Optimization of Nutrition after Brain Injury: Mechanistic and Therapeutic Considerations

Roy A Poblete¹, Shelby Yaceczko², Raya Aliakbar¹, Pravesh Saini¹, Saman Hazany³, Hannah Breit¹, Stan G Louie⁴, Patrick D Lyden⁵, Arthur Partikian⁶

Affiliations

¹ Department of Neurology, Keck School of Medicine, The University of Southern California, 1540 Alcazar Street, Suite 215, Los Angeles, CA 90033, USA.
² UCLA Health, University of California, 100 Medical Plaza, Suite 345, Los Angeles, CA 90024, USA.
³ Department of Radiology, Keck School of Medicine, The University of Southern California, 1500 San Pablo Street, Los Angeles, CA 90033, USA.
⁴ Department of Clinical Pharmacy, School of Pharmacy, The University of Southern California, 1985 Zonal Avenue, Los Angeles, CA 90089, USA.
⁵ Department of Neurology, Department of Physiology and Neuroscience, Zilkha Neurogenetic Institute, Keck School of Medicine, The University of Southern California, 1540 Alcazar Street, Suite 215, Los Angeles, CA 90033, USA.
⁶ Department of Neurology, Department of Pediatrics, Keck School of Medicine, The University of Southern California, 2010 Zonal Avenue, Building B, 3P61, Los Angeles, CA 90033, USA.

PMID: 37760993
PMCID: PMC10526443
DOI: 10.3390/biomedicines11092551

Review

Optimization of Nutrition after Brain Injury: Mechanistic and Therapeutic Considerations

Roy A Poblete et al. Biomedicines. 2023.

. 2023 Sep 17;11(9):2551.

doi: 10.3390/biomedicines11092551.

Authors

Roy A Poblete¹, Shelby Yaceczko², Raya Aliakbar¹, Pravesh Saini¹, Saman Hazany³, Hannah Breit¹, Stan G Louie⁴, Patrick D Lyden⁵, Arthur Partikian⁶

Affiliations

¹ Department of Neurology, Keck School of Medicine, The University of Southern California, 1540 Alcazar Street, Suite 215, Los Angeles, CA 90033, USA.
² UCLA Health, University of California, 100 Medical Plaza, Suite 345, Los Angeles, CA 90024, USA.
³ Department of Radiology, Keck School of Medicine, The University of Southern California, 1500 San Pablo Street, Los Angeles, CA 90033, USA.
⁴ Department of Clinical Pharmacy, School of Pharmacy, The University of Southern California, 1985 Zonal Avenue, Los Angeles, CA 90089, USA.
⁵ Department of Neurology, Department of Physiology and Neuroscience, Zilkha Neurogenetic Institute, Keck School of Medicine, The University of Southern California, 1540 Alcazar Street, Suite 215, Los Angeles, CA 90033, USA.
⁶ Department of Neurology, Department of Pediatrics, Keck School of Medicine, The University of Southern California, 2010 Zonal Avenue, Building B, 3P61, Los Angeles, CA 90033, USA.

PMID: 37760993
PMCID: PMC10526443
DOI: 10.3390/biomedicines11092551

Abstract

Emerging science continues to establish the detrimental effects of malnutrition in acute neurological diseases such as traumatic brain injury, stroke, status epilepticus and anoxic brain injury. The primary pathological pathways responsible for secondary brain injury include neuroinflammation, catabolism, immune suppression and metabolic failure, and these are exacerbated by malnutrition. Given this, there is growing interest in novel nutritional interventions to promote neurological recovery after acute brain injury. In this review, we will describe how malnutrition impacts the biomolecular mechanisms of secondary brain injury in acute neurological disorders, and how nutritional status can be optimized in both pediatric and adult populations. We will further highlight emerging therapeutic approaches, including specialized diets that aim to resolve neuroinflammation, immunodeficiency and metabolic crisis, by providing pre-clinical and clinical evidence that their use promotes neurologic recovery. Using nutrition as a targeted treatment is appealing for several reasons that will be discussed. Given the high mortality and both short- and long-term morbidity associated with acute brain injuries, novel translational and clinical approaches are needed.

Keywords: anoxic brain injury; malnutrition; neuroinflammation; nutrition; status epilepticus; stroke; traumatic brain injury.

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Conflict of interest statement

R.A.P. is a consultant to various law firms as an expert in medical malpractice litigation. P.D.L. is a consultant for various law firms as an expert in medical malpractice litigation. S.G.L. reports non-financial support and other from Eyemedix, LLC, outside the submitted work; S.G.L. has a patent for lipid-based compounds licensed to Eyemedix, LLC. A.P. is a consultant to various law firms as an expert in medical malpractice litigation. A.P. also receives honorarium from Nutricia and funding from Vitaflo, Inc. (Bridgewater, NJ, USA) outside of the work submitted.

Figures

**Figure 1**
Conceptual schematic of the influence of nutritional status on mechanisms of secondary brain injury and recovery after acute brain injury.

**Figure 2**
Interconnected mechanisms through which ketogenic diet confers broad neuroprotective effects in models of brain injury.

**Figure 3**
Generation and Sites of Activity of Eicosanoid Lipids. PL: phospholipid transporter, PLA2: phospholipase A2, MRP: multidrug resistance protein transporter, CNS: central nervous system.

See this image and copyright information in PMC

References

1. Thayabaranathan T., Kim J., Cadilhac D.A., Thrift A.G., Donnan G.A., Howard G., Howard V.J., Rothwell P.M., Feigin V., Norrving B., et al. Global stroke statistics 2022. Int. J. Stroke. 2022;17:946–956. doi: 10.1177/17474930221123175. - DOI - PMC - PubMed
1. Dewan M.C., Rattani A., Gupta S., Baticulon R.E., Hung Y.C., Punchak M., Agrawal A., Adeleye A.O., Shrime M.G., Rubiano A.M., et al. Estimating the global incidence of traumatic brain injury. J. Neurosurg. 2018;1:1–18. doi: 10.3171/2017.10.JNS17352. - DOI - PubMed
1. Feigin V.L., Brainin M., Norrving B., Martins S., Sacco R.L., Hacke W., Fisher M., Pandian J., Lindsay P. World Stroke Organization (WSO): Global Stroke Fact. Sheet 2022. Int. J. Stroke. 2022;17:18–29. doi: 10.1177/17474930211065917. - DOI - PubMed
1. Fuentes Padilla P., Martinez G., Vernooij R.W., Urrutia G., Roque I.F.M., Bonfill Cosp X. Early enteral nutrition (within 48 hours) versus delayed enteral nutrition (after 48 hours) with or without supplemental parenteral nutrition in critically ill adults. Cochrane Database Syst. Rev. 2019;2019:CD012340. doi: 10.1002/14651858.CD012340.pub2. - DOI - PMC - PubMed
1. Guenter P., Abdelhadi R., Anthony P., .Blackmer A., Malone A., Mirtallo J.M., Phillips W., Resnick H.E. Malnutrition diagnoses and associated outcomes in hospitalized patients: United States, 2018. Nutr. Clin. Pract. 2021;36:957–969. doi: 10.1002/ncp.10771. - DOI - PubMed

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Optimization of Nutrition after Brain Injury: Mechanistic and Therapeutic Considerations

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Optimization of Nutrition after Brain Injury: Mechanistic and Therapeutic Considerations

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