Preface

This Institute of Medicine report was the result of a request by the Department of Defense’s (DoD’s) Military Nutrition Division of the U.S. Army Research Institute of Environmental Medicine (USARIEM) to the Institute of Medicine (IOM) to review the potential role of nutrition in improving the outcomes of traumatic brain injury (TBI) at the acute stage. As background, the committee was to include an overview of types of TBI that are most commonly associated with combat operations. The committee also was asked to identify research needed in promising areas.

Active military service members experience a high percentage of traumatic brain injury ranging from severe to mild cases. The biological mechanisms of TBI are still not fully understood, and it involves a cascade of events resulting in a diversity of adverse effects in many realms of an individual’s health. In fact, brain injury has been the topic of several National Academies studies in the past decade, many of them revealing the paucity of answers in regard to treating or preventing the injury. To date, there is no single standardized or effective approach for managing TBI and targeting a single aspect of the injury cascade following TBI has largely been unsuccessful. Because of the evidence that nutrition can modulate brain function in the healthy and injured population, nutrient approaches have been proposed as a way to provide resilience prior to TBI and as an adjuvant to other treatments after injury. The U.S. military forces are currently deployed in areas that present new challenges, such as the use of new types of warfare that increases the risk of experiencing blast injuries. In addition, since 2001, the number of troops deployed and the frequency and length of deployments augment the demands on our troops. The numbers of military personnel being affected by TBI in its various types (concussion/mild, mild, moderate, severe, penetrating, or blast) have frequently reached the news. As awareness of this public health problem increases, the military has devoted more resources in technology, research, diagnosis, and treatment to manage this disease.

A committee of 11 experts was formed with extensive knowledge across both military and civilian populations in the areas of neurology; nutritional sciences, clinical nutrition and dietetics; physiology; physical medicine and rehabilitation; psychiatry and behavior; xi



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