Protein Needs in Compromised Populations Part I

There does not appear to be much debate when discussing the importance of nutrition on patients suffering from wounds and burns and likewise with people who are HIV positive. More specifically, increased intake of protein is often posed as the essential nutrient for such patients. However, as is always the case, it is of paramount importance to examine the scientific findings of such claims before making the assumption that the recommendations are sound. For the purposes of this paper, a brief review of the literature concerning the afore-mentioned populations in relation to protein intake will be presented.

Wound and Burn Healing

According to an article published in the British Journal of Nursing, author Linda Russell reported that protein deficiency poses many detriments to the healing process such as reduction in collagen formation.¹ Further, Russell commented that high exudate loss has the potential to deplete protein stores by 100 grams per day, thus indicating the need for heightened intake of protein.¹ It should be noted that in addition to increased protein intake, the author encouraged a comprehensive evaluation of nutrition overall, stating that a holistic approach to nutrient load is vital to wound healing.¹

A 2014 review of the literature looked at the necessity of nutrition, including the subset of protein, in relation to wound healing.² Researchers stated that increased  protein needs were noted as a result of protein loss due to large surface area of unhealed wounds, wound exudates, chronic wound sites, and losses in lean body mass.^{2, 3} Further, researchers stated that in order to experience wound healing, protein losses must be accounted for and replaced by increased intake of protein.² Once again, it is noteworthy to mention that the authors recommend a comprehensive overview of nutrition and possible supplementation of various sources to enhance wound healing, rather than solely relying upon increased protein intake.

In a 1993 study of 28 malnourished patients with truncal pressure ulcers, researchers examined the effect of protein on wound healing.³ Patients were divided into two groups, one receiving 24% protein (high intake) and the other receiving 14% protein (moderately high intake).³ Researchers observed a decrease in wound surface area in the higher protein group but not the moderate protein group.³ Higher caloric intake was also noted as a contributing factor to the reduction in wound surface area in the higher protein group.³ Though the researchers concluded that high protein diets may improve wound healing, it is important to point out the uniqueness of the population studied (malnourished nursing home patients) and not automatically apply the findings to the general population.

A 2009 review of the literature studied the connection between nutrition and wound healing and confirmed conclusions previously mentioned. Authors stated, based upon their review,  that protein is a vital component to wound and burn healing.⁴ Skin regrowth, according to the review, is dependent upon cell proliferation and protein synthesis, both of which require increased protein consumption.⁴ In addition, researchers concluded that rapid protein initiation was vital in preventing protein malnourishment in patients.⁴ Researchers not only recommended protein intake increase but also the inclusion of anabolic hormones to heighten the body’s response to protein⁴  Of key importance would be an additional review of the data concerning risks involved with this type of supplementation,  a suggestion not examined in the current article.

A literature review in the Indian Journal of Critical Care Medicine examined the importance of hydration and nutritional intake in relation to pressure ulcers.⁵ Researchers noted that though hydration is of key importance to the regeneration of skin, nutrition is equally imperative to the wound healing process.⁵ Protein, along with a multitude of other nutrients, was recommended  as essential to the process of wound healing, stating that protein was the most important macronutrient involved in the repair of tissues.⁵

In a 2014 Cochrane Review, researchers studied a variety of factors in regard to wound healing, including increased protein intake.⁶ Outcome results showed a lack of efficacy in regard to the incorporation of increased protein and wound healing.⁶ Furthermore, out of the fourteen studies reviewed, authors concluded that nutritional supplements overall showed no benefit to wound healing (with the questionable exception of arginine which showed possible but not convincing efficacy).⁶

References

1. Russell, L. The importance of patients' nutritional status in wound healing. British Journal               of Nursing. 2013; 10(1): 44-49.

2. Molnar JA, Underdown MJ, Clark WA. Nutrition and chronic wounds. Advanced Wound                  Care (New Rochelle). 2014;3(11):663–681.

3. Breslow RA, Hallfrisch J, Guy DG, Crawley B, Goldberg AP. The importance of dietary                 protein in healing pressure ulcers. Journal of the American Geriatric Society. 1993; 41(4):                   357-362.

4. Demling RH. Nutrition, anabolism, and the wound healing process: an overview. Eplasty.                2009;9:e9.

5. Saghaleini SH, Dehghan K, Shadvar K, Sanaie S, Mahmoodpoor A, Ostadi Z. Pressure                    ulcer and nutrition. Indian Journal of Critical Care Medicine. 2018;22(4):283–289. 

6. Langer  G, Fink  A. Nutritional interventions for preventing and treating pressure ulcers.                  Cochrane Database of Systematic Reviews 2014, Issue 6. Art. No.:CD003216. 

DOI:  10.1002/14651858.CD003216.pub2.