Intake of potassium- and magnesium-enriched salt improves functional outcome after stroke: a randomized, multicenter, double-blind controlled trial [Vitamins, minerals, and phytochemicals]

  1. Wen-Harn Pan1,
  2. Ying-Ho Lai1,2,
  3. Wen-Ting Yeh1,
  4. Jiunn-Rong Chen4,
  5. Jiann-Shing Jeng5,
  6. Chyi-Huey Bai6,7,
  7. Ruey-Tay Lin8,9,
  8. Tsong-Hai Lee10,
  9. Ku-Chou Chang11,
  10. Huey-Juan Lin12,
  11. Chin-Fu Hsiao3,13,
  12. Chang-Ming Chern14,15,
  13. Li-Ming Lien16,
  14. Chung-Hsiang Liu17,18,
  15. Wei-Hung Chen16, and
  16. Anna Chang16
  1. 1Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan;
  2. 2Department of Biochemical Science and Technology, College of Life Science, and
  3. 3Division of Biometry, Department of Agronomy, National Taiwan University, Taipei, Taiwan;
  4. 4Department of Neurology, Yunlin Christian Hospital, Yunlin, Taiwan;
  5. 5Stroke Center Intensive Care Unit, National Taiwan University Hospital, Taipei, Taiwan;
  6. 6Department of Public Health, College of Medicine, and
  7. 7School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan;
  8. 8Department of Neurology, College of Medicine, and
  9. 9Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan;
  10. 10Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang Gung University,
    Taoyuan, Taiwan;
  11. 11Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung,
    Taiwan;
  12. 12Department of Neurology, Chi Mei Medical Center, Tainan, Taiwan;
  13. 13Division of Biostatistics and Bioinformatics, Institute of Population Health Sciences, National Health Research Institutes,
    Miaoli, Taiwan;
  14. 14Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan;
  15. 15Department of Medical Education and Research, Taipei Veterans General Hospital, Taipei, Taiwan;
  16. 16Department of Neurology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; and
  17. 17Graduate Institute of Integrated Medicine, College of Chinese Medicine, and
  18. 18Department of Neurology, China Medical University Hospital, Taichung, Taiwan
  1. Address correspondence to W-HP (e-mail: pan{at}ibms.sinica.edu.tw).
  • Supported by grants from the Institute of Biomedical Sciences, Academia Sinica, and from the Ministry of Health and Welfare
    (DOH098-TD-F-113-098030).

  • The funding source had no involvement in study design; in the collection, analysis, and interpretation of data; in the writing
    of the report; or in the decision to submit the article for publication. The corresponding author had final responsibility
    for the decision to submit for publication.

  • Supplemental Figure 1 and Supplemental Tables 1 and 2 are available from the “Online Supporting Material” link in the online
    posting of the article and from the same link in the online table of contents at http://ajcn.nutrition.org.

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.

Keywords:

Footnotes

  • Abbreviations used: BI, Barthel Index; DRI, Dietary Reference Intake; K salt, potassium-enriched salt; K/Mg salt, potassium
    and magnesium-enriched salt; mRS, modified Rankin scale; Na salt, regular salt; NIHSS, NIH Stroke Scale.

  • Received November 8, 2016.
  • Accepted August 7, 2017.

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