Resting energy expenditure-guided nutritional support in acute ischaemic stroke patients: a single-centre quasi-randomised controlled trial

Abstract Acute stroke induces a hypermetabolic/hypercatabolic state, causing malnutrition and muscle wasting that hinder recovery. Weight-based predictive equations for nutritional support may fail to meet individual energy needs. This study compared resting energy expenditure (REE)-guided nutrition with weight-based calorie calculation in acute stroke patients. This single-centre, quasi-randomised controlled trial assessed seventy-four acute ischaemic stroke patients requiring enteral nutrition. Six patients were excluded before allocation, and sixty-eight were allocated by odd/even hospital admission number to the REE-guided group ( n 30; energy target 120 % of indirect calorimetry-measured REE) or the control group ( n 38; 25 kcal/kg/d). The complete-case analysis included fifty-four patients (REE-guided n 24; control n 30). Primary analyses compared day 14 fat-free mass surrogate indicators after adjustment for baseline values and prespecified covariates. Secondary outcomes included nutritional and inflammatory biomarkers, feeding efficiency and complications. Baseline energy and protein intake were comparable between groups. In unadjusted comparisons at day 14, no statistically significant differences were observed for left or right temporal muscle thickness, whereas calf circumference was lower in the REE-guided group. After adjustment for age, sex, baseline National Institutes of Health Stroke Scale (NIHSS) score, total energy intake and day 0 C-reactive protein (CRP), left temporal muscle thickness was significantly higher in the REE-guided group ( β = 0·56, 95 % CI 0·07–1·05, P = 0·031). Right temporal muscle thickness and calf circumference showed non-significant adjusted differences. At day 14, prealbumin was numerically higher in the REE-guided group, but the difference was not statistically significant. Albumin and transferrin were similar between groups. Inflammatory biomarkers, including leucocyte count, CRP and procalcitonin, showed no statistically significant between-group differences. Clinical secondary outcomes, including complications, NIHSS score, time to reach target calories and enteral nutrition interruption, did not differ significantly between groups. REE-guided nutritional support was feasible and safe in acute ischaemic stroke patients and was associated with higher adjusted left temporal muscle thickness at day 14; biomarker findings were exploratory; only prealbumin showed a non-significant favourable numerical trend, whereas inflammatory biomarkers did not show a consistent favourable pattern. Effects on right temporal muscle thickness and calf circumference were not statistically significant. These findings support further evaluation in larger, randomised trials. Trial registration: Chinese Clinical Trial Registry, ChiCTR-IPR-16010051.