Nutrition 411: Vitamin Supplementation: The Lingering Questions in Wound Healing
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The decision to recommend vitamin supplements to patients with wounds continues to be an open question for wound care and nutrition experts. Studies to date have not conclusively shown that routine multi- or individual vitamin supplementation in the absence of specific nutrient deficiencies hastens wound healing. The issue of vitamin supplementation is important and often discussed in the wound care world but is not extensively researched. This leaves many healthcare professionals to make treatment decisions based on the limited evidence they see in the available literature. In clinical situations, more often than not practitioners must rely on expert opinion and professional judgment as their guideline.1
Data in the available studies are difficult to evaluate for many reasons. Some research does not include enough anthropometric information, such as patient height, weight, and body mass index (BMI); some studies lack detailed descriptions of the type of wounds involved; and many studies tend to categorize enteral or parenteral nutrition therapy as single entities without detailing their specialized nutrient profiles, making it difficult to know which nutrient combinations are responsible for any particular outcome.1
In addition, many older studies use outdated biochemical assessments, such as serum albumin and serum prealbumin. These blood values often are low because of the inflammation associated with the wound and not necessarily because of protein depletion. In studies of pressure ulcers specifically, it is difficult to separate the outcomes related to nutrition status from other variables, such as topical treatments, repositioning schedule, and mobility.1
Turning to Supplements
One thing experts know for sure is that under-nutrition is a large contributor to poor or delayed wound healing2,3 and that adequate nutrition has been shown to promote healing.4 To date, research evidence has been strong enough to establish nutrition guidelines in the case of pressure ulcers,5 but these are just one type of wound among many, including diabetic ulcers, arterial ulcers, venous ulcers, burns, traumatic injuries, and surgical incisions. No guideline similar to what is available for pressure ulcers as yet exists for these other types of wounds.3
In the quest to achieve optimal wound care for their patients, many healthcare providers feel compelled to be as proactive as possible, turning to vitamin and mineral supplements as the answer to a faster, more complete recovery. Many health professionals themselves report taking vitamin supplements and often recommend them to their patients.6 Surveyors, plaintiff attorneys, family members, and others may inadvertently influence care because lack of interventions may be misconstrued as lack of care.
Although this notion of looking to multivitamins for added healing support is not misguided, it is important for health providers to be aware not only of the benefits provided, but also the possible harm these supplements may cause and to understand the importance of obtaining an accurate nutritional assessment of their patients. Such an assessment should include a list of comorbidities, patient history, medications, usual food intake, and prior nutritional status. In addition, a detailed wound history is necessary, including evaluation of any wound drainage, use of air-fluidized mattresses, and other factors that may affect nutrition.