Mohd Ibrahim Abdullah, Aryati Ahmad, Noor Aini Mohd Yusoff, Sharifah Wajihah Wafa Syed Saadun Tarek Wafa, Ahmad Zubaidi Abdul Latif, Nujaimin Udin, Kartini Abdul Karim
Mohd Ibrahim Abdullah1, Aryati Ahmad1*, Noor Aini Mohd Yusoff1, Sharifah Wajihah Wafa Syed Saadun Tarek Wafa1, Ahmad Zubaidi Abdul Latif2, Nujaimin Udin3, Kartini Abdul Karim4
1Faculty of Health Science, Universiti Sultan Zainal Abidin (UniSZA), Gong Badak Campus, 21300 Kuala Terengganu, Terenganu, Malaysia.
2Faculty of Medicine, Universiti Sultan Zainal Abidin (UniSZA), Medical Campus, 20400 Kuala Terengganu, Terengganu, Malaysia.
3Neurosurgery Department, Hospital Sultanah Nur Zahirah (HSNZ), Ministry of Health Malaysia, Jalan Sultan Mahmud, 20400 Kuala Terengganu, Terengganu, Malaysia.
4Dietetic and Food Service Department, Hospital Sultanah Nur Zahirah (HSNZ), Ministry of Health Malaysia, Jalan Sultan Mahmud, 20400 Kuala Terengganu, Terengganu, Malaysia.
Volume - 13,
Issue - 10,
Year - 2020
Cognitive recovery is a major concern to traumatic brain injury (TBI) patients and their caregivers as patients need to resume normal life after hospital discharge. A recent discovery showed that low calorie was beneficial for cognitive function with lower mortality rate and produced better clinical outcomes in critically-ill and medical intensive care unit patients. However, the effect of low calorie on cognitive function among TBI patients has not been determined yet. Hence this study was conducted to provide preliminary evidence of the relation between calorie and cognitive function and to determine calorie adequacy for optimal cognitive recovery among them. This pilot study involved ten patients recruited from Hospital Sultanah Nur Zahirah, Kuala Terengganu. The patients underwent a series of nutritional assessments including 24-hours diet recall combined with food diary; neuropsychology test [Montreal Cognitive Assessment (MoCA)], and eye-open-eye-close paradigm of electroencephalography (EEG) for two to six days. Socio-demography, nutritional and neuropsychology data were analyzed using SPSS version 22 with the percentage of calorie intake (%CI) was set as the independent variable; whilst duration to finish trail-making subtest (FT), and the total score (TS) of MoCA were the dependent variables. EEG data were analyzed using Fast-Fourier Transform (FFT) and power ratio (PR) which is the ratio of slow to fast frequency brain band was calculated. Then the comparison of %CI, FT, TS, and PR were done between day-1 and discharge-day (early or follow-up visit in EEG). Six male and four female patients with mild TBI, median age 24.0 years (IQR = 9.5) were included in the study. Scatter dot plot between %CI to FT and TS showed that the graph increased at the beginning before it became a plateau at 70%. The %CI had significant negative correlation with FT (r = -0.717; p = 0.000) but positive correlation with TS (r = 0.789; p = 0.000). Results revealed that cognitive function was improved at low %CI, approximately below CI of 70%. Improvement in neuropsychology test results was strengthened by the significant differences of median EEG power ratio between follow-up and first visit (p = 0.000). In this pilot study, it appears that cognitive function showed improvement with low calorie intake among TBI patients.
Cite this article:
Mohd Ibrahim Abdullah, Aryati Ahmad, Noor Aini Mohd Yusoff, Sharifah Wajihah Wafa Syed Saadun Tarek Wafa, Ahmad Zubaidi Abdul Latif, Nujaimin Udin, Kartini Abdul Karim. Effect of Calorie on Cognitive Function among Traumatic Brain Injury (TBI) Patients: A Pilot Study. Research J. Pharm. and Tech. 2020; 13(10):4545-4549. doi: 10.5958/0974-360X.2020.00801.X
1. Mekhlef AK, Hameed IH, Khudhair ME. Prevalence of Physical Injuries on the Head, neck and Entire body in, Hilla, Iraq. Research Journal of Pharmacy and Technology. 2017 Oct 1;10(10): 3276-82.
2. Reena VT, Gopichandran L, Sinha S, Muthuvenkatachalam S. Comparison of Glutamine Enriched Feed over normal Routine feed in Traumatic brain Injury Patients: A Randomized double blind Controlled Trial. Asian Journal of Nursing Education and Research. 2016 Oct 1;6(4): 485.
3. Maas AI, Stocchetti N, Bullock R. Moderate and severe traumatic brain injury in adults. Lancet2008;7(8): 728-41.
4. World Health Organization. The World health report: 2003: Shaping the Future. 2003.
5. Jamaluddin SF, Wahab MA, Mohamed FL, Saiboon IM. National trauma database January to December 2007–second report. Ministry of Health Malaysia. 2009.
6. Vos T, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study. Lancet 2016. 2017;390(10100): 1211-59.
7. Priya RS, Lavanya S. A Study to Evaluate the Effectiveness of Sensory Stimulation to Improve the Level of Consciousness among Traumatic Brain Injury Patients wit GCS 7 – 10 at Thanthai Perriyar Government Head Quarters Hospital, Erode. Int. J. Adv. Nur. Management. 2(4): Oct – Dec, 2014; 216-220
8. Deiva K, Vijayalakshmi S, Suseela T. Effectiveness of Coma Stimulation Therapy on Traumatic Brain Injury patients in a Government hospital setup–A Feasibility Study. Asian Journal of Nursing Education and Research. 2017 Oct 1;7(4): 569-72.
9. Ministry of Transport Malaysia. Transport Statistics Malaysia. 2011. 2011.
10. Burgess P, Sullivent EE, Sasser SM, Wald MM, Ossmann E, Kapil V et al. Managing traumatic brain injury secondary to explosions. J Emerg Trauma Shock. 2010;3(2): 164.
11. Koehler R, Wilhelm E, Shoulson I. Cognitive rehabilitation therapy for traumatic brain injury: evaluating the evidence: National Academies Press; 2012.
12. Gomez-Pinilla F, Gomez AG. The influence of dietary factors in central nervous system plasticity and injury recovery. PM R 2011;3(6):S111-S6.
13. Gomez-Pinilla F, Kostenkova KJ. The influence of diet and physical activity on brain repair and neurosurgical outcome. Surg Neurol. 2008;70(4):333.
14. Murphy T, Dias GP, Thuret S. Effects of diet on brain plasticity in animal and human studies: mind the gap. Neural Plasticity. 2014;2014.
15. Arabi YM, Tamim HM, Dhar GS, Al-Dawood A, Al-Sultan M, Sakkijha MH, et al. Permissive underfeeding and intensive insulin therapy in critically ill patients: a randomized controlled trial. Am J Clin Nutr. 2011;93(3): 569-77.
16. Arabi YM, Haddad SH, Tamim HM, Rishu AH, Sakkijha MH, Kahoul SH, et al. Near‐target caloric intake in critically ill medical‐surgical patients is associated with adverse outcomes. JPEN. 2010;34(3):280-8.
17. Krishnan JA, Parce PB, Martinez A, Diette GB, Brower RG. Caloric intake in medical ICU patients: consistency of care with guidelines and relationship to clinical outcomes. Chest. 2003;124(1):297-305.
18. Connelly LM. Pilot studies. Medsurg Nursing. 2008;17(6):411.
19. Julious SA. Sample size of 12 per group rule of thumb for a pilot study. Pharmaceutical Statistics. 2005;4(4):287-91.
20. Burton-Danner CO, Gregory R. Jackson, Kerri J. Aging and feature search: The effect of search area, experimental aging research. An International Journal of Vevoted to the Scientific Study of the Aging Process. 2001;27(1):1-18.
21. Harris JA, Benedict FG. A biometric study of human basal metabolism. Proceedings of the National Academy of Sciences of the United States of Amerika. 1918 No 4: 370.
22. Mifflin MD, St Jeor ST, Hill LA, Scott BJ, Daugherty SA, Koh YO. A new predictive equation for resting energy expenditure in healthy individuals. The American Journal of Clinical Nutrition. 1990;51(2):241-7.
23. Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695-9.
24. Norman K, Pichard C, Lochs H, Pirlich MJCn. Prognostic impact of disease-related malnutrition. Clin Nutr. 2008;27(1):5-15.
25. Goiburu M, Goiburu MJ, Bianco H, Díaz JR, Alderete F, Palacios M, et al. The impact of malnutrition on morbidity, mortality and length of hospital stay in trauma patients. Nutr Hosp. 2006;21(5):604-10.
26. McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN). JPEN. 2016;40(2):159-211.
27. Daradkeh G, Essa MM, Al-Adawi SS, Subash S, Mahmood L, Kumar PR. Nutritional status, assessment, requirements and adequacy of traumatic brain injury patients. Pakistan Journal of Biological Sciences. 2014;17(10):1089-97.
28. Walker RN, Heuberger RA. Predictive equations for energy needs for the critically ill. Respiratory Care. 2009;54(4):509-21.
29. Munia TT, Haider A, Schneider C, Romanick M, Fazel-Rezai RJ. A novel EEG based spectral analysis of persistent brain function alteration in athletes with concussion history. Scientific Report. 2017;7(1):17221.
30. Chen C-C, Hsu C-Y, Chiu H-W, Hu C-J, Lee T-CJJotFMA. Frequency power and coherence of electroencephalography are correlated with the severity of Alzheimer's disease: A multicenter analysis in Taiwan. Journal of the Formosan Medical Association. 2015;114(8):729-35.