{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T04:56:11Z","timestamp":1791089771524,"version":"4.1.0"},"reference-count":23,"publisher":"King Faisal Specialist Hospital and Research Centre","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Ann Saudi Med"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>DESIGN:<\/jats:title>\n                    <jats:p>Prospective observational cohort study<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>SETTING:<\/jats:title>\n                    <jats:p>A tertiary neurology intensive care unit (ICU) in T\u00fcrkiye<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PATIENTS AND METHODS:<\/jats:title>\n                    <jats:p>Consecutive adults (\u226518 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>MAIN OUTCOME MEASURES:<\/jats:title>\n                    <jats:p>Longitudinal changes in serum I-FABP and MMP-9 concentrations between baseline and day 7, and their correlations with neurological severity (NIHSS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>SAMPLE SIZE:<\/jats:title>\n                    <jats:p>73 patients (40 EN, 33 PN)<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Median age was 73 years (interquartile range, 64\u201380) and 37 (51%) were female. At baseline, I-FABP and MMP-9 levels were comparable between groups (all\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &gt;.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 (\u03c1=0.385 and \u03c1=0.440, respectively; both\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;.001). Repeated measures analysis of covariance, adjusted for baseline NIHSS score, confirmed significant time \u00d7 nutritional route interactions for both biomarkers (I-FABP: F[1,70]=4.22,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.044, P_FDR=.044, \u03b7\n                      <jats:sup>2<\/jats:sup>\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      =.057; MMP-9: F[1,70]= 4.76,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =.033, P_FDR=.044, \u03b7\n                      <jats:sup>2<\/jats:sup>\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      =0.064).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LIMITATIONS:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.5144\/0256-4947.2026.376","type":"journal-article","created":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T04:44:41Z","timestamp":1791089081000},"page":"376-387","source":"Crossref","is-referenced-by-count":0,"title":["Association between route of nutrition and serum I-FABP and MMP-9 levels in critically ill patients with acute ischemic stroke: a prospective cohort study"],"prefix":"10.5144","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8260-9295","authenticated-orcid":true,"given":"Nurhayat Tugra","family":"Ulema","sequence":"first","affiliation":[{"name":"From the Nutrition and Dietetic Department, A\u011fr\u0131 \u0130brahim \u00c7e\u00e7en University, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sevda","family":"Onuk","sequence":"additional","affiliation":[{"name":"From the Department of Intensive Care Unit, Kayseri City Education and Research Hospital, Kayseri, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osman","family":"Ozocak","sequence":"additional","affiliation":[{"name":"From the Department of Intensive Care Unit, Kayseri City Education and Research Hospital, Kayseri, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omer Faruk","family":"Bolatturk","sequence":"additional","affiliation":[{"name":"From the Department of Neurology, Kayseri City Education and Research Hospital, Kayseri, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Memet","family":"Aslanyavrusu","sequence":"additional","affiliation":[{"name":"From the Department of Intensive Care Unit, Kayseri City Education and Research Hospital, Kayseri, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sibel","family":"Kuzuguden","sequence":"additional","affiliation":[{"name":"From the Department of Biochemistry Kayseri City Education and Research Hospital, Kayseri, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kursat","family":"Gundogan","sequence":"additional","affiliation":[{"name":"From the Department of Intensive care unit, Erciyes University, Kayseri, 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