Malnutrition is a significant issue in aged care and an independent risk factor for the development of Pressure Ulcers. Therefore it follows that adequate nutrition can play an important role in the healing of Pressure Ulcers. Pressure Ulcers can be categorized in stages from I – IV. Nutritional requirements for a stage IV ulcer can be very different for those of a stage I ulcer.

Pressure ulcer prevention requires a team approach. Residents should undergo regular screening for pressure ulcers and malnutrition to ensure that early interventions are initiated. It is important to remember that residents can also be malnourished whether they are of a healthy weight, overweight or obese.  

There are some key nutrients that are important in the healing process, including:

• Energy
• Protein
• Fluid
• Micronutrients (zinc and iron, and vitamin A and C)

We also look at the role that the amino acid Arginine may play in the healing process.

Energy

Energy is essential for pressure ulcer healing as it is required for the development of collagen (a type of protein that connects and supports other body tissues). Energy requirements increase according to the increasing size and complexity of the wound site.

A mix of carbohydrate, protein and fat provides the body with energy. Food intake should not be heavily restricted when pressure ulcers are present due to increased energy requirements. Energy requirements must be individualised based on clinical status. An Accredited Practising Dietitian should be engaged to manage individualised energy requirements and any dietary restrictions.

Protein

Protein is essential for the maintenance and repair of body tissue.  Protein improves healing by increasing adequacy of blood flow, improving immune function, and reducing any protein losses which are the result of breakdown of tissue.

Fluid

Hydration is important for healing as the skin is more susceptible to breakdown when it is dehydrated. Dehydration can also affect the efficiency of blood circulation which reduces the supply of oxygen and nutrients to the wound site. Fluids can include the more obvious choices such as water, cordial, juice, milk, tea and coffee as well as soups, gravies, custards and yoghurts. See following page for more suggestions on high fluid foods.

However, adequate energy is essential, otherwise the body will utilise protein for energy rather than for wound healing. Protein in excess of 2g/kg/day is not recommended as it may affect renal and hepatic function. Good sources of protein include meat, poultry, eggs, dairy products and soy products.

Micronutrients

Micronutrient deficiencies can negatively affect pressure ulcer healing, but studies suggest that supplementation should be given only if a deficiency exists. Zinc is essential for skin repair as is vital for collagen production and enhances tissue regeneration. It is also involved with taste and smell perception. Assessing zinc deficiency is difficult as serum levels may not be true indicator of the level at the wound. Iron plays a role in transporting oxygen around the body, and is essential for a strong immune function.

Vitamins also play a role. Vitamin A increases the development of collagen and supports immune function. Vitamin C plays a role in collagen development, and is an antioxidant which helps the immune system. Studies on vitamin E indicate that it may reduce injury to the wound by controlling excessive free radicals.

Arginine

L-Arginine is a non-essential amino acid which becomes essential during wound healing. Research indicates that it is beneficial to wound healing for a stage II pressure ulcer or above. Supplementation with arginine for wound healing has been shown to enhance protein metabolism, help decrease muscle loss, enhance the immune system and aid collagen synthesis. Studies indicate that adequate protein intake is necessary for any beneficial effect. There is ongoing research in this area, and it is important to remember that L-Arginine supplementation is just one part of the nutrition picture. First priorities should always be adequate energy, protein and fluid.