Guidance for Meeting Protein Needs for Wound Healing During a Period of High Inflation

QUESTION: I am a nurse at an outpatient wound clinic. I remind patients that proper nutrition (eg, adequate calo- ries, extra protein) is important in wound healing. Lately, patients are telling me they are having difficulty making ends meet because of rising prices. I am afraid that healthy food purchases go by the wayside as mortgages or rent, gas, and medications come first. How can patients meet their nutrition needs, particularly their protein needs, during these times of high inflation?

Answer: The Economic Research Service of the US Department of Agriculture (USDA) predicts that supermarket food prices will rise between 8.5% and 9.5% during 2022.¹ Food is not the only category of goods with rising prices; gas, housing, and utility prices have all increased. These increases mean that patients, many of whom are on fixed incomes, sometimes are forced to make difficult choices when it comes to spending. Their nutritional status will suffer if they do not have enough money for adequate and appropriate foodstuffs. In turn, wound healing will be affected because insufficient nutritional substrate is available from which to build new tissue. This is a genuine concern for many patients, so wound healing practitioners need to have practical advice ready when patients express fears, concerns, or questions about how to eat well on a budget. Although this is probably not a traditional role for wound healing clinicians, it is important to acknowledge and anticipate these concerns in modern times.

FOOD PURCHASING

It is impossible to eat well if the refrigerator or pantry is not stocked for meals. Menu planning and food shopping are always the first step toward proper nutritional intake for patients at home. These tasks may involve family members or caregivers, so it is essential to ask questions to determine who is responsible for grocery shopping.

Several companies and big box stores began home delivery services of groceries during the stay-at-home directives triggered by the COVID-19 public health emergency. Many people continue to avoid extra shopping trips or simply enjoy the convenience and continue to have foodstuffs delivered today. While this is a good option that addresses mobility and frailty issues, it does require using a computer or mobile device to place an order. Older patients may not have this access or technical ability but may have a family member who can help place delivery orders for them.

Getting more for your dollar is more important than ever during the current inflationary period. If patients express financial worries and concerns, wound healing clinicians should offer a variety of tips to address these concerns. Table 1 outlines 10 strategies patients can use to help stretch the food purchasing budget.

HIGH-PROTEIN FOODS ON A BUDGET

Protein is the macronutrient most closely tied to wound healing for many reasons. Protein, a complex nitrogenous compound made up of amino acids in peptide linkages, is essential for life. Proteins carry out the work of the cell by serving as enzymes, receptors, transporters, hormones, antibodies, or communicators that build, maintain, and repair body tissues.²

The typical protein recommendation for wound patients with malnutrition or at risk of malnutrition ranges from 1.25 to 1.5 g/kg of body weight.³ In simple terms, this equates to about 10 to 12 oz per day for a 125- to 145-lb patient. The usual recommendation is for these patients to increase their consumption of whole-protein foods, such as beef, chicken, pork, eggs, fresh seafood, and dairy items. The price of these foods has risen, so wound healing practitioners should suggest some lower-cost, good alternatives, such as the following:

• Canned tuna
• Peanut butter
• Greek yogurt
• Beans
• Lentils
• Ground turkey
• Sardines
• Amaranth
• Canned salmon
• Chicken drumsticks
• Ground beef (lean)

PRICE COMPARISONS OF FOOD TO MEDICAL NUTRITIONAL PRODUCTS

Marketing tactics influence consumer perception of price. Techniques such as ending prices at $0.99 give the illusion of a lower price point. An entire industry is devoted to advertising and changing the perceived value of items so that consumers will make a purchase. Patients often state that protein supplements are too costly and defer recommendations to use these products because of their price perception.

It is necessary to compare the price per gram of protein to evaluate food versus medical nutritional products on equal footing. Table 2 breaks down the price per gram of protein of some budget-friendly, high-protein foods. These foods are compared to two common liquid protein supplements used specifically for wound healing. From this gram-to-gram comparison, it is evident that liquid protein supplements are in line with the cost of many food items. In addition, these products provide more grams of protein in a very small serving size.

For patients who complain of a lack of appetite or cannot prepare protein foods daily, a liquid protein product can fill nutritional gaps easily and cost-effectively. Pricing for health care institutions will differ according to their purchasing agreements and is often considerably lower than retail pricing. Wound healing clinicians can obtain coupons, product samples, and educational materials from nutritional supplement manufacturers to provide to their patients.

FOOD INSECURITY

Food insecurity and hunger are affecting more Americans than ever. According to the USDA, 38 million people in the United States, including 6.1 million children, are food insecure.⁴ Food insecurity is a lack of consistent access to enough food for every person in a household to live an active, healthy life.⁵ This is sometimes a temporary situation for a household, or it can be a long-term problem. Practitioners need to offer patients different advice in these situations.

Wound healing clinicians should have a general familiarity with the resources available in the community, such as food banks, food pantries, and other outreach programs. In addition, there are several governmental programs, including the Supplemental Nutrition Assistance Program (SNAP, also known as food stamps), the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and even cash programs. The WIC program and SNAP benefits are designed for low-income families on a limited budget. Depending on the individual situation, the social worker, case manager, home care nurse, or even family and friends may help patients research eligibility and apply for these programs.

PRACTICE POINTS

The economy and inflation are top of mind for most Americans. To paraphrase a post on Facebook: the most expensive vehicle to operate today is a grocery store shopping cart. Wound care patients are not exempt from these economic concerns and may express their fears and worries during wound care visits. Rather than brush off these difficult discussions, wound healing practitioners should offer practical advice and reassurance, such as referrals to community and government-based programs when needed.

The bottom line is that a wound cannot heal without adequate nutritional intake, so skimping on food purchases or going to bed hungry is not the proper course of action. Clinicians should encourage patients to use their money wisely by following shopping tips to purchase cost-effective sources of protein, including liquid protein supplements when necessary, to reach daily protein goals. The role of financial consultant surely was not in the original job description of a wound care practitioner, but compassionate, empathetic care certainly was; indeed, it is needed now more than ever. ν

REFERENCES

1. Economic Research Service. Summary findings: food price outlook, 2022. US Department of Agriculture. Accessed August 2, 2022. https://www.ers.usda.gov/data-products/food-price-outlook/summary-findings/

2. Functions of protein. Medicine/LibreTexts. Accessed August 2, 2022. https://med.libretexts.org/Courses/Metropolitan_State_University_of_Denver/Introduction_to_Nutrition_(Diker)/06%3A_Proteins/6.05%3A_Proteins_Functions_in_the_Body

3. European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers/Injuries. Haesler E, ed. 3rd ed. EPUAP/NPIAP/PPPIA; 2019.

4. Economic Research Service. Food security in the U.S. US Department of Agriculture. Accessed August 2, 2022. https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-u-s/key-statistics-graphics/#insecure

5. Hunger in America. Feeding America. Accessed August 2, 2022. https://www.feedingamerica.org/hunger-in-america/food-insecurity

Dr Collins is a wound care certified registered dietitian nutritionist based in Las Vegas, NV. She is well known for her expertise in the complex relationship between malnutrition, body composition, and tissue regeneration. To contact Dr Collins, visit her website at www.drnancycollins.com.
The opinions and statements expressed herein are specific to the respective authors and not necessarily those of Wound Management & Prevention or HMP Global. This article was not subject to the Wound Management & Prevention peer-review process.