ARLINGTON, VA. — It may not be the first tool that physicians think of, but nutrition can be a powerful one against pressure ulcers, dietitian Mary Ellen Posthauer told a meeting of the National Pressure Ulcer Advisory Panel.
“Please involve dietitians early on if you see people with pressure ulcers or those who are at high risk of developing pressure ulcers,” said Ms. Posthauer of the company Supreme Care West in Evansville, Ill.
People with pressure ulcers are in a hypermetabolic condition, she explained. A small person with a pressure ulcer is probably pulling protein from his or her lean body tissue.
More research is needed on the impact of nutrition on wound healing in obese patients, Ms. Posthauer said. Patients with stage III or IV pressure ulcers should not be on restricted diets. Patients with pressure ulcers need to eat 30-35 kilocalories per kilogram of body weight a day, she said. “If the person doesn't eat the food, you aren't going to get wound healing.”
Ms. Posthauer offered several tips for how to provide enough calories:
▸ Consider the individual's favorite foods and cultural preferences. The goal is to serve “foods that they are actually going to eat, not give to their tablemates.”
▸ Offer variety. A chocolate milkshake is less attractive than usual when a person gets three a day.
▸ Use fortified foods, such as high-density cereal and pudding, or follow recipes for high-calorie, high-protein foods.
▸ Offer high-calorie, high-protein supplements, using trial and error to determine which one the patient prefers. Research has shown that offering a nutritional supplement between meals improves the acceptance of the supplement and mealtime food.
“There needs to be a team effort in following up to see that the food is being consumed,” Ms. Posthauer emphasized. “Dietitians are great at developing menus and sending out food, but if nobody is eating it, we haven't achieved much.”
Studies have shown that increased protein intake is associated with better healing of pressure ulcers, with a recommended daily intake of 1.25 to 1.5 g/kg of body weight. But it's important to monitor both healing rates and renal function in a person getting supplements and to adjust intake as needed, Ms. Posthauer said. “Monitor the healing, and if you aren't seeing results, try increasing the amount of protein.”
Enteral nutrition is an option for some individuals, but only if it is monitored carefully, Ms. Posthauer said. When considering enteral nutrition, ask the individual and family members whether they understand the risks and benefits associated with this more invasive form of feeding. If individuals receive tube feeding, then the formula for the liquid being administered should be evaluated periodically to make sure that it is providing enough calories and protein to improve wound healing.
Research does not support the use of mega doses of vitamin C to enhance wound healing, but some evidence supports the use of zinc supplements if a deficiency exists in that mineral. Strive for a balanced diet and confirm a deficiency before adding any vitamin supplement, said Ms. Posthauer. Remember that many liquid calorie supplements meet the daily recommendations for most vitamins and minerals, so further additions may be unnecessary, she added.
Relatives may know which foods older kin prefer and may offer strategies to help elders get the calories they need for optimal wound healing.
Ms. Posthauer disclosed no financial conflicts relevant to her presentation.