Nutrition in Burns

A serious burn stimulates heightened metabolism, which is a metabolic response that can last for up to 24 months following the injury [1, 2]. This response involves an almost 50-fold increase in inflammatory cells, hormones related to emotional and physical stress, and cortisol, the stress hormone. Increased levels of stress-related hormones due to a major burn are associated with [1, 2]:

  • an increased risk of infection
  • dramatically heighten pumping of the heart
  • an increased demand for oxygen to sustain heart function
  • the dysfunction of multiple organs (e.g., liver)
  • the excessive breakdown of carbohydrates and fats, including stored fat
  • insulin resistance (an improper response to insulin)
  • the extensive breakdown of muscle protein that leads to muscle loss and stunted growth

When someone experiences a serious burn, their body needs extra protein, and energy in the form of calories, to target inflammation and promote healing of the burn [3]. To account for this extra need, the body will use up muscle protein and energy reserves, depriving the rest of the body (e.g., vital organs) of nutrients that are needed for optimal health. This in turn causes additional complications such as a weakened immune system and decreased wound healing, among other issues [2]. In the absence of nutrient supplementation burn survivors struggle to recover.

Importance of Nutrition Support

Early, aggressive nutrition support, typically through tube feeding, greatly improves the outcomes of individuals who are severely burned, by preventing the body from excessively breaking down stored nutrients [4, 5]. Indeed, supplementation that begins within 2 hours of the burn, if this is possible, prevents the harmful metabolic response from occurring [6].

Research also shows that continuously supplementing the diet with high protein and high carbohydrates reduces the occurrence of complications in burn victims, supports muscle maintenance, improves wound healing, and shortens the hospital stay [1, 7, 8]. This is because high protein supplementation meets the body’s ongoing demands of the burn injury, thereby preventing the daily loss of half a pound of skeletal muscle or more, in some cases [5].

The effects of metabolic stress that are caused due to a severe burn can last as long as two years after the initial injury occurred and protein-energy requirements usually remain high in burn victims for extended periods of time [1, 5]. Therefore, long-term protein supplementation becomes the key to lowering the incidence of serious complications as well as increasing survival rates.

References

  1. Williams FN, Herndon DN, Jeschke MG. The hypermetabolic response to burn injury and interventions to modify this response. Clin Plast Surg. 2009;36(4):583-96.
  2. Hart DW, Wolf SE, Mlcak R, et al. Persistence of muscle catabolism after severe burn. Surgery. 2000;128(2):312-9.
  3. Jeschke MG, Chinkes DL, et al. Pathophysiologic response to severe burn injury. Ann Surg. 2008; 248(3):387-401.
  4. Dominioni L, Trocki O, et al. Enteral feeding in burn hypermetabolism: nutritional and metabolic effects of different levels of calorie and protein intake. JPEN J Parenter Enteral Nutr. 1985 May-Jun; 9(3):269-79.
  5. Clark A, Imran J, Madni T, Wolf SE. Nutrition and metabolism in burn patients. Burns Trauma. 2017;5:11.
  6. Mochizuki H, Trocki O, et al. Mechanism of prevention of postburn hypermetabolism and catabolism by early enteral feeding. Ann Surg. 1984;200(3):297-310.
  7. Mosier MJ, Pham TN, Klein MB, et al. Early enteral nutrition in burns: compliance with guidelines and associated outcomes in a multicenter study. J Burn Care Res. 2011;32(1):104-9.
  8. Peng YZ, Yuan ZQ, Xiao GX. Effects of early enteral feeding on the prevention of enterogenic infection in severely burned patients. Burns. 2001;27(2):145-9.