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Acute stroke patients are being underfed: a nitrogen balance study
Julio A Chalela1, Joseph Haymore, Peter D Schellinger
1Section on Stroke Diagnostics and Therapeutics, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA. chalelaj@ninds.nih.gov
Neurocritical Care
|September 22, 2005
Summary
Critically ill stroke patients often experience hypercatabolism, leading to negative nitrogen balance in 44% of cases. Current methods using the Harris-Benedict Equation (HBE) may underestimate energy needs in acute stroke patients.
Area of Science:
- Neurology
- Critical Care Medicine
- Nutritional Science
Background:
- Acute neurological illness, particularly stroke, can induce a hypercatabolic state.
- The Harris-Benedict Equation (HBE) is commonly used to estimate energy requirements in acute stroke patients.
- Existing stress factors for stroke are absent, and the accuracy of HBE in estimating energy expenditure for ischemic or hemorrhagic stroke is unknown.
Purpose of the Study:
- To assess nitrogen balance in patients with acute stroke.
- To identify clinical variables associated with negative nitrogen balance in this population.
Main Methods:
- A single-center case series study involving 27 acute stroke patients requiring enteral nutrition.
- Enteral feeding was administered to meet HBE requirements, followed by a 12-hour urine collection for nitrogen excretion after 24 hours of goal feeding.
- Variables analyzed for association with negative nitrogen balance included gender, elevated glucose, advanced age, high NIHSS score, mechanical ventilation, and diabetes mellitus.
Main Results:
- 44% of patients (12 out of 27) exhibited negative nitrogen balance.
- No significant association was found between negative nitrogen balance and age, NIHSS score, stroke type, admission glucose, diabetes history, or mechanical ventilation.
- Only 11 out of 27 patients were found to be anabolic.
Conclusions:
- Critically ill stroke patients are frequently underfed due to current caloric estimation methods.
- Hypercatabolism is prevalent in acute stroke, and clinical variables do not reliably predict this catabolic state.