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FIGURE 3 Theoretical basis for positive feedback loop for brain References
injury and O3FA deficiency. 1. Hai T, Agimi Y, Stout K. Clusters of conditions among US ser-
vice members diagnosed with mild TBI from 2017 through 2019.
Front Neurol. 2022;13:976892. doi:10.3389/fneur.2022.976892
Brain Injury 2. Pavlovic D, Pekic S, Stojanovic M, Popovic V. Traumatic brain
Impact occurs injury: neuropathological, neurocognitive and neurobehavioral
Inflammatory cascade sequelae. Pituitary. 2019;22(3):270–282. doi:10.1007/s11102-
is triggered 019-00957-9
3. Gardner RC, Byers AL, Barnes DE, Li Y, Boscardin J, Yaffe K.
Increased Risk Response Mild TBI and risk of Parkinson disease: A Chronic Effects of Neu-
rotrauma Consortium study. Neurology. 2018;90(20):e1771–
Nerve repair and
Depleted omega-3 stores inflammatory mediators e1779. doi:10.1212/WNL.0000000000005522
increase the risk of secondary u lize omega-3 stores 4. Li Y, Li Y, Li X, et al. Head Injury as a risk factor for dementia
damage by brain injury and Alzheimer’s disease: a systematic review and meta-analysis
‘Leaky gut’ likely to occur
of 32 observational studies. PLoS One. 2017;12(1):e0169650.
doi:10.1371/journal.pone.0169650
Depleted Omega-3 5. Patch CS, Hill-Yardin EL, Lewis M, Ryan L, Daly E, Pearce AJ.
Stores The more, the better: high-dose omega-3 fatty acids improve be-
U liza on and malabsopr on
of omega-3 likely to decrease havioural and molecular outcomes in preclinical models in mild
stores of omega-3 brain injury. Curr Neurol Neurosci Rep. 2021;21(9):45. doi:
10.1007/s11910-021-01132-z
6. Agimi Y, Marion D, Schwab K, Stout K. Estimates of long-term
disability among US Service Members with traumatic brain inju-
Conclusion ries. J Head Trauma Rehabil. 2021;36(1):1–9. doi:10.1097/HTR.
0000000000000573
While human data on the relationship between O3I and brain 7. Capo X, Martorell M, Sureda A, Tur JA, Pons A. Effects of doco-
injury are limited, data from preclinical studies and human sahexaenoic supplementation and in vitro vitamin C on the oxi-
models consistently show brain injury protection with im- dative and inflammatory neutrophil response to activation. Oxid
proved omega-3 status and supplementation. Future research Med Cell Longev. 2015;2015:187849. doi:10.1155/2015/187849
should investigate the O3I risk score that correlates to optimal 8. Heileson JL, Anzalone AJ, Carbuhn AF, et al. The effect of
brain injury outcomes, as the risk score in this study was based omega-3 fatty acids on a biomarker of head trauma in NCAA
on research conducted on omega-3 status and heart disease. football athletes: a multi-site, non-randomized study. J Int Soc
Sports Nutr. 2021;18(1):65. doi:10.1186/s12970-021-00461-1
What is optimal for acute and long-term recovery from brain 9. Oliver JM, Jones MT, Kirk KM, et al. Effect of docosahexae-
injury is likely to have different parameters than what is opti- noic acid on a biomarker of head trauma in American football.
mal for heart health. Med Sci Sports Exerc. 2016;48(6):974–982. doi:10.1249/MSS.
0000000000000875
Military personnel at moderate or high risk for exposure to 10. Mishra S, Singh VJ, Chawla PA, Chawla V. Neuroprotective
factors associated with increased risk for brain injury should role of nutritional supplementation in athletes. Curr Mol Phar-
macol. 2022;15(1):129–142. doi:10.2174/18744672146662112
take an omega-3 index test regularly. Although there is a need 09144721
for more data on the long-term effects of omega-3 status prior 11. Turnagöl HH, Kosar SN, Güzel Y, Aktitiz S, Atakan MM. Nutri-
̧
to and at the time of a TBI in human subjects, associations tional considerations for injury prevention and recovery in com-
observed in this study support O3FA supplementation in mil- bat sports. Nutrients. 2022;14:53. doi:10.3390/nu14010053
itary personnel in these categories. Improved omega-3 status 12. Black EK, Phillips JK, Seminetta J, Bailes J, Lee JM, Finan JD. The
in groups at high risk of TBI may benefit individuals both effect of dietary supplementation with high- or low-dose omega-3
acutely, by improving recovery and functional outcomes, and fatty acid on inflammatory pathology after traumatic brain in-
jury in rats. Transl Neurosci. 2021;12(1):76–82. doi:10.1515/
also chronically, by decreasing the incidence of chronic symp- tnsci-2021-0010
toms (e.g., headaches and brain fog) and the risk of chronic 13. Chen X, Chen C, Fan S, et al. Omega-3 polyunsaturated fatty
neurodegenerative diseases such as Alzheimer’s and dementia. acid attenuates the inflammatory response by modulating mi-
croglia polarization through SIRT1-mediated deacetylation of the
Finally, screening military personnel for the Alzheimer’s- HMGB1/NF-kappaB pathway following experimental traumatic
associated APOE ε4 gene form would enable tailored omega-3 brain injury. J Neuroinflammation. 2018;15(1):116. doi:10.1186/
s12974-018-1151-3
supplementation for maximum bioavailability. 14. Chen X, Pan Z, Fang Z, et al. Omega-3 polyunsaturated fatty acid
attenuates traumatic brain injury-induced neuronal apoptosis by
Author Contributions inducing autophagy through the upregulation of SIRT1-mediated
MS, SK, and KB conceived the study concept. MS, SK, KB, JB, deacetylation of Beclin-1. J Neuroinflammation. 2018;15(1):310.
MH, and AH contributed to the final study design. MS, SK, doi:10.1186/s12974-018-1345-8
and KB coordinated and collected the data. JB, MH, and KL 15. Hall JC, Priestley JV, Perry VH, Michael-Titus AT. Docosa-
analyzed the data. JB, KL, MH, and AH interpreted the data hexaenoic acid, but not eicosapentaenoic acid, reduces the
early inflammatory response following compression spinal cord
analysis results. JB wrote the first draft. All authors contrib- injury in the rat. J Neurochem. 2012;121(5):738–750. doi:10.1111/
uted to manuscript revisions and read and approved the final j.1471-4159.2012.07726.x
manuscript. 16. Pu H, Guo Y, Zhang W, et al. Omega-3 polyunsaturated fatty
acid supplementation improves neurologic recovery and attenu-
Disclosures ates white matter injury after experimental traumatic brain injury.
The authors have indicated that they have no financial rela- J Cereb Blood Flow Metab. 2013;33(9):1474–1484. doi:10.1038/
tionships relevant to this article to disclose. jcbfm.2013.108
17. Ren H, Yang Z, Luo C, et al. Enriched endogenous omega-3
fatty acids in mice ameliorate parenchymal cell death after trau-
Funding matic brain injury. Mol Neurobiol. 2017;54(5):3317–3326. doi:
No funding was received for this work. 10.1007/s12035-016-9931-1

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