Specialised oral nutritional supplement can be a therapeutic option for hard-to-heal wounds, conclude Adriano A Mehl (Universidade Tecnológica Federal do Paraná, Curitiba, Brazil) and colleagues in the Journal of Wound Care.
“Hard-to-heal wounds [defined as those that fail to proceed through the healing phases of haemostasis, inflammation, proliferation, and tissue remodelling in three to four weeks] represent a silent epidemic,” Mehl et al write. “They affect a large fraction of the world’s population and pose a growing threat to public health, with a substantial negative economic impact.”
Based on the logic that nutritional intake plays an essential role in repairing damaged tissue, as has previously been established in the literature, the investigators conducted a prospective, randomised controlled assessment of the effects of nutritional supplements specialised in the repair of hard-to-heal wounds. The supplements used contained the amino acids proline and arginine, as well as high levels of vitamins A, C, and E, in addition to zinc and selenium. Mehl was the principal investigator.
Mehl, the principal investigator for the study, explained the choice underpinning this choice of nutritional make-up: “Although wound healing is a complex process, collagen synthesis is required for it to take place. This synthesis depends on proline and lysine hydroxylation, the presence of cofactors such as vitamins A, E and C, iron, zinc and selenium, and the oxygenation of cells. For this process to occur ideally, special attention must be given to factors such as adequate protein energy supply. In spite of this, little is known about the exact mechanism of some nutrients in the healing process, as well as their direct action on the healing process, supplementation dosage, and optimal period of use.”
Patients with hard-to-heal wounds were evaluated at five time points (S0–S4) over four consecutive weeks. At baseline, patients were randomised to the specialised oral nutritional supplement (n=15; 25 wounds) or control (n=15; 25 wounds) groups. The mean age was 65 years, and 50% of patients had diabetes. Of the total evaluated wounds, 78% were <50cm2, 14% were 50–150cm2‑, and 8% were >250cm2. The vast majority (96%) of wounds were in the lower limbs.
Dosage was 200ml twice daily over the research period. In addition to the metric data of wound surface area and perimeter, Mehl and colleagues also calculated the rate of wound contraction and the linear growth of the wound edges, looking for wound-healing predictive factors.
They report a statistically significant reduction (p=0.004) in surface area of the wounds in the group given the specialised oral nutritional supplement, with a performance peak between the first and second follow-up appointments. Furthermore, they found that this specialised oral nutritional supplement did not induce changes in blood pressure, blood glucose level, or renal function.
A mean weekly wound edge growth of 1.85mm in patients with diabetes and 3mm in those without diabetes was observed. These results were 2.9 and 4.6 times higher than expected, respectively, according to the literature, they say.
Mehl and colleagues comment: “Awareness among health professionals of the important role that nutrition plays in overall wellness and disease treatment is very low, and should be encouraged. An early and timely nutritional intervention will help reverse the negative consequences of malnutrition. The use of a specialised oral nutritional supplement aimed at healing should be considered from the initial assessment as a tool of early intervention in wound treatment.
“An adequate nutritional status can be measured not only through wound evolution and resolution but also through absence of infections and other complications during the healing process. The specialised oral nutritional supplement tested achieved the nutritional goals and provided this study with results that corroborate the findings in the literature.”
Despite saying that the findings of this study are “promising”, the authors also say a larger study is needed to corroborate their results.