tion, and increasingly indicates that nutritional interventions could possibly help with the prevention, resilience, or treatment of the acute events of TBI. Because the literature on the pathophysiology and treatment of TBI still contains significant information gaps, this study effectively raises more research questions than it provides specific recommendations for preventive interventions or acute treatments to mitigate an injury.

PURPOSE AND SCOPE OF THE STUDY

For these reasons, the Institute of Medicine (IOM) was requested to convene an ad hoc expert committee under the oversight of the Committee on Military Nutrition Research to review the potential role of nutrients and dietary supplements in the prevention and treatment of TBI. As requested in the statement of task presented in Box 1-1, this study reviews only the potential nutritional implications for primary and secondary physiological sequelae of neurotrauma. Although the effects of TBI (primary, secondary, and long-term effects) are conceptually expressed according to the amount of time elapsed after the initial insult, the boundaries of these definitions are actually ambiguous, and extrapolating the timing of effects from animal models to humans is not always feasible. That is, some of the early pathogenic events related to cell death may extend into the more chronically injured brain, while other pathogenic events typically associated with wound healing are also initiated—and perhaps resolved—within the more acutely injured brain. Given these challenges, this

  1. Do the metabolic responses to neurotrauma suggest that resilience and susceptibility to neurotrauma might be positively or negatively modulated by metabolic or nutritional status (and hydration) before injury?

  2. If nutritional status does affect resilience and susceptibility, would a preventive nutritional approach be feasible to mitigate the primary or secondary physiological sequelae and functional outcomes of neurotrauma when it does occur?

  1. Do the metabolic and physiological responses to CNS-related neurotrauma (primary and secondary effects) have nutritional implications for optimal clinical treatment?

    1. What nutrition interventions for concussion and other CNS-related neurotrauma are included in current standards of practice, best practice, or clinical practice guidelines for treatment and recovery?

    2. How do regulation of metabolism and physiology in tissues injured by neurotrauma differ from non-injured tissue? Are the differences, if any, “dose-dependent”? Do those differences have nutritional implications for optimizing treatment?

    3. What specific nutritional approaches (e.g., nutrients, diets and nutritional interventions, including enteric and intravenous nutrition) have been shown to enhance efficacy of clinical treatment for patients experiencing CNS-related neurotrauma?

  1. What research is needed to adequately address the questions listed above?

    1. What research methods and models are appropriate for evaluating putative nutritional interventions for neurotrauma (e.g., animal models, epidemiological and clinical studies)?

    2. Are there other injuries (e.g., high pressure nervous syndrome) or situations (e.g., high altitude exposure) that might have similar underlying biological mechanisms as those for brain injury and recovery that could be useful models when exploring nutrition interventions for CNS-related neurotrauma and health disorders?

    3. Are there other populations (e.g., football, boxing, cyclists) that would be useful models for studying how nutrition modulates resilience, susceptibility, and recovery from neurotrauma? What specific nutrients, botanicals, and other nutritional interventions are the highest priority, i.e., most promising, for the military to study for mitigating and treating combat neurotrauma?



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