Acute stroke patients are being underfed: a nitrogen balance study
- PMID: 16174930
- DOI: 10.1385/NCC:1:3:331
Acute stroke patients are being underfed: a nitrogen balance study
Abstract
Introduction: Patients with acute neurological illness may be hypercatabolic. The Harris-Benedict Equation (HBE) is used to estimate energy needs in acute stroke. A "stress factor" for stroke does not exist, and it is not known if the HBE accurately estimates the energy expenditure needs in acute ischemic or hemorrhagic stroke. We sought to assess nitrogen balance in patients with acute stroke and to determine the variables associated with negative nitrogen balance.
Materials and methods: This was a case series, single-center study. Eligibility criteria included acute stroke requiring enteral nutrition, tolerating tube feedings at goal, normal urine output, and no underlying catabolic illness. Enteral feeding was adjusted to meet HBE requirements. After 24 hours of goal feeding, a 12-hour urine collection for nitrogen excretion was done. We determined if any of the following variables were associated with negative nitrogen balance: gender, glucose 6.6 mmol/L or more, age 80 years or older, National Institutes of Health Stroke Scale (NIHSS) 20 or higher, mechanical ventilation, and diabetes mellitus.
Results: We studied 27 patients (10 with intracranial hemorrhages and 17 with ischemic strokes) during an 18-month period. The median age was 80 (range: 48-90), and the median NIHSS was 19 (range: 4-38). The median time to feeding was 2 days (range: 1-8), the median time from onset to nitrogen balance was 5 days (range: 2-11), and the median interval between initiation of feeding and nitrogen collection was 2 days (range: 1-5)Negative nitrogen balance was seen in 12 of 27 (44%) patients. There was no relation between age, NIHSS, stroke type, admission glucose, history of diabetes, and mechanical ventilation use and nitrogen balance. Only 11 of 27 patients were anabolic.
Conclusion: Critically ill stroke patients are being underfed using the current methods to estimate caloric needs. Hypercatabolism is common in acute stroke; clinical variables do not seem to allow prediction of this catabolic state.
Comment in
-
Nutritional support in stroke: a balanced meal or a feast?Neurocrit Care. 2004;1(3):283-5. doi: 10.1385/NCC:1:3:283. Neurocrit Care. 2004. PMID: 16174925 No abstract available.
Similar articles
-
Are patients fed appropriately according to their caloric requirements?JPEN J Parenter Enteral Nutr. 1998 Nov-Dec;22(6):375-81. doi: 10.1177/0148607198022006375. JPEN J Parenter Enteral Nutr. 1998. PMID: 9829611
-
Comparison of the effect of three different protein content enteral diets on serum levels of proteins, nitrogen balance, and energy expenditure in critically ill infants: study protocol for a randomized controlled trial.Trials. 2019 Oct 11;20(1):585. doi: 10.1186/s13063-019-3686-8. Trials. 2019. PMID: 31604481 Free PMC article.
-
Estimation of energy requirements for mechanically ventilated, critically ill patients using nutritional status.Crit Care. 2003 Oct;7(5):R108-15. doi: 10.1186/cc2366. Epub 2003 Aug 28. Crit Care. 2003. PMID: 12974978 Free PMC article.
-
Efficacy of tube feeding in supplying energy requirements of hospitalized patients.JPEN J Parenter Enteral Nutr. 1989 Jul-Aug;13(4):387-91. doi: 10.1177/0148607189013004387. JPEN J Parenter Enteral Nutr. 1989. PMID: 2506375 Review.
-
Parenteral nutrition: never say never.Crit Care. 2015;19 Suppl 3(Suppl 3):S5. doi: 10.1186/cc14723. Epub 2015 Dec 18. Crit Care. 2015. PMID: 26728859 Free PMC article. Review.
Cited by
-
Monitoring nutrition and glucose in acute brain injury.Neurocrit Care. 2014 Dec;21 Suppl 2:S159-67. doi: 10.1007/s12028-014-0036-2. Neurocrit Care. 2014. PMID: 25208674 Review.
-
The neurovascular unit and systemic biology in stroke - implications for translation and treatment.Nat Rev Neurol. 2022 Oct;18(10):597-612. doi: 10.1038/s41582-022-00703-z. Epub 2022 Sep 9. Nat Rev Neurol. 2022. PMID: 36085420 Review.
-
Dysphagia, nutrition, and hydration in ischemic stroke patients at admission and discharge from acute care.Dysphagia. 2013 Mar;28(1):69-76. doi: 10.1007/s00455-012-9414-0. Epub 2012 Jun 9. Dysphagia. 2013. PMID: 22684924
-
Nutritional and Bioenergetic Considerations in Critically Ill Patients with Acute Neurological Injury.Neurocrit Care. 2017 Oct;27(2):276-286. doi: 10.1007/s12028-016-0336-9. Neurocrit Care. 2017. PMID: 28004327 Review.
-
Nutrition support in hospitalised adults at nutritional risk.Cochrane Database Syst Rev. 2017 May 19;5(5):CD011598. doi: 10.1002/14651858.CD011598.pub2. Cochrane Database Syst Rev. 2017. PMID: 28524930 Free PMC article.
References
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Medical