The role of macronutrients and micronutrients in wound healing: a narrative review
There is an extensive amount of research and literature discussing the role of various nutrients throughout the wound healing process. Despite the importance of nutrition in wound healing, dietary protocols often remain absent from wound care standards. This may be due to a lack of comprehensive literature that summarises the complexities and considerations associated with nutrient deficiency and supplementation into an easily accessible and inclusive reference tool. The purpose of this review is to assess the nutrients with key roles in the wound healing process, and subsequently provide information that enables optimisation of nutrition in wound healing. The goal is to consolidate the complexities associated with this topic into a simple, easy-to-use reference tool. We have identified the most important nutrients required for optimal wound healing and condensed the findings into an inclusive chart to be utilised in a clinical setting. This reference tool will include patient populations at risk of deficiency, the stage of wound healing in which each nutrient is required, delivery method and recommended daily intake, outpatient recommendations for rich food sources of each nutrient, and considerations associated with each nutrient.
According to the US Department of Agriculture (USDA), 88.9% (114.9 million) of US households were food secure throughout 2018, with food security defined as ‘having access, at all times, to enough food for an active, healthy life for all household members.’1 While this statistic implies that the majority of citizens have access to enough food, it fails to define the food as not only calorically sufficient, but nutritionally sufficient. It also suggests that 14.3 million households are not food secure. Thus malnutrition, the imbalance of nutrients and lack of micronutrients, remains a widespread problem in the US.
Screening for malnutrition is a challenge for physicians. A number of factors can contribute to patients’ nutritional status: diet, age, sex, genetic makeup, and history of disease are just a few examples.2 While there is an obvious nutritional deficit in patients who are severely underweight, the potential for severe malnutrition in patients of normal weight or who are obese is often overlooked.3,4 This is of particular concern because patients who are obese frequently present with poorly-healing wounds and are susceptible to macronutrient imbalances.5 Direct risks associated with obesity include increased likelihood of developing pressure ulcers (PU) or general wound dehiscence. Indirect risks of obesity in developing hard-to-heal wounds are associated with comorbidities such as diabetes. For this reason, the importance of in-depth nutritional assessments for all patients with wounds, as opposed to only visibly underweight patients, is of utmost importance. This article will attempt to promote this idea through providing recommendations for specific patient populations at risk for both macronutrient and micronutrient deficiencies.
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