7 Practical Nutrition Solutions for DFUs, Pressure Ulcers, & Chronic Wounds

  When it comes to conducting proper wound care and assisting patients in preventing chronic wounds, proper nutrition is as important as topical skin care. Although wound healing is complex and treatment can become problematic, ensuring timely nutrition intervention remains vital. The following facts related to wound care offer solutions for optimal nutrition and healing.

  Fact 1: About 15% of individuals living with diabetes develop a foot ulcer and 84% of them will end up with lower leg amputations.¹

  Solution: Some diseases, such as diabetes, affect how the body metabolizes carbohydrates. This can hinder the normal wound healing process. Carbohydrate is the body’s preferred source of energy. Adequate carbohydrates in the diet protect the body from breaking down muscle to use the protein for energy. Encourage patients to eat complex carbohydrates such as whole grains, fruits, and vegetables.

  Recommend that patients eat at regular times throughout the day, choose snacks that optimize nutrient intake, and cut calories by drinking noncaloric beverages. Through proper blood glucose control and optimal diet, it is possible to heal existing wounds and prevent future amputations. Individuals living with diabetes would benefit from a carbohydrate-controlled diet and nutrition counseling with a registered dietitian (RD) to ensure optimal blood glucose control.

  Fact 2: When a wound is present, energy needs are increased to support the immune response and regeneration of new tissue.²

  Solution: It is imperative to provide sufficient calories to fuel normal body functions and to meet the needs for tissue repair. The revised guidelines from the National Pressure Ulcer Advisory Panel (NPUAP) and European Pressure Ulcer Advisory Panel (EPUAP) recommend 30–35 kcal/kg per day.³ Because no evidence-based guidelines exist at this time, it is necessary to adjust calorie needs according to age, nutritional status, comorbid conditions, wound severity, stage in the healing process, and amount of wound drainage. RDs are trained to assess nutritional needs and provide interventions to optimize healing.

  Fact 3: Protein provides the foundation for tissue growth, cell renewal, and wound repair after an injury and is important throughout all phases of wound healing.⁴

  Solution: The NPUAP and EPUAP recommend 1.25–1.5 g/kg of protein daily.³ High-quality, complete protein is found in meat, poultry, fish, eggs, dairy products, and soybeans. Help patients meet their protein needs by encouraging eggs or cereal with milk for breakfast, a cold-cut or tuna fish sandwich for lunch, and a meat entrée or rice and beans for dinner.

  Fact 4: Supplementation of vitamin A, vitamin C, zinc, and copper should occur only in individuals with a known deficiency.⁴

  Solution: Currently, no consistent evidence shows that vitamin and mineral supplementation facilitates wound healing in well-nourished individuals. In the presence of a healthy diet, most vitamin and mineral requirements are met. Unfortunately, the majority of patients don’t consume an ideal diet daily, often due to overall medical conditions. This has led to routine supplementation as a protective measure. The goal is to encourage a well-balanced diet that incorporates high-quality protein, whole grains, and plenty of fruits and vegetables.

  Fact 5: Those with draining wounds, emesis, diarrhea, elevated temperature, or increased perspiration need additional fluids.⁵

  Solution: Water has several roles in wound healing, including wound-site hydration, transport, and waste removal. Fluid needs are met from the water content of foods plus liquids. Various formulas are available to calculate fluid requirements. However, a common formula utilizes 1 mL fluid/kcal consumed. For example, patients who require 2,200 calories would also require 2,200 mL fluids. Signs of dehydration include changes in weight, urine output, calculated serum osmolality, elevated serum sodium, and poor skin turgor. Practitioners should reassess fluid needs as the patients’ medical conditions change.

  Fact 6: Malnutrition leads to delayed wound healing. Approximately 40–60% of hospitalized older adults are malnourished or at risk for malnutrition, 40–85% of nursing home residents are malnourished, and 20–60% of home care patients are malnourished.⁴

  Solution: The causes of malnutrition are multifactorial and sometimes related to physical limitations, functional decline, self-feeding deficits, decreased appetite, environmental changes, new disease onset, or psychosocial factors. Providers play a unique role in determining the risk of becoming malnourished and should ask patients appropriate questions to uncover nutritional deficiencies. The most efficient method of identifying at-risk individuals is through nutrition screening and assessment. Common signs of malnutrition include decreased grip strength, decayed or missing teeth, spoon-shaped nails, or skin-color loss. If patients are unable to consume adequate calories, a high-calorie/high-protein oral nutritional supplement may prove beneficial.

  Fact 7: Lack of cognition is a known risk factor for the development of pressure ulcers. The accumulated effects of immobility, poor nutritional intake, and immune system challenges increase the risk of pressure ulcers by 74%.⁶

  Solution: As a patient’s cognitive and functional ability decline, eating and feeding difficulties become prevalent. Difficulty swallowing, choking, poor dentition, and self-feeding deficit often lead to decreased appetite and oral intake. Coupled with limited communication and weight loss, pressure ulcers become a frequent complication.

  To improve intake, aim to serve meals at regular times and in a simplified dining environment to minimize distractions and develop a familiar routine. When a wound is present, it is crucial to provide adequate protein and calories to rebuild tissue and prevent muscle from wasting away.

  Nancy Collins is founder and executive director of Nutrition411.com and Wounds411.com. She also serves as a consultant to healthcare institutions and as a medico-legal expert to law firms involved in healthcare litigation. Correspondence may be sent to NCtheRD@aol.com. Colleen Sloan is president of 360 Nutrition Solutions; serves as nutrition expert at the Cardiac Institute of the Palm Beaches, Palm Beach Gardens, FL; and is a contributor/member of the management team for Nutrition411.com.

References

1. Collins N, Tobia R. The importance of glycemic control in wound healing. Ostomy Wound Manage. 2010;56(9):18-24.

2. Sherman AR, Barkley M. Nutrition and wound healing. J Wound Care. 2011;20(8):357-367.

3. European Pressure Ulcer Advisory Panel, National Pressure Ulcer Advisory Panel. Pressure Ulcer Treatment: Quick Reference Guide. Accessed online: www.epuap.org/guidelines/Final_Quick_Treatment.pdf.

4. Stechmiller JK. Understanding the role of nutrition and wound healing. Nutr Clin Pract. 2010;25(1):61-68.

5. Thomas DR, Cote TR, Lawhorne L, et al. Understanding clinical dehydration and its treatment. J Am Med Dir Assoc. 2008;9(5):292-301.

6. Harris C, Fraser C. Malnutrition in the institutionalized elderly: the effects on wound healing. Ostomy Wound Manage. 2004;50(10):54-63.