Predictive Equations Overestimate Resting Metabolic Rate in Survivors of Chronic Stroke

Objective: To measure resting metabolic rate (RMR) in survivors of chronic (> 3 months prior) stroke (mean & PLUSMN; SEM age, 61 +/- 7.5 years) and to compare to predicted RMR using predictive equations in adults without stroke. Design: Cross-sectional study. Setting: Hospital. Participants: Survivors of stroke (N=71). Intervention: Not applicable. Main Outcome Measures: RMR was measured by indirect calorimetry. Participants underwent a total body dual-energy x-ray absorptiometry scan and treadmill test for peak oxygen consumption (V?O2peak). RMR was calculated using 9 established equations. Results: RMR measured (1552 +/- 319 kcal/d) was significantly lower than 9 predicted RMR values (all P <.001), with the best being McArdleKatch (1652 +/- 233 kcal/d), Livingston (1677 +/- 230 kcal/d), and Mifflin (1707 +/- 242 kcal/d). The Institute of Medicine of the National Academies (2437 +/- 386 kcal/d) had the largest discrepancy with measured RMR. Predicted RMR determined with 8 of 9 equations was between 9% and 18% greater than measured RMR. Appendicular lean mass (r=0.64, P <.001), total lean mass (r=0.64, P <.001), and V?O2peak (r=0.41, P <.001) were associated with measured RMR. Conclusions: RMR predictive equations established in adults without stroke are not appropriate for the population with stroke population, indicating the need to measure RMR until a more accurate predictive equation is developed. This could support modifications to nutritional intake guidelines in patients with conditions of muscle atrophy. If measurement of RMR is not feasible, the Katch-McArdle equation should be used to estimate RMR in a patient with stroke because on average it provides the lowest percentage overestimate compared with other equations. (C) 2022 by the American Congress of Rehabilitation Medicine.