Practical aspects of nutritional support for wound-healing patients

doi:10.1016/S0002-9610(03)00291-5

The American Journal of Surgery

Volume 188, Issue 1, Supplement 1, July 2004, Pages 52-56

https://doi.org/10.1016/S0002-9610(03)00291-5 Get rights and content

Abstract

Nutrition and metabolic support of acutely and chronically ill patients is an emerging branch of medicine that has direct applicability to wound healing. The occurrence of pressure ulcers is associated with malnutrition, as well as specific micronutrient deficiencies. A comprehensive approach is reviewed that involves nutritional assessment, selection of an appropriate route for nutrition support (enteral versus parenteral), prioritizing nitrogen retention over energy balance in stressed patients, micronutrient management, and incorporation of specialized nutritional pharmacologic interventions.

Section snippets

Link between nutritional status and wound healing

In chronically hospitalized patients, the occurrence of pressure ulcers has been associated with nutritional status. The relative risk of developing a pressure ulcer in high-risk, malnourished patients was 2.1 times greater (95% confidence interval) compared with normally nourished patients [4]. In another study, 65% of severely malnourished nursing home patients had pressure ulcers, whereas no ulcers were detected in the mild to moderately malnourished or normally nourished nursing home

Clinical practice algorithms

During the initial evaluation of a patient with wound-healing issues, a nutritional assessment must be performed. Briefly, an unintentional loss of >10% usual body weight in the previous month, and/or a low serum albumin, defines a malnourished condition. Operationally, simple starvation or “marasmus” exists if the patient has lost >10% usual body weight and has a normal serum albumin. In this condition, low carbohydrate intake produces a low-insulin state with decreased energy expenditure and

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^☆: This work was supported in part by the United Spinal Association.

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Practical aspects of nutritional support for wound-healing patients☆

Abstract

Section snippets

Link between nutritional status and wound healing

Clinical practice algorithms

Chest

Chest

Nutrition

Exp Mol Pathol

Nutrition

Clin Nutr

Am J Cardiol

Lancet

J Clin Epidemiol

J Am Acad Dermatol

Gastroenterology

Endocr Pract

J Crit Care

Hypotestosteronemia in chronically critically ill men

Crit Care Med

Hospital-acquired pressure ulcers and risk of death

J Am Geriatr Soc

Correlation of pressure sores and nutritional status

J Am Geriatr Soc

A prospective study of outcome from protein-energy malnutrition in nursing home residents

J Parenter Enteral Nutr

Improved wound healing in transtibial amputees receiving supplementary nutrition

Int Orthop

The effect of a very high-protein liquid formula on decubitus ulcer healing in long-term tube-fed institutionalized patients

J Am Diet Assoc

The importance of dietary protein in healing pressure ulcers

J Am Geriatr Soc

Routine protein energy supplementation in adultssystematic review

BMJ

The risk factors and impact on survival of feeding tube placement in nursing home residents with severe cognitive impairment

Arch Intern Med

Prolonged tube feeding in long-term carenutritional status and clinical outcomes

J Am Coll Nutr

Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures

Ann Thorac Surg

Intensive insulin therapy in the critically ill patients

N Engl J Med

Patients with chronic leg ulcers show diminished levels of vitamins A and E, carotenes, and zinc

Dermatol Surg

Effect of zinc supplementation on epidermal Langerhans' cells of elderly patients with decubital ulcers

J Dermatol

Effects of exogenous zinc supplementation on intestinal epithelial repair in vitro

Eur J Clin Invest

Matrix metalloproteinases (MMPs) are required for re-epithelialization of cutaneous wounds

Arch Dermatol Res

Matrix metalloproteinases in wound repair [review]

Int J Mol Med

Extracellular calcium stimulates DNA synthesis in synergism with zinc, insulin and insulin-like growth factor I in fibroblasts

Eur J Biochem

Calprotectin inhibits matrix metalloproteinases by sequestration of zinc

Mol Pathol

Sequential changes in trace metal, metallothionein and calmodulin concentrations in healing skin wounds

J Anat

Effects of cortisone and vitamin A on wound healing

Ann Surg