Nutrition 411

Nutrition 411: Back to Basics: Nutrition as Part of the Overall Wound Treatment Plan

  Over the past decade, advancements in wound care have revolutionized wound healing outcomes. Cutting-edge interventions and innovative products and techniques are helping wound care become a topic of interest in scientific research. With exciting new findings and high-tech treatments in the spotlight, it may be easy to overlook the role that basic nutrition plays in wound care management. It is important to address adequate nutrition and hydration early on, because poor nutritional status can prolong the inflammatory phase of healing and decrease collagen synthesis and fibroblast proliferation. ...

Nutrition 411: Changing the Malnutrition Paradigm

  The Merriam Webster Dictionary defines malnutrition as “faulty nutrition due to inadequate or unbalanced intake of nutrients or their impaired assimilation or utilization”.1 This classic dictionary definition may work for grade school and middle school science classes but is no longer applicable for diagnosing adult patients. In recent years, it has become clear that malnutrition is a complex syndrome that manifests in different ways. As a result of this new understanding, the definition of the condition and how to diagnose it have been subject to intense scientific scrutiny. Many clinicians struggle to understand this change and wonder what parameters to use in order to assign a diagnosis of malnutrition. In an attempt to understand the whys and wherefores of recent changes in the malnutrition paradigm, a summary of the evidence follows....

Nutrition 411: Wound Healing in the Era of Long-term Care Culture Change

  Patients in skilled nursing facilities (SNFs) have seen institutional life change dramatically over the past several years. SNFs, often called long-term care (LTC) communities, operate under vastly different guidelines than traditional acute care hospitals. Although patients average a 3- to 4-day length of stay, LTC patients often reside in the facility for years, frequently until their death. This necessitates a different approach to care and a more homelike environment. A culture change revolution has taking been shape for several years and is gaining speed.

  Understanding related changes can help healthcare providers (HCPs) treat patients and their wounds more effectively....

Nutrition 411: Diabetes and Wounds: Weight Loss as a Preventative Strategy

  Self-management of diabetes often is a daunting prospect for patients, particularly when newly diagnosed. Hearing they must test blood sugar, follow a new diet, engage in physical activity, take medications appropriately, and be concerned with comorbidity complications can be overwhelming. Although healthcare professionals (HCPs) are aware of the dangers of uncontrolled diabetes, patients often are not concerned until detrimental symptoms, such as a wound, occur. Diabetes and wounds is a dangerous combination; a wound is never simple for a patient with diabetes. According to the American Diabetes Association,1 25.8 million people in the United States have diabetes; currently, it is the sixth leading cause of death....

Nutrition 411: 3rd Annual Nutrition Best Practices, Tips, Tricks, and Techniques

  In this annual “innovations” column, registered dietitians from across the United States offer their best practices, tips, tricks, and techniques for dealing with unintended weight loss and wounds to help improve the level of care we offer when faced with these challenging problems.

  Often patients with unintended weight loss, malnutrition, or wounds who live at home do not have the energy to shop for food or prepare meals. In addition, many caregivers lack cooking skills for special diets. One solution is to have meals delivered to the home. National and local meal providers are available, including Meals On Wheels, Mom’s Meals, or local providers who may deliver meals. Mom’s Meals, for example, has meals for diabetic, heart health, gluten-free, renal, vegetarian, and low-sodium diets. These fresh meals are delivered by FedEx® and keep in the refrigerator for up to 18 days. Just heat and eat. Ask the meal providers in your area if they are able to provide meals for people on special diets. — Dee Sandquist, MS, RD, LD, CDE, Fairfield, IA...

Nutrition 411: Vitamin Supplementation: The Lingering Questions in Wound Healing

  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...

Nutrition 411: Tips for Utilizing MyPlate with Patients with Wounds

  Although patients with wounds often benefit from nutrition education, they often do not have the opportunity to meet with a registered dietitian (RD) or nutrition professional. Other healthcare practitioners (HCPs) must fill the educational gaps. Fortunately, many credible resources are available online to obtain patient handouts, sample meal plans, and other tools. One of these sources is the MyPlate program from the US Department of Agriculture (USDA)....

Nutrition 411: Are Vegetarian Diets Adequate for Wound Healing?

  Healthcare professionals who work in wound management know the routine: When faced with a patient with compromised skin integrity, they pump up the protein — typically, by recommending increased amounts of meat, poultry, fish/seafood, eggs, dairy products, and sometimes protein supplements. But well-meaning health practitioners who offer these suggestions to their vegetarian patients will likely encounter strong resistance. Vegetarianism is not simply a diet plan that a person goes on (and off); it encompasses an entire lifestyle. In fact, not only do some vegetarians abstain from eating anything derived from animals, but they also may abstain from using animal products such as silk, leather, wool, and similar items.1 ...

Nutrition 411: Nutrition Q & A: Real Answers to Your Questions

  When I started working in wound care, email was in its infancy. If a colleague had a question about nutrition, he or she would use the telephone to speak with me directly. Nowadays, email is the way most people communicate. Each week, I receive inquiries from patients, caregivers, colleagues, strangers, and the media. This month’s column features some of the most common questions from my mailbox — real questions from real healthcare practitioners seeking nutrition advice. ...

Nutrition 411: Nutrition Implications for Postsurgical Wound Healing

  An abundance of research supports nutrition guidelines for treating pressure ulcers, but published guidelines on medical nutrition therapy for postsurgical wounds do not exist. Surgical wounds are distinctly different from chronic types of wounds; key factors in nonhealing surgical wounds are ischemia and bacterial colonization, which stall healing in the inflammatory stage.1 Primary wound healing typically begins within hours of closing a surgical incision.2 Nevertheless, the principle goals of wound healing are to eliminate factors that may complicate or delay wound healing, and then optimize the wound healing environment3,4 (see Table 1). Some factors that may complicate or delay wound healing can be addressed (at least partially) through nutrition....