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KEY SESSION: NUTRITION IN WOUND CARE
Key Session: Nutrition in Wound Care
103
Nutrition treatment and wound healing
Lubos Sobotka 1
1 Charles University in Prague, Medial Faculty – University Hospital (Prague, Czech
Republic)
The strong increase in cell proliferation, protein synthesis, and enzyme activity during
the wound healing process requires local accumulation of energy and building
substrates. In general amino acids are released from body protein stores, whereas
glucose is produced in the liver. Glucose oxidation is low during the early period of
wound healing probably due to glucose flux to synthetic pathways like the pentose cycle.
Undernourished subjects are at risk of delayed wound healing. When undernutrition is
associated with systemic inflammation the wound healing may be almost blocked. High
protein supplements have been shown to reduce the incidence of pressure ulcers.
Assessment of nutritional status and monitoring of food intake should be an essential
part of the care of patients with wounds. Nutrition intake must always cover daily
requirement of energy (30 to 35 kcal•kg-1) and protein (1 to 1.5 g•kg-1). In already
malnourished patients or in the presence of non-healing wounds the daily energy and
protein intake should be increased to 35-40 kcal•kg-1 and 1.5-2.0 g•kg-1, respectively.
Frequently, such intake cannot be provided in a standard diet and nutritional
supplements must be given. They should be as specific as possible to a patient’s
nutritional deficiency. Protein, micronutrients, and vitamins as well as substrates that are
turned over rapidly (e.g., arginine) should be included. A specific energy and protein
enriched supplement, containing elevated amounts of arginine, zinc, vitamin C and
antioxidants accelerated healing of pressure ulcers in a recent double blind, prospective,
randomised study.
Reference
van Anholt RD, Sobotka L, Meijer EP, Heyman H, Groen HW, Topinková E, van Leen M, Schols JM. Specific
nutritional support accelerates pressure ulcer healing and reduces wound care intensity in non-malnourished
patients. Nutrition. 2010;26:867-72
104
Specific nutritional support:
nutraceutics and molecular mechanisms
Key Session: Nutrition in Wound Care
Miriam Theila 1
1 ICU (Israel)
A wound is a disruption of the integrity and continuity of epithelial surfaces and their
underlying tissues. Several mechanisms of injury may be involved in wound formation,
including mechanical (pressure, and/or shear), thermal or chemical (burns) forces, or
infection. Wound healing is the complex, multi-stage response to tissue injury. This
physiologic repair response requires a dynamic temporal and spatial interplay of several
cell types, including local parenchymal and mesenchymal cells as well as resident and
recruited inflammatory cells. This is a dynamic and highly regulated process of cellular,
humoral and molecular mechanisms which begins directly after wounding and might last
for years
The healing of wounds is of relevance to clinical nutrition. The EUPAP endorses the
delivery of at least 30-35 kcal/kg/day and 1.25 to 1.5 grams protein/kg body to patients
with, or at risk of developing PU(s) and to adjust the nutrition prescription according to
the individual patient’s overall condition. The Panel considers the role of zinc, arginine,
Vitamin C and A that are essential for wound healing. Some evidence suggests that a
combination of enriched nutritional formulas which include calories, protein,
micronutrients and omega-3-polyunsaturated fatty acids may have a role to play in the
prevention of new ulcers and healing of existing ulcers. The specific role of omega-3
fatty acids has been described recently through a modulation of expression of adhesion
molecules. Additional studies are required before clear recommendations may be made.
EWMA 2013
COPENHAGEN
15-17 May · 2013
Danish Wound
Healing Society
71