IOM Panel: Early Nutrition Therapy Can Be Benefit to Wounded Warriors with Severe TBI

by U.S. Medicine

June 14, 2011

Washington – Severe traumatic brain injusry (TBI) may be a complex medical condition with serious long-term consequences, but the latest recommendations are for a relatively simple change in diet to improve morbidity and mortality.

A recently released Institute of Medicine (IOM) study suggests that a high energy, high protein diet received immediately after a severe TBI injury and through the first two weeks of treatment may benefit patients with these injuries. The findings were part of an IOM review of the potential role of nutrition in protecting against or treating the immediate and near-term effects of TBI.

“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,” the IOM study stated. “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.”

DoD asked the IOM to review the potential role that nutrition could play in providing resilience or treating TBI. The study was sponsored by the U.S. Army Medical Research and Materiel Command. 

The IOM committee found that the majority of current clinical guidelines for TBI do not specifically address what the optimal nutritional regimen is for TBI patients. It recommended that evidence-based guidelines requiring the provision of a nutrition level representing more than 50% of the injured person’s total energy expenditure and providing 1 to 1.5 grams of protein per kilogram of body weight.

Other dietary 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 stated. B vitamin choline; creatine, an amino acid-like compound; n-3 fatty acids, commonly known as EPA and DHA; and the mineral zinc, were all identified by the committee as promising areas of research, and it recommended that DOD scientists and other researchers give them priority attention.

“The majority of the committee recommendations direct the DoD to conduct research,” wrote John Erdman PhD, a professor emeritus of food science and human nutrition at the University of Illinois, who chaired the IOM committee. “It is the opinion of the committee that nutrition is a promising component of managing TBI, but many answers are still needed before any nutrition intervention can be utilized.”

Erdman’s panel also recommended that DoD review the regular diets of servicemembers to make sure they are getting the kind of nutrients necessary to make them more resilient if traumatic injury occurs.

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. A review of nutrition approaches to impact TBI’s long-term effects would be useful, the committee noted. 

According to figures provided in the report, from 2000 to 2010, 202,281 servicemembers have been diagnosed with TBI. The majority of these injuries (77 percent) are classified as mild TBI.

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