:1669591.
21. Suzuki K, Sugiyama R, Katano T, Shigehara H, Takagiwa T, Katafuchi I, et al. The safety of rapid administration of enteral nutrition in acute stroke patients. Journal of the neurological sciences. 2022;437:120270.
22. Bretscher C, Buergin M, Gurzeler G, Kagi-Braun N, Gressies C, Tribolet P, et al. Association between prealbumin, all-cause mortality, and response to nutrition treatment in patients at nutrition risk: Secondary analysis of a randomized controlled trial. JPEN Journal of parenteral and enteral nutrition. 2023;47(3):408-19.
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