Head Injury: Metabolic, Nutritional, and Energy Considerations

  • Christine Charrueau
  • Béatrice Morio
  • Christophe Moinard


Head injury does not consist of the primary injury alone, it also includes secondary type injury. Although primary brain injury is irreversible, it is not necessarily the cause of death. Morbidity and mortality often result from secondary brain injury. Within the brain, head injury effects are mediated by deleterious neurotransmitters such as glutamate, reactive oxygen species (ROS), and inflammatory processes governed by complement and cellular immunity. These damaging processes result in cerebral edema, brain cell metabolic dysfunction, and ultimately cell death due to energy failure. At the systemic level, extensive adaptations immediately follow head injury. They include inflammatory cascade; increase in catabolic and counterregulatory hormones, such as catecholamines, glucagon, and cortisol; and alterations in the hypothalamic–pituitary feedback mechanism. The consequences are alterations in whole-body metabolism such as hypermetabolism, hypercatabolism, hyperglycemia, diminished immunocompetence, altered gastric functioning, and increased endothelial permeability. These metabolic disturbances (in particular protein wasting) lead to a dysimmunity, which compromises clinical outcome and thereby increases morbidity and mortality. So far little attention has been paid to nutritional intervention as a potential treatment of head injury. However, nutrition may have many interests, among which preventing the wasting syndrome, preserving the immune function, restoring the gastrointestinal function, and improving the neurological outcome. Despite promising experimental and clinical results, there are not yet sufficient clinical trials to make nutritional recommendations in head injury patients. Therefore, the development of large trials is mandatory to determine which nutrient, at which dose, would be the most appropriate to positively influence head injury patients’ outcome.

Key words: Head trauma, nutritional management, hypermetabolism, dysimmunity, resistance to renutrition


Head Injury Enteral Nutrition Rest Metabolic Rate Glasgow Coma Scale Score Severe Head Injury 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Adenosine triphosphate


Deoxyribonucleic acid


Glasgow coma scale


Head injury


Immune-enhancing diet


Insulin-like growth factor-1










Resting metabolic rate


Ribonucleic acid


Reactive oxygen species


Mammalian silent information regulator


Tumor necrosis factor-α





The authors wish to thank Geneviève Arnaud-Vincent from the Paris Descartes University Language Center for proofreading the English version of this chapter.


  1. Adibhatla RM, Hatcher JF. Subcell Biochem. 2008; 48:410–4.Google Scholar
  2. Ahmed SM, Rzigalinski BA, Willoughby KA, Sitterding HA, Ellis EF. J Neurochem. 2000; 74:1951–60.PubMedCrossRefGoogle Scholar
  3. Andres RH, Ducray AD, Schlattner U, Wallimann T, Widmer HR. Brain Res Bull. 2008; 76:329–43.PubMedCrossRefGoogle Scholar
  4. Aydin S, Ulusoy H, Usul H, Yulug E, Cobanoglu U, Aydin K, Yenilmez E, Kutun S. Surg Today. 2005; 35:751–9.PubMedCrossRefGoogle Scholar
  5. Bareyre FM, Saatman KE, Helfaer MA, Sinson G, Weisser JD, Brown AL, McIntosh TK. J Neurochem. 1999; 73:271–80.PubMedCrossRefGoogle Scholar
  6. Belabed L, Charrueau C, Besson V, Gupta S, Walrand S, Marchand-Verrecchia C, Richon S, Nafziger J, Plotkine M, Chaumeil JC, Cynober L, Moinard C. Clin Nutr. 2006; 25:832–41.PubMedCrossRefGoogle Scholar
  7. Braughler JM, Hall ED. J Neurotrauma. 1992; 9 Suppl 1:S1–7.PubMedGoogle Scholar
  8. Briassoulis G, Filippou O, Hatzi E, Papassotiriou I, Hatzis T. Nutrition. 2005; 21:799–807.PubMedCrossRefGoogle Scholar
  9. Briassoulis G, Filippou O, Kanariou M, Papassotiriou I, Hatzis T. Pediatr Crit Care Med. 2006; 7:56–62.PubMedCrossRefGoogle Scholar
  10. Bucci MN, Dechert RE, Arnoldi DK, Campbell J, McGillicuddy JE, Bartlett RH. Acta Neurochir (Wien). 1988; 93:133–6.CrossRefGoogle Scholar
  11. Carpentier YA, Scruel O. Curr Opin Clin Nutr Metab Care. 2002; 5:153–8.PubMedCrossRefGoogle Scholar
  12. Cernak I. NeuroRx. 2005; 2:410–22.PubMedCrossRefGoogle Scholar
  13. Chen G, Shi J, Hu Z, Hang C. Mediators Inflamm. 2008: ID716458 (8 pages).Google Scholar
  14. Cook AM, Peppard A, Magnuson B. Nutr Clin Pract. 2008; 23:608–20.PubMedCrossRefGoogle Scholar
  15. Dai W, Cheng HL, Huang RQ, Zhuang Z, Shi JX. Brain Res. 2009; 1251:287–95.PubMedCrossRefGoogle Scholar
  16. Dempsey DT, Guenter P, Mullen JL, Fairman R, Crosby LO, Spielman G, Gennarelli T. Surg Gynecol Obstet. 1985; 160:128–34.PubMedGoogle Scholar
  17. Dewitt DS, Smith TG, Deyo DJ, Miller KR, Uchida T, Prough DS. J Neurotrauma. 1997; 14:223–33.PubMedCrossRefGoogle Scholar
  18. Dickerson RN, Roth-Yousey L. J Am Diet Assoc. 2005; 105:835–43.PubMedCrossRefGoogle Scholar
  19. Falcao de Arruda, I, Aguilar-Nascimento JE. Clin Sci (Lond). 2004; 106:287–92.CrossRefGoogle Scholar
  20. Faries PL, Simon RJ, Martella AT, Lee MJ, Machiedo GW. J Trauma. 1998; 44:1031–5.PubMedCrossRefGoogle Scholar
  21. Feighery L, Smyth A, Keely S, Baird AW, O’Connor WT, Callanan JJ, Brayden DJ. J Trauma. 2008; 64:131–7.PubMedCrossRefGoogle Scholar
  22. Feldman Z, Gurevitch B, Artru AA, Oppenheim A, Shohami E, Reichenthal E, Shapira Y. J Neurosurg. 1996; 85:131–7.PubMedCrossRefGoogle Scholar
  23. Finnie JW, Blumbergs PC. Vet Pathol. 2002; 39:679–89.PubMedCrossRefGoogle Scholar
  24. Fitzsimmons L, Hadley SA. Dimens Crit Care Nurs. 1991; 10:4–12.PubMedCrossRefGoogle Scholar
  25. Frankenfield D. Nutr Clin Pract. 2006; 21:430–7.PubMedCrossRefGoogle Scholar
  26. Harris LK, Black RT, Golden KM, Reeves TM, Povlishock JT, Phillips LL. J Neurotrauma. 2001; 18:993–1009.PubMedCrossRefGoogle Scholar
  27. Hartley CE, Varma M, Fischer JP, Riccardi R, Strauss JA, Shah S, Zhang S, Yang ZJ. J Neurosurg. 2008; 109:708–14.PubMedCrossRefGoogle Scholar
  28. Hatton J, Luer MS, Rapp RP. Pharmacotherapy. 1993; 13:17–27.PubMedGoogle Scholar
  29. Hatton J, Rapp RP, Kudsk KA, Brown RO, Luer MS, Bukar JG, Chen SA, McClain CJ, Gesundheit N, Dempsey RJ, Young B. J Neurosurg. 1997; 86:779–86.PubMedCrossRefGoogle Scholar
  30. Hayes RL, Jenkins LW, Lyeth BG. J Neurotrauma. 1992; 9 Suppl 1:S173–87.PubMedGoogle Scholar
  31. Holland MA, Tan AA, Smith DC, Hoane MR. J Neurotrauma. 2008; 25 1:40–52.Google Scholar
  32. Juurlink BH, Paterson PG. J Spinal Cord Med. 1998; 21:309–34.PubMedGoogle Scholar
  33. Kiymaz N, Ekin S, Yilmaz N. Surg Neurol. 2007; 68:67–70.PubMedCrossRefGoogle Scholar
  34. Levasseur JE, Alessandri B, Reinert M, Bullock R, Kontos HA. J Neurotrauma. 2000; 17:101–12.PubMedCrossRefGoogle Scholar
  35. Loan T. Nutrition. 1999; 15:809–12.PubMedCrossRefGoogle Scholar
  36. Maas AI, Stocchetti N, Bullock R. Lancet Neurol. 2008; 7:728–41.PubMedCrossRefGoogle Scholar
  37. Maegele M, Sauerland S, Bouillon B, Schafer U, Trubel H, Riess P, Neugebauer EA. Inflamm Res. 2007; 56:318–23.PubMedCrossRefGoogle Scholar
  38. Mansoor O, Beaufrere B, Boirie Y, Ralliere C, Taillandier D, Aurousseau E, Schoeffler P, Arnal M, Attaix D. Proc Natl Acad Sci USA. 1996; 93:2714–8.PubMedCrossRefGoogle Scholar
  39. Mansoor O, Cayol M, Gachon P, Boirie Y, Schoeffler P, Obled C, Beaufrère B. Am J Physiol. 1997; 273:E898–902.PubMedGoogle Scholar
  40. Marie C, Bralet J. Cerebrovasc Brain Metab Rev. 2009; 3:29–38.Google Scholar
  41. Matzilevich DA, Rall JM, Moore AN, Grill RJ, Dash PK. J Neurosci Res. 2002; 67:646–63.PubMedCrossRefGoogle Scholar
  42. McClain CJ, Twyman DL, Ott LG, Rapp RP, Tibbs PA, Norton JA, Kasarskis EJ, Dempsey RJ, Young B. J Neurosurg. 1986; 64:224–30.PubMedCrossRefGoogle Scholar
  43. McIntosh TK, Vink R, Yamakami I, Faden AI. Brain Res. 1989; 482:252–60.PubMedCrossRefGoogle Scholar
  44. Menon DK. Crit Care Med. 2009; 37:S129–35.PubMedCrossRefGoogle Scholar
  45. Moinard C, Belabed L, Gupta S, Besson V, Marchand-Verrecchia C, Chaumeil JC, Cynober L, Charrueau C. Nutrition. 2006; 22:1039–44.PubMedCrossRefGoogle Scholar
  46. Moinard C, Gupta S, Besson V, Morio B, Marchand-Leroux C, Chaumeil JC, Cynober L, Charrueau C. J Neurotrauma. 2008; 25:124–9.PubMedCrossRefGoogle Scholar
  47. Moinard C, Neveux N, Royo N, Genthon C, Marchand-Verrecchia C, Plotkine M, Cynober L. Intensive Care Med. 2005; 31:281–8.PubMedCrossRefGoogle Scholar
  48. Nordenstrom J, Carpentier YA, Askanazi J, Robin AP, Elwyn DH, Hensle TW, Kinney JM. Ann Surg. 1983; 198:725–35.PubMedCrossRefGoogle Scholar
  49. Oddo M, Schmidt JM, Carrera E, Badjatia N, Connolly ES, Presciutti M, Ostapkovich ND, Levine JM, Le Roux P, Mayer SA. Crit Care Med. 2008; 36:3233–8.PubMedCrossRefGoogle Scholar
  50. Osteen CL, Giza CC, Hovda DA. Neuroscience. 2004; 128:305–22.PubMedCrossRefGoogle Scholar
  51. Paschen W, Doutheil J. J Cereb Blood Flow Metab. 1999; 19:1–18.PubMedCrossRefGoogle Scholar
  52. Perel P, Yanagawa T, Bunn F, Roberts I, Wentz R, Pierro A. Cochrane Database Syst Rev. 2006; Issue 4. Art. No.: CD001530. DOI: 10.1002/14651858.CD001530.pub2.Google Scholar
  53. Petersen SR, Jeevanandam M, Harrington T. J Trauma. 1993; 34:653–61.PubMedCrossRefGoogle Scholar
  54. Quattrocchi KB, Frank EH, Miller CH, MacDermott JPA, Hein L, Frey, Wagner FC. J Neurotrauma. 1990; 7:77–87.PubMedCrossRefGoogle Scholar
  55. Ritter AM, Robertson CS, Goodman JC, Contant CF, Grossman RG. J Neurotrauma. 1996; 13:473–85.PubMedCrossRefGoogle Scholar
  56. Robertson CS, Clifton GL, Grossman RG. Neurosurgery. 1984; 15:307–14.PubMedCrossRefGoogle Scholar
  57. Saatman KE, Contreras PC, Smith DH, Raghupathi R, McDermott KL, Fernandez SC, Sanderson KL, Voddi M, McIntosh TK. Exp Neurol. 1997; 147:418–27.PubMedCrossRefGoogle Scholar
  58. Sacks GS, Brown RO, Teague D, Dickerson RN, Tolley EA, Kudsk KA. J Parent Ent Nutr. 1995; 19:387–92.CrossRefGoogle Scholar
  59. Sakellaris G, Kotsiou M, Tamiolaki M, Kalostos G, Tsapaki E, Spanaki M, Spilioti M, Charissis G, Evangeliou A. J Trauma. 2006; 61:322–9.PubMedCrossRefGoogle Scholar
  60. Siesjo BK. J Neurosurg. 1984; 60:883–908.PubMedCrossRefGoogle Scholar
  61. Soustiel JF, Zaaroor M, Vlodavsky E, Veenman L, Weizman A, Gavish M. Exp Neurol. 2008; 214:201–8.PubMedCrossRefGoogle Scholar
  62. Stahl N, Mellergard P, Hallstrom A, Ungerstedt U, Nordstrom CH. Acta Anaesthesiol Scand. 2001; 45:977–85.PubMedCrossRefGoogle Scholar
  63. Stippler M, Fischer MR, Puccio AM, Wisniewski SR, Carson-Walter EB, Dixon CE, Walter KA. J Neurotrauma. 2007; 24:1347–54.PubMedCrossRefGoogle Scholar
  64. Suchner U, Senftleben U, Eckart T, Scholz MR, Beck K, Murr R, Enzenbach R, Peter K. Nutrition. 1996; 12:13–22.PubMedCrossRefGoogle Scholar
  65. Suh SW, Chen JW, Motamedi M, Bell B, Listiak K, Pons NF, Danscher G, Frederickson CJ. Brain Res. 2000; 852:268–73.PubMedCrossRefGoogle Scholar
  66. Sullivan PG, Thompson MB, Scheff SW. Exp Neurol. 1999; 160:226–34.PubMedCrossRefGoogle Scholar
  67. Temkin NR, Anderson GD, Winn HR, Ellenbogen RG, Britz GW, Schuster J, Lucas T, Newell DW, Mansfield PN, Machamer JE, Barber J, Dikmen SS. Lancet Neurol. 2007; 6:29–38.PubMedCrossRefGoogle Scholar
  68. Vagnozzi R, Signoretti S, Tavazzi B, Cimatti M, Amorini AM, Donzelli S, Delfini R, Lazzarino G. Neurosurgery. 2005; 57:164–71.PubMedCrossRefGoogle Scholar
  69. Verweij BH, Amelink GJ, Muizelaar JP. Prog Brain Res. 2007; 161:111–24.PubMedCrossRefGoogle Scholar
  70. Vink R, Golding EM, Headrick JP. J Neurotrauma. 1994; 11:265–74.PubMedCrossRefGoogle Scholar
  71. Wilson RF, Dente C, Tyburski JG. Neurol Res. 2001; 23:121–8.PubMedCrossRefGoogle Scholar
  72. Wu A, Ying Z, Gomez-Pinilla F. J Neurotrauma. 2007; 24:1587–95.PubMedCrossRefGoogle Scholar
  73. Young B, Ott L, Kasarskis E, Rapp R, Moles K, Dempsey RJ, Tibbs PA, Kryscio R, McClain C. J Neurotrauma. 1996; 13:25–34.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Christine Charrueau
  • Béatrice Morio
  • Christophe Moinard
    • 1
  1. 1.Laboratoire de Biologie de la Nutrition EA 4466, Faculté des Sciences Pharmaceutiques et BiologiquesUniversité Paris DescartesParis Cedex 06France

Personalised recommendations