Protein and calories may help troops with brain injury, says IoM

The IoM report emphasizes the importance of nutrition, not only to augment overall defensive mechanisms against the effects of traumatic brain injury (TBI), “but also as post injury treatment to lessen the acute and sub-acute effects of TBI.”​

The report backs the provision of adequate protein and calories immediately after trauma, and through the first two weeks of treatment, for military personnel with traumatic brain injury.

“Based on recent meta-analyses showing that mortality and morbidity of TBI patients are improved by early feeding, the committee strongly supports the provision of energy and protein to patients with severe TBI early after injury,” ​stated the report.

“This important recommendation should be implemented immediately and will achieve significant positive outcomes by reducing the inflammatory response, which is likely to be at its height during the first two weeks after the injury.”​

Brain injury​

The military defines traumatic brain injury (TBI) as “a traumatically induced structural injury or physiological disruption of brain function […] that is indicated by new onset or worsening of symptoms involving level of consciousness, memory, mental or neurological states, or intracranial lesion.”​

Widespread use of weapons such as improvised explosive devices (IEDs) is leading to a higher number of non penetrating head and neck wounds, particularly traumatic brain injury

The report notes that TBI has emerged as an important concern for the military, as any injury to the brain “will likely result in a complex disease or condition.”​

Research has suggested that nutrition may play an important role in the prevention of, or therapy for, injuries to the brain, including neurodegenerative disorders and ischemia.

In light of this research the Department of Defense’s Military Nutrition Division requested that the Institute of Medicine (IOM) review the potential role of nutrition in improving the outcomes of traumatic brain injury (TBI) at the acute stage.

The report committee was not asked to evaluate the role of nutritional therapies in the rehabilitation phase or the potential role of nutrition in ameliorating long-term effects of TBI.

Report recommendations​

The report reviewed nutritional approaches that show promise in providing resilience or treating the acute and sub-acute effects of traumatic brain injury. It also stated that report found that the majority of guidelines for traumatic brain injury do not specifically address optimal nutritional support.

The committee of 11 experts noted that evidence from several studies of severely brain-injured patients’ shows that providing energy and protein to patients early reduces inflammation and improves outcomes.

However, the need for early provision of protein and energy was the only nutrition-related approach to treating traumatic brain injury that the committee recommended Department of Defense (DoD) implement at the time.

The expert panel highlighted that several other nutritional approaches showed potential for reducing the symptoms of brain injury, but said there is not yet enough evidence about their effectiveness to recommend their adoption.

Research priority​

The committee identified the B vitamin choline, creatine, the omega-3 fatty acids EPA and DHA, and zinc as the most promising areas of investigation and recommended that DoD scientists and other researchers give them priority attention.

They also noted the potential for other nutritional approaches, including the use of antioxidants, flavonoids, ketogenic diets, adding that although researchers must prioritize resources, the military should continue to monitor the scientific literature for any new findings about the potential of these nutrients and diets in lessening brain injury effects.

The report noted that such a recommendation was “a reflection of the gaps in data about the efficacy of most of the nutrition approaches reviewed … for this reason, the committee thought it premature to direct DoD to adopt any of them at this time,” ​it stated.

The findings also highlighted the need to develop better clinical biomarkers for all types of traumatic brain injury “for the purposes of diagnosis, treatment, and outcome assessment.”​

“Although the importance of early feeding for patients with severe TBI is recognized and its recommendation included in this report, there are still key questions, such as determining the optimal blood glucose concentration for the period immediately after a severe injury,”​ stated the report.

Source: Institute of Medicine
“Nutrition and Traumatic Brain Injury: Improving Acute and Subacute Health Outcomes in Military Personnel”​
Committee on Nutrition, Trauma, and the Brain; Institute of Medicine