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Si l Eff i TSimple, Effective TreatmentOf Wounds
The Role of Nutrition in Wound CareSue Stillman Linja, RD, LD - S&S Nutrition Network, Inc.
The adult learner will:
OBJECTIVES
The adult learner will:
Recognize the basic principles of nutrition and wound care
Identify methods to optimize healing through simple, yet
effective nutrition measures
Identify low cost products that can be used to improveIdentify low cost products that can be used to improve
nutrition and promote wound healing
Discuss cost effectiveness of standardizing nutrition
formulary
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Remember, We Must Treat the Whole Person, Not Just the HOLE
Dr. Margaret (Peggy) Doucette - 2005
Nutrition Considerations in Wound Prevention & Treatment
Energy (Calories)Energy (Calories)
Protein
Amino Acids
Arginine
Glutamine
Fluids
Micronutrients (Vitamins/Minerals)
Ascorbic Acid -Vitamin C
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Calories/Energy
Energy is provided through
carbohydrates, protein and
fats
Adequacy is essential for
pressure ulcer healing
Promotes anabolism,
nitrogen & collagen
synthesis
Calories/Energy
Kg Weight 30 35 caloriesKg Weight x 30-35 calories
175#= 79.5 kg x 30-35 =
2,385-2,785 calories qd
Mifflin-St. Jeor vs. Harris
Benedict Equation
Needs are adjusted up or
down individually based on
assessment, wound status
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Calorie Boosting Ideas
SEE HANDOUTSSEE HANDOUTS
Fortification/Enhancemen
ts
Fat - More than double
the calories
Nutrient-Rich vs. Empty
Calories
Don’t forget: Liberalize!
Cheap Tricks - CaloriesCheese - 1 oz (slice) = 100-125 calories
Add it t d i h t t t blAdd it to sandwiches, eggs, potatoes, vegetables
Avocado and Guacamole - 180 calories in 4 oz
EGGNOG - 1 cup = 350 calories
Nuts and Nut Butters - Nearly 100 calories per tablespoon
Add Nuts, PB or Nutella into cookies, muffins, shakes
Olive Oil and Maybe Even Butter - 1 Tablespoon = 135 calories
Salad Dressings, Mayos, Spreads - 2 oz = 175 calories
Chocolate - Peanut Butter Fudge- ok for PUREE diets - 100 calories in 1 inch
square
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Protein
Necessary for tissue
maintenance & repair
Depletion of protein
stores/intake impairs healing
Inhibits fibroblasts
Inhibits collagen synthesis
Consider overall nutritional
status, wound size, stage and
characteristics
Protein20-25% of calories daily
f t ifrom protein
Monitor renal function
1.2-1.5 grams of protein per
kilogram of body weight (may
go as high as 2.0 for severe wounds if renal
function allows per some studies)function allows per some studies)
175#=79.5 kg x 1.2-1.5 = 95-120
grams per day
Standard meat portion is 3 oz
(deck of cards) w/ 21 gr protein
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Protein Boosting Ideas
SEE HANDOUTS
Fortification/Enhancements
Best sources of protein
Use of Amino Acids
(Arginine & Glutamine)
Cheap Tricks - Protein
Beans, beans, beans - Make them into spreads, dips, add p p
them into soups, stews, cakes and cookies - 1/2 c = 10
grams protein
Eggs and liquid eggs - 2 eggs or 1/2 c = 12 grams protein
Whey protein isolates - 1/8 c = 12 grams
Non-fat dry milk powder - 1/2 c = 12 grams protein
Nuts and Nut Butter - 1 c = 20-25 grams
Greek yogurt - Mix it in or eat it plain - Up to 20 grams/6 oz
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Fluids
Necessary for Normal Cell
Function
Dehydration is a risk factor
for PU development and
poor healing
Optimal: Intake=Output
Fluids
30-35 ml per kilogram of
body weight
1 ml per calorie consumed
>1500 ml per dayp y
Adjust for drainage, air
beds, N/V/D, other losses
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Cheap Tricks - Fluids
Lattes, mochas, hot or cold cocoa and British teas - use
whole milk or cream if additional calories are needed
Soups, stews, sauces, hot cereals
Fruit or flavored smoothies, icees, shakes, malts
Fresh fruit or fruit in juice
Yogurt, gelato, pudding, custard, flan, ice cream, sherbet
Ascorbic Acid
It’s unlikely that moderate y
supplementation with Vitamin C
is harmful
Stabilizes the triple helix
structure of collagen & provides
strength to new collageng g
Antioxidant & improves iron
absorption
Consider 500-1000 mg Vit C qd
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Ascorbic Acid
Kakadu plum and camu
camu have 1000x more
Vitamin C then an orange (3000-5000 mg/100g)
Chili peppers & red and
green peppers
Guava, kiwi, parsley,
broccoli, brussel sprouts,
papaya, and strawberries
are all higher than oranges
Zinc
Cell proliferation & collagen
synthesis
Role in immune function
Antioxidant properties
Competes with copper and
increase in one can lead to
deficiency of the other
Use for wound healing
remains controversial
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ZincRDA/DRI- 15 mg
S l t ti 40 50Supplementation- 40-50 mg
Oysters - 6 medium =77 mg
Beef - 3 ounces = 9 mg
Fortified breakfast cereal -
3/4 43/4 c = 4 mg
Yogurt 1 cup = 2 mg
Chickpeas, pumpkin seeds,
dark chocolate
Cheap Tricks - Vitamin C and Zinc
F tifi d l ith t d f itFortified cereal with yogurt and fruit
Fruit and yogurt smoothies
Fruit/nut mix
Smoked oysters and cheese
Peppers - raw as a snack, cooked as a side or stuffed
Kiwi/strawberries - blended and added as topping to
desserts, ice cream, yogurt, fish
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1000 Calorie, 30 gram Protein, 240 ml Fluid, Rich in Vit C & Zinc - Cup of Soup & Half Sandwich
How would you do it?
Other Considerations -Lactose Intolerance
Often mis-diagnosed and over treated
Misconception - Lactose Intolerant = Dairy Free
Suggestions:
Chocolate milk vs white
Start small & increase
Don’t drink milk alone
Use lactose free milk or give Lactaid before
meals
Active culture yogurt & cheese are often
tolerated
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Other Considerations -Management of Diarrhea
Identify the cause as soon as possible
(usually not lactose)
Drink fluids often but should be broths,
non-caffeinated soda, tea w/honey, sport
drinks
Foods that are bulk-forming include
apples, bananas, rice, cheese, white
bread, applesauce
Active culture yogurt; probiotics
May purchase Pectin (ie-Sure Jell, Certa)
- Mix 30 ml w/fluid BID
Supplements vs Food
#1 Goal = Use
FOOD FIRST!
Some companies,
however pay veryhowever, pay very
little for
supplements
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Supplement vs Food
Cost for 4 oz Homemade Milkshake
Calories = ~180
Whole Milk - $.09
Ice Cream - $.06
Fruit - $ 12Fruit $.12
Labor - $.53 (4 min)
Total = $.80 or $.20/oz
Cost for 4 oz Ensure Plus w/ Great Corporate Pricing
Standardized FormulariesRD, MD and Wound Team
decides 2-3 choices for
supplements
High calorie, high protein,
lactose free
Juice based, less sweetJuice based, less sweet
Lower calorie, higher
protein (Protein isolate)
Price shop; order bulk
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Tips for Low Cost Purchases
Buy bulk when possible - Ex:
Nuts (Planters Pecans 6 oz =Nuts (Planters Pecans 6 oz =
$20 vs. $8/lb bulk)
Shop the bargains - Canned
Food Warehouse, Costco,
local sales, online options like
AmazonAmazon
Use leftovers - makes great
soup, stews, casseroles,
muffins
http://www.walgreens.com/pharmacy/http://www.walmart.com/cp/Pharmacy
http://www.abbottstore.com/ajax-only-do-not-edit/first-order-savings/page/save15percentoff/
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Questions & Thank You’s
Any questions?
Sue Stillman Linja, RD, LD - [email protected]
Thank you to Abbott Lab for sponsoring this session and forThank you to Abbott Lab for sponsoring this session and for
the Idaho Dairy Council for some of the colorful handouts
1. American Dietetic Association. ADA Nutrition Care Manual. Chicago: American Dietetic Association, 2010.
2. National Pressure Ulcer Advisory Panel and European Pressure Ulcer Advisory Panel. (National Pressure Ulcer Advisory Panel). Prevention
References
and treatment of pressure ulcers: clinical practice guideline. 2009.
3. Dorner B, Posthauer ME, Thomas D, National Pressure Ulcer Advisory Panel. (National Pressure Ulcer Advisory Panel). The Role of Nutrition in Pressure Ulcer Prevention and Treatment: National Pressure Ulcer Advisory Panel White Paper. 2009.
4. Posthauer ME, Droner B, Collins N. Nutrition: A Critical Component of Wound Healing. Adv in Skin and Wound Care. December 2010;23:560-571
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5. Litchford MD. Advanced Practitioner's Guide to Nutrition & Wounds Greensboro, NC: CASE Software & Books; 2010 www.casesoftware.com).
6. Molnar J, ed. Nutrition and wound healing. Boca Raton, Fl: CRC Press; 2007.
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