Little, M. O. (2013). Nutrition and skin ulcers. Current Opinion in Clinical Nutrition & Metabolic Care, 16(1), 39-49.

Little conducted a study on the effects of good nutrition on the wound healing process in diabetic patients. The scope of the study involved patients suffering from diabetic wounds. Nearly 60 percent of the diabetic patients have lower limb amputations. Diabetic wound care requires proper nutrition guidelines that help to reduce the high rate of mortality. The author also examined the research by National Pressure Ulcer Advisory Panel (NPUAP) on the role of nutrition in prevention of pressure ulcers and its treatments. According to NPUAP study, a comprehensive nutritional assessment is the beginning point for maximum care. In this respect, it needs to include vitamins/minerals, fluids, proteins, calories and renal function. The author notes that the influence of diabetes on wound healing is multifactorial, complex and affects all phases of healing.

Hyperglycemia leads to tissue damage via the protein non-enzymatic glycation. Proteins such as hemoglobin, albumin, fibrin and collagen accrue advanced products of glycation. These can lead to thickening of the cell membrane in the microcirculation. Consequently, it causes ischemia and delayed healing of wound. In addition, inadequacy of insulin in diabetic wounds causes higher levels of protein degradation and decreased formation of collagen. Subsequently, it affects the capacity of the body to heal the wounds. The study findings show that since carbohydrates is the main source of energy for the tissues, particularly those involved in the healing of wound, poor utilization of carbohydrates leads to proteolysis. In addition, because of hyperglycemia causes more lipolysis, glycogenolysis and ultimate decrease in the rate of wound healing.

Moreover, hyperglycemia causes osmotic diuresis and water and electrolyte loss that negatively affect wound healing because it decreases oxygenation of tissues. Intracellular and extracellular dehydration take place, destroying the capacity of the skin to heal. In addition, the study findings reveal that hyperglycemia affects the activity of white blood cells, immune function, and macrophages that causes higher levels of risk of infection and decreased wound healing ability. Furthermore, it causes production of free radicals that increases the oxidative stress and leads to tissue damage. Therefore, the study concludes that patients suffering from diabetic wounds should subject to medical nutrition therapy (MNT).

Patel, G. K. (2009). The role of nutrition in the management of lower extremity wounds. The International Journal of Lower Extremity Wounds, 4(1), 12-22.

A research by Patel, 2009 investigated the importance of good nutrition in wound healing. The researcher noted that health promotion is acceptable in many areas, but there is low priority in health care, as many patients do not receive nutritional assessment. The author argues that practitioners should have adequate knowledge on the role of nutrition in facilitating faster wound healing. Malnutrition complicates inhibits and delays the process of healing. The scope of the study involved patients affected by the wounds in their lower extremities. Nutritional support is the key to patient care and necessities changes depending on the individual. The study examines the relevance of nutrients such as proteins, carbohydrates and vitamins that play a key role in the process.

The findings of the study reveal that depletion of protein can affect the quality and rate of wound healing. In the presence of a wound, protein is required and its demand increases as due to stress and sepsis. In addition, it is needed because it takes part in the inflammatory process, immune response and granulation tissue development. During the wound healing process, protein such as collagen is synthesized. The strength of the collagen determines the strength of the wound tissue. Inadequacy of proteins causes delayed wound healing.

Carbohydrates are required in the healing process because they take part in hyper metabolic phase. Due to cellular activity, ATP provides energy for the inflammatory response to take place. However, when carbohydrates are insufficient, the body breaks down protein to supply glucose for cellular activity. The study concludes that carbohydrates and proteins are needed in order to correct hypoalbuminaemia.

Markova, A., & Mostow, E. N. (2012). US skin disease assessment: ulcer and wound care. Dermatologic clinics, 30(1), 107-111.

Markova & Mostow conducted a research on the wound care of elderly patients. The study revealed that most people experience slow or chronic wounds relative to osteoporosis. The scope of research involved 5076 persons aged over 50 years. The researchers noted that nearly 17 percent of the respondents reported that they suffer from a chronic or severe wound. Chronic wounds are a huge and increasing health burden on the society with slow wound healing. In addition, infection of wound puts significant financial liability on the health care systems and individuals. The study noted that chronic wounds such as pressure ulcers more than 200 000 people and the prevalence of PrU increases as people become older.

Fortunately, the author reveals that proper nutrition plays a critical role in wound care practices and wound healing. The better the nutritional intake of the patient, the healthier they are, and have a better chance to recover from illness. In addition, lack of proper nutrition before or during the healing of a wound is likely to impair the strength of wound and delay healing. Consequently, it makes the wound to be more prone to breakdown. In addition, nutritional health neglect of an individual suffering from a wound can adversely affect the wound management process. The process of healing of wound involves injured tissue replacements with new ones from the body. The research therefore, concludes that higher consumption of energy and specific nutrients is very important for these patients.

Additionally, delayed wound healing is a product of risk factors such as arthritis, polypharmacy, kidney diseases and smoking as well as older age over 65 years.  Therefore, the elderly require essential elements such as protein, carbohydrates and vitamins.

Tappenden, K. A., Quatrara, B., Parkhurst, M. L., Malone, A. M., Fanjiang, G., & Ziegler, T. R. (2013). Critical role of nutrition in improving quality of care: an interdisciplinary call to action to address adult hospital malnutrition. Journal of the Academy of Nutrition and Dietetics, 113(9), 1219-1237.

A study by Tappenden, Quatrara, Parkhurst, Malone, Fanjiang, & Ziegler examine the role of supplemental nutrition in the wound healing process. In order to satisfy the proteins and calorie needs, supplements are required in some people. They include homemade high-calorie or high-protein or commercial supplements such as Glucerna, BOOST or similar supplements. The body produces amino acid known as arginine in adequate levels. The scope of the study involved a group of hospitalized patients who were suffering from malnutrition and with diabetic wounds. Nonetheless, illness and stress may need more amounts of arginine to enhance wound healing.

Therefore, high amounts of proteins and calorie will be required to as the first priority. Patients experiencing insufficient nutritional status were provided with multivitamins and additional zinc and vitamin C. the study findings demonstrated that wound healing process requires vitamin B-complex. Vitamins acts as co-enzymes cofactors in different metabolic functions in the process of wound healing. They help in releasing energy from carbohydrates. In addition, vitamin C has a crucial role in synthesis of collagen, bond formation between collagen fiber strands.

Furthermore, they also help to provide stability and strength to the wound. The findings of the study points out that vitamin c help in sepsis, stress and injury.  Vitamin K supplements assist to form thrombin and its deficiency during this process leads to a hematoma. Minerals such as Zinc are beneficial in wound healing as they act as co-factors in the protein synthesis. During cell proliferation, there are higher demands of zinc.

References

Little, M. O. (2013). Nutrition and skin ulcers. Current Opinion in Clinical Nutrition & Metabolic Care, 16(1), 39-49.

Markova, A., & Mostow, E. N. (2012). US skin disease assessment: ulcer and wound care. Dermatologic clinics, 30(1), 107-111.

Patel, G. K. (2009). The role of nutrition in the management of lower extremity wounds. The International Journal Of Lower Extremity Wounds, 4(1), 12-22.

Tappenden, K. A., Quatrara, B., Parkhurst, M. L., Malone, A. M., Fanjiang, G., & Ziegler, T. R. (2013). Critical role of nutrition in improving quality of care: an interdisciplinary call to action to address adult hospital malnutrition. Journal of the Academy of Nutrition and Dietetics, 113(9), 1219-1237.

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