WASHINGTON — To help alleviate the effects of severe traumatic brain injury (TBI), the U.S. Department of Defense should ensure that all military personnel with this type of injury receive adequate protein and calories immediately after the trauma and through the first two weeks of treatment, says a new report from the Institute of Medicine. Evidence from several studies of severely brain-injured patients shows that providing energy and protein to patients early reduces inflammation and improves their outcomes, said the committee of experts who wrote the report.
This is the only nutrition-related approach to treating 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. Several other nutritional approaches show potential for reducing the symptoms of brain injury, but there is not yet enough evidence about their effectiveness to recommend their adoption.
The committee identified the B vitamin choline, the amino acid-like compound creatine, n-3 fatty acids commonly known as EPA and DHA, and zinc as the most promising areas of investigation and recommended that DOD scientists and other researchers give them priority attention. These approaches are ones for which human clinical trials have been undertaken or are ongoing.
Other approaches, 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. Although researchers must prioritize resources, DOD should continue to monitor the clinical literature for any new findings about the potential of these nutrients and diets in lessening brain injury effects, the report says.
The research priorities outlined in the report could generate information that provides health professionals with a fuller picture of which nutrients and dietary approaches work safely and most effectively. This information could also lead to new evidence-based clinical guidelines. There are few well-supported guidelines to inform health professionals’ use of foods and dietary supplements to treat brain-injured patients, so clinicians employ a wide range of practices.
The IOM study focused on the potential role of nutrition in protecting against or treating the immediate and near-term effects of TBI. It did not evaluate the role of nutritional therapies in the rehabilitation phase or address long-term health effects associated with brain trauma, such as post-traumatic stress disorder, Alzheimer’s disease, pain, and depression. A review of nutrition approaches to lessen long-term effects of TBI would be useful, the committee noted.
TBI is a significant cause of death and disability among personnel serving in the wars in Iraq and Afghanistan. It also contributes to nearly one-third of all injury-related deaths in the United States, making it a major health concern for the civilian population as well. According to recent estimates, between 1.6 million and 3.8 million sports-related TBIs occur annually, including those not treated by a health care provider.
The study was sponsored by the U.S. Army Medical Research and Materiel Command of the U.S. Department of Defense. Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public. The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies. For more information, visit http://national-academies.org or http://iom.edu. A committee roster follows.
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Pre-publication copies of Nutrition and Traumatic Brain Injury: Improving Acute and Subacute Health Outcomes in Military Personnel are available from the National Academies Press; tel. 202-334-3313 or 1-800-624-6242 or on the Internet at http://www.nap.edu. Reporters may obtain a copy from the Office of News and Public Information (contacts listed above).
INSTITUTE OF MEDICINE
Food and Nutrition Board
Committee on Nutrition, Trauma, and the Brain
John W. Erdman Jr., M.S., Ph.D. (chair)
Department of Food Science and Human Nutrition
University of Illinois
Eldon Wayne Askew, Ph.D.
Professor and Director
Division of Nutrition
University of Utah
Salt Lake City
Bruce R. Bistrian, M.D., Ph.D.
Professor of Medicine
Harvard Medical School, and
Beth Israel Deaconess Medical Center
Joseph G. Cannon, Ph.D.
College of Allied Health Services
Georgia Health Sciences University
Xiang Gao, M.D., Ph.D.
Department of Nutrition
Harvard School of Public Health, and
Harvard Medical School
Michael S. Jaffee, M.D.
San Antonio Uniformed Services Health Education Consortium
Lackland Air Force Base
Robin B. Kanarek, Ph.D.
John Wade Professor of Psychology
Cathy W. Levenson, Ph.D.
Associate Professor of Biomedical Science and Neuroscience, and
Hazel K. Stiebeling Associate Professor
Department of Nutrition, Food, and Exercise Sciences
Florida State University
Esther F. Myers, Ph.D., R.D.
Chief Science Officer
Research and Strategic Business Development
American Dietetic Association
Linda J. Noble, Ph.D.
Professor of Neurological Surgery and Physical Therapy and Rehabilitation Science,
Co-Director and Principal Investigator
Brain and Spinal Injury Center
University of California
Ross D. Zafonte, D.O.
Professor and Chair
Department of Physical Medicine and Rehabilitation
Harvard Medical School, and
Vice President of Medical Affairs
Spaulding Rehabilitation Hospital
Maria Oria, Ph.D.