Long term change in nutritional status after severe traumatic brain injury

Mrs Sara ARIASa, Prof Sophie JACQUIN-COURTOISa, Dr Sophie CIANCIAa, Prof Gilles RODEa, Prof Jacques LUAUTÉa

a CHU de Lyon, Hôpital Henry Gabrielle

Introduction: In the acute phase, patients who sustained a severe Traumatic Brain injury (TBI) (Glasgow Coma Scale under 8) frequently present malnutrition during critical care. Long-term nutritional outcome after a severe TBI has been less studied. Cognitive impairments and behavioral disorders together with hormonal disorders can lead to persisting malnutrition or over-eating and obesity. The purpose of this study was to follow the weight, the body mass index (BMI), albuminemia and hormonal dosage after a severe TBI.

Methods: this study relied on a research protocol designed to follow concurrently and prospectively endocrine disorders and cognitive disorders in a cohort of patients with severe TBI (Inspire-TC protocol). In the present work, we focused specifically on the evolution in weight, height, body mass index, albuminemia and endocrine abnormalities. These parameters were collected upon admission to the rehabilitation department, at 4 months, 12 months and 18 months when feasible for the severe TBI patients included in the Inspire-TC protocol. Albuminaemia was measured late after the TBI when patients agreed.

Results: 10 patients were included. Initially 60% of the patients had biological malnutrition, 10% were overweight, 80% presented a normal BMI and 10% had an insufficient BMI. All patients gained weight during the monitoring with an overweight at 18 months for three patients. Along the overall monitoring, 44% of the patients had hormonal disruptions. The 3 patients with long-term overweight had frontal-temporal brain lesions. All three recovered walking. Only one had hormonal disruptions. Albuminaemia was normal for all patients who accepted to make this bioessay control.

Conclusion: There is a tendency to gain weight after a severe TBI. Favorable factors include fronto-temporal injuries, and the presence of executive disorders. Endocrine perturbation and immobility can also contribute to overweight but were less frequently observed in this cohort.

Keywords : traumatic brain injury , nutrition, behavioural disorders