Nutritional status of elderly patients with venous ulceration of the leg–report of a pilot study

The role of nutrition in the management of lower extremity wounds

From 3000 BC, healers have understood the importance of nutrition in wound care and used nutritional supplements to aid healing. Many of the teachings from Hippocrates, the father of modern-day medicine, clearly state his firm belief that good health can be achieved through nutrition. In the early 1900s when advances in biochemistry were frequent, many of the essential constituents of nutrition were characterized, which formed the basis for many animal and human wound-healing experiments. This led to the discovery of vitamin C, zinc, and many other components essential for the orderly progression of healing. Modern-day research has concentrated on finding nutritional components that can enhance healing through supra-physiological doses, such as in the use of the amino acids arginine and carnitine. However, clinicians need to be aware that approximately 50% of patients admitted to the hospital are malnourished, requiring dietary supplementation; appropriate nutritional assessment and advice therefore should be an integral part of all wound management. This review provides an up-to-date commentary on the role of nutrition in wound care, with specific emphasis on lower limb wounds, from a historical perspective, and within it both the biomedical approach and current herbalist practices are considered.

Can individualised nutritional support improve healing in therapy-resistant leg ulcers?

OBJECTIVE

This study investigated whether an individually designed programme of nutritional support can improve healing in otherwise therapy-resistant venous leg ulcers.

METHOD

Six primary health-care patients, aged between 79 and 93 years, with venous ulcers that had been open for one year or more (range: 1.5-8 years) were recruited into the study. The patients were asked to follow an individualised diet plan which included the use of liquid dietary supplements. Ulcer area, anthropometric and biochemical variables, and energy and nutrient intake were assessed before intervention and then regularly for nine months.

RESULTS

At nine months ulcer healing had occurred in two patients, of whom one had had ulcers on both legs. In a third patient the ulceration on one leg had healed and that on the other leg had almost healed. In a fourth patient, the ulcer area reduced by approximately 90%.

CONCLUSION

The use of nutritional support might have assisted the wound healing in these patients. Although the relationship between nutritional supplementation and wound healing is not well defined, an appropriate nutritional plan is recommended if undernourishment is suspected and leg ulcers are not healing.