Early Feeding Beneficial After Severe Traumatic Brain Injury

From Medscape Medical News > Neurology
Megan Brooks

April 25, 2011 — Military personnel with severe traumatic brain injury (TBI) should receive early adequate nutrition immediately after the injury, according to a new report from the Institute of Medicine (IOM).

The report is titled "Nutrition and Traumatic Brain Injury: Improving Acute and Subacute Health Outcomes in Military Personal."

It recommends that, within the first 24 hours, the patient should receive a level of nutrition that represents more than 50% of the patient's total energy expenditure and provides 1 to 1.5 grams of protein per kilogram of body weight. This nutrition level should be maintained for 2 weeks.

On the basis of several studies of severely brain injured patients, this nutritional intervention is likely to limit the early inflammatory response, which typically is at a peak during the first 2 weeks after injury, and thereby improve health outcomes, the IOM committee that wrote the report notes. They say more study is needed to pinpoint optimal nutrition goals after the first 2 weeks after injury.

TBI is a significant cause of death and disability among military personnel, with 10% to 20% of returning veterans having a TBI, according to 1 estimate. Other estimates suggest that TBI accounts for up to 33% of combat-related injuries.

Early Adequate Nutrition

Recent studies have suggested that nutritional interventions can benefit patients with TBI. This prompted the US Department of Defense (DoD) to ask the IOM to convene an expert committee to review the potential role for nutrition in TBI. John W. Erdman, professor emeritus, Department of Food Science and Human Nutrition at University of Illinois at Urbana-Champaign, chaired the 11-member committee.

Early adequate feeding was the only nutrition-related supplemental treatment for TBI that the committee recommended DoD implement at this time based on its review of the possible benefits of nutrients, dietary supplements, and specific diets to improve outcomes for TBI, ranging from mild to severe.

"Given the complexity of TBI and the current gaps in scientific knowledge," the committee notes, early adequate nutrition was the only "promising solution that can immediately improve treatment efforts."

However, the committee identified several other nutritional interventions that hold promise for improving TBI outcomes. They are the provision of or treatment with choline, creatine, n-3 fatty acids, and zinc. "DoD should prioritize research on these interventions," the committee advises.

Other nutritional approaches for TBI, including antioxidants, flavonoids, ketogenic diets, and vitamin D, have less supporting evidence that has come solely from animal studies or from studies in people with different conditions, the committee notes.

The committee did not evaluate the role of nutritional therapies in the rehabilitation phase or address long-term health effects associated with brain trauma but say this would be useful.

They also note that given parallels between some types of combat-related TBI, such as concussions, and sports-related and other civilian brain injuries, "the nutritional interventions explored in this report can similarly be considered for other types of injuries."

The study was sponsored by the US Army Medical Research and Material Command of the US Department of Defense.