Abstract

Objectives: The aims of this study were to assess the nutritional status and nutritional adequacy of among attendees seeking consultation at the National Trauma Center, Oman, for the sequel of traumatic brain injury (TBI). 

Method: Anthropometric measurements (weight, height, body mass index, skinfold thickness) were estimated using standard protocol. Dietary intake was assessed by using “24 – Hour recall method”. Nutritional status and nutritional adequacy were analyzed electronically using a computer program (super tracker) to assess the adequacy/inadequacy of micronutrients. 

Results: Approximately 46% of attendees were classified as having ‘mild TBI’ while 12.7% and 40.8% were classified as moderate and severe TBI respectively. In terms of nutritional parameters, half of the cohort was at high risk of malnutrition (50.7%) while 12.7% and 36.6% were at moderate and no risk of malnutrition respectively. In terms of anthropometric status, 28.1% of attendees were underweight, while 16.9% and 7.1% were overweight and obese respectively. Approximately 30.2%, 43.0%, 24.8% and 54.1% were noted to have energy deficient in energy, carbohydrate, protein, and fiber respectively.

Conclusion: This study indicates that TBI patients in Oman are at a high risk of developing malnutrition, which in turn, could impede their road to recovery. Therefore, nutritional assessment and support is vital to improve patient’s outcomes amongst the TBI population.

Keywords: Traumatic Brain Injury; Nutrition Adequacy; Nutrition Assessment; Malnutrition

References

1. Kraus JF., et al. “Incidence, severity and external Causes of pediatric brain injury”. Amrican Journal of Diseases in Children 140 (1986): 687-693.
2. Faul M., et al. Traumatic brain injury in the United States: Emergency department visits, hospitalizations, and deaths, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Atlanta, Ga, USA, 2010.
3. CDC. Quick Stats: injury and traumatic brain injury-related death rates by age-United States. Morbidity and Mortality Weekly Report 59.10 (2006): 303.
4. Maas AI., et al. “Moderate and severe traumatic brain injury in Adults”. Lancet Neurology 7 (2008): 728-741.
5. Hannay HJ and Lezak MD. “The neuropsychological examination: interpretation”. In Lezak D, HOwieson DB, Loring DW, editors, Neuropsychological assessment, 4^th edn. New York: Oxford University Press. Finfer SR, Cohen J. Severe traumatic brain injury. Resuscitation (2001): 48-77-90.
6. Zaloshnja E., et al. “Prevalence of long-term disability from traumatic brain injury in the civilian population of the United Statet 2005”. Journal of Head Trauma Rehabilitation 23.6 (2008): 394-400.
7. Al-Reesi H., et al. “Economic growth, motorization, and road traffic injuries in the Sultanate of Oman, 1985-2009”. Traffic Injury Prevention 14.3 (2013): 322-328.
8. Stocchetti N., et al. “Clinical application of intracranial pressure monitoring in traumatic brain injury: report of the Milan consensus conference”. Acta Neurochirurgica 156.8 (2014): 1615-1622.
9. Young B., et al. “Nutrition and brain injury”. Journal of Neurotrauma 8 .1 (1992): S372-S383. 
10. Denes Z. “The influence of severe malnutrition on rehabilitation in patients with Severe head injury”. Disability and Rehabilitation 26 (2004): 1163-1165.
11. Brandi LS., et al. “Energy Expenditure and severity of injury and illness indices in multiple trauma patients”. Critical Care Medicine 27 (1999): 2684-2689.
12. Faisy C., et al. “Assessment of resting energy Expenditure in mechanically ventilated patients”. The American Journal of Clinical Nutrition 78 (2003): 241-249.
13. Plank LD and Hill GL. “Sequential metabolic changes following induction of systemic Inflammatory response in patients with severe sepsis or major blunt trauma”. World Journal of Surgery 24 (2000): 630-638.
14. Clifton GL., et al. “Assessment of nutritional requirements of headinjured patients”. Journal of Neurosurgery 64 (1986): 895-901.
15. Fried RC., et al. “Barbiturate therapy Reduces nitrogen excretion in acute head injury”. The Journal of Trauma and Acute Care Surgery 29 (1989): 1558- 1564.
16. Young B., et al. “Metabolic and nutritional sequelae in the no steroid Treated head injury patient”. Neurosurgery 17 (1985): 784-791.
17. Boullata J., et al. “Acurate determination of energy needs in hospitalized patients”. Journal of the American Dietetic Association 107 (2007): 393-401. 
18. Weekes E and Elia M. “Observations on the patterns of 24-hour energy expenditure Changes in body composition and gastric emptying in head-injured patients receiving Nasogastric tube feeding”. Journal of Parenteral and Enteral Nutrition 20 (1996): 31-37.
19. Borzotta AP., et al. “Enteral versus parenteral Nutrition after severe closed head injury”. The Journal of Trauma and Acute Care Surgery 37 (1994): 459-468.
20. Robertson CS., et al. “Oxygen utilization and Cardiovascular Function in head-injured patients”. Neurosurgery 15 (1984): 307- 314.
21. Hatton J and Ziegler TR. “Nutritional support of the neurosurgical patient”. In: Tindall G, Cooper PR, Barrow DL, Eds. The Practice of Neurosurgery. Baltimore, MD: Williams and Wilkins (1998): 381-396.
22. Nasreddine ZS., et al. “The Montreal Cognitive Assessment (MoCA): a brief screening tool for mild cognitive impairment”. Journal of the American Geriatrics Society 53.4 (2005): 695-669.
23. Rahman TT and El Gaafary MM. “Montreal Cognitive Assessment Arabic version: Reliability and validity prevalence of mild cognitive impairment among elderly Attending geriatric clubs in Cairo”. Geriatrics and Gerontology International 9.1 (2009): 54-61. 
24. Lohman T., et al. “Anthropometric standardization reference Manual”. Champaign, IL: Human Kinetics Books (1988).
25. Cheng HS., et al. “Estimatig stature from knee height for adults in Taiwan”. Chang Gung Medical Journal 24.9 (2001): 547.
26. Gauld LM., et al. “Hight prediction from ulna Length”. Developmental Medicine and Child Neurology 46.7 (2004): 475-480.
27. Bassey EJ. “Demi-span as a measure of skeletal size”. Annals of Human Biology 13 (1986): 499-502.
28. Organization WH. “World Health Organization”. Global Database on Body Mass (2011). 
29. Lim SL., et al. “Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3- years mortality”. Clinical Nutrition 31.3 (2012): 345-350.
30. Ahuja JKA., et al. “USDA Food and Nutrient Database for Dietary Studies, 5.0. USDA”, Agricultural Research Service, Food Surveys Research Group, Beltsville (2012). 
31. Report of the Panel on Macronutrients, Subcommittees on Upper Reference Levels Of Nutrients and Interpretation and Uses of Dietary Reference Intakes, and the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, Protein and amino acids (macronutrients). Washington, DC: National Academies Press (2005).
32. Henderson S., et al. “Do the malnutrition universal Screening tool (MUST) and Birmingham nutrition risk (BNR) score predict mortality in older hospitalized patients?”. BMC Geriatrics 10 (2008): 26.
33. Kondrup J., et al. “ESPEN guidelines for Nutrition screening”. Clinical Nutrition 22 (2003): 415-421.
34. Clifton GL., et al. “The metabolic response to severe Head injury”. Journal of Neurosurgery 60 (1984): 687-696.
35. Deutschman CS., et al. “Physiological and metabolic Response to isolated closed head injury. Part 1: Basal metabolic state: Correlation of Metabolic and physiological parameters with fasting and stressed controls”. Journal of Neurosurgery 64 (1986): 89-98.
36. Gadisseux P., et al. “Nutrition and neurosurgical patient”. Journal of Neurosurgery 60 (1984): 219-32.
37. Brooke MM., et al. “Nutritional status during Rehabilitation after head injury”. Journal of NeuroEngineering and Rehabilitation 3 (1989): 27-33.
38. Haynes MKM. “Nutrition in severely head-injured patient”. Clinical Rehabilitation 6 (1992): 153-158.
39. Gadisseux P., et al. “Nutrition and neurosurgical patient”. Journal of Neurosurgery 61 (1984): 76-86.
40. Krakau K., et al. “Nutritional treatment of patients with severe traumatic brain injury during the first six Months after injury”. Nutrition 23 (2007): 308-317
41. Dhandapani SS., et al. “Clinical malnutrition in severe traumatic brain injury: Factors associated and outcome at 6 months”. Indian Journal of Neurotrauma 4.1 (2007): 35-39.
42. Ghajar J. “Traumatic brain injury”. Lancet 356 (2000): 923-929.
43. Stratton RJ., et al. Disease-Related Malnutrition: Evidence Based Approach to Treatment, 1^st edn, Nutriticia Healthcare S.A, CABI Publishing, CAB International, Wallingford UK, (2003): 113-156.
44. Jackson AA. Severe malnutrition. In: Warrell DA, Cox TM, Firth JD, Benz EJ (eds). Oxford textbook of medicine, 4^th edn, vol 1. Oxford: Oxford University Press, (2003): 1054-1061.
45. McCall M., et al. “Effect of neuromuscular blockade on energy expenditure in patients with severe head injury”. Journal of Parenteral and Enteral Nutrition 27 (2003): 27-35.
46. Bernstein LH. “Relationship on nutritional markers to length of hospital stay”. Nutrition 11 (1995): 205S.
47. Bernstein L. “Measurement of Visceral Protein Status in Assessing Protein Energy Malnutrition: Standards of Care. Prealbumin in Nutritional Consensus Group”. Nutrition 11.2 (1995): 169-171.
48. Mears E. “Outcome of Continuous Process Improvement of a Nutritional Care Program Incorporating Serum Prealbumin Measurements”. Nutrition 12.7-8 (1996): 479-484.
49. Alhashemi HH. “Dysphagia in severe traumatic brain injury”. Neurosciences 15.4 (2010): 231-236.
50. Walters JL., et al. “Evidence of dietary inadequacy in adults with chronic spinal cord injury”. Spinal Cord 47 (2009): 318-322.
51. Popkin BM., et al. “The nutrition transition and prevention of diet related diseases in Asia and the Pacific”. Food and Nutrition Bulletin 22 (2001): 1-58.
52. Popkin BM. “An overview of the nutrition transition and its health implications: the Bellagio Meeting”. Public Health Nutrition 5 (2002): 93-103.
53. Sabour H., et al. “Calorie and Macronutrients intake in people with spinal cord injuries: An analysis by sex and Injury-related variables”. Nutrition 28 (2012): 143-147
54. Tomey KM., et al. “Dietary intake and nutritional Status of urban community-dwelling men with paraplegia”. Archives of Physical Medicine and Rehabilitation 86 (2005): 664-671.
55. Groah SL., et al. “Nutrient Intake and body habitus after spinal cord injury: an analysis by sex and level of injury”. The Journal of Spinal Cord Medicine 32 (2009): 25-33.
56. Moussavi RM., et al. “Dietary and serum Lipids in individuals with spinal cord injury living in the community”. Journal of Rehabilitation Research and Development 38 (2001): 225-233.
57. Blundell JE. “Pharmacological approaches to appetite suppression”. Trends in Pharmacological Science 12 (1991b): 147-157.
58. Mrozek S., et al. “Brain Temperature: Physiology and Pathophysiology after Brain Injury”. Anesthesiology Research and Practice (2012): 989487

Citation

Citation: Ghazi Daradkeh., et al. “Assessment of Nutritional Status and Macronutrients Adequacy of Traumatic Brain Injury Patients Attending Tertiary Health Care in Oman". Acta Scientific Nutritional Health 4.2 (2020): 144-150.

Copyright

Copyright: © 2020 Ghazi Daradkeh., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.