Nutrition, Anabolism, and the Wound Healing Process: An Overview

Robert H. Demling, MD

Disclosures

ePlasty. 2009;9:65-94. 

In This Article

Anabolic Hormone Adjunctive Therapy to Nutrition

As described, there are a number of key hormones involved with energy production, catabolism, and anabolism, all directly or indirectly affecting wound healing. The stress response to injury leads to a maladaptive hormone response, producing an increase in the catabolic hormones and a decrease in anabolic hormones, growth hormones, and testosterone. The altered stress hormonal environment can lead to both a significant increase in catabolism, or tissue breakdown, and a decrease in the overall anabolic activity.[9,10]

It is now well recognized that the hormonal environment, so critical to wound healing, can be beneficially modified.[108,109,130–138] In general, restoration or improvement in net protein synthesis and, therefore, in wound healing, is the result of 2 hormonal processes. The first is an attenuation of the catabolic hormonal response, and the second is an increase in overall anabolic activity, recognizing that adequate nutrition is being provided. Any hormonal manipulation that decreases the rate of catabolism would appear to be beneficial for wound healing. Blocking the cortisol response would seem to be intuitively beneficial and, as stated, growth hormone and testosterone analogues decrease the catabolic response to cortisol.

A number of clinical studies have demonstrated the ability of exogenous delivery of anabolic hormones to increase net nitrogen retention and overall protein synthesis. Wound healing has also been reported to be improved.* However, it remains unclear as to how much of the wound healing is the result of an overall systemic anabolic effect, or whether there is a direct effect on wound healing. Anabolic hormones for which data are available are listed in Table 18.

In subsequent sections, individual anabolic hormones will be discussed, including HGH, insulin-like growth factor (IGF), insulin, testosterone, and testosterone analogues, also known as anabolic steroids.

*References.[108,109,130–138,142–154]

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