Nutritional formula speeds pressure ulcer healing

By Will Boggs MD

NEW YORK (Reuters Health) - A nutritional formula enriched with arginine, zinc, and antioxidants speeds healing of pressure ulcers in malnourished adults, researchers from Italy report.

"We want to highlight and remind that in our study the control group has received a high-quality nutritional care and support, which is really better than current standards in most settings," Dr. Emanuele Cereda from Fondazione IRCCS Policlinico San Matteo in Pavia and Dr. Federico D'Andrea from Azienda Ospedaliera Universitaria Maggiore della Carità in Novara told Reuters Health in a joint email.

"On the other hand," they added, "based on our findings, something better exists and, if available, it should be considered the first choice and provided."

Evidence from previous trials supports supplementation with a nutritional formula enriched with arginine, zinc, and antioxidants, but the independent effect of arginine supplementation on wound healing had not been studied in patients with pressure ulcers.

Dr. Cereda, Dr. D'Andrea, and colleagues in the OligoElement Sore Trial Study Group tested an oral nutritional supplement enriched with arginine, zinc, and antioxidants in a randomized trial of 200 malnourished patients with pressure ulcers.

All patients received an energy-dense, protein-rich oral formula and wound care according to an evidence-based guideline. Patients in the intervention group received the enriched supplement, and patients in the control group received a similar formulation with no arginine, half as much zinc, and substantially less selenium and vitamins C and.

The intervention and control groups gained about 1.5 kg during the eight-week study, according to a report released online February 2 in Annals of Internal Medicine.

Pressure ulcer size decreased to a greater extent in the intervention group than in the control group (60.9% vs 45.2%, mean adjusted difference, 18.7%; p=0.017).

The treatment effect was similar when the analysis was restricted to patients who remained in the study for at least four weeks (17.1% difference in favor of the intervention; p=0.005) and when restricted to patients without heel ulcers (16.8% difference; p=0.030).

Significantly more patients in the intervention group (69.9%) than in the control group (54.1%) experienced at least a 40% reduction in pressure ulcer size at eight weeks (p=0.018), but the difference between the groups in complete healing did not reach statistical significance (16.9% versus 9.7%; P=0.097).

The groups did not differ in the reduction in pressure ulcers at four weeks, the incidence of wound infection during the study, or the number of dressings required.

"Consistently with clinical conditions and specific dietary restrictions, this sort of nutritional support should be recommended for most patients," Dr. Cereda and Dr. D'Andrea said. "We cannot use this intervention in patients with systemic infections, because arginine may have adverse effects. On the other hand, we would say that most patients with pressure ulcers present with nutritional derangements, and nutritional support is likely to have positive effects. Nonetheless, in future guidelines this intervention is going to become a grade-A recommendation."

They added that cost-effectiveness analyses are under way and should be available soon.

The research was supported by Azienda Ospedaliera Universitaria Maggiore della Carità. The authors report no disclosures.

SOURCE: http://bit.ly/1Cr8sxq

Ann Intern Med 2015.

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