Nutrition in Wound Healing Jeffrey D. Lehrman, DPM, FASPS, MAPWCA

Transcription

1 Nutrition in Wound Healing Jeffrey D. Lehrman, DPM, FASPS, MAPWCA Editorial Advisory Board, WOUNDS APMA Coding Committee APMA MACRA Task Force Expert Panelist, Codingline Fellow, American Academy of Podiatric Practice Management Board of Directors, ASPS Board of Directors, APWCA

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5 Neuropathic Ulcer 5-Year Mortality Rate

6 70% 60% 50% 40% 30% 20% 10% 0% Continuing Research: Healing of Diabetic Foot Ulcers After 4 weeks Percentage of Patients in Whom the Ulcer Healed During the 12 Week Period 9% >53% area reduction at week 4 <53% area reduction at week 4 Wounds achieving less than 53% closure at week 4 have minimal chance of healing with conventional therapy Sheehan et. al. Diabetes Care. 2001; 25

7 During healing need more: Calories Protein Vitamin A Vitamin C Zinc

8 Protein Meats Beans Eggs Milk Soy protein products Yogurt (Greek yogurt better) Tofu Soy Nuts

9 Vitamin A Dark green, leafy vegetables Orange or yellow vegetables Cantaloupe Fortified dairy products Liver Fortified cereals

10 Vitamin C Citrus fruits Juices Strawberries Tomatoes Tomato juice Cabbage Peppers Baked potatoes Spinach Broccoli Cauliflower Brussels sprouts

11 Zinc Fortified cereals Red meats Seafood

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14 Labs Likely to impact the potential for healing HgB, Hct, Iron Protein, Albumin, Pre-Albumin HgA1c

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16 Glycosylation of proteins Diabetes Proteins = collagen, fibrin, albumin, and hemoglobin Proteins accumulate glycosylation end products which leads to thickening of basement membranes in microcirculation Ischemia and impaired wound healing

17 Hyperglycemia Increased diuresis Loss of water and electrolytes Extracellular and intracellular dehydration Decrease oxygenation Negative impact on wound healing

18 Hyperglycemia Negative impact on function of: WBC Macrophages Immune function

19 Negative impact on: Hyperglycemia Fibroblast function Angiogenesis Collagen production

20 Hyperglycemia Increase production of free radicals Increases oxidative stress Tissue damage / Cell death

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22 30 to 35 kcal/kg body weight, adjusted based on changes in weight and wound healing 1.25 to 1.5 g protein/kg body weight to achieve a positive nitrogen balance 30 ml fluid/kg body weight to prevent dehydration Encourage a balanced diet that meets the RDA for all vitamins and minerals

23 Supplements May be needed to meet caloric / protein needs High-protein/high-calorie shakes Specialized commercial formulas

24 Arginine Amino acid Stress or illness may require increased amounts of arginine from the diet. Consider a 30-day trial period of arginine to promote wound healing

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26 Thank You!!

27 References Nutrition Guidelines to Improve Wound Healing ects_how_we_feel/hic_keeping_your_digestive_tract_healthy/hic_nutr ition_guidelines_to_improve_wound_healing August 2009 Issue Nutrition and Wound Care Lynn Grieger, RD, CDE, cpt Today s Dietitian Vol. 11 No. 8 P. 12

28 References Dorner B, Posthauer ME, Thomas D. The role of nutrition in pressure ulcer prevention and treatment: National Pressure Ulcer Advisory Panel white paper. Available at: df. Accessed May 24, Dorner B. New recommendations for treating pressure ulcers. Today s Dietitian. 2009;11(5): Khan MN. The influence of diabetes on wound healing. The Diabetic Foot. Autumn Posthauer ME. Diet, diabetes, and wound management: How important is glycemic control? Holist Nurs Pract. 2004;18(6): Hill J, Landers P, Butcher J, Solnok H. Are wound care protocols evidence based? J Am Diet Assoc. 2008;108(9):A29.

29 Nutrition in Wound Healing Jeffrey D. Lehrman, DPM, FASPS, MAPWCA Editorial Advisory Board, WOUNDS APMA Coding Committee APMA MACRA Task Force Expert Panelist, Codingline Fellow, American Academy of Podiatric Practice Management Board of Directors, ASPS Board of Directors, APWCA