Nutritional interventions to support acute mTBI recovery

Abstract

When mild traumatic brain injury (mTBI) occurs following an impact on the head or body, the brain is disrupted leading to a series of metabolic events that may alter the brain's ability to function and repair itself. These changes may place increased nutritional demands on the body. Little is known on whether nutritional interventions are safe for patients to implement post mTBI and whether they may improve recovery outcomes. To address this knowledge gap, we conducted a systematic review to determine what nutritional interventions have been prescribed to humans diagnosed with mTBI during its acute period (<14 days) to support, facilitate, and result in measured recovery outcomes.MethodsDatabases CINAHL, PubMed, SPORTDiscus, Web of Science, and the Cochrane Library were searched from inception until January 6, 2021; 4,848 studies were identified. After removing duplicates and applying the inclusion and exclusion criteria, this systematic review included 11 full papers.ResultsPatients that consumed enough food to meet calorie and macronutrient (protein) needs specific to their injury severity and sex within 96 h post mTBI had a reduced length of stay in hospital. In addition, patients receiving nutrients and non-nutrient support within 24–96 h post mTBI had positive recovery outcomes. These interventions included omega-3 fatty acids (DHA and EPA), vitamin D, mineral magnesium oxide, amino acid derivative N-acetyl cysteine, hyperosmolar sodium lactate, and nootropic cerebrolysin demonstrated positive recovery outcomes, such as symptom resolution, improved cognitive function, and replenished nutrient deficiencies (vitamin D) for patients post mTBI.ConclusionOur findings suggest that nutrition plays a positive role during acute mTBI recovery. Following mTBI, patient needs are unique, and this review presents the potential for certain nutritional therapies to support the brain in recovery, specifically omega-3 fatty acids. However, due to the heterogenicity nature of the studies available at present, it is not possible to make definitive recommendations.Systematic review registrationThe systematic review conducted following the PRISMA guidelines protocol was registered (CRD42021226819), on Prospero.

Nutrition in acute concussion recovery – how is this currently being managed by performance dietitians and nutritionists?

“…Specific supplementation protocols with nutrients such as omega-3 fatty acids (Docosahexaenoic (DHA), a combination of DHA and Eicosapentaenoic (EPA) acid), magnesium, and N-acetyl cysteine (NAC) may help with SRC recovery. However, their application is unclear and requires further investigation (2) .Therefore, this study aimed to investigate Irish PD and PN knowledge and implementation of nutritional strategies to manage and support their athletes following an acute SRC diagnosis.In-depth, semi-structured, audio-recorded interviews were conducted with 17 PDs and PNs recruited from professional registrations (SENR), sporting bodies (IRFU, GAA, Sports Ireland) and networks. Participants practiced/had practiced with amateur and/or professional athletes within the last ten years.…”

“…Following SRC, the brain becomes injured, its function disrupted, and an “energy crisis” (5) occurs. In response, the brain requires energy and nutrient support to restore cognitive function, reduce symptoms and support healing (2) . Performance dietitians (PN) and nutritionists (PN) play a critical role in supporting athletes’ acute injury nutritional demands via fuelling and supplementation.…”

“…This research developed insight on PD/PN's (1) awareness, knowledge and (2) implementation of nutritional supports in concussion recovery with athletes. There was a clear contrast between participants who had an awareness and knowledge of the importance of nutrition in supporting brain recovery after a concussion and those who did not.…”

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The incidence of sport-related concussion (SRC) has increased in many team-based sports (1,2,3) , such as rugby, Gaelic (camogie, hurling and football), and hockey in Ireland (3,4) . Following SRC, the brain becomes injured, its function disrupted, and an "energy crisis" (5) occurs.

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“…Specific supplementation protocols with nutrients such as omega-3 fatty acids (Docosahexaenoic (DHA), a combination of DHA and Eicosapentaenoic (EPA) acid), magnesium, and N-acetyl cysteine (NAC) may help with SRC recovery. However, their application is unclear and requires further investigation (2) .…”