Nutrition and Traumatic Brain Injury Improving Acute and Subacute Health Outcomes in Military Personnel (2011) / Chapter Skim
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17 Summary of Recommendations
17 Summary of Recommendations
Pages 249-256
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From page 249... ...
In addition to the evidence indicating that nutrition can affect the disease pathophysiology, there is increasing information indicating that nutrition affects brain function and that nutritional strategies may improve resilience or support treatment of brain disorders. With this in mind, an IOM expert committee reviewed the evidence supporting the potential role for nutrition in the acute and subacute phases of TBI.
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From page 250... ...
Based on the literature searches the committee concluded that conducting a review of the nutrition approaches to improve long-term effects of TBI, which was part of the initial task and later excluded because of financial constraints, would also be important. Specifically, it would be important to review the alterations in metabolism associated with TBI, together with the nutritional interventions that could enhance or impair recovery from those long-term health disorders in the areas of motor dysfunction and cognitive, neuropsychiatric, and neurodegenerative states, should be reviewed (see also workshop papers by Metzger, Gomez-Pinilla, and Sands in Appendix C)
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From page 251... ...
RECOMMENDATION 5-2. Routine dietary intake assessments of TBI patients in medical treatment facilities should be undertaken as soon after hospitalization as possible to estimate preinjury nutri tion status as well as to provide optimal nutritional intake throughout the various stages of treatment.
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From page 252... ...
These should be clinical trials of early feed ing using intense insulin therapy to maintain blood glucose concentrations at less than 150–160 mg/ dL versus current usual care of acute TBI in intensive care unit (ICU) settings for the first two weeks.
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From page 253... ...
These guidelines should address unique nutritional concerns of severe TBI when different from generic critical illness nutrition guidelines (e.g., meeting energy needs and benefits of specific nutrients, food components, or diets)
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From page 254... ...
Research Needs The rest of the recommendations concern research questions about the potential benefits and adverse effects of nutritional interventions for TBI. The committee made research recommendations for animal studies as well as for both observational and randomized controlled trials in humans.
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From page 255... ...
On that point, the committee made two general recommendations: first, to continue to develop better animal models, and second, to identify biomarkers of both injury and improved brain function. There also is a need to assess the nutritional status of military personnel to determine whether there are nutrients that need to be added to the diets of military personnel to maintain optimal readiness and mission performance goals.
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From page 256... ...
The committee found that, except for guidance on energy intake, the majority of clinical guidelines for critical care and TBI patients do not include specific recommendations for adequate nutrition either early after injury or in the long term. In addition, discussions with critical care and rehabilitation clinicians indicate there is diversity in clinical practices, and that the small number of current nutrition guidelines is followed by few practitioners.
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