The Role of Nutrition In Wound Healing

Sheri H. Smith, R.N., Ph.D., C.E.T.N.
Cheryl P. Griffin, R.D., L.D.

Carrington Laboratories Inc

2001 Walnut Hill Lane
Irving, Texas 75038
Tel:(972) 518-1300
Fax: (972) 518-1020

The Importance of Nutritional Assessment

Inadequate nutrition can increase the risk of developing pressure ulcers and impede the healing process of all wounds. Accordingly, early nutrition intervention can prevent the increased risk of infection and/or progression of the wound, improving healing time. A comprehensive patient assessment should, therefore, include a nutritional component to assure the patient's diet can adequately support wound healing. A patient suffering from poor nutritional status can be identified by addressing a number of factors, including the following:

* Serum albumin: Mildly depleted - 3.0 to 3.2 g/dl Moderately depleted - 2.5 to 2.9 g/dl Severely depleted - <1.5 g/dl

* Prealbumin: Mildly depleted - 10 to 15 mg/dl Moderately depleted - 5 to 10 mg/dl Severely depleted - <5 mg/dl

* Total lymphocyte count of <1,500mm3

* Poor oral intake

* Inability or unwillingness to eat

* Recent weight loss of 15% or greater

Adequate Intake

Adequate intake is best accomplished by an oral diet of food that provides sufficient protein, calories, minerals, vitamins and trace substances needed by the body. There are often a number of physical and/or psychological reasons that oral intake may not be adequate. The reasons are determined by a comprehensive nutritional assessment. The nutritional assessment will also provide a guideline for the patient's nutritional requirements, as well as his usual or average intake. When oral intake is inadequate or if the patient is physically or psychologically unable to eat, adjustments may be required in the approach used to provide nutrition.

Medical Nutritional Supplements

An ideal intake for patients with wounds usually includes 30-35 calories/kg/day and 1.25-1.50 grams of protein/kg/day. In the event that oral intake is inadequate, oral supplements may be required. This can take the form of liquid medical nutritional supplements; or if unable to take food by mouth, tube feedings may be utilized. A dietitian can provide invaluable assistance in determining dietary needs for the high-risk patient. A dietary consult is therefore indicated for patients with significant, chronic, or non-healing wounds.

Vitamin and Mineral Supplements

Vitamin and mineral deficiencies have been identified in a large percentage of patients with wounds. Vitamin and mineral supplementation have also been associated with wound healing. (Table 1). lists important vitamins along with their function in tissue maintenance and wound healing; sources for each vitamin are given. The Agency for Health Care Policy and Research's (AHCPR) Clinical Practice Guideline on Treatment of Pressure Ulcers recommends a daily high-potency vitamin and mineral supplement for all patients suspected of having deficiencies.

Case Study

The following photos illustrate the effects of nutrition on wound healing.

This patient is an elderly female who had an open surgical wound on the knee that had been present for a number of months. The wound had been treated with a variety of different topical treatments without improvement. Her diagnoses included pancreatitis, rheumatoid arthritis, and anorexia related to side effects of her medication.

During her last hospitalization, the patient had a feeding tube placed for enteral feedings. She also was given vitamin and mineral supplements. The feeding tube was in place for only two weeks before she was able to resume oral feedings.

She continued vitamin and mineral supplements and nutritional supplements by mouth. The wound began to improve shortly after the tube feeding and vitamins had begun. These illustrations show the progress of the wound over time.

New Product Available

CarraVite™ , a comprehensive vitamin and mineral supplement that contains the essential elements necessary to support wound healing, has recently been introduced by Carrington Laboratories, Inc. CarraVite™ also contains AVMP® (Aloe vera mucilaginous polysaccharide), an extract of the Aloe vera plant linked to beneficial cellular elements in the wound. Correction of nutritional deficiencies and improved nutrition status is strongly linked to improved wound healing. Carrington Laboratories, Inc. also makes DiaB™ Nutri, a nutritional supplement specifically formulated for use by diabetics. For orders, additional information, or technical support, call 1-800-358-5205. Carrington Labs Home Page

Table 1

ESSENTIAL VITAMINS & MINERALS
Vitamin A - Important for cellular differentiation and proliferation. Using Beta carotene to supple vitamin A activity avoids toxicity associated with higher doses of preformed vitamin A.. Contained in green leafy vegetables, dark yellow vegetables, milk, sweet potatoes, pumpkin, broccoli.

Vitamin C - Involved in collagen synthesis. Deficiency prolongs healing time and wound strength and contributes to decreased resistance to infection. Contained in citrus fruits, strawberries, cantaloupe, potatoes, tomatoes, dark green vegetables.

Vitamin D - Necessary for strong bone healing and normal calcium metabolism. Contained in milk and sunshine.

Vitamin E - Stabilizes cell membranes, antioxidant, protects vitamin A, enhances immune response, collagen synthesis. Contained in plant oils, green leafy vegetables, whole grain products, egg yolks, nuts, seeds.

Vitamin B Complex - Cofactors in many enzyme systems, collagen strength, energy production, protein synthesis and enhanced immune response. Contained in whole grain products, pork, dark green leafy vegetables, nuts, seeds, legumes.

Iron - oxygen transport, collagen metabolism, constituent of hemoglobin. Contained in red meats, poultry, fish, legumes and beans, eggs and dried fruit.

Zinc - assists with collagen synthesis, transport of vitamin A, enhances immune response. Contained in meats, fish, poultry, milk, whole grain products, legumes, nuts.

Copper - assists with collagen formation, assists with RBC synthesis. Contained in meats and drinking water.

References: Agency for Health Care Policy and Research (AHCPR) Clinical Practice Guideline on Treatment of Pressure Ulcers, AHCPR Publication No. 95-0652, Dec. 1994.