BOX 17-1

Standardize the Provision of Energy and Protein to Patients with Severe TBI

RECOMMENDATION 6-1. The committee recommends that evidence-based guidelines include the provision of early (within 24 hours after injury) nutrition (more than 50 percent of total energy expenditure and 1–1.5 g/kg protein) for the first two weeks after injury. This intervention is critical to limit the intensity of the inflammatory response due to TBI, and to improve outcome.

BOX 17-2

Continue Improving Animal Models and Identifying Biomarkers

RECOMMENDATION 3-1. The committee recommends that the Department of Defense (DoD), in cooperation with others, refine existing animal models to investigate the potential benefits of nutrition throughout the spectrum of TBI injuries, that is, concussion/mild, moderate, severe, and penetrating, as well as repetitive and blast injuries. Development of animal models is particularly urgent for concussion/mild TBI and brain injuries due to blast as well as for repetitive injuries. These models also will aid in understanding the pathobiology of TBI, which is particularly needed for concussion/mild TBI, blast, and repetitive injuries.

RECOMMENDATION 3-2. The committee recommends that DoD, in cooperation with others, continue to develop better clinical biomarkers of TBI (i.e., concussion/mild, moderate, severe, penetrating, repetitive, and blast injuries) for the purposes of diagnosis, treatment, and outcome assessment. In addition, the committee recommends the identification of biomarkers specifically related to proposed mechanisms of action for individual nutritional interventions.

BOX 17-3

Assessing Nutrition Status

RECOMMENDATION 5-1. DoD should conduct dietary intake assessments in different military settings (e.g., when eating in military dining facilities or when subsisting on a predominantly ration-based diet) both predeployment and during deployment to determine the nutritional status of soldiers as a basis for recommending increases in intake of specific nutrients that may provide resilience to TBI.

RECOMMENDATION 5-2. Routine dietary intake assessments of TBI patients in medical treatment facilities should be undertaken as soon after hospitalization as possible to estimate preinjury nutrition status as well as to provide optimal nutritional intake throughout the various stages of treatment.

RECOMMENDATION 5-3. In individuals with TBI, DoD should estimate preinjury and postinjury dietary intake or status for those nutrients, dietary supplements, and diets that might show a relationship to TBI outcome. For example, based on the current evidence, the committee recommends collecting those estimates for creatine, n-3 fatty acids, choline, and vitamin D. The data could be used to investigate potential relationships between preinjury nutritional intake or status and recovery progress. Such data also would show possible synergistic effects between nutrients and dietary supplements.

Energy and Protein to Patients with Severe TBI

The committee made one urgent recommendation to standardize the feeding regimen for TBI patients early after a severe injury. This important recommendation focuses on including specific energy and protein provisions for patients with severe TBI in the current evidence-

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