Nutrition and Traumatic Brain Injury: Improving Acute and Subacute Health Outcomes in Military Personnel

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Table of Contents
Front Matter R1-R12
Summary 1-10
Part I: Background 11-12
1 Introduction 13-22
2 Nutrition in Clinical Practice Guidelines for Traumatic Brain Injury 23-30
3 Understanding Pathophysiological Changes 31-52
Part II: Nutrition and TBI 53-54
4 Approach for Selecting Nutritional Interventions: Mechanistic Targets 55-68
5 Acquiring Resilience to TBI Prior to Injury 69-78
6 Energy and Protein Needs During Early Feeding Following Traumatic Brain Injury 79-87
7 Antioxidants 88-107
8 Branched-Chain Amino Acids 108-114
9 Choline 115-129
10 Creatine 130-139
11 Ketogenic Diet 140-156
12 Magnesium 157-187
13 Eicosapentaenoic Acid (EPA) and Docosahexaenoic Acid (DHA) 188-204
14 Polyphenols 205-226
15 Vitamin D 227-232
16 Zinc 233-246
Part III: Recommendations 247-248
17 Summary of Recommendations 249-256
Appendixes 257-258
Appendix A: Agenda 259-262
Appendix B: Evidence-Based Guidelines for Traumatic Brain Injury 263-285
Appendix C: Workshop Speakers' Papers 286-412
Appendix D: Glossary 413-420
Appendix E: Acronyms 421-426
Appendix F: Committee Member Biographical Sketches 427-432

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TABLE B-1 Content of Evidence-Based Guidelines (EBG) for Acute Traumatic Brain Injury (TBI) in Intensive Care Unit (ICU) Setting (e.g., Critical Illness)

Guideline/Step of Care Process with Nutrition Implications	Brain Trauma Foundation (BTF) Guidelines for the Management of Severe Traumatic Brain Injury^a	American Society for Parenteral and Enteral Nutrition Critically Ill Patient^b
Nutrition-related assessment information		A1. Traditional nutrition assessment tools (albumin, pre-albumin, and anthropometry) are not validated in critical care. Before initiation of feedings, assessment should include evaluation of weight loss and previous nutrient intake prior to admission, level of disease severity, comorbid conditions, and function of the gastrointestinal (GI) tract. (Grade: E)
Nutrition-related assessment information		C1. The target goal of enteral nutrition (EN) (defined by energy requirements) should be determined and clearly identified at the time of initiation of nutrition support therapy. (Grade: C) Energy requirements may be calculated by predictive equations or measured by indirect calorimetry. Predictive equations should be used with caution, because they provide a less accurate measure of energy requirements than indirect calorimetry in the individual patient. In the obese patient, the predictive equations are even more problematic without availability of indirect calorimetry. (Grade: E)

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