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More evidence of role of nutrition after TBI

New biomarker helps determine levels of calories and nutrition in early stages of recovery

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New research has again highlighted the importance of nutrition in the recovery process after traumatic brain injury (TBI). 

While food and nutrients can be an afterthought in the early days after TBI amidst clinical recovery being the priority, a new study suggests that getting vital calories can boost the brain’s healing process. 

Through the research, a new biomarker has also been developed to assess nutritional status, giving greater insight into the nutrition and calories a patient needs. 

“This evidence highlights the importance of ensuring proper nutrition for TBI patients during recovery,” says Casey C. Curl, doctoral candidate at the University of California, Berkeley.

“Specifically, formulations containing fuels that are preferred by the brain, such as lactate, should be prioritised during the acute and chronic phases of recovery from TBI.”

When a person is admitted to hospital with TBI, the tools clinicians use to calculate a patient’s nutritional needs are not designed for the unique circumstances of a brain injury, and recent studies suggest that most TBI patients get far fewer calories than they need.

Key to the research is the new biomarker the team developed to assess nutritional status. While it is possible to measure the amount of calories a person consumes, measuring whether the amount of calories provided to the patient to meet their energy needs is more complex. 

To fill this gap, the researchers created a way to measure the amount of glucose produced internally as the body processes energy inputs. 

This metric, called fractional gluconeogenesis, ranges from zero (fully fed) to 100 per cent (drastically underfed).

For the study, researchers tracked how nutritional status affects fractional gluconeogenesis and protein synthesis in a rat model of TBI. 

They used deuterium oxide, also known as heavy water, as a tracer to assess fractional gluconeogenesis and protein synthesis in different parts of the brain and body. 

By comparing these dynamics in rats with different levels of caloric intake, they were able to gain insights into how nutrition affects brain healing processes.

“Our study found that after TBI, the brain responds abnormally by increasing protein synthesis in the higher brain region while decreasing it in the lower regions,” said Curl.

Previous studies have shown that being underfed leads to reduced protein synthesis in skeletal muscle and liver cells. The new findings suggest a similar thing happens in the brain. 

“Understanding this decrease in protein turnover during the brain healing process is crucial because a caloric deficit may affect the patient’s ability to heal from their injury,” said Curl.

The findings suggest that providing adequate nutrition in the aftermath of TBI can help the brain manufacture the proteins it needs for the healing process, without having to prioritise certain brain regions over others.

In addition to feeding patients sooner as part of routine practice, Curl noted that clinicians could use fractional gluconeogenesis as a practical metric to assess whether patients are getting enough calories during TBI treatment and recovery.

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