Measuring longitudinally the metabolic demands of stroke patients: resting energy expenditure is not elevated.
OBJECTIVE
Little is known of the acute, subacute, and longer-term energy demands of stroke, information essential to appropriate clinical and nutritional management. The goals of this study were to (1) determine the resting energy expenditure (REE) of stroke patients from stroke onset to 3 months, (2) examine relations between stroke size, type, location, severity, and REE, and (3) evaluate whether estimation of REE from the Harris-Benedict equation (HB) requires the addition of a "stress factor" to capture the possible additional REE imposed by stroke.


METHODS
The REE of new stroke patients was measured prospectively at hospital admission and on days 7, 11, 14, 21, and 90 by indirect calorimetry. Stroke patients' REEs (Kcal/d) over time and REEs as a percentage of HB were compared with control subjects' single measurements.


RESULTS
Mean REE and %HB of stroke patients ranged from 1521+/-290 to 1663+/-268 Kcal/d and from 107+/-14.9 to 114+/-12.9 %HB, respectively. Mean measurements of control subjects were 1665+/-265 Kcal/d and 112.9+/-11.4 %HB (NS). REE was not associated with stroke characteristics (NS). Changes in REE measured longitudinally were not clinically meaningful (4 to 62 Kcal/d) though statistically significant (P=0.004).


CONCLUSIONS
The REEs of stroke patients and controls were both approximately 10% higher than those predicted by HB. No hypermetabolic response pattern of energy expenditure was evident after stroke. REE did not vary with stroke characteristics, although confirmation with larger subgroups is required.
Finestone
Hillel M
HM
Department of Physical Medicine and Rehabilitation, Elizabeth Bruyère Health Centre, University of Ottawa, Ottawa, Canada. hfinesto@scohs.on.ca
Greene-Finestone
Linda S
LS
Foley
Norine C
NC
Woodbury
M Gail
MG
D000368:Aged; D002153:Calorimetry, Indirect; D016001:Confidence Intervals; D004734:Energy Metabolism / Q000502:physiology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011446:Prospective Studies; D012016:Reference Values; D015203:Reproducibility of Results; D012146:Rest / Q000502:physiology; D012720:Severity of Illness Index; D013312:Stress, Physiological / Q000378:metabolism*; D020521:Stroke / Q000145:classification / Q000378:metabolism*; D000071939:Stroke Rehabilitation