23 October 2013

Nutrition and pressure sores

When it comes to preventing pressure sores, maintaining the health of your skin is crucial. And, yes, that means paying careful attention to nutrition.

Recovering from surgery or illness, or confined to a bed or wheelchair?

When it comes to preventing pressure sores, maintaining the health of your skin is crucial. And, yes, that means paying careful attention to nutrition.

The development of pressure sores is often linked to poor appetite, difficulty eating, and the inadequate intake of nutrients – factors that are all often present in bed-resting people.

In addition, weight loss, inadequate protein intake, a diet poor in protective vitamins and minerals, and either a very low or very high body mass index, could slow down the wound-healing process where pressure sores already exist.

The good news is that nutrition intervention can have a very direct effect on pressure sores, significantly reducing their size in a relatively short space of time.

Here’s what to keep in mind:

Your body needs adequate energy for wounds to heal and to prevent them from forming in the first place. Apart from your immediate energy needs in terms of healing the pressure sore(s), extra calories will also add a bit of “padding” to your body, which will reduce pressure on the skin. This is particularly important if you’re underweight.

Carbohydrates (e.g. pasta, rice, bread, starchy vegetables) and healthy fats (e.g. avocado, olive oil, canola oil, fatty fish) are good sources of energy. The glucose found in carbohydrate foods provide energy to the skin cells, while the polyunsaturated fatty acids found in healthy fats form part of the cell membranes.

In elderly, disabled or chronically ill patients, early, aggressive micronutrient treatment with carbohydrates, fat and protein is crucial in order to prevent or treat pressure sores.

While carbohydrate and fat spare protein for wound healing, you might also have to increase your protein intake significantly.

Research shows that low blood levels of the protein albumin often correlate with the onset of pressure sores. What’s more, protein needs increase when other disease conditions are present.

In one article published by the Irish Nurses and Midwives Organisation, it’s noted that, through a wound, you may lose up to 90g-100g protein per day. This means that, if pressure sores are present, your protein requirements may be twice as much as usual.

The amino acid arginine seems to be particularly important in terms of wound healing. This is found in soy, wheat, seeds, nuts, dairy products, chickpeas and meat and eggs, among other foods.

Vitamin C
In the past, vitamin C was routinely prescribed for patients with wounds. However, there is still not enough scientific evidence to show that increased doses make a difference in terms of wound healing.

What we do know is that vitamin C plays a role in collagen formation. It’s also important in terms of immune system function, which is key when you have open pressure sores that may become infected.

Experts currently recommend only a balanced diet that includes foods rich in vitamin C (e.g. broccoli, peppers, oranges, papaya). Remember that vitamin C is a water-soluble vitamin that gets excreted through urine. This means it needs to be replenished every day.

Look out for signs of deficiency, which may include skin that bruises easily, bleeding gums, or skin that’s rough or discoloured. If you suspect a deficiency, a supplement may be necessary.

Zinc plays an important role in wound healing, immunity and the production of protein – factors that are all important if you have pressure sores.

The mineral also helps to maintain the integrity of the skin, and zinc deficiency has been linked to decreased production of collagen – the protein that makes up connective tissue and which is also found in skin.

What’s more, your risk for zinc deficiency is higher if you’re ill, especially if you’re vomiting or if you have diarrhoea.

Once again, however, experts don’t recommend routinely supplementing patients’ diets with zinc. Instead, a diet rich in zinc (found in sardines, wheat germ, red meat and pumpkin seeds) is recommended.

Good hydration is key when it comes to your overall health, wound healing and, ultimately, also recovering from pressure sores. Fluid helps to maintain a healthy blood volume which, in turn, ensures proper circulation of the blood and nutrients, as well as the repair of skin cells.

Dehydration is often a problem in elderly people, especially those living in old-age homes.  Dehydration may significantly increase the risk for pressure sores in the elderly .

What’s more, certain conditions such as diabetes and kidney disease can interfere with fluid regulation in the body. If you have been diagnosed with one of these diseases, your risk for dehydration and, ultimately, pressure sores is even greater.

Make a point of including sufficient fluids in your diet.

(Carine Visagie, Health24, October 2013)

- Ohura T. et al. 2013. Effects of nutrition intervention for pressure ulcer patients – healing rate and speed of wound size and nutrition. Nihon Ronene Iqakkai Zasshi. 2013;50(3):377-83.
- Tarrant R. Extracted from web: September 2013. Nutrition – Diet crucial in pressure sores. Irish Nurses and Midwives Organisation.
- Collins N. 2013. Nutrition 411: revisiting vitamin C and wound healing. Ostomy Wound Management. 2013 Sep;59(9):12.
- Zwiefelhofer D. October 2007. Pressure ulcers and hydration.
- Demling, R.H. 2009. Nutrition, Anabolism, and the Wound Healing Process: An Overview. Eplasty. 2009; 9: e9.


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