The Essential Role of Nutrition in Wound Care

When tackling the complexities of wound healing, it is easy to overlook your patient’s nutritional status on this journey. We often glaze over nutrition in wound care and focus on other concerns when the healing process is not optimal, posing questions like: Have we ordered vascular studies? Have we gotten them on to the most adequate support surface? Is there an underlying infection we need to address? Why has healing stalled?!

The frustration can be overwhelming. Which is one of the reasons to remember the importance of nutrition in wound healing.

According to the National Library of Medicine, good nutrition is essential for healing, though this is often the last box we check when reviewing wound healing requirements. Nutrition in wound healing is so much more important than the attention we often give it, and conversations surrounding nutrition should take place with patients and their caregivers at the beginning of treatment. Ongoing reinforcement of this education is also critical. Let’s look at some of those essential nutrients.

Essential nutrients in wound care

Protein: Everyone knows this one! It’s usually the first thing we bring up when talking about nutrition with our wound patients. Protein deficiency is associated with poor healing rates, decreased collagen formation, and wound dehiscence. A highly draining wound can cause a protein deficit of up to 100 grams per day. And that’s just for one wound! Now, imagine your patient with multiple pressure injuries and moderate to high-draining wounds. The protein losses stack up, and the impact of protein deficiency on these patients can be profound. Add in lean muscle loss to the equation, and you may feel like you’re fighting a losing battle.

All wound care patients should be provided nutrition education to help them visualize protein as building blocks and using “food as medicine” during the wound healing process. Good protein sources include lean meats, fish, eggs, beans, yogurt, cottage cheese, nuts, seeds, milk, and cheese. A good protein supplement in the form of shakes or bars may also be suggested. It is important to instruct patients that these supplements are for use between meals already high in protein and not to be used as meal substitutes. Dialysis patients should consult their nephrologist about safe amounts of protein intake prior to altering their diet.

Calories: During wound healing, the body requires calories to repair tissue. Due to the energy demanding process of wound healing, it is important for your patient to take in enough calories. In more severe wounds, the body’s hyper metabolic state can cause up to 50% more calorie use. It may be helpful to educate these patients that their current diet is managing their everyday metabolic demands and there is truly not much left over for the body to use to heal their wound. Individuals with less severe wounds usually do not require a significant calorie surplus. When recommending an increase in calorie intake, educate your patient on the most healthful way to achieve this. This will prevent an unnecessary excessive intake of sodium and sugar. This is especially important with your diabetic patients.

Fluids: Adequate hydration will assist the body in delivering the necessary nutrients to the healing wound. Patients with highly draining wounds or chronically dehydrated patients will need to increase their hydration to achieve this. Education on proper choices for increasing hydration is important to prevent excess sodium, sugar, and caffeine consumption. Dialysis and heart failure patients should check with their nephrology and cardiology specialists prior to making significant changes in their fluid intake. Diabetic patients will also need special focus on appropriate ways to increase their hydration status while also managing their blood sugar levels.

Vitamin A: Vitamin A is an important nutrient during the proliferation phase of healing. It assists with the formation of new granulation and epithelial tissues. It also assists with collagen synthesis and angiogenesis. An increase in Vitamin A can also assist wound healing of a chronic oral steroid patient by helping cellular migration. Good sources of Vitamin A include eggs, carrots, sweet potatoes, liver, spinach, broccoli, pumpkin, bell pepper, kale, milk, tomatoes, fish, grapefruit, and cantaloupe.

Vitamin C: Vitamin C is used by the body throughout all phases of wound healing and is significant in collagen formation. JAMA (The Journal of the American Medical Association) noted back in 1942 that a deficiency in Vitamin C may contribute to the breakdown of non-infected surgical wounds in patients with cachexia and patients with a gastrointestinal anomaly. Good sources of Vitamin C include citrus fruits, bell peppers, strawberries, tomatoes, white potatoes, and cruciferous vegetables.

Zinc: A zinc deficiency alters the body’s inflammatory response. As a result, delayed wound healing may occur. Correcting this deficiency can help move the wound from the inflammatory phase into the proliferation phase. Good sources of zinc include cashews, beef, eggs, yogurt, milk, whole grain, chickpea, seeds, shellfish, almonds, chicken, beans, tofu, spinach, and oats.

Copper: Copper plays a role in angiogenesis, endothelial growth factor induction, and the stabilization of skin proteins. These are essential parts of the proliferation stage of wound healing. Good sources of copper include oysters, liver, sunflower seeds, avocado, nuts, beans, chickpea, whole grain, leafy greens, peas, salmon, fish, tofu, and lentils.

Arginine and Glutamine: Arginine assists Nitric Oxide to increase blood flow bringing oxygen and other vital nutrients to the wound. It also assists with angiogenesis, cell proliferation, and collagen formation. Glutamine provides energy to proliferating cells. Good sources of arginine and glutamine include meats, fish, nuts, seeds, legumes, whole grain, dairy products, tofu, spinach, and cabbage.

Additional nutrition in wound care considerations

A good, balanced diet should provide most patients with the nutrition they need for wound healing. Patients with chronic wounds, protein-calorie malnutrition, alcoholism, cachexia, and cancer patients will likely need supplementation to achieve adequate levels of nutrition for wound healing. These patients will benefit from increased and ongoing nutrition education.

Vitamin supplementation as well as protein supplementation in the form of shakes and/or bars will also be helpful. These patients, as well as diabetic patients, would also benefit from a referral to a professional nutritionist. As always, dialysis patients should consult their nephrologist concerning safe protein intake and fluid limitations prior to altering their diet.