Nutrition in Wound Healing

According to a 2018 review, approximately 1-2% of the general population or 2 out 1,000 people in the total population suffer from chronic wounds, most of which are chronic leg ulcers [1]. Another study indicates that about 15% (8.2 million) of Medicare beneficiaries have chronic non-healing wounds that amount to Medicare costs between $28.1to $31.7 billion [2]. Both studies described numerous types of wounds such as [1, 2]:

  • burns
  • chronic ulcers (e.g., leg and foot ulcers)
  • arterial ulcers
  • diabetic foot ulcers
  • pressure ulcers
  • surgical wounds (e.g., non-healing wounds)
  • traumatic wounds
  • venous ulcers
  • soft-tissue radionecrosis (radiation therapy-induced wounds)

Nutritional and Metabolic Demands for Wound Healing

There are two processes that can hinder proper wound healing. The first is the activation of a stress response due to the injury, and the second involves the development of protein-energy malnutrition (PEM) [3]. These complications often arise with chronic wounds because of their heightened metabolic and caloric demands. More specifically, wounds cause a hypermetabolic state due to their significantly increased nutritional needs. Therefore, nutrient supplementation often becomes vital for wound healing [4].

The adequate flow of nutrients such as protein, carbohydrates, and vitamins within a wound prevents PEM, which is described as inefficient energy and protein intake that leads to a loss of lean muscle mass and reduced protein stores [3]. For instance, protein supports the repair of damaged tissue, while carbohydrates and vitamin C promote collagen formation at the wound site [3, 4]. In the absence of proper nutrient intake, the body breaks down protein and fat that is used for energy faster than it can be used to promote wound healing. Therefore, PEM further disrupts the healing process. PEM is commonly observed in populations with chronic wounds such as chronically ill, disabled, or elderly populations [3, 5]. However, early aggressive macronutrient (e.g., proteins, carbohydrates) and micronutrient (e.g., vitamins and minerals) supplementation can stop this from occurring [3].

Role of Nutrient Supplementation in Wound Healing

High protein supplements are essential for wound healing because they help maintain protein synthesis and support a level of protein intake that consistently meets the body’s demands during wound healing [3, 6, 7]. In the absence of a high protein and high caloric diet, the stress response that was activated by the wound causes too much protein and fat to be used for energy and inadequate amounts are transported to the wound. This imbalance contributes to the onset of PEM. Fortunately, high protein/calorie supplements along with additional micronutrients can help prevent PEM.

For example, arginine boosts blood circulation as well as the transportation of nutrients to wounds by enhancing the activity of enzymes that cause blood vessels to widen [8]. Arginine also improves wound strength and collagen distribution in wounds [9].

Accordingly, collagen peptides initiate a signal in the body that causes new collagen fibers to be produced. This signal also encourages healthy cells to migrate toward the wound and promotes new cell growth, which is a key step in the wound healing process [10].

The combination of arginine, collagen peptides, and Beta-hydroxy-Beta methylbutyrate (HMB) supports wound healing as HMB supplementation is linked to increased muscle mass growth, enhanced protein turnover, and reduced protein breakdown. These processes promote healing by restoring lean muscle mass and protein stores [4].

References

  1. Martinengo L, et al. Prevalence of chronic wounds in the general population: systematic review and meta-analysis of observational studies. Ann Epidemiol. 2019;29:8-15.
  2. Nussbaum SR, et al. An economic evaluation of the impact, cost, and Medicare policy implications of chronic nonhealing wounds. Value Health. 2018;21(1):27-32.
  3. Demling RH. Nutrition, anabolism, and the wound healing process: an overview. Eplasty. 2009;9:e9.
  4. Sipahi S, Gungor O, et al. The effect of oral supplementation with a combination of beta-hydroxy-beta-methylbutyrate, arginine and glutamine on wound healing: a retrospective analysis of diabetic haemodialysis patients. BMC Nephrol. 2013;14:8.
  5. Mouve M, Bokmor T. The prevalence of undiagnosed protein caloric under nutrition in a population of hospitalized elderly patient. J Am Geriatr Soc. 1991;13:202-05.
  6. Wray C, Mammen J, Hasselgren P. Catabolic response to stress and potential benefits of nutritional support. Nutrition. 2002;18:97.
  7. Biols G, Toigo G, Ciocechi B, et al. Metabolic response to injury and sepsis: changes in protein metabolism. Nutrition. 1997;13:52-7.
  8. Debats IB, Wolfs TG, Gotoh T, et al. Role of arginine in superficial wound healing in man. Nitric Oxide. 2009;21(3-4):175-83.
  9. Stechmiller JK, Childress B, Cowan L. Arginine supplementation and wound healing. Nutr Clin Pract. 2005;20(1):52-61.
  10. Felician FF, Yu RH, et al. The wound healing potential of collagen peptides derived from the jellyfish Rhopilema esculentum. Chin J Traumatol. 2019;22(1):12-20.