Traditionally, nutrition has not been a common intervention strategy for patients recovering from injury or undergoing rehabilitation. However, nutritional intervention is a promising low-cost strategy that is effective in reducing hospital costs. All traumatic states have an initial acute phase, which is followed by a longer-term recovery phase.
Recovery in the clinical setting also comes with the psychological and physical costs associated with long-term bed rest. Similar conditions are also found in patients after a stroke and those with traumatic brain injury (TBI). Some of these conditions can be treated surgically or conservatively, depending on the injury.
Regardless of the severity of the injury or trauma, the initial phase involves an inflammatory response, which is the body’s natural response to healing. Minimizing the acute stage of inflammation through optimal nutrition can help speed the recovery process. This acute phase is followed by a recovery and rehabilitation phase, which is a hypermetabolic state accompanied by injury-related immobilization. The main physiological and metabolic changes noted during this phase are muscle atrophy, reduction in muscle synthesis, increased anabolic resistance and loss of strength. Studies show that even five days of inactivity can lead to significant muscle loss.
Therefore, when a patient is recovering from injury or trauma, their nutritional management goals should primarily focus on: providing adequate calories and protein to promote wound healing; maintenance of lean body mass (LBM); assisting in the management of inflammatory and immune responses; and management of inflammation and immune responses.
A common misconception among patients with limited mobility is that they don’t need many calories because they are no longer active. Whether the injury was surgically treated or conservatively treated, during the recovery period, basal metabolic energy (BMR) increases in proportion to cellular turnover. Providing adequate calories protects dietary proteins from being used as a source of energy and instead used for protein synthesis in the body. In such cases, a diet rich in low-glycemic foods and high in protein is recommended.
The hypermetabolic state following an injury significantly increases protein requirements, which are further increased when surgery follows this injury, since protein is essential for wound healing and tissue formation. Protein deficiency during this time can result in a significant loss of lean body mass, which is itself an independent risk factor for delayed wound healing, prolonged hospital stay, and a high risk of postoperative infections. Research strongly suggests that not the amount of protein but also the timing of protein intake has a significant impact on strength, functionality and lean body mass. Spreading total protein requirements in 20-30 gram servings throughout the day has been shown to be more effective at preventing muscle wasting and promoting muscle recovery. Additionally, leucine, an essential amino acid found primarily in chicken, milk, and fish, is an anabolic trigger that stimulates muscle synthesis, thereby contributing to faster recovery. Therefore, in addition to meeting increased protein needs, protein timing and quality also play an important role in recovery and rehabilitation.
There are certain micronutrients that play an important role in reducing the inflammatory response after an injury. Omega-3 fatty acids are known for their anti-inflammatory properties and also support wound healing and muscle building. Other key vitamins that are important during the recovery period include vitamin D, which is known for its immune-regulating properties, and vitamins A, C, and K, which play important roles in wound healing. Additionally, it’s important to note that 70 percent of the body’s immunity comes from products produced by the good bacteria in our gut. So, foods rich in probiotics and prebiotics may also help boost immunity and diarrhea caused by antibiotics. All of these dietary supplements must be taken in consultation with your doctor.
Nutrition plays a crucial role in recovery and rehabilitation from injury or trauma. Adequate energy and protein intake along with all essential micronutrients can contribute to minimal muscle loss after surgery and immobilization and speed up the recovery process.
Views from Manasa Lakshmi Penta, Clinical Nutritionist, GITAM Institute of Medical Sciences and Research, Visakhapatnam.