Nutrition and Wound Healing
April 2007 - compiled by Caroline White
Contents
Summary
Evidence Based Literature
Summary
In two recent articles, the prevalence of hospitalised patients with malnutrition has been reported to be between 25-50%, a variable that is associated with length of stay and morbidity. However, only 50% of malnourished patients are identified by the medical and nursing staff.1-2
The role of nutrition in relation to maintaining and improving overall health status is well documented. In particular research indicates that good nutritional status is essential to promoting effective growth and repair of body tissue.
Nutrients play vital roles in the constitution of a well-balanced diet and any depletion in a person's nutritional intake, especially proteins, can lead to malnutrition and protein-energy malnutrition, conditions which are known to have considerable impact on health and well-being and on the wound healing process.3
This is echoed in a recent guideline:
The consequences of malnutrition include vulnerability to infections, delayed wound healing, impaired function of heart and lungs, muscle weakness and depression. Furthermore, preoperative nutrition support might reduce risks of infection or poor wound healing, whilst early postoperative intervention might limit the nutritional risks arising from the standard practice of keeping patients ‘nil by mouth’ for several days (with a view to protecting gastro-intestinal anastomoses and allowing any ileus to resolve).4
Recommendations from the management of pressure ulcers practice guidelines acknowledges the need for nutritional intervention in patients with pressure sores; including effective nutritional assessment (using a recognised screening tool), assessing general health status, acknowledging patient preference, and involving dieticians/specialists in the decision-making process. However, the guidelines also acknowledge the need for further research;
Further research with larger numbers of patients and sound methodology is required to procure evidence on the impact of nutrition on pressure ulcers. Consideration should be given to the constituents of the supplement and method of administration, as studies have reported low tolerance of nasogastric tube feeding.5
Furthermore, a Cochrane Review on nutritional interventions for patients with pressure ulcers concluded;
Dietary supplementation may prevent pressure ulcers in acutely ill older people, but more research is needed. Poor nutritional status or dehydration can weaken the skin and make people more vulnerable to developing pressure ulcers. Nutritional interventions to try and prevent or treat pressure ulcers include providing additional nutrition and dietary supplements, including zinc and vitamin C. The review of trials found that although there is some evidence that nutritional interventions may be able to reduce the number of people who develop pressure ulcers, more research is needed.6
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References
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De-Luis-Daniel-A, Nutritional assessment: predictive variables at hospital admission related with length of stay. Annals of nutrition & metabolism, 2006 (epub: 30 Jun 2006), vol. 50, no. 4, p. 394-8
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Anderson-B. Nutrition and wound healing: the necessity of assessment. British Journal of Nursing, 2005 Oct 27-Nov 9, vol. 14, no. 19, Tissue ViabilitySupplement: p. S30, S32, S34 passim.
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