University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA.
Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
J Neurotrauma. 2023 Aug;40(15-16):1557-1566. doi: 10.1089/neu.2022.0498. Epub 2023 Mar 14.
Mild traumatic brain injury (mTBI) affects 42 to 56 million individuals worldwide annually. Even more individuals are affected by sub-concussive repetitive head impacts (SRHIs). Such injuries may result in significant acute and chronic symptoms. A study of how individuals may adjust or augment their nutritional and dietary habits to prevent cumulative neurotrauma and promote post-injury recovery is necessary. The objective of the current study is to systematically review nutritional and dietary interventions for neurotrauma prevention and mTBI recovery to direct clinical decision-making and identify future areas of research. This systematic review, without a specified time-period, was performed in PubMed, Scopus, Cochrane, CINAHL, and Web of Science followed by a manual search of references. Search strings were generated by a research librarian. Studies were included if they: 1) investigate human subjects with mTBI or SRHI; 2) investigate a supplement/ingredient of dietary supplement sold in the U.S. or dietary intervention without classification as a drug or prohibitive statement against use by the U.S. Food and Drug Administration (FDA); 3) assess a quantifiable outcome; and 4) are published in English in a peer-reviewed journal with an accessible full-length article. Studies were excluded if: 1) the study included non-mTBI or SRHI subjects (e.g., moderate/severe TBI, stroke); 2) mTBI is not assessed separately from moderate/severe mTBI; or 3) the studies that required intracranial hemorrhage. Fifteen studies from 12 unique subject populations met inclusion and exclusion criteria. A total of 1139 mTBI or SRHI subjects were enrolled across intervention arms in the study populations. A total of eight intervention were studied. Omega-3 fatty acid (-3FA), melatonin, and were the only interventions examined in multiple studies. Studies included 10 randomized-control trials, three prospective observational studies, and two retrospective observational studies. Seven of the 15 studies had a low risk of bias. Eleven studies reported benefit of the intervention. Strongest evidence supports -3FA utility for neurotrauma prevention in athletes exposed to SRHI. Both and melatonin may have benefit for persistent post-concussion symptoms; however, additional multi-center studies are necessary prior to making a definitive conclusion on these supplements' efficacy. Future studies should continue to assess both novel interventions and additional interventions examined in this review to bring additional evidence to the burgeoning field of nutritional and dietary interventions for SRHI and mTBI.
轻度创伤性脑损伤（mTBI）影响全球每年 4200 万至 5600 万人。更多的人受到亚急性反复头部冲击（SRHI）的影响。这些伤害可能导致严重的急性和慢性症状。有必要研究个体如何调整或增强营养和饮食习惯，以防止累积性神经创伤并促进受伤后的恢复。本研究的目的是系统地审查预防神经创伤和 mTBI 恢复的营养和饮食干预措施，以指导临床决策，并确定未来的研究领域。本系统评价未规定时间范围，在 PubMed、Scopus、Cochrane、CINAHL 和 Web of Science 中进行，随后手动搜索参考文献。搜索字符串由研究图书馆员生成。如果研究符合以下条件，则纳入研究：1）研究对象为 mTBI 或 SRHI 患者；2）研究在美国销售的补充剂/膳食补充剂成分或不分类为药物的饮食干预措施，且美国食品和药物管理局（FDA）未禁止使用；3）评估可量化的结果；4）以同行评议期刊的英文形式发表，并可获得全文。如果研究符合以下条件，则排除在外：1）研究包括非 mTBI 或 SRHI 患者（例如，中度/重度 TBI、中风）；2）mTBI 未与中度/重度 mTBI 分开评估；或 3）需要颅内出血的研究。从 12 个独特的研究人群中筛选出 15 项符合纳入和排除标准的研究。在研究人群的干预组中共有 1139 名 mTBI 或 SRHI 患者入组。共研究了 8 种干预措施。ω-3 脂肪酸（-3FA）、褪黑素和维生素 D 是仅在多项研究中进行了检查的干预措施。这些研究包括 10 项随机对照试验、3 项前瞻性观察性研究和 2 项回顾性观察性研究。15 项研究中有 7 项具有低偏倚风险。11 项研究报告了干预的益处。最强的证据支持 -3FA 在暴露于 SRHI 的运动员中预防神经创伤的效用。褪黑素和维生素 D 可能对持续性脑震荡后症状有益；然而，在对这些补充剂的疗效作出明确结论之前，还需要进行更多的多中心研究。未来的研究应继续评估本综述中检查的新干预措施和其他干预措施，为营养和饮食干预措施在 SRHI 和 mTBI 方面的新兴领域提供更多证据。
