Ann Saudi Med. 2026 Sep-Oct;46(5):376-387. doi: 10.5144/0256-4947.2026.376. Epub 2026 Oct 1.
ABSTRACT
BACKGROUND: Gut barrier dysfunction and neuroinflammation are increasingly recognised as linked pathophysiological processes in acute ischaemic stroke (AIS). However, the influence of nutritional routes on these processes remains poorly characterised.
OBJECTIVE: To compare the longitudinal effects of enteral nutrition (EN) versus parenteral nutrition (PN) on serum intestinal fatty acid-binding protein (I-FABP), a marker of intestinal epithelial integrity, and matrix metalloproteinase-9 (MMP-9), a marker of neuroinflammatory activity, in critically ill AIS patients.
DESIGN: Prospective observational cohort study.
SETTING: A tertiary neurology intensive care unit (ICU) in Türkiye.
PATIENTS AND METHODS: Consecutive adults (≥18 years) admitted to the neurology ICU within 24 hours of a confirmed AIS diagnosis were enrolled between October 2024 and January 2026. Nutritional route was assigned by the treating clinician according to ESPEN guidelines. Serum I-FABP and MMP-9 concentrations were measured using commercial enzyme-linked immunosorbent assay (ELISA) kits at baseline and on day 7.
MAIN OUTCOME MEASURES: Longitudinal changes in serum I-FABP and MMP-9 concentrations between baseline and day 7, and their correlations with neurological severity (NIHSS).
SAMPLE SIZE: 73 patients (40 EN, 33 PN).
RESULTS: Median age was 73 years (interquartile range, 64-80) and 37 (51%) were female. At baseline, I-FABP and MMP-9 levels were comparable between groups (all P>.05). Over the 7-day observation period, I-FABP trajectories diverged between groups (EN: 7.22 (2.68) to 6.69 (2.78) ng/mL; PN: 6.74 (3.09) to 7.82 (2.97) ng/mL), as did MMP-9 trajectories (EN: 11.5 (1.45) to 10.9 (2.31) ng/mL; PN: 11.3 (2.41) to 11.8 (1.87) ng/mL). At day 7, both biomarkers correlated significantly with NIHSS score (ρ=0.385 and ρ=0.440, respectively; both P<.001). Repeated measures analysis of covariance, adjusted for baseline NIHSS score, confirmed significant time × nutritional route interactions for both biomarkers (I-FABP: F[1,70]=4.22, P=0.044, P_FDR=.044, η2p=.057; MMP-9: F[1,70]= 4.76, P=.033, P_FDR=.044, η2p=0.064).
CONCLUSION: In critically ill AIS patients, EN was associated with more favourable 7-day trajectories of gut barrier integrity and neuroinflammatory activity compared with PN, after adjustment for baseline stroke severity.
LIMITATIONS: Single-center design, biomarker sampling restricted to two time points, reliance on delivered rather than utilised nutritional measures, and non-randomised nutritional route assignment with residual potential for confounding by indication.
PMID:42829458 | DOI:10.5144/0256-4947.2026.376