Disease-Specific, Versus Standard, Nutritional Support for the Treatment of Pressure Ulcers in Institutionalized Older Adults: A Randomized Controlled Trial

Authors

  • Emanuele Cereda MD,

    1. From the *International Center for the Assessment of Nutritional Status, University of Milan, Milan, ItalyServizio di Nutrizione Clinica e Dietetica, Azienda Sanitaria Locale Como, Como, ItalyDietetic and Clinical Nutrition Unit, Trento Hospital, Trento, Italy.
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  • Anna Gini MD,

    1. From the *International Center for the Assessment of Nutritional Status, University of Milan, Milan, ItalyServizio di Nutrizione Clinica e Dietetica, Azienda Sanitaria Locale Como, Como, ItalyDietetic and Clinical Nutrition Unit, Trento Hospital, Trento, Italy.
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  • Carlo Pedrolli MD,

    1. From the *International Center for the Assessment of Nutritional Status, University of Milan, Milan, ItalyServizio di Nutrizione Clinica e Dietetica, Azienda Sanitaria Locale Como, Como, ItalyDietetic and Clinical Nutrition Unit, Trento Hospital, Trento, Italy.
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  • Alfredo Vanotti MD

    1. From the *International Center for the Assessment of Nutritional Status, University of Milan, Milan, ItalyServizio di Nutrizione Clinica e Dietetica, Azienda Sanitaria Locale Como, Como, ItalyDietetic and Clinical Nutrition Unit, Trento Hospital, Trento, Italy.
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  • Abstract presented at the 30th ESPEN Congress, September 13–16, 2008, Florence, Italy.

Address correspondence to Emanuele Cereda, International Center for the Assessment of Nutritional Status (ICANS), University of Milan, via Botticelli 21, 20133 Milan, Italy. E-mail: emanuele.cereda@virgilio.it

Abstract

OBJECTIVES: To investigate whether a disease-specific nutritional approach is more beneficial than a standard dietary approach to the healing of pressure ulcers (PUs) in institutionalized elderly patients.

DESIGN: Twelve-week follow-up randomized controlled trial (RCT).

SETTING: Four long-term care facilities in the province of Como, Italy.

PARTICIPANTS: Twenty-eight elderly subjects with Stage II, III, and IV PUs of recent onset (<1-month history).

INTERVENTION: All 28 patients received 30 kcal/kg per day nutritional support; of these, 15 received standard nutrition (hospital diet or standard enteral formula; 16% calories from protein), whereas 13 were administered a disease-specific nutrition treatment consisting of the standard diet plus a 400-mL oral supplement or specific enteral formula enriched with protein (20% of the total calories), arginine, zinc, and vitamin C (P<.001 for all nutrients vs control).

MEASUREMENTS: Ulcer healing was evaluated using the Pressure Ulcer Scale for Healing (PUSH; 0=complete healing, 17=greatest severity) tool and area measurement (mm2 and %).

RESULTS: The sampled groups were well matched for age, sex, nutritional status, oral intake, type of feeding, and ulcer severity. After 12 weeks, both groups showed significant improvement (P<.001). The treatment produced a higher rate of healing, the PUSH score revealing a significant difference at Week 12 (−6.1±2.7 vs −3.3±2.4; P<.05) and the reduction in ulcer surface area significantly higher in the treated patients already by Week 8 (−1,140.9±669.2 mm2 vs −571.7±391.3 mm2; P<.05 and ∼57% vs ∼33%; P<.02).

CONCLUSION: The rate of PU healing appears to accelerate when a nutrition formula enriched with protein, arginine, zinc, and vitamin C is administered, making such a formula preferable to a standardized one, but the present data require further confirmation by high-quality RCTs conducted on a larger scale.

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