The value of good nutrition

The importance of good nutrition in the healing of wounds is widely accepted, but still remains of low priority in health care.

Dubbed a “hidden epidemic” by healthcare professionals, chronic wounds affect around 200,000 people in Australia at any one time and this prevalence rises as people age. A nationwide survey found more people aged over 50 suffer with chronic or slow-to- heal wounds than osteoporosis and heart disease.

Chronic wounds may develop as a result of long hospital stays, inactivity or even from ill-fitting shoes or bumping a leg on passing items. Slow-to-heal wounds are a huge problem for all those involved in aged and long term patient care.

Clinical research clearly shows that good nutrition is a major factor in the body’s ability to rebuild and recover from serious wounds.

According to geriatrician and wound expert Associate Professor Michael Woodward, president of the Australian Wound Management, nutrition can be an issue for seniors even when everything seems to be going well, “but add one or more health issues such as a chronic wound and the body simply may not have the resources to cope”.

“In an ideal world we should be able to obtain sufficient nutrients from diet alone but in certain situations such as wound healing, supplementation of key amino acids such as arginine may be essential,” Woodward says.

“What many people don’t realise is that nutritional supplement drinks such as Arginaid can significantly reduce the recovery time for those with chronic wounds which in turn reduces the amount spent on dressings and medical visits.“

Further results from survey, conducted by Nestlé Nutrition, indicate that respondents’ understanding of nutrition does not automatically lead to ideal behaviours. For example only one in four respondents said that they eat three meals a day with as many as 19 per cent indicating they only have one main meal a day, replacing other meals with snacks.

This can create significant problems, says Jane Winter, accredited practising dietitian.

“Weight loss among the elderly is often a concern as it can lead to malnutrition, increasing the likelihood of hospital admission due to avoidable injury or illness. Eating smaller meals more often and choosing nutritious snacks between meals can be beneficial when someone has a poor appetite.”

People recovering from injury who aren’t up to consuming their usual volume of food each day or who have slow to heal wounds after a long hospital stay may benefit from a nutritional supplement drink.

“Few people are aware that nutrition can help to promote wound healing (by working from the inside out). As the body needs more protein during wound healing the demand for normally nonessential amino acids such as arginine becomes essential,” Winter says.

Case study

Peter, a 43-year-old father of two, presented with a chronic leg ulcer that had been present for two years. He had undergone many treatments for the wound that was not initially diagnosed as a venous ulcer. Unfortunately very little progress had been made with any of the treatments.

Prolonged ill health had led to a reactive depression.

Before his illness, he had worked at a physically demanding job, however he had been unable to work during these two years because of his chronic illness and the long-term treatment required.

Significant factors contributing to his inability to work included lack of mobility, an inability to stand for any significant time, constant pain and the need for numerous daily dressings.

At the time of presentation Peter was living at home with his wife and children. He was morbidly obese with a weight of 170 kg. He had no other current illnesses, including no diabetes and no Doppler ultrasound evidence of arterial disease. He had severe chronic venous insufficiency.

The key findings on examination were a large midtibial ulcer and venous eczema. He had severe left lower limb swelling with copious exudate and significant erythema. His condition was causing constant pain and pruritis. There was significant odour associated with the ulcer as well as soiling of clothing and bedding. Up to five dressing changes a day were required.

Not surprisingly these symptoms were having a most adverse effect on his life and a major impact on his mood. The whole family were suffering, not only through his psychological problems but also because they were involved in his frequent daily dressings.

It was at this point, after two years without progress that Peter was referred by nurses to Tal Ellis at Wound Heal Australia. Examination confirmed a large venous ulcer with a central necrotic area, erythema and significant cellulitis. He had a mixed growth on wound swab. Biopsy revealed chronic ulcerative changes only.

It seemed an appropriate time to focus on a more holistic approach. The dressings were changed to Allevyn (Smith and Nephew) twice weekly, and use of the Coban 2 Layer system (3M) was implemented. He was commenced on Ciprofloxacin and Keflex for control of infection as well as moisturizer and Celestone for the venous eczema.

A key aspect of the holistic approach was to improve nutrition to aid wound healing and he was prescribed a twice-daily nutritional supplement of Arginaid (Nestle) to provide him with the essential amino acid l-arginine that is so important in the promotion of wound healing. During wound healing this normally nonessential amino acid becomes essential and a dietary supplementation is required.

After only two weeks of this new regime Peter’s ulcer had already shown marked improvement and within six weeks he was virtually pain free, had ceased all pain medications and was able to sleep at night. There was marked resolution of the oedema. In fact there was a decrease in calf and ankle width by 7cm. Peter had also lost 23 kg.

As a result of all this, Peter’s mental state was substantially improved. Once again he was able to participate in family life and planned to return to work within three weeks. Moreover he was able to make plans with his family for the future, which he had not been able to do for over two years.

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