Cath Lab Digest

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Index: Ostomy Wound Manage. 2008;54(9):34-42.

Abstract

  The nutritional requirements of healthy people differ from those who have chronic wounds and while it is generally suggested that the nutritional status of persons with chronic wounds must be addressed, actual data about the nutritional status of older adults with venous ulcers is limited. The nutritional status of hospitalized older adults (n = 40, average age 77 ± 7.4) with vascular disease was compared to randomly selected outpatients with venous insufficiency ulcers (n = 37, average age 70.4 ± 8.13) using the Mini Nutritional Assessment instrument. Among all patients assessed, 37 (48%) were at risk for malnutrition or were malnourished. No differences between nutritional status and age or gender were found. The proportion of patients at risk for malnutrition or currently malnourished was significantly higher in the venous ulcer (24 out of 37) than in the control group (13 of 40, chi² = 15.51, P < 0.05). Statistically significant differences were found between the control and venous ulcer group for all anthropometrical assessment variables (BMI, arm circumference, calf circumference, and weight loss in past 3 months), use of more than three prescription drugs, dietary history/assessment (appetite, fluid consumption, independent feeding), and patient self-rated health. The results of this study confirm that a complete patient assessment must include evaluating patient nutritional status and that nutritional disorders are a serious problem among the elderly, especially those with venous ulcers. Additional studies to help optimize the nutritional assessment and management of older adults with venous ulcers are needed.

KEYWORDS: nutritional assessment, malnutrition, venous ulcer, elderly, comparative study

   Wound healing requires optimal nutritional status. Studies^1-3 performed on animal models have shown that energy deficiencies and chronic protein malnutrition significantly inhibit the healing process. In humans, malnutrition even for a short time has been found to require a two-fold increase in collagen synthesis time and impairs granulation tissue formation. Every stage of the healing process – inflammation, granulation tissue formation, epithelialization, and remodeling – requires the distribution of nutrients in correct proportion.^4-6 Intensive proliferation processes and building materials for new cells require energy, obtained through carbohydrates and lipids, to prevent catabolism and avoid protein depletion that could lead to uncontrolled loss of muscle mass and severe malnutrition.^7-9

   Carbohydrates provide approximately 55% to 65% of an organism's energy needs, which equates to 35 to 40 kcal/kg/day in a healthy person. Patients with ulcers or in a catabolic state require increases of 25 to 30 kcal/kg/day over normal requirements.⁹ Glucose, the main carbohydrate, is necessary in adequate amounts for leucocyte chemotaxis, fibroblast activation, and numerous cell divisions. Lipids cover the remaining 20% of energy needs. These substances provide a concentrated source of energy and build cell membranes of all new cells.^4,9 Proteins cover the remaining 15% of energy needs.

   Amino acids and nucleic acids delivered in the form of protein products provide fundamental building materials and support new protein synthesis. If these substances are not consumed in the recommended amount (1.2 to 1.5 g/kg/day), collagen synthesis and fibroblast activity will be inhibited.