Determination of calorie and protein intake among acute and sub-acute traumatic brain injury patients

Abstract

Purpose Malnutrition is a common problem among hospitalized patients, especially among traumatic brain injury (TBI) patients. It is developed from hypermetabolism and the condition may worsen under the circumstance of underfeeding or incompatible dietary management. However, the data of nutrient intake especially calorie and protein among TBI patients were scarce. Hence, this study aimed to determine the calorie and protein intake among acute and sub-acute TBI patients receiving medical nutrition therapy in hospital Sultanah Nur Zahirah, Terengganu. Methods This observational study involved 50 patients recruited from the neurosurgical ward. Method of 24 h dietary recall was utilized and combined with self-administered food diaries for 2–8 days. Food consumptions including calorie intake and protein intake were analyzed using Nutritionist PRO™ (Woodinville, USA) and manual calculation based on the Malaysian food composition database (2015). Results Patients consisted of 56% males and 44% females with the median age of 28.0 (IQR = 22.8-36.5) years, of which 92% were diagnosed as mild TBI and the remaining (8%) as moderate TBI. The Glasgow coma scale (GCS) was adopted to classify TBI severity with the score 13–15 being mild and 9–12 being moderate. The median length of hospital stay was 2 (IQR = 2.0–3.3) days. Calorie and protein intake improved significantly from day 1 to discharge day. However, the intake during discharge day was still considered as suboptimal, i.e. 75% of calorie requirement, whilst the median protein intake was only 61.3% relative to protein requirement. Moreover, the average percentages of calorie and protein intakes throughout hospitalization were remarkably lower, i.e. 52.2% and 41.0%, respectively. Conclusion Although the calorie and protein intakes had increased from baseline, hospitalized TBI patients were still at a risk to develop malnutrition as the average intakes were considerably low as compared to their requirements. Optimum nutrient intakes especially calorie and protein are crucial to ensure optimum recovery process as well as to minimize risks of infection and complications.

Low-Protein, Hypocaloric Nutrition with Glutamine versus Full-Feeding in the Acute Phase in ICU Patients with Severe Traumatic Brain Injury

“…In the 1980s, researchers revealed that the physiological characteristics of severe TBI patients in the acute phase were large amounts of catabolism, increased energy expenditure, severe pro-inflammatory reactions, insulin resistance, and increased AGI (acute gastrointestinal injury) risk. Some studies have unilaterally emphasized the need to provide enough calories for patients with severe TBI 8 while the appearance of insulin resistance, gastrointestinal dysfunction, hyperglycemia on the nervous system, and other sequelae was caused by the lack of evaluation. 9 After entering the ICU, patients with severe brain injury will be given corresponding treatments such as hypothermia, sedation, and mechanical ventilation.…”

Albumin and total protein concentration – selected parameters of catabolic reaction and nutritional status among patients with craniocerebral injuries diagnosed with surgically treated cerebrovascular diseases

“…A study among patients with mild to moderate TBI (according to the Glasgow scale) showed that a significant number of patients had reduced protein levels at the start of hospitalisation, which gradually improved after nutritional treatment (on the first day of nutritional treatment, protein levels increased by 23.1%, while 75% of the total protein requirement was reached on the day of discharge). The authors of the study believe that optimal nutrient intake, especially calories and protein, is crucial to ensure an optimal recovery process, as well as minimising the risk of infection and complications [25]. A study by Stewart et al among critically ill patients revealed that calorie and protein deficits in patients with moderate to severe TBI (Glasgow score 9-12 and 3-8, respectively), reached 18,242 kcal (1 kcal = 4186 kJ) and 1315 g protein, respectively [26].…”

“…Malnutrition is a common problem among hospitalized patients, especially among patients with TBI. It develops as a result of hypermetabolism, and the condition can worsen with undernourishment or poor dietary management [24,25]. In particular, elderly trauma patients and patients with postoperative infections should be carefully monitored during hospitalisation [20].…”

Nutritional interventions to support acute mTBI recovery

“…Abdullah et al (57) conducted an observational intervention looking at the calorie and macronutrient intakes of patients hospitalized after sustaining a TBI. In order to prevent underfeeding and unsuited dietary management practices, researchers wanted to determine an accurate nutritional baseline requirements to support patients during their length of stay at hospital and recovery post TBI.…”