Objective: To study the enteral nutritional approach to decrease the risk of hypoalbumenia in the patients with severe stroke. Methods: Fifty-one patients with severe stroke were randomly allocated into two groups with high protein enteral nutrition formula (EN was supplied as Fresubin 750 MCT, NPC:N = 100:1, n = 25) or standard enteral nutrition formula (EN was supplied as Nutrition Fibre, NPC:N = 130:1, n =26) respectively. They received equal non-protein-calorie (104.5 kJ · kg -1 · d -1) in all cases for 14 days. Results: Compared to standard nutritional supplementation, high protein nutritional supplementation was associated with a lower incidence of serum protein decrease, including total protein, albumin, and especially prealbumin in patients on the 7th day after stroke (P < 0.05). In the case of APACHE II > 19, incidence of hypoalbumemia was significantly lower in the high protein group during the 14 days after stroke (P < 0 05). Three-month survival rate was similar between groups, but high protein group tended to have a higher one-month survival rate. Conclusion: High protein enteral nutritional formula could reduce the risk of hypoalbumemia significantly in the patients with severe stroke. Thus high protein enteral nutrition is recommended to be used in severe stroke patients.