A refined enteral nutrition intervention was associated with improved short-term nutritional status and reduced incidence of feeding intolerance in critically ill stroke patients, though causal claims cannot be made due to the quasi-experimental design.
Key Findings
Results
Post-intervention serum albumin levels were significantly higher in the refined EN intervention group compared to the control group.
Intervention group post-intervention albumin: 40.69 ± 1.88 g/L vs. Control group: 38.92 ± 1.21 g/L (t = -7.147, p < 0.001)
Mean difference of 1.77 g/L [95% CI: 1.29–2.25], Cohen's d = 1.12 indicating a large effect size
Baseline values were comparable between groups (36.97 ± 2.34 vs. 36.81 ± 1.67 g/L; p = 0.056)
Each group contained 81 patients in a quasi-experimental pre-post design
Results
Post-intervention hemoglobin levels were significantly higher in the intervention group despite comparable baseline values.
Intervention group: 114.40 ± 8.00 g/L vs. Control group: 110.57 ± 6.52 g/L (t = -3.337, p = 0.001)
Baseline hemoglobin was comparable: 97.37 ± 9.89 vs. 99.77 ± 5.92 g/L (t = 1.870, p = 0.630)
Both groups had n = 81 patients
Results
Triceps skinfold thickness (non-paralyzed side) was significantly greater in the intervention group after the intervention.
Post-intervention: 12.29 ± 2.08 mm vs. 11.20 ± 2.40 mm (t = -3.087, p = 0.002)
Baseline values were comparable: 9.97 ± 2.10 mm vs. 9.82 ± 2.21 mm (t = -0.448, p = 0.655)
Results
Mid-upper arm circumference (non-paralyzed side) was significantly higher in the intervention group post-intervention.
Post-intervention: 21.11 ± 1.47 cm vs. 19.86 ± 1.65 cm (t = -5.068, p < 0.001)
Baseline values were comparable: 17.15 ± 1.22 cm vs. 16.99 ± 1.37 cm (t = -0.762, p = 0.447)
Results
Post-intervention Nutritional Risk Screening 2002 (NRS2002) scores were significantly lower in the intervention group, indicating reduced nutritional risk.
Intervention group NRS2002: 4.56 ± 0.82 vs. Control group: 5.07 ± 0.83 (p < 0.001)
Lower NRS2002 scores reflect reduced nutritional risk after the refined EN intervention
Results
APACHE II scores post-intervention were significantly lower in the intervention group, indicating reduced disease severity.
Intervention group: 15.06 ± 2.89 vs. Control group: 19.85 ± 3.36 (t = 9.236, p = 0.000)
APACHE II score is a measure of disease severity in critically ill patients; lower scores indicate less severity
Results
The intervention group achieved significantly higher rates of meeting energy and protein targets compared to the control group.
91.4% of intervention patients achieved ≥70% of energy targets vs. 64.2% in controls (p < 0.001)
88.9% of intervention patients achieved ≥70% of protein targets vs. 59.3% in controls (p < 0.001)
Energy targets were set at 25–30 kcal/kg/day and protein targets at 1.2–2.0 g/kg/day, calculated individually
Achievement of ≥70% of both targets was defined as adequate nutritional intake
Results
Hospital length of stay was significantly shorter in the intervention group compared to the control group.
Intervention group: 42.22 ± 7.25 days vs. Control group: 44.78 ± 5.21 days (p = 0.011)
Difference of approximately 2.56 days
Discussion
The study design was quasi-experimental with historical controls, limiting causal inference about the refined EN intervention.
Control group (n = 81) was retrospectively enrolled from January–December 2022; intervention group (n = 81) was prospectively enrolled from January–December 2023
Authors note that 'the observed benefits may be associated with the comprehensive nursing protocol rather than the refined EN intervention alone'
The study included adjunctive therapies with unproven efficacy and lacked long-term outcome data including 30-day mortality and functional recovery
Authors conclude findings 'should be interpreted as demonstrating an association rather than a causal relationship'
Background
The study population consisted of critically ill stroke patients who frequently experience dysphagia, high stress, hypermetabolism, and reduced immunity.
Critically ill stroke patients often remain in a prolonged state of high stress, hypermetabolism, and reduced immunity
Dysphagia poses challenges to adequate nutrient intake in this population
Feeding intolerance (diarrhea ≥3 stools/day, vomiting, abdominal distension, elevated gastric residual volume ≥250 mL) was assessed as a primary outcome
Both groups had n = 81 patients each
What This Means
This research suggests that a more carefully structured ('refined') approach to tube feeding in critically ill stroke patients may improve their nutritional status and reduce digestive complications compared to standard nutrition management. The study compared 81 patients who received routine nutrition care in 2022 to 81 patients who received the refined tube-feeding protocol in 2023. Patients receiving the refined approach showed better markers of nutrition — including higher blood protein (albumin) and hemoglobin levels, greater arm muscle and fat measurements, and lower nutritional risk scores — and were more likely to meet their individualized calorie and protein targets (91% vs. 64% for calories; 89% vs. 59% for protein). They also had a shorter hospital stay by about 2.5 days on average.
This research also suggests that the refined intervention was associated with reduced disease severity scores (APACHE II) after treatment, though the study cannot confirm whether this reflects a direct effect of the nutrition approach or other aspects of the overall care protocol. Because the study was not a randomized controlled trial and used historical comparison patients rather than a concurrent control group, it is not possible to rule out other explanations for the improvements, such as differences in general care practices between 2022 and 2023.
The findings are promising but preliminary. The authors themselves caution that the benefits 'may be associated with the comprehensive nursing protocol rather than the refined EN intervention alone' and call for large-scale, multicenter randomized controlled trials to confirm whether this type of structured tube-feeding approach truly improves outcomes for critically ill stroke patients. Long-term outcomes such as survival and functional recovery were not measured in this study.
Huang N, Huo C, Zhu Y, He J, Huang C, Zheng L. (2026). The influence of refined enteral nutrition intervention on nutritional status and feeding intolerance in critically ill stroke patients.. Frontiers in neurology. https://doi.org/10.3389/fneur.2026.1860690