NUTRITION AND STROKE

Transcription

1 Nestle Nutrition Workshop Series Supplement NUTRITION AND STROKE EDITED BY PIERRE GUESRY MICHAEL I1ENNERICI GERHARD SITZER NESTLE NUTRITION SERVICES Lippincott - Raven

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3 NUTRITION AND STROKE

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5 Nestle Nutrition Workshop Series Supplement NUTRITION AND STROKE Editors Pierre Guesry Nestle Research Center Lausanne, Michael Hennerici Ruprecht-Karls-Universitdt Heidelberg Mannheim, Gerhard Sitzer Stiftung Deutsche Schlaganfall-Hilfe Giitersloh, NESTLE NUTRITION SERVICES Nestle LIPPINCOTT-RAVEN PHILADELPHIA

6 Acquisitions Editor: Joyce-Rachel John Manufacturing Manager: Dennis Teston Production Manager: Lawrence Bernstein Production Editor: Mary Antonette V. Manasis Indexer: Chesapeake Indexing Associates Compositor: Maryland Composition Printer: Quebecorp Printing-Kingsport Press Nestec Ltd., 55 Avenue Nestle, CH-1800 Vevey, Lippincott-Raven Publishers, 227 East Washington Square, Philadelphia, Pennsylvania , Nestec Ltd. and Lippincott-Raven Publishers. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, or recording, or otherwise, without the written permission of the publisher. Made in the United States of America Library of Congress Cataloging-in-Publication Data Nutrition and stroke / editors, Michael Hennerici, Gerhard Sitzer, Pierre Guesry. p. cm. (Nestle Nutrition Workshop Series, Supplement.) "Nestle Nutrition Services." Includes bibliographical references and index. ISBN Cerebrovascular disease Nutritional aspects Congresses. 2. Cerebrovascular disease Prevention Congresses. 3. Cerebrovascular disease Diet therapy Congresses. 1. Hennerici, M. (Michael) II. Sitzer, G. (Gerhard) III. Guesry, Pierre. IV. Nestle Nutrition Services. V. Series. [DNLM: 1. Cerebrovascular Disorders physiopathology congresses. 2. Cerebrovascular Disorders diet therapy congresses. 3. Cerebrovascular Disorders prevention & control congresses. 4. Diet congresses. WL 355 N ] RC388.5.N '1 dc21 DNLM/DLC for Library of Congress CIP The material contained in this volume was submitted as previously unpublished material, except in the instances in which credit has been given to the source from which some of the illustrative material was derived. Great care has been taken to maintain the accuracy of the infonnation contained in the volume. However, neither Nestec nor Lippincott-Raven Publishers can be held responsible for errors or for any consequences arising from the use of the information contained herein

7 Preface After coronary heart disease and cancer, strokes are the most frequent cause of death in industrialized countries. The United States alone has about half a million cases of stroke per year, 30% of them being fatal in In 1994, 30 billion US dollars were spent on treatment during the acute phase and on management during the chronic state in the USA alone (1). We could speculate from WHO data (2) that the financial burden per inhabitant, or as a percentage of GNP, is as high in the other industrialized countries. Since efficacy of treatment for stroke itself is, up to now, quite limited, it is important to use to the greatest extent all of the possibilities offered by prevention: this is for the large part still nutritional, as suggested by changes in mortality induced by change of the environment of peoples of the same ethnic origin (3). This is why we have chosen the topic of Nutrition and Stroke for the joint Meeting between the ' 'Deutsche Schlaganfallstiftung'' (a German institution for the prevention of stroke), sponsored by the Bertelsmann Foundation, and the Nestle Research Center which specializes in nutrition research. There are basically two kinds of stroke with uneven distribution according to diets: ischemic stroke which shares with coronary heart disease the same type of dietary features: excessive energy intake leading to obesity (4), excessive saturated fat intake (5) and excessive salt intake favoring high blood pressure (6), although high blood pressure also plays a very important role in the second type of stroke which is hemorrhagic. Besides hypertension, there is the possibility that certain diets rich in n-3 long chain polyunsaturated fatty acids, useful through their inhibition of platelet aggregation for the prevention of ischemic stroke, could increase the risk of hemorrhagic stroke as observed in Eskimos. All of these aspects have been extensively discussed during the Workshop, as well as the role of antioxidants, which is for the time being still not unequivocally proved. We hope that reading the articles and the subsequent discussions will give food for thought and promote both new research and some kind of palliative therapeutic measures, as well as possible preventive nutritional strategies which may help to reduce the large amount of pain and cost of stroke in our society. PIERRE GUESRY, M.D. Vice-President of Research Nestle Research Center, Lausanne,

8 vi PREFACE REFERENCES 1. National Stroke Association. Cost of stroke. Stroke Clinical Update. 1994; 5: World Health Organization World Health Statistics Annual. Geneva, WHO Reed D.M. The paradox of high risk of stroke in populations with low risk of coronary heart disease. Am J Epidemiol 1990; 131: Shinton R., Shipley M., Rose G. Overweight and Stroke in the Withehall study. J Epidemiol Community Health 1991; 45: Iso H., Jacobs D.R., Wentworth D., et al. Serum cholesterol levels and six year mortality from stroke in 350,977 men screened for the multiple risk factor intervention trial. N Engl J Med 1989; 320: INTERSALT cooperative research group: an international study of electrolyte excretion and blood pressure. Brit Med J 1988; 297:

9 Contents Clinical Classification and Manifestations of Stroke 1 Julien Bogousslavsky Pathophysiology of Ischemic Stroke 15 K.-A. Hossmann Risk Factors for Stroke 31 Philip A. Wolf Diagnostic Procedures for the Selection of Patients at Risk for Stroke 39 Michael Hennerici Lipids in the Prevention of Stroke 45 Gayle Crozier and Marco Turini Dietetic Prevention of Arteriosclerosis 57 Anselm W. Kornhuber Antioxidants and Atherosclerosis 75 Hannes B. Stahelin The Stroke-Prone Spontaneously Hypertensive Rat and its Role in the Genetic Dissection of Cardiovascular Disease 87 Norbert Htibner, Young-Ae Lee, Reiner Kreutz, Klaus Lindpaintner, and Detlev Ganten Hypertension and Sodium Intake 101 Diederick E. Grobbee Genetic Variation of Sodium Sensitivity 109 Yukio Yamori, Yasuo Nara, Katsumi Ikeda, Shunsako Mizushima, Chiho Matsumoto, Tomoji Mashimo, Tomoko Tamada, Jacob P. Mtabaji, Emilio Moriguchi, and Yukio Moriguchi

10 viii CONTENTS Therapeutic Approaches to the Treatment of Acute Ischemic Stroke 119 Myron D. Ginsberg Potassium and Calcium Intake in Stroke Prevention: A Role for the Food Industry in the Prevention of Cerebrovascular and Cardiovascular Diseases 129 Kurt Ornstein Antioxidants in Ischemic Stroke 145 Armand Malnoe Nutrition Support in the Stroke Patient 159 Axel G. Feller, Manuel E. Alva, and Stuart P. Richer Conclusion 171 Subject Index 173

11 Contributors Speakers Julien Bogousslavsky Centre Hospitalier Universitaire Vaudois (CHUV) Rue du Bugnon Lausanne, Pierre Guesry Nestle Research Center Vers-chez-les-Blanc P.O. Box 44 CH-1000 Lausanne 26, Gayle Crozier Nestle Research Center Vers-chez-les-Blanc P.O. Box 44 CH-1000 Lausanne 26, Axel G. Feller Finch University of Health Sciences The Chicago Medical School Department of Medicine, Division of Gastroenterology 3333 Green Bay Road North Chicago, Illinois USA Detlev Ganten Max Delbruck Centrum fur Molekulare Medizin Robert-Rossle-Strasse Berlin, Myron D. Ginsberg University of Miami School of Medicine Department of Neurology P.O. Box Miami, Florida USA Diederick E. Grobbee Erasmus University Medical School P.O. Box DR Rotterdam, The Netherlands Michael Hennerici Ruprecht-Karls- Universitat Heidelberg Fakultat fur Klinische Medizin Mannheim Neurologische Klinik Postfach Mannheim, K.-A. Hossmann Max-Planck-Institut ftir Neurologische Forschung Gleueler Strasse Koln, Anselm W. Kornhuber Bundeswehrkrankenhaus Ulm Abt. Neurologie und Psychiatrie Oberer Eselsberg 40 D Ulm, Armand Malnoe Nestle Research Center Vers-chez-les-Blanc P.O. Box 44 CH-1000 Lausanne 26, Kurt Ornstein Nestle Research Center Vers-chez-les-Blanc P.O. Box 44 CH-1000 Lausanne 26,

12 CONTRIBUTORS Gerhard Sitzer Stiftung Deutsche Schlaganfall-Hilfe Carl-Bertelsmann-Strasse Gutersloh, Hannes B. Stahelin Geriatric University Clinic University Hospital Basel CH-4031 Basel, Philip A. Wdf Boston University School of Medicine Robinson Building, B East Concord Street Boston, Massachusetts USA Yukio Yamori Graduate School of Human and Environmental Studies Kyoto University Yoshida Nihonmatsu-cho Sakyo-ku, Kyoto 606, Japan Session Chairmen Michael Hcnncnci/Mannheim, Pierre Guesry/Lausanne, Gerhard Sitzery'Giitersloh, Invited Attendees Birgit Becke/Ettenheim, Daniela Betg/Wurzburg, H. Boeing/Bergholz-Renbriicke, Christian Bomke/Bochum, Ibrahim Elmadfa/Men, Austria Michael Fetter/Tubingen, B. Hofferberth/Coppenbriigge, Volker HombeTg/Dusseldorf, Renate Husmann/Bielefeld, Ingrid Kiefer/Wien, Austria Bernhard Kleiser/Ulm, Johannes Koster/Leipzig, Andreas Kottmeier/Giitersloh, Johannes Leweling/Mannheim, Jakob Linseisen/Frming- Weihenstephan, Giinter Manzl/Allensbach, Karin Molders/Giitersloh, Karl Pfadenhauer/AM^^Mrg, Wolfgang Roessy/Marburg, Richard Rohrer/Saarbriicken, Wolfgang Stemke/Mannheim, Barbara Tettenborn/Ma/nz, Franz Weilbach/Wurzburg, Michael Wemz/Freiburg, Burghard Wollenhaupt/Dre^en, Elke Wollenhaupt/ )re«fen, Alexandra Zurloh/Lubeck, Nestle Representatives Bjorn Akesson/Lund, Sweden Denis Barclay /Lausanne, Isabelle Baid/Fribourg, Vittorio Betele/Milano, Italy Claude Cavadini/Lausanne, Frangois Couzy/Lausanne, Ernesto Dalan/Lausanne, Henri Dirren/Lausanne, Paul Andre Finot/Lausanne, Stina Fjelkner-Modig/ZJ/'wv, Sweden

13 CONTRIBUTORS XI Miguel Ganote/Lausanne, Daniele Gaudmd-de-Weck/Lausanne, Francois Guillot/Lausanne, Jean-Claude Maire/'Lausanne, Selma Mead/Washington, D.C., USA Hubert Milon/Lausanne, Bernard Nater/Lausanne, Bertrand Pertuiset/Neuilly, France David Richardson/London, U.K. Bernard ScaXton/Bagneux, France Thomas Schweizer/Vefey, France Joanna Scott/'London, U.K. Evelyn Spive/Lausanne, Pierre Tachony'Lausanne, Philippe Vuadens/Lausanne, Anne-Marie Wamet/Beauvais, France J.Y. Wessely/Lausanne, Hanspeter WiiTzner/Lausanne, Press Matthias Ninck/Zurich, Fritz SchmtgerI Munich,