and the military is generating greater overall awareness about this significant public health problem. However, TBI’s mechanisms and its damaging effects on the brain are still not fully understood. The multifactorial injury process of blast injuries—the most frequent cause of TBI in current combat operations—adds to the complexity of TBI. Similarly, multiple clinical trials on the acute treatment of TBI in civilian populations using pharmacological agents targeted at a single aspect of the injury cascade that follows TBI have been largely unsuccessful. Combat-related brain injury and stress disorders (such as posttraumatic stress disorder [PTSD]) as well as sports-related brain injuries have been the topic of several National Academies studies since 2000, including Returning Home from Iraq and Afghanistan: Preliminary Assessment of Readjustment Needs of Veterans, Service Members, and Their Families (IOM, 2010); Gulf War and Health: Volume 7: Long-Term Consequences of Traumatic Brain Injury (IOM, 2009); Opportunities in Neuroscience for Future Army Applications (NRC, 2009); Systems Engineering to Improve Traumatic Brain Injury Care in the Military Health System Workshop Summary (NAE/IOM, 2009); Treatment of Posttraumatic Stress Disorder: An Assessment of the Evidence (IOM, 2008); Evaluating the HRSA Traumatic Brain Injury Program (IOM, 2006a); Posttraumatic Stress Disorder: Diagnosis and Assessment (IOM, 2006b); and Is Soccer Bad for Children’s Heads?: Summary of the IOM Workshop on Neuropsychological Consequences of Head Impact in Youth Soccer (IOM, 2002).

Despite the paucity of evidence on effective treatments for TBI, new information is advancing the understanding of the relationship between nutrition status and brain func-

BOX 1-1

Statement of Task

An expert committee will review the existing evidence that supports the potential role for nutrition in providing resilience (i.e., protecting), mitigating, or treating of primary (i.e., within minutes of insult) and secondary (i.e., within 24 hours of insult) associated effects of neurotrauma, with a focus on traumatic brain injury. As a background, it will include an overview of types of central nervous system–related neurotrauma (primary and secondary effects) that are most commonly associated with combat operations. Research in promising areas will also be identified. Specifically the committee will respond to the following questions:

  1. What specific types of CNS-related neurotrauma (primary and secondary effects) are most commonly associated with combat operations? (Developed as an overview for background)

    1. Compare injury effects of severe neurotrauma produced by a single causative event versus accumulating effects of multiple concussions associated with lower-level events.

    2. What clinical standards qualitatively and quantitatively define severity of neurotrauma-associated injury?

  1. What biological mechanisms of combat-associated CNS-related neurotrauma injury (primary and secondary effects) are likely to have nutritional implications, vis-à-vis resilience to injury and/or severity of injury?

    1. What are the metabolic responses to neurotrauma in cells and tissues?

    2. How do metabolic responses to neurotrauma influence development of physiological sequelae and functional outcomes associated with injury?

    3. Do biological mechanisms (metabolic and cellular) and physiological sequelae of combat-associated neurotrauma (items 2.a and 2.b, above) exhibit “dose-dependency” such that concussion elicits the same response, albeit quantitatively less pronounced, compared to a single severe neurotrauma, or do the biological mechanisms in response to neurotrauma initiate in a “threshold” manner?

    4. Do quantitative and temporal relationships among metabolic responses, physiological sequelae, and functional outcomes to neurotrauma provide any useful clinical biomarkers of the severity, progression, or resolution of injury?



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