Nutritional deficiency is the term used when the reserves of nutrients stored in the body are insufficient to support healthy cellular function. A wound requires nutrients to be redirected from their normal functions to use in the various stages of the healing process.

However, when the individual is malnourished, any trauma may prove disastrous as they lack the reserves to respond to the metabolic demands of the wound. It is worth noting that malnutrition refers to insufficient calories, protein, or other nutrients needed for tissue maintenance and repair.

The World Health Organization has outlined different forms of malnutrition. This includes malnutrition related to undernutrition, wasting, and overweight and obesity amongst others. The body requires macronutrients and micronutrients to support body functions and systems.

Macronutrient refers to the energy yielding nutrients such as carbohydrates , proteins , and fats , whereas micronutrients refers to non-energy yielding nutrients such as vitamins and minerals. Micronutrients generally support the functions of macronutrients and as such, are vitally important to the wound healing process.

See below for the breakdown of the roles played by macro- and micronutrients in wound healing:. Screening tools that are quick, easy to use and have been validated should be used to identify individuals with wounds who are at risk for malnutrition.

A variety of validated tools are available for the conduct of a nutritional screen. These include: the Malnutrition Screening Tool MST , the Short Nutritional Assessment Questionnaire SNAQ and the Mini-Nutritional Assessment-Short Form MNA-SF®.

The MST and the SNAQ were developed to help health care providers quickly screen nutritional status in acute care settings. The MST tool has three screening parameters: body mass index BMI with alternative measures noted if BMI is not appropriate, weight loss, and the acute disease effect score.

The total of the three scores identifies low, medium or high risk nutritional status and includes appropriate interventions linked to each level of risk. The MNA-SF ® is validated in both the community and healthcare setting specifically for adults over The questions on the MNA-SF® address appetite, weight loss in the past three months, mobility, psychological stress or acute disease, neuropsychological problems, and BMI.

Additional tools are the Subjective Global Assessment SGA and the Nutrition Risk screening NRS Weight loss, low BMI, and reduced appetite, which are predictors for the risk of malnutrition, are common characteristics of these validated tools.

Once a nutrition assessment is completed, and the gap between the nutrients needed and the nutrients consumed is identified, efforts to meet the nutrient gap should be part of the plan of care.

Oral nutritional supplements ONS , enhanced and fortified foods can be used to prevent or manage unintended weight loss and malnutrition in individuals who are unable to consume their estimated nutritional requirements consuming a regular diet.

Posthauer ME. The Case for Implementing Validated Nutrition Screening Tools in Wound Care. Accessed April 3, White J. Consensus Statement: AND and ASPEN: characteristics recommended for the identification and documentation of adult malnutrition undernutrition.

J Acad Nutr Diet. Vitamin E, another type of antioxidant, is found in nuts, leafy greens, and avocados. Zinc helps make proteins and can be found in red meats and beans.

The overwhelming benefits of real foods outweigh taking general vitamin and mineral supplements. If you are found to be deficient in a nutrient, a healthcare professional can recommend a supplement.

Tip: Load your plate with vibrant colors! Fruits, vegetables, and whole grains are rich in cancer-fighting, wound-healing nutrients. Each food group plays a part in contributing unique nutrients. Check out the New American Plate from the American Institute of Research to see how you can tweak your plate to get the most out of a meal.

Staying hydrated helps your blood carry essential nutrients to areas of healing. Think of fluids like the delivery truck that drops off what you need, right where you need it.

This is important because dehydration can delay recovery. Not to mention, staying hydrated is key to tolerating chemotherapy and radiation therapy. Types of hydrating beverages include water, juices, and sports drinks. Water content is high in foods like watermelon, berries, popsicles, and gelatin.

Tip: Check your body for things like a dry mouth and lips, dry and flaking skin, little or no urine, and lack of energy. This is especially important during summertime! Your body could be telling you to hydrate. There are, of course, many factors that play a role in the healing process.

Blood sugar is a major factor. If you or a loved one have been diagnosed with diabetes mellitus, it is even more crucial to manage blood sugars for recovery.

Consult with your primary care physician and registered dietitian for support in managing blood sugars. Smoking not only has health risks like cardiovascular disease and cancer but a less recognized risk of smoking is delayed wound healing.

This is important to address since even one cigarette per day can increase risks for infection and poor wound healing. Talk to your healthcare team about your goals around smoking cessation.

pdf abbottnutrition. ESPEN expert group recommendations for action against cancer-related malnutrition — ScienceDirect.

Radiation and Diet eatright. Nutrition Tips to Improve Wound Healing clevelandclinic. New American Plate — American Institute for Cancer Research aicr. Blog — February 9, Blog Posts.

Proteins are an amazing nutrient, doing everything from maintaining cell growth to balancing fluids to helping with blood clotting. When it comes to wound care, proteins help support immunity while also assisting with the repair and synthesis of cells, as well as collagen and connective tissues.

Carbs not only provide the energy the body needs to heal, they also stimulate insulin production, which is helpful in the anabolic processes of wound healing. As the most concentrated source of calories, fats provide a vital source of energy. Vitamin A, C, E and K. These vitamins provide a number of benefits, including.

Vitamin A helps collagen synthesis and epithelization, which contribute to wound closure. Vitamin C is important for membrane integrity and as an anti-oxidant. Vitamin E, among its many benefits, can help heal wounds infected with methicillin-resistant Staphylococcus aureus MRSA.

Vitamin D plays a critical role in two of the more challenging wounds to treat — venous and pressure ulcers 8 , and recent studies have identified vitamin D receptors in a variety of tissues where their presence was previously unknown.

Apart from calories, another factor of malnutrition to consider in wound healing is fluid intake. Work with caregivers, the nursing and dietary team to make sure fluid intake is carefully monitored.

Nutrition Matters in Wound Healing The science behind the critical role nutrition plays in wound care continues to grow. November 1, Share this post.

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Introducing 'MUST'. Global Nutrition Report Haesler E Ed. European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance.

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Nutritional Support. Section editor: Nancy Munoz. Wound Healing and Nutritional Support The body requires macronutrients and micronutrients to support body functions and systems. See below for the breakdown of the roles played by macro- and micronutrients in wound healing: Proteins: Vital to the healing process.

Supports platelet function, fibroblast proliferation, and wound remodeling. Helps with formation of lymphocytes, collagen, and new vasculature. Carbohydrates: Provide energy for recovery. Glucose is vital to wound healing as it supports cell growth, fibroblasts, and leukocytes.

It plays a vital role in cell communication as a part of the immune response. Energy needs must be met in order to spare protein for wound repair and healing.

Fats: Helps meet the increased caloric demand that results from post-trauma hypermetabolism. Influences the localized metabolism of the wound.

Helps modulate inflammation and the immune response. B Vitamins: Moderates local wound metabolism and tissue synthesis. Participates in collagen synthesis. Vitamin C: Helps stabilize collagen, and support the tensile strength of the wound tissues.

Modulates free radical metabolism. Vitamin D: Regulates growth and differentiation of cells, including lymphocytes, melanocytes, and fibroblasts. Vitamin K: Required for blood clotting.

Zinc: Supports protein synthesis and immune functions. Vital for cell growth and proliferation, liberates vitamin A from the liver, interacts with platelets in flood clotting. Mega doses of zinc may inhibit healing and cause copper deficiency anemia. Iron: Delivers oxygen to tissues.

Generation of energy from cells, transferrin, a blood protein, transfers iron to the tissues of the bed. Copper: Helps facilitate angiogenesis. Assists with cross linking of collagen fibers to rebuild tissue.

Fluid serves as the solvent for minerals, vitamins, amino acids, and glucose, maintains fluid and electrolyte balance. Nutritional Interventions in Wound Management Screening tools that are quick, easy to use and have been validated should be used to identify individuals with wounds who are at risk for malnutrition.

References Molnar JA, eds. Nutrition and Wound Healing. Boca Raton, Fl: CRC Press; Related Products. Nature of Wound Healing: Lessons from 17th Century.

Protein-energy malnutrition PEM is when there is an inadequate or impaired absorption of both protein and energy. PEM causes the body to break down protein to use for energy, reducing the supply of amino acids needed to maintain body proteins and healing; this causes loss of lean body mass.

As an individual loses more lean body mass LBM , wound healing is more likely to be delayed. There are a number of nutrients that play an important role in wound healing. The following is a summary of these nutrients:. Protein is essential for the maintenance and repair of body tissue.

Low protein levels will cause a decrease in collagen development, slowing the wound healing process. Adequate protein levels will help achieve optimal wound healing rates. Sources of protein include red and white meats, fish, eggs, liver, dairy products milk, cheese, and yoghurt , soy beans, legumes, nuts and seeds.

The main sources of energy for the human body — and for wound healing — are carbohydrates and fats. The main demand for energy from a wound is produced by collagen synthesis. Energy needs for healing increase according to increasing size and complexity of the wound. Fats, including mono- and polyunsaturated fats, provide vital fuel for wound healing.

Fats are a safe and concentrated source of energy. Adequate fats are needed to prevent the body using protein for energy. Fatty acids are a major component of cell membranes, and demands for essential fatty acids increase after injury.

Good sources of fats to promote wound healing include meat, full-fat dairy products such as milk, cheese, butter, cream, yoghurt, ice-cream, and oils and fats used in cooking or as spreads. It is important to aim for weight maintenance during wound healing.

If a person is overweight they should not try to lose weight until their wound has completely healed. A person who is underweight should try to put on enough weight to bring them into the normal range.

L-Arginine is an amino acid that has properties that enhances some of the pathways involved in wound healing, such as its role in structural protein synthesis. As the body needs more protein during wound healing the demand for normally nonessential amino acids, such as l-arginine, becomes conditionally essential.

Dietary supplementation with arginine has been shown to enhance protein metabolism, helping to reduce muscle loss, and collagen synthesis, which then helps to increase the strength of the wound. This is why arginine-containing nutritional supplements, such as Arginaid, may be useful.

Vitamin C plays an important role in collagen synthesis and subsequent cross-linking, as well as the formation of new blood vessels angiogenesis. Adequate Vitamin C levels will help strengthen the healing wound.

Vitamin C deficiency has been found to impair wound healing and has also been associated with an increased risk of wound infection.

Research has shown vitamin C supplementation helps promote pressure ulcer healing. Vitamin C is found mostly in fruit and vegetables, especially oranges, grapefruit, tomatoes, and leafy vegetables.

Fruit juices with added vitamin C are also a good source, although often they contain only small amounts of vitamin C. Vitamin A increases the inflammatory response in wounds, stimulating collagen synthesis.

Low vitamin A levels can result in delayed wound healing and susceptibility to infection. Serious stress or injury can cause an increase in vitamin A requirements. While the mechanisms of vitamin A in wound healing are still not well understood, it is clear that it plays an important role.

Supplementation with vitamin A requires caution, as there is a risk of toxicity. Vitamin A is found in milk, cheese, eggs, fish, dark green vegetables, oranges, red fruits and vegetables.

Zinc is a trace element, found in small amounts in the body, which plays a role in wound healing. Zinc is involved in protein and collagen synthesis, and in tissue growth and healing. Zinc deficiency has been associated with delayed wound healing, reduced skin cell production and reduced wound strength.

Dietary zinc sources include red meat, fish and shellfish, milk products, poultry and eggs. Iron is a mineral that provides oxygen to the site of the wound; therefore iron haemoglobin deficiency can impair healing. Iron deficiency can also result in impaired collagen production and strength of the wound.

The best sources of iron in the diet are red meat, offal, fish, eggs, wholemeal bread, dark green leafy vegetables, dried fruits, nuts and yeast extracts.