References

The importance of nutrition in wound healing. 2013. https://tinyurl.com/yczp33my (accessed 22 February 2021)

Arnold M, Barbul A. Nutrition and wound healing. Plast Reconstr Surg. 2006; 117:42S-58S https://doi.org/10.1097/01.prs.0000225432.17501.6c

Breslow RA, Hallfrisch J, Guy DG, Crawley B, Goldberg AP. The importance of dietary protein in healing pressure ulcers. J Am Geriatr Soc. 1993; 41:(4)357-62 https://doi.org/10.1111/j.1532-5415.1993.tb06940.x

British Association for Parenteral and Enteral Nutrition. Malnutrition Universal Screening Tool. 2006. https://www.bapen.org.uk/pdfs/must/must-full.pdf (accessed on 18 October, 2020)

British Association for Parenteral and Enteral Nutrition. What are the consequences of malnutrition?. 2018. https://tinyurl.com/ycybdg3s (accessed 22 February 2021)

British Dietetic Association. The management of malnourished adults in all community and all health and care settings. Policy statement. 2017. https://tinyurl.com/ybxgof3f (accessed 19 October 2020)

Brown L. Wound essentials 4: nutrition screening—to identify risk of malnutrition. Wounds UK. 2009; 4:8-13

Cederholm T, Barazzoni R, Austin P ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr. 2017; 36:(1)49-64 https://doi.org/10.1016/j.clnu.2016.09.004

Chen CCH, Schilling LS, Lyder CH. A concept analysis of malnutrition in the elderly. J Adv Nurs. 2001; 36:(1)131-142 https://doi.org/10.1046/j.1365-2648.2001.01950.x

The cost of malnutrition in England and potential cost savings from nutritional interventions (short version). A report on the cost of disease-related malnutrition in England and a budget impact analysis of implementing the NICE clinical guidelines/quality standard on nutritional support in adults. 2015. http://www.bapen.org.uk/pdfs/economic-report-short.pdf (accessed 22 February 2021)

Combating malnutrition: recommendations for action. report from the advisory group on malnutrition, BAPEN. 2009. https://www.bapen.org.uk/pdfs/reports/advisory_group_report.pdf (accessed 22 February 2020)

Gogia PP. Physiology of wound healing. In: Gogia PP (ed). Thorofare (NJ): Slack Incorporated;

Green SM, Watson R. Nutritional screening and assessment tools for use by nurses: literature review. J Adv Nurs. 2005; 50:(1)69-83 https://doi.org/10.1111/j.1365-2648.2004.03350.x

Guest JF, Vowden K, Vowden P. The health economic burden that acute and chronic wounds impose on an average clinical commissioning group/health board in the UK. J Wound Care. 2017; 26:(6)292-303 https://doi.org/10.12968/jowc.2017.26.6.292

Guo S, DiPietro LA. Factors affecting wound healing. J Dent Res. 2010; 89:(3)219-229 https://doi.org/10.1177/0022034509359125

Johnston E. The role of nutrition in tissue viability. Wound Essentials. 2007; 2:10-21

Keys A, Brozek J, Henschel A, Mickelsen O, Taylor HL. The biology of human starvation.Minneapolis (MN): University of Minnesota Press; 1950 https://doi.org/10.5749/j.ctv9b2tqv

Lansdown ABG, Mirastschijski U, Stubbs N, Scanlon E, Ågren MS. Zinc in wound healing: 5heoretical, experimental, and clinical aspects. Wound Repair Regen. 2007; 15:(1)2-16 https://doi.org/10.1111/j.1524-475X.2006.00179.x

Molnar JA, Underdown MJ, Clark WA. Nutrition and chronic wounds. Adv Wound Care. 2014; 3:(11)663-681 https://doi.org/10.1089/wound.2014.0530

National Institute for Health and Care Excellence. Nutrition support in adults. Quality standard QS24. 2012. http://www.nice.org.uk/guidance/qs24 (accessed 22 February 2021)

Porter J, Raja R, Cant R, Aroni R. Exploring issues influencing the use of the Malnutrition Universal Screening Tool by nurses in two Australian hospitals. J Hum Nutr Diet. 2009; 22:(3)203-209 https://doi.org/10.1111/j.1365-277X.2008.00932.x

Pryke R, Lopez B. Managing malnutrition in the community: we will all gain from finding and feeding the frail. Br J Gen Pract. 2013; 63:(610)233-234 https://doi.org/10.3399/bjgp13X665495

Quain AM, Khardori NM. Nutrition in wound care management: a comprehensive overview. Wounds. 2015; 27:(12)327-335

Dekubitusprophylaxe und-therapie aus ernährungsmedizinischer Sicht (article in German). 2005. https://tinyurl.com/ybs2dapr (accessed 22 February 2021)

Stratton R, Green C, Elia M. Disease-related malnutrition: an evidence-based approach to treatment.Wallingford: CABI; 2003 https://doi.org/10.1079/9780851996486.0000

Sundaramurthi D, Krishnan UM, Sethuraman S. Electrospun nanofibers as scaffolds for skin tissue engineering. Polym Rev (Phila Pa). 2014; 54:(2)348-376 https://doi.org/10.1080/15583724.2014.881374

2019. Wound healing phases. 2020 Treasure Island (FL): StatPearls Pu blishing. https://tinyurl.com/y8zbwbu6 (accessed 22 February 2021)

The role of nutrition in wound healing: an overview

11 March 2021

Nutrition

02 March 2021

Volume 30 · Issue 5

ISSN (print): 0966-0461

ISSN (online): 2052-2819

Abstract

Wounds are a commonly encountered and complex entity in healthcare, and often require multidisciplinary involvement for their management. Wound care and healing are affected by a range of factors of which nutrition, a modifiable factor, plays an integral part. Familiarity with the phases of wound healing and the differing nutritional requirements at each stage is fundamental to managing wounds. Additionally, awareness of the signs of malnutrition, screening tools and educational resources for managing malnutrition in primary care settings are all vital to minimising malnutrition and its adverse effects on wound healing. This article reviews the phases of wound healing and the associated nutritional requirements required for optimal healing, the clinical signs of malnutrition and screening resources for identifying at-risk groups, as well as reviewing current guidelines for managing malnutrition in the inpatient and outpatient setting.

Wound healing is a complex, multistep process influenced by a range of modifiable and non-modifiable risk factors. The failure of hard-to-heal wounds to progress to complete healing has been widely studied, and identifying nutritional status is key to achieving optimal wound resolution.

This article discusses the stages of wound healing, the role of macro- and micronutrients in the wound healing journey and the clinical signs of malnutrition. It also highlights screening tools for high-risk groups as well as resources available for the management of malnourished patients, particularly in community settings.

As defined by the British Association of Parenteral and Enteral Nutrition (BAPEN), malnutrition is a state where there is an imbalance (either deficiency or excess) of energy, protein and other nutrients that adversely affects tissue and bodily functions and clinical outcome (Chen et al, 2001; Johnston, 2007; Cederholm et al, 2017; BAPEN, 2018). Although malnutrition is often considered to be a purely deficient state, it encompasses obesity, and ‘undernutrition’ concerns inadequate nutritional states. For the purposes of this paper, the term ‘malnutrition’ will be used synonymously to mean ‘undernutrition’.

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Wound healing

Nutrition

Macronutrients

Micronutrients