Disease-Specific, Versus Standard, Nutritional Support for the Treatment of Pressure Ulcers in Institutionalized Older Adults: A Randomized Controlled Trial |
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| Authors: | Emanuele Cereda MD Anna Gini MD Carlo Pedrolli MD Alfredo Vanotti MD |
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| Affiliation: | From the International Center for the Assessment of Nutritional Status, University of Milan, Milan, Italy;;Servizio di Nutrizione Clinica e Dietetica, Azienda Sanitaria Locale Como, Como, Italy;;Dietetic and Clinical Nutrition Unit, Trento Hospital, Trento, Italy. |
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| Abstract: | ![]()
OBJECTIVES: To investigate whether a disease‐specific nutritional approach is more beneficial than a standard dietary approach to the healing of pressure ulcers (PUs) in institutionalized elderly patients. DESIGN: Twelve‐week follow‐up randomized controlled trial (RCT). SETTING: Four long‐term care facilities in the province of Como, Italy. PARTICIPANTS: Twenty‐eight elderly subjects with Stage II, III, and IV PUs of recent onset (<1‐month history). INTERVENTION: All 28 patients received 30 kcal/kg per day nutritional support; of these, 15 received standard nutrition (hospital diet or standard enteral formula; 16% calories from protein), whereas 13 were administered a disease‐specific nutrition treatment consisting of the standard diet plus a 400‐mL oral supplement or specific enteral formula enriched with protein (20% of the total calories), arginine, zinc, and vitamin C (P<.001 for all nutrients vs control). MEASUREMENTS: Ulcer healing was evaluated using the Pressure Ulcer Scale for Healing (PUSH; 0=complete healing, 17=greatest severity) tool and area measurement (mm2 and %). RESULTS: The sampled groups were well matched for age, sex, nutritional status, oral intake, type of feeding, and ulcer severity. After 12 weeks, both groups showed significant improvement (P<.001). The treatment produced a higher rate of healing, the PUSH score revealing a significant difference at Week 12 (?6.1±2.7 vs ?3.3±2.4; P<.05) and the reduction in ulcer surface area significantly higher in the treated patients already by Week 8 (?1,140.9±669.2 mm2 vs ?571.7±391.3 mm2; P<.05 and ～57% vs ～33%; P<.02). CONCLUSION: The rate of PU healing appears to accelerate when a nutrition formula enriched with protein, arginine, zinc, and vitamin C is administered, making such a formula preferable to a standardized one, but the present data require further confirmation by high‐quality RCTs conducted on a larger scale. |
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| Keywords: | pressure ulcers nutrition elderly protein arginine zinc vitamin C |
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