Enriched nutritional formula improved pressure ulcers in malnourished patients

Consuming a protein-rich formula with arginine, zinc, and antioxidants increased the area of pressure ulcer healing in a recent study.

The trial included 200 malnourished patients with stage II, III, or IV pressure ulcers who either lived in a long-term care facility or received home care services. The patients were randomized to 400 mL/d of an energy-dense, protein-rich oral formula enriched with arginine, zinc, and antioxidants or a formula with the same calorie and protein content without the supplemental nutrients. Results were published in the Feb. 3 Annals of Internal Medicine.

After 8 weeks, the patients who had received the enriched formula showed a greater reduction in pressure ulcer area: 60.9% versus 45.2% (adjusted mean difference, 18.7%; 95% CI, 5.7% to 31.8%; P=0.017). They were also more likely than control patients to have a reduction of 40% of pressure ulcer area or greater at 8 weeks (odds ratio, 1.98; 95% CI, 1.12 to 3.48; P=0.018). There was no significant difference between groups in rates of complete healing, wound infections, the number of dressings at 8 weeks, or the change in area at 4 weeks.

The researchers concluded that the provision of arginine, zinc, and antioxidants improved pressure ulcer healing in these patients. They speculated that the effect of the nutrients is likely synergistic, although results of another recent study suggest that the increased lipid fraction in the intervention formula, particularly the doubled concentration of polyunsaturated fatty acids, could have contributed to the observed effect.

The findings apply to long-term care residents and patients receiving home care, because other groups, such as ICU patients, were not included, the study authors said. Adherence to oral nutritional supplements is often a challenge, they noted, and this trial overcame this by integrating the therapy into patients' daily care, spreading it throughout the day, and not leaving it to patients to take it. Further research is needed on the cost-effectiveness of the intervention.