Nutritional considerations in the patient with disabling brain disease

Area of Science:

• Neurology
• Nutritional Science
• Critical Care Medicine

Background:

• Increased nutritional requirements are a known complication of head injuries.
• The nutritional demands associated with non-traumatic brain diseases are not well understood.
• Clinical assessments of neurological impairment do not reliably predict nutritional needs.

Purpose of the Study:

• To explore the nutritional requirements in patients with non-traumatic brain diseases.
• To compare nutritional needs in head-injured versus non-injured brain disease patients.
• To discuss the implications for nutritional support strategies.

Main Methods:

• Review of existing data on nutritional requirements post-brain injury.
• Analysis of clinical criteria for assessing neurological impairment and nutritional risk.
• Discussion of parenteral and enteral nutrition methods, including newer enteral access techniques.

Main Results:

• Head-injured patients exhibit increased caloric and protein needs, suggesting benefit from early, intensive nutritional intervention.
• Nutritional risk in non-trauma brain disease patients is difficult to establish, leading to less clear indications for aggressive nutritional support.
• Parenteral nutrition is often necessary due to gastrointestinal dysfunction impacting enteral nutrition.
• Branched-chain amino acids may mitigate body cell mass loss in head-injured patients.
• Fat and glucose combinations may improve nutrient utilization in non-head-injured patients.

Conclusions:

• Early nutritional intervention may reduce mortality in head-injured patients.
• Enteral nutrition, particularly via newer techniques like percutaneous gastrostomies or small bore feeding tubes, offers physiological and economic advantages over parenteral nutrition when feasible.
• Further research is needed to clarify nutritional risks and optimize support for non-traumatic brain diseases.