{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T07:41:37Z","timestamp":1791013297879,"version":"4.1.0"},"reference-count":48,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Severe traumatic brain injury (TBI) induces a hypermetabolic state that heightens the risk of mortality and poor neurological outcomes. Early enteral nutrition (EEN), typically defined as initiation within 48\u202fh of injury, is considered crucial, yet robust evidence of its specific benefits in TBI patients remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Following PRISMA guidelines, we systematically searched the PubMed, Embase, Web of Science, and Cochrane Library databases through December 25, 2025, for studies comparing EEN with delayed enteral nutrition (DEN) in adults with TBI. Outcomes included clinical outcomes, nutrition status, and complications. Study quality was assessed using the Newcastle-Ottawa Scale and the Cochrane Risk of Bias tool. The primary outcome was short-term mortality, defined as from hospital admission to 90\u202fdays post-discharge. Sensitivity analyses and subgroup analyses explored heterogeneity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Ten studies (6 randomized controlled trials [RCTs]; 4 observational; 13,046 patients) were included. When all studies (RCTs and observational) were pooled, there was no significant difference in short-term mortality risk between EEN and DEN (risk ratio [RR]\u202f=\u202f0.64; 95% CI, 0.32\u20131.31). However, a prespecified sensitivity analysis limited to RCTs showed a significant reduction in mortality with EEN (RR\u202f=\u202f0.58; 95% CI, 0.35\u20130.96). EEN significantly shortened mechanical ventilation duration and reduced both ICU and hospital length of stay. Nutritional status, including serum albumin levels, glucose control, caloric intake, and positive nitrogen balance, was markedly improved with EEN, without increasing hospitalization costs. EEN also significantly lowered rates of sepsis, central nervous system infection, stress ulcer, ventilator-associated pneumonia, and total adverse events (all\n                      <jats:italic>p<\/jats:italic>\n                      values range from &amp;lt;0.00001 to 0.04), though it was associated with a mildly elevated risk of diarrhea (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.02).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this meta-analysis, EEN initiated within 48\u202fh of TBI showed a trend toward reduced short-term mortality and improvements in clinical and nutritional outcomes compared to DEN. However, these findings should be interpreted cautiously given the high risk of bias and substantial statistical heterogeneity in the included studies. Future high-quality, large-scale RCTs are needed to confirm these effects and refine optimal feeding strategies in this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/inplasy.com\/wp-content\/uploads\/2026\/01\/INPLASY-Protocol-8729.pdf<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2026.1795734","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T04:33:07Z","timestamp":1784781187000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Efficacy of early enteral nutrition in patients with traumatic brain injury: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Wei","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Critical Care Medicine, The Second People\u2019s Hospital Affiliated to Fujian University of Traditional Chinese Medicine","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Lei","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, The Second People\u2019s Hospital Affiliated to Fujian University of Traditional Chinese Medicine","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiu","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, The Second People\u2019s Hospital Affiliated to Fujian University of Traditional Chinese Medicine","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao-Ying","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, The Second People\u2019s Hospital Affiliated to Fujian University of Traditional Chinese Medicine","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui-Bin","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Guang\u2019anmen Hospital, China Academy of Chinese Medical Sciences","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-He","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, The Second People\u2019s Hospital Affiliated to Fujian University of Traditional Chinese Medicine","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"987","DOI":"10.1016\/S1474-4422(17)30371-X","article-title":"Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research","volume":"16","author":"Maas","year":"2017","journal-title":"The Lancet Neurology"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1055\/s-0040-1716493","article-title":"Management and challenges of severe traumatic brain injury","volume":"42","author":"Rakhit","year":"2021","journal-title":"Semin Respir Crit Care Med"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1271","DOI":"10.1097\/TA.0b013e3181493080","article-title":"Using a cost-benefit analysis to estimate outcomes of a clinical treatment guideline: testing theBrain trauma foundation guidelines for the treatment of severe traumatic brain injury","volume":"63","author":"Faul","year":"2007","journal-title":"J Trauma"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1186\/s13054-015-1177-1","article-title":"Nutrition support practices in critically ill head-injured patients: a global perspective","volume":"20","author":"Chapple","year":"2016","journal-title":"Crit Care"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"47","DOI":"10.3390\/clinpract15030047","article-title":"Extracranial effects of traumatic brain injury: a narrative review","volume":"15","author":"Evanson","year":"2025","journal-title":"Clin Pract"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1007\/s00068-024-02711-8","article-title":"Prevalence, incidence, and complications of malnutrition in severely injured patients","volume":"51","author":"Verheul","year":"2025","journal-title":"Eur J Trauma Emerg Surg"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"3209","DOI":"10.1007\/s00068-024-02624-6","article-title":"The correlation of CT-derived muscle density, skeletal muscle index, and visceral adipose tissue with nutritional status in severely injured patients","volume":"50","author":"van Ee","year":"2024","journal-title":"Eur. 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