The Potential Role of Specific Amino Acids, Vitamins, and Zinc Oral Supplementation as Support Strategies for the Management of Chronic Wound

Review Article

Int J Nutr Sci. 2023; 8(1): 1071.

The Potential Role of Specific Amino Acids, Vitamins, and Zinc Oral Supplementation as Support Strategies for the Management of Chronic Wound

Colombo F*; Milani M

Department of Medical, Cantabria Labs Difa Cooper, Italy

*Corresponding author: Francesca Colombo Department of Medical, Cantabria Labs Difa Cooper, Via Milano 160, Caronno P. (VA) Italy. Email: francesca.colombo@difacooper.com

Received: March 02, 2023 Accepted: April 11, 2023 Published: April 18, 2023

Abstract

The oral supplementation with some amino acids (such as arginine, glutamine and Hydroxy-Methylbutyrate - HMB), vitamins and zinc could contribute to accelerate the healing process in subjects with chronic wounds such as pressure sores. In this mini review we summarized the rational and the evidences available regarding the possible role of some nutrients supplementation in the management of chronic wounds. In particular we focused on clinical data available for arginine, HBM, glutamine, vitamins and Zn oral supplementation. Several studies suggested that these foods could promote the recovery of muscle mass and the reconstruction of damaged tissue (e.g in patients with pressure sores, ulcers, sarcopenia and burns). Food supplements containing all these components are commercially available. These products could be useful in the management of subjects with or at risk of Pressure Ulcers (PUs). In addition, these formulas can be us as integrations in the treatment of sarcopenic subjects, a condition that could be associated to PUs. The use of specific oral nutritional formula not only could allow a better healing of PUs, but also can reduce the costs of healthcare system. In these respects, controlled clinical trials are warranted to confirm the efficacy of this supplementation strategy.

Keywords: Pressure ulcers; Wound healing; Food supplement; Protein malnutrition

Introduction

The skin is an organ responsible for numerous processes in human body (e.g. protection, thermal regulation, vitam D synthesis). Skin possesses different repair processes to counteract severe skin damages [1]. However, the repair processes could be limited in presence of chronic wounds. Chronic wounds include vascular ulcers, diabetic ulcers, and pressure ulcers. Pressure ulcer is defined by National Pressure Ulcer Advisory Panel as “localised injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear” [2]. Pressure ulcers are classified based on severity and level of tissue injury in different grades: from Grade 1 (persistent non-blanching erythema) to Grade 4 (the damage is extended to the underlining bone, tendon, or joint capsule) [3,4]. The overall prevalence of Pressure Ulcers (PUs) across European countries is 13.7% [5]. The factors responsible for pressure sore are different such as vascular diseases, loss of sensory stimuli, reduce mobility, fecal and urine incontinence, and malnutrition. Patients with reduce activity/mobility present the highest risk of developing a PU. Indeed, sarcopenia increases the risk of pressure ulcers [6]. Sarcopenia is defined as the loss of muscle mass and muscle strength. These conditions, along with a decreased immune function, can lead to impaired wound healing [7]. PUs significantly affects the quality of life of patients, increase morbidity and mortality and is associated with high costs for the individuals and health care system [8]. In this contest the prevention and management of PU is essential and required a multidisciplinary approach. The management of underlying causes and comorbidities (e.g. diabetes, deep vein thrombosis, chronic kidney disease, coronary artery disease, heart failure) is required; in addition, different preventive intervention are available such as various support surfaces, frequent changes of position, and an appropriate local wound care (adequate dresses, cream and management of incontinence). Patients with PUs required also an appropriate psychosocial support; indeed, these subjects suffer of pain and the disease impacts on their normal activities [9,10].

A relevant role in PU management is also specific nutritional supplement strategies. There are some evidences that the incidence and severity of PUs is negatively correlate with poor nutrition [4,11,12]. On the other hand, there is no clear evidence on improve PU healing with nutritional supplements [4]. However, there is a consensus that nutrition is an important factor, cited in numerous guidelines such as the reference guide from the European Pressure Ulcer Advisory Panel (EPUAP) [3,13,14]. Patients with chronic wounds are often in catabolic rate, showing an increased need for energy and macronutrients (such as proteins), therefore an optimization in protein and total caloric intake is important [10,15]. An increase protein intake (1.25 to 1.5g/kg/day) promotes healing [10,16,17]. In addition, in presence of adequate quantities of proteins and calories, some authors suggesting to considered arginine and glutamine supplementation. There is some evidence of improved healing, evaluated measuring surrogate outcomes, after the supplementation with arginine compared to a standard hospital diet. Micronutrients deficiency may have a significant impact on would healing. Some micronutrients such as vitamin C and zinc, are usually supplemented to promote heling, although their efficacy has not to be conclusive demonstrated [4,10]. In addition, the water-soluble vitamins and some minerals are important cofactors for some metabolic reactions. Therefore, the nutrition supplementation could represent an important tool in the prevention and management of PUs. In presence of an adequate ingestion of proteins and energy, the supplementation with some amino acids (such as arginine, glutamine and hydroxy-methylbutyrate), vitamins and zinc could contribute to accelerate the wound healing process. In this mini review the possible role of some nutrients in the management of chronic wounds was further explorer. In particular, we focused on clinical data available for arginine, HBM, glutamine, vitamins (A, B, and C) and Zn supplementation. The data are summarized in Table 1.

Citation: Colombo F, Milani M. The Potential Role of Specific Amino Acids, Vitamins, and Zinc Oral Supplementation as Support Strategies for the Management of Chronic Wound. Int J Nutr Sci. 2023; 8(1): 1071.