Effects of early versus delayed nutrition on intestinal mucosal apoptosis and atrophy after traumatic brain injury.
OBJECTIVE
To determine the optimal time to start nutritional support after traumatic brain injury (TBI).


METHODS
Rats were divided into six groups of seven. All but one of these groups were subjected to moderate closed head trauma under general anesthesia. Groups Ia and Ib were commenced on immunonutrition and standard enteral nutrition, respectively, 8 h later; groups IIa and IIb were commenced on immunonutrition and standard enteral nutrition, respectively, 72 h later; and group III was commenced on a parenteral saline infusion 8 h later. Group IV was a control group fed a laboratory diet and not subjected to trauma. The rats were killed 7 days later, and ileal segments were examined using light and electron microscopy. We used the deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling (TUNEL) technique to detect intestinal mucosal apoptosis.


RESULTS
Group III had a lower body weight than the other groups (P < 0.005). The mean villous height was highest in groups Ia and IV and lowest in group III. The villi count was lower in groups Ib, IIa, IIb, and III than in group IV (P < 0.005). The apoptotic index counts were higher in groups IIa, IIb, and III than in group IV (P < 0.005).


CONCLUSIONS
The addition of enriching immunonutrients to early enteral feeding helps preserve an almost normal gut mucosa.
Aydin
Sevim
S
Department of Histology, Karadeniz Technical University, Farabi Hospital, Anabilim Dali, 61080, Trabzon, Turkey.
Ulusoy
Hülya
H
Usul
Haydar
H
Yulug
Esin
E
Cobanoglu
Umit
U
Aydin
Kemalettin
K
Yenilmez
Engin
E
Kutun
Suat
S
D000704:Analysis of Variance; D000818:Animals; D017209:Apoptosis; D001835:Body Weight; D001930:Brain Injuries / Q000473:pathology*; D004750:Enteral Nutrition / Q000379:methods*; D005526:Food, Formulated; D020287:In Situ Nick-End Labeling; D007408:Intestinal Absorption / Q000502:physiology; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D008854:Microscopy, Electron; D008871:Microvilli / Q000473:pathology; D010784:Photomicrography; D011897:Random Allocation; D051381:Rats; D017207:Rats, Sprague-Dawley; D018709:Statistics, Nonparametric; D013997:Time Factors