Kawakami Michiyuki, Liu Meigen, Wada Ayako, Otsuka Tomoyoshi, Nishimura Atsuko
Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.
Cerebrovasc Dis. 2015;39(3-4):170-5. doi: 10.1159/000375155. Epub 2015 Feb 26.
The energy demands in patients with stroke during the subacute phases are unclear. However, this information is essential for appropriate clinical and nutritional management. The aims of this study were to determine the resting energy expenditure (REE) during the subacute phases, examine its relationships with stroke types, location, severity of hemiparesis, and activities of daily living (ADL), and evaluate whether estimation of REE from the Harris-Benedict equation (HB) requires the addition of a 'stress factor' to capture possible additional REE imposed by stroke.
We measured REE in 95 patients with subacute stroke (53.5 ± 16.6 days post-stroke) with indirect calorimetry, and compared it with predicted values of energy expenditure estimated from the HB (expressed as percentage). Patients were admitted for rehabilitation of their first ischemic or nonsurgical hemorrhagic stroke. The severity of hemiparesis was assessed with the motor items of the Stroke Impairment Assessment Set (SIAS). The ADL was assessed with the Functional Independence Measure (FIM). We compared REE and %HB of the two groups divided by hemiparesis severity and ADL limitation using the Student's t-test, and those of the five groups divided by stroke location. The correlations between REE and the motor items of the SIAS and the FIM score were assessed with the Spearman rank correlation test. A multiple regression analysis for REE was conducted.
The average body weight (BW) was 57.1 ± 11.3 kg. The average body mass index (BMI) was 22.5 ± 4.0. The mean REE (%HB) was 1,271 ± 284 kcal/day (106.0 ± 17.3%). REE and %HB of the low ADL group was less than that of the high ADL group (p < 0.05). The REE had a positive correlation with the FIM score (rs = 0.51, p < 0.01). The motor items of the SIAS were not significantly correlated with REE. BW, FIM, and stroke location were independent predictors of REE.
Analysis of energy expenditure suggests that stroke patients are not hypermetabolic during the subacute phase. The 'stress factor' in stroke patients during the subacute phase was 1.0-1.1. This finding provides important information for improving nutritional management during the subacute phase in patients with stroke.
中风患者亚急性期的能量需求尚不清楚。然而，这些信息对于适当的临床和营养管理至关重要。本研究的目的是确定亚急性期的静息能量消耗（REE），研究其与中风类型、部位、偏瘫严重程度和日常生活活动（ADL）的关系，并评估根据哈里斯-本尼迪克特方程（HB）估算的REE是否需要加上“应激因子”以捕捉中风可能带来的额外REE。
我们采用间接测热法测量了95例亚急性中风患者（中风后53.5±16.6天）的REE，并将其与根据HB估算的能量消耗预测值进行比较（以百分比表示）。患者因首次缺血性或非手术出血性中风入院接受康复治疗。采用中风损伤评估量表（SIAS）的运动项目评估偏瘫严重程度。采用功能独立性测量（FIM）评估ADL。我们使用学生t检验比较了按偏瘫严重程度和ADL受限情况分为两组的REE和%HB，以及按中风部位分为五组的REE和%HB。采用Spearman等级相关检验评估REE与SIAS运动项目及FIM评分之间的相关性。对REE进行多元回归分析。
平均体重（BW）为57.1±11.3kg。平均体重指数（BMI）为22.5±4.0。平均REE（%HB）为1271±284千卡/天（106.0±17.3%）。低ADL组的REE和%HB低于高ADL组（p<0.05）。REE与FIM评分呈正相关（rs=0.51，p<0.01）。SIAS的运动项目与REE无显著相关性。BW、FIM和中风部位是REE的独立预测因素。
能量消耗分析表明，中风患者在亚急性期并非高代谢状态。中风患者亚急性期的“应激因子”为1.0 - 1.
