Nutrition Plays Vital Role in Traumatic Brain Injury Recovery
Critically ill patients who suffer traumatic injuries, including head and brain trauma, should begin to receive nutrition support soon after the injury occurs – within 24 hours – to optimize recovery. These findings, reported by the Institute of Medicine (IOM), should be incorporated into the standard of care for service members wounded on the battlefield and in critical care units nationwide treating for patients with head injuries.
High Calorie, High Protein Nutrition Support May Improve Brain Injury Outcomes
During traumatic injury, the body increases metabolism in response to stress. Patients with isolated head injuries have 140% of the normal caloric demand. For a 70 kg man (155 lbs), this can equal a need of as much as 3500 calories per day. The goal of aggressive early nutrition is to provide sufficient nutrients to support healing while preserving lean body mass.
The Department of Defense commissioned the IOM to review the scientific literature linking nutrition to brain injury outcomes as reported cases have tripled since 2000 in service members in Iraq and Afghanistan facing improvised explosive devices (IEDs).
IOM panel chairman John Erdman PhD, a professor emeritus of food science and human nutrition at the University of Illinois, and colleagues reviewed several studies, none more than 20 years old, and concluded that infusions of calories and protein begun within the first 24 hours of injury and continuing for at least two weeks significantly reduced inflammation in the brain and aided recovery.
Early feeding, typically via enteral nutrition (feeding tube) or parenteral nutrition (IV), can mitigate the effects of head injuries and reduce mortality in critically ill patients by 25-50%, reports Bruce Bistrian, chief of clinical nutrition at Beth Israel Deaconess Medical Center.
The researchers identified several nutrients that show preliminary promise in treating traumatic brain injury, including choline, creatine, omega-3 fatty acids, and zinc.
The IOM panel also urges the military to investigate the role of nutrition prior to traumatic injuries. They advised the Department of Defense to study the regular diets of service members and assess the types of nutrients they are getting and if it is enough to make them more resilient should injury occur.
The findings will also impact the standard of care for civilians as well. Each year, about 52,000 people in the United States die each year from traumatic brain injury and about 1.5 million patients report to emergency rooms each year with head injuries from car accidents, motorbike accidents, and sports injuries. TBI can range from mild concussions to severe episodes where memory loss lasts for more than seven days or involves trauma to the outer layers of brain tissue.
The study findings only apply to the potential role of nutrition in protecting against or treating the immediate and near-term effects of traumatic brain injuries. It did not evaluate the long-term health effects associated with brain trauma, such as post-traumatic stress disorder, Alzheimer's disease, pain, and depression.
The Defense Department said it would evaluate the report and consider the panel's recommendations for conducting clinical research on the issue.
"Coordination among DoD researchers and clinical-care experts could certainly develop clinical research protocols to determine if evidence for benefit can be identified," said Cynthia Smith, a Defense Department spokeswoman.