Pressure Ulcers Improve With Nutrition Therapy

Beth Skwarecki

February 03, 2015

Malnourished patients given a specific nutritional supplement showed improvement in the size of their pressure ulcers in a recent multicenter randomized controlled trial, although previous trials had not shown the same effects with similar ingredients.

Both experimental and control groups were given a high-calorie, high-protein supplement, but the experimental group's supplement also contained high levels of zinc, arginine, and a group of antioxidants: selenium, manganese, and vitamins C and E.

The rate of complete healing of pressure ulcers did not differ between the groups, but patients who received the extra micronutrients showed a larger decrease in the area of their wounds, with a reduction of 60.9% (95% confidence interval [CI], 54.3% - 67.5%) in 101 patients who received the enriched formula vs 45.2% (95% CI, 38.4% - 52.0%) in 99 patients receiving the control, for an adjusted mean difference of 18.7% (95% CI, 5.7% - 31.8%; P = .017).

"To our knowledge, this is the first study supporting the usefulness of this mixture of specific nutrients in wound healing," write Emanuele Cereda, MD, PhD, from the Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo in Pavia, Italy, and colleagues in an article published online February 3 in the Annals of Internal Medicine.

The researchers recruited patients in long-term care facilities or home care who had a grade 2, 3, or 4 pressure ulcer. To be included, patients had to be malnourished but able to drink supplements. The mean age in both groups was approximately 81 years. Patients were randomly assigned by center and were given 400 mL per day of the nutritional supplement for 8 weeks. All patients received general dietary advice and evidence-based wound care that included pressure-relieving devices and repositioning programs. The authors caution that their results may not be seen in patients who do not receive optimized wound care.

Adverse events included gastrointestinal intolerance of the supplement (two patients in the experimental group and three patients in the control group). One patient in the experimental group was hospitalized for pressure ulcer-related sepsis, and 32 patients died for reasons believed to be unrelated to supplementation.

Patients receiving the supplement showed more of a reduction in the size of their pressure ulcers, but the researchers found no difference in the secondary outcomes of the study, including complete healing or the incidence of infections. Complete healing is thought to be a better outcome than area in studies of pressure ulcers, David Thomas, MD, from the Division of Geriatrics at the Saint Louis University School of Medicine, Missouri, told Medscape Medical News. Dr. Thomas was not involved in this study.

"It's one of the better studies in terms of nutrition and pressure ulcers," Dr Thomas said, but he noted that this trial should be taken in context with others that have shown no effect or negative effects of nutrition supplementation on pressure ulcers. The authors speculate that the supplement tested in this study may owe its efficacy to a synergistic combination of ingredients.

"We're sort of looking at an outlier trial," concluded Dr Thomas. "It's a very important and interesting study, but it needs to be replicated."

The authors and Dr Thomas have disclosed no relevant financial relationships.

Ann Intern Med. 2015;162:167-174.

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