| Summary: | Cognitive impairment is a common problem after traumatic brain injury (TBI). In
addition to the healing process of physical injury and prevention of malnutrition, the
ideal dietary recommendation is crucial for favourable cognitive outcomes. However,
to date, it is less clear on the amount of calorie for optimal cognitive recovery among
TBI patients. Therefore, this research aimed to determine adequate calorie for optimal
cognitive recovery among hospitalized TBI patients. This research was conducted in
two phases which were Phase 1 (Observational study) to determine the association
between calorie intake and cognitive function and Phase 2 (Intervention study) to
determine the effect of a hypocaloric diet on cognitive function among mild TBI
patients. The TBI patients (Phase 1; n=60, and Phase 2; n=26) from the neurosurgery
ward of Hospital Sultanah Nur Zahirah who met the criteria were enrolled in this study.
Patients were interviewed using 24-hour diet recall and cross-checked with a selfÂ
administered food diary and later were analysed for determination of calorie intake.
Progression of clinical parameters such as vital signs, associated symptoms, number of
wounds, bedsore and length of stay were noted in clinical assessment using available
hospital records. Whereas, cognitive function was evaluated by neuropsychology test
(Montreal Cognitive Assessment and Digit Symbol Coding test) and neurophysiology
test (electroencephalography). Findings from Phase 1 demonstrated a significant
association between calorie intake and cognitive function for both high and low calorie
intake groups with better cognitive improvement was exhibited in the latter group. The
findings also suggested that calorie intake of 55% from calculated calorie requirement
was optimal for cognitive recovery as proven by the ROC curve (AUC=0.684,
S =0.004, 95%CI=0.597-0.770) and fit model equation. Whilst, findings from Phase 2
confirmed that the provision of a hypocaloric diet (50-60% of calculated calorie
requirement) showed significant cognitive improvement compared to a normocaloric
diet (80-100% of calculated calorie requirement) among mild TBI patients (p<0.05).
Besides, the risk of obtaining poorer cognitive function was reduced by 66.7% among
hypocaloric diet relative to the normocaloric diet group (risk ratio 0.333 [95%CI 0.040-
2.801]) using risk estimation test. More interestingly, all clinical outcomes and weight
changes were not compromised even though with the provision of a hypocaloric diet.
Both Phase 1 and 2 showed that cognitive improvement was inversely associated with
the power ratio of slow to fast brain frequency bands, with the slow frequency bands
were dominant across electrodes during the first visit and vice versa fast frequency
bands during the follow-up visit. In conclusion, hypocaloric diet (50-60% of calculated
calorie requirement) exhibited better cognitive recovery compared to a normocaloric
diet (80-100% of calculated calorie requirement) without compromising clinical
outcomes or imposing risk of malnutrition among mild TBI patients. This study
provides a novel approach in the dietary recommendation for TBI patients which produces a beneficial impact on cognitive rehabilitation and this preferable outcome
will certainly improve their post-injury quality of life.
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