Wen-Harn Pan1, Ying-Ho Lai2,3, Wen-Ting Yeh2, Jiunn-Rong Chen4, Jiann-Shing Jeng5, Chyi-Huey Bai6,7, Ruey-Tay Lin8,9, Tsong-Hai Lee10, Ku-Chou Chang11, Huey-Juan Lin12, Chin-Fu Hsiao13,14, Chang-Ming Chern15,16, Li-Ming Lien17, Chung-Hsiang Liu18,19, Wei-Hung Chen17, Anna Chang17. 1. Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan; pan@ibms.sinica.edu.tw. 2. Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan. 3. Department of Biochemical Science and Technology, College of Life Science, and. 4. Department of Neurology, Yunlin Christian Hospital, Yunlin, Taiwan. 5. Stroke Center Intensive Care Unit, National Taiwan University Hospital, Taipei, Taiwan. 6. Department of Public Health, College of Medicine, and. 7. School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan. 8. Department of Neurology, College of Medicine, and. 9. Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. 10. Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan, Taiwan. 11. Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan. 12. Department of Neurology, Chi Mei Medical Center, Tainan, Taiwan. 13. Division of Biometry, Department of Agronomy, National Taiwan University, Taipei, Taiwan. 14. Division of Biostatistics and Bioinformatics, Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan. 15. Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan. 16. Department of Medical Education and Research, Taipei Veterans General Hospital, Taipei, Taiwan. 17. Department of Neurology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; and. 18. Graduate Institute of Integrated Medicine, College of Chinese Medicine, and. 19. Department of Neurology, China Medical University Hospital, Taichung, Taiwan.
Abstract
Background: Stroke is one of the leading causes of mortality and neurologic deficits. Management measures to improve neurologic outcomes are in great need. Our previous intervention trial in elderly subjects successfully used salt as a carrier for potassium, demonstrating a 41% reduction in cardiovascular mortality by switching to potassium-enriched salt. Dietary magnesium has been associated with lowered diabetes and/or stroke risk in humans and with neuroprotection in animals.Objective: Because a large proportion of Taiwanese individuals are in marginal deficiency states for potassium and for magnesium and salt is a good carrier for minerals, it is justifiable to study whether further enriching salt with magnesium at an amount near the Dietary Reference Intake (DRI) amount may provide additional benefit for stroke recovery.Design: This was a double-blind, randomized controlled trial comprising 291 discharged stroke patients with modified Rankin scale (mRS) ≤4. There were 3 arms: 1) regular salt (Na salt) (n = 99), 2) potassium-enriched salt (K salt) (n = 97), and 3) potassium- and magnesium-enriched salt (K/Mg salt) (n = 95). The NIH Stroke Scale (NIHSS), Barthel Index (BI), and mRS were evaluated at discharge, at 3 mo, and at 6 mo. A good neurologic performance was defined by NIHSS = 0, BI = 100, and mRS ≤1. Results: After the 6-mo intervention, the proportion of patients with good neurologic performance increased in a greater magnitude in the K/Mg salt group than in the K salt group and the Na salt group, in that order. The K/Mg salt group had a significantly increased OR (2.25; 95% CI: 1.09, 4.67) of achieving good neurologic performance compared with the Na salt group. But the effect of K salt alone (OR: 1.58; 95% CI: 0.77, 3.22) was not significant.Conclusions: This study suggests that providing the DRI amount of magnesium and potassium together long term is beneficial for stroke patient recovery from neurologic deficits. This trial was registered at clinicaltrials.gov as NCT02910427.
RCT Entities:
Background: Stroke is one of the leading causes of mortality and neurologic deficits. Management measures to improve neurologic outcomes are in great need. Our previous intervention trial in elderly subjects successfully used salt as a carrier for potassium, demonstrating a 41% reduction in cardiovascular mortality by switching to potassium-enriched salt. Dietary magnesium has been associated with lowered diabetes and/or stroke risk in humans and with neuroprotection in animals.Objective: Because a large proportion of Taiwanese individuals are in marginal deficiency states for potassium and for magnesium and salt is a good carrier for minerals, it is justifiable to study whether further enriching salt with magnesium at an amount near the Dietary Reference Intake (DRI) amount may provide additional benefit for stroke recovery.Design: This was a double-blind, randomized controlled trial comprising 291 discharged strokepatients with modified Rankin scale (mRS) ≤4. There were 3 arms: 1) regular salt (Na salt) (n = 99), 2) potassium-enriched salt (K salt) (n = 97), and 3) potassium- and magnesium-enriched salt (K/Mg salt) (n = 95). The NIH Stroke Scale (NIHSS), Barthel Index (BI), and mRS were evaluated at discharge, at 3 mo, and at 6 mo. A good neurologic performance was defined by NIHSS = 0, BI = 100, and mRS ≤1. Results: After the 6-mo intervention, the proportion of patients with good neurologic performance increased in a greater magnitude in the K/Mg salt group than in the K salt group and the Na salt group, in that order. The K/Mg salt group had a significantly increased OR (2.25; 95% CI: 1.09, 4.67) of achieving good neurologic performance compared with the Na salt group. But the effect of K salt alone (OR: 1.58; 95% CI: 0.77, 3.22) was not significant.Conclusions: This study suggests that providing the DRI amount of magnesium and potassium together long term is beneficial for strokepatient recovery from neurologic deficits. This trial was registered at clinicaltrials.gov as NCT02910427.