Nutrition, Trauma, and the Brain
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), secondary (i.e., within 24 hours of insult), and long-term (i.e., more than 24 hours after insult) associated effects of neurotrauma, with a focus on traumatic brain injury. The study will be conducted in two phases. Phase I will review the metabolic responses and primary and secondary physiological sequella of neurotrauma and potential nutritional implications. As a background, it will include an overview of types of CNS-related neurotrauma (primary and secondary effects) that are most commonly associated with combat operations. Phase II will assess whether the long-term health disorders associated with neurotrauma might be affected by nutritional status of the individual. Research areas 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)
a. Compare injury effects of severe neurotrauma produced by a single causative event versus accumulating effects of multiple concussions associated with lower-level events.
b. What clinical standards qualitatively and quantitative define severity of neurotrauma associated injury?
2) What biological mechanisms of combat-associated CNS-related neurotrauma injury (primary and secondary effects) are likely to have nutritional implications, vis a vis resilience to injury and/or severity of injury?
a. What are the metabolic responses to neurotrauma in cells and tissues?
b. How do metabolic responses to neurotrauma influence development of physiological sequella and functional outcomes associated with injury?
c. Do biological mechanisms (metabolic and cellular) and physiological sequella 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?
d. Do quantitative and temporal relationships among metabolic responses, physiological sequella, and functional outcomes to neurotrauma provide any useful clinical biomarkers of the severity, progression, or resolution of injury?
e. 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?
f. If nutritional status does affect resilience and susceptibility, would a preventative nutritional approach be feasible to mitigate the primary or secondary physiological sequella and functional outcomes of neurotrauma when it does occur?
3) Do the metabolic and physiological responses to CNS-related neurotrauma (primary and secondary effects) have nutritional implications for optimal clinical treatment?
a. 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?
b. 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?
c. 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?
4) Does nutritional status modulate development of long-term health disorders associated with neurotrauma, or alternatively, does development of long-term health disorders associated with neurotrauma (e.g., post-traumatic stress disorders) affect nutritional status via altered metabolism or eating behaviors (i.e., as co-morbidities)?
a. What are the long-term health disorders associated with neurotrauma?
b. What is the relationship between severity of the injury (i.e., concussion versus severe neurotrauma) and the types and severity of long-term health disorders associated with neurotrauma?
c. Do metabolic mechanisms contribute to long-term health disorders, or do the health disorders themselves alter metabolism such that nutritional requirements are altered?
d. What alterations in metabolism and/or eating behaviors are co-morbidities or characteristic components of long-term health disorders associated with CNS-related neurotrauma?
e. What diets, food products, and nutritional interventions could enhance or impair recovery from long-term health disorders associated with CNS-related neurotrauma in the following functional areas:
i. Cognitive (e.g., information processing, reaction, responsiveness, loss of memory, attention)
ii. Somatic (e.g., sleep, fatigue)
iii. Neuropsychiatric states (e.g., PTSD, depression, anxiety)
v. Behavioral disorders, to include disordered eating behavior and addiction
5) What research is needed to adequately address the questions listed above?
a. What research methods and models are appropriate for evaluating putative nutritional interventions for neurotrauma (e.g. animal models, epidemiological and clinical studies)?
b. Are there other injuries (e.g. high pressure nervous syndrome) or situations (e.g. high altitude exposure) that might have similar underlying biological mechanisms than those for brain injury and recovery that could be useful models when exploring nutrition interventions for CNS-related neurotrauma and associated long-term health disorders?
c. 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 and associated long-term health disorders? 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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