What is the significance of nutrition in the treatment of diabetic ulcerswounds

The MNA is available in over a dozen languages, allowing patients to complete it independently in the waiting room and then hand it to the clinician for review. In general, nutrient deficiencies can affect the complex process of wound healing in a multitude of ways. For these reasons, it is important to ask patients about their food intake and help them understand the importance of eating a variety of nutrient-dense foods each day.

A validated nutrition screening tool is an easy way to begin to do this. Once the risk information is obtained, clinicians may face challenges in deciding what to say to patients when a problem is uncovered. Remind patients to read food labels on all foods and to look for the sugar content.

For example, yogurt often has hidden sugar, so stress the importance of getting into the habit of looking at food labels. This question is a little more complex because it depends on how well patients are eating, if weight loss has recently occurred, and many other factors, including other medical conditions. In general, a multivitamin and mineral supplement is probably a good idea. An optimal diet alone usually is adequate to meet all the vitamin and mineral requirements of healthy individuals.

A supplement can fill any gaps and acts as a good insurance policy. Many micronutrients are involved in wound healing, including vitamin A, vitamin C, magnesium, copper, and zinc. Unfortunately, not many studies are available to help determine optimal intake levels or if supplementation is beneficial. What is known is that every patient should meet the Dietary Reference Intakes DRIs for vitamins and minerals for these and other nutrients daily.

In addition, sometimes supplementation of specific nutrients is recommended if a deficiency is confirmed or suspected. The big unanswered question is whether to supplement above the DRI level, and if so, how much above?

Many clinicians recommend additional vitamin C and zinc. Vitamin C is water soluble and may help in other areas including immune function, so if patients take additional vitamin C, it is not of much concern. Zinc, however, is more concerning because it is not water soluble, and long-term zinc supplementation may in turn cause a copper deficiency.

Additional zinc is typically recommended only for correcting a known or suspected deficiency. Vitamin D deficiencies are quite common and are easily identified by a simple blood test. If a deficiency is confirmed, patients should receive supplementation along with a recommendation to sit in the sunshine for minutes every day.

Individuals with darker skin will require a longer time in the sun for complete vitamin D synthesis. A newer treatment beyond vitamins is supplementing with amino acids. Amino acids are the building blocks of protein. Arginine is an amino acid that supports nitric oxide production, and thereby blood flow, and is a building block for protein, which can contribute to wound healing.

Glutamine plays a role in collagen production in fibroblast cultures and supports the immune system. HMB is a compound found in small amounts in the body and in small amounts in certain foods, such as grapefruit, alfalfa, and catfish. Because the conversion rate is not very high and the foods it is found in are not typically consumed in great amounts, supplements are used.

In order to replenish the specific amino acids needed in an efficacious amount, a medical nutrition supplement often is used. Each packet of Juven contains 7 g of arginine, 7 g of glutamine, and 1. Each packet of flavored powder is mixed with about 8 fl oz of water or juice.

Fluid-restricted patients can mix the unflavored powder with food. Nutrition is a critical component of healing DFUs, particularly as it relates to immune function, malnutrition, glycemic control, and weight loss and weight maintenance.

It is very important not to overlook nutrition screening to identify any problems and then take the necessary steps to address any nutritional gaps. Healing begins from the inside out. Building new tissue requires calories, protein, and many vitamin and mineral cofactors. Poor nutrition can hinder the success of healing diabetic foot wounds, so make sure to ask patients about how their meals are going.

If you discover a complex nutritional problem that is beyond a simple discussion, refer patients to an RDN. Medical nutrition therapy for patients with diabetes is often a covered benefit on many insurance plans, as well as Medicare Part B.

Nancy Collins is a wound care-certified dietitian specializing in the relationship between nutrition and wound healing. She is also a medico-legal expert dedicated to improving provider-patient communication and bettering the patient experience. To contact her, visit her website, www. Hemoglobin A1c predicts healing rate in diabetic wounds. J Invest Dermatol. Targeted amino acid supplementation in diabetic foot wounds: pilot data and a review of the literature.

Surgical Infect Larchmt. Wound healing in diabetic foot ulceration: a review and commentary. Current aspects in the pathophysiology and treatment of chronic wounds in diabetes mellitus. BioMed Res Int. Accessed Apr 21, Sign in. Podiatry Today. Today's Wound Clinic. Symposium on Advanced Wound Care. Business Briefs. Consultation Corner. Facility in Focus. Legal Counsel. From the Editor. Hyperbaric Oxygen Therapy. Practice Management. Google Scholar. Maria Spicer. Keiser University.

Joseph Munoz. Bahram Arjmandi. Select Format Select format. Permissions Icon Permissions. Abstract Objectives. Issue Section:. Download all slides. View Metrics. Email alerts Article activity alert. Advance article alerts. Receive exclusive offers and updates from Oxford Academic. These ulcers are common, expensive to manage and cause significant morbidity and mortality.

The presence of a wound has an impact on nutritional status because of the metabolic cost of repairing tissue damage, in addition to the nutrient losses via wound fluid. Nutritional interventions may improve wound healing of foot ulcers in people with diabetes. Objectives: To evaluate the effects of nutritional interventions on the healing of foot ulcers in people with diabetes. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies.

There were no restrictions with respect to language, date of publication or study setting. Selection criteria: We included randomised controlled trials RCTs that evaluated the effect of nutritional interventions on the healing of foot ulcers in people with diabetes.