Nutrition and Traumatic Brain Injury Improving Acute and Subacute Health Outcomes in Military Personnel (2011) / Chapter Skim
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Defense and Veterans Brain Injury Center to serve the military through clinical care, research initiatives, and educational programs. Any injury to the brain, the main center for receiving and processing information and response, will likely result in a complex disease or condition.
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The following nutritional interventions were identified for review: energy needs for severe cases of TBI, acetyl coA, antioxidants, branched-chain amino acids, choline, creatine, ketogenic diets, magnesium, nicotinamide adenine dinucleotide (NAD+) , n-3 fatty acids, polyphenols, probiotics, vitamin D, and zinc.
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. Research on interventions for which animal studies in TBI or human studies in associated conditions have shown improvements in outcomes are presented as "other research" (Box 17-5)
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Energy and Protein Needs in Patients with Severe TBI The current clinical practice guidelines for patients with TBI or other critical illnesses recommend early feeding, but the elements of the feeding regimen vary substantially, from BOX S-3 Assessing Nutrition Status RECOMMENDATION 5-1. DoD should conduct dietary intake assessments in different military set tings (e.g., when eating in military dining facilities or when subsisting on a predominantly ration-based diet)
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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 ICU settings for the first two weeks.
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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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Increasing protein intake while following a lower energy intake regimen will improve the retention of lean tissue and may favorably affect clinical outcome in these patients. Intensive insulin therapy has been widely used to produce normal blood glucose levels, but its use appears most valid for the reduction of inflammation and improvement in morbidity and mortality in surgical patients.
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For some of the selected interventions, studies have demonstrated benefits in animal models of TBI or related brain injuries, but there are no clinical trials that confirm similar beneficial effects in humans. In other cases, human trials are under way, and the military should review those studies as the results are made public.
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Because it is well documented that fish oil supplementation decreases inflammation, n-3 fatty acids are the subject of many studies evaluating their health benefits and elucidating their mechanism of action. The ratio of n-3:n-6 composition may affect cell membrane fluidity, thickness, or other characteristics.
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The nutrition assessments of TBI patients recommended here will help substantiate the hypothesis that zinc deficiency affects outcomes of TBI. Findings from animal studies suggest that supplementation of diets beyond required levels might be even more beneficial, and this possibility should be explored.
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