A randomised, double-blind assessment of the effect of nutritional supplementation on the prevention of pressure ulcers in hip-fracture patients.
OBJECTIVE
Malnutrition is a risk factor for development of pressure ulcers (PU). Nutritional supplementation may thus reduce the incidence of PU. We investigated the effect of nutritional supplementation on incidence of PU in hip-fracture patients at risk of developing PU.


METHODS
Hip-fracture patients (n=103) were included in this double-blind, randomised, placebo-controlled trial. They received 400 ml daily of a supplement enriched with protein, arginine, zinc and antioxidants (n=51) or a non-caloric, water-based placebo supplement (n=52). Presence and stage of PU were assessed daily for 28 days or until discharge (median: 10 days during supplementation).


RESULTS
Incidence of PU was not different between supplement (55%) and placebo (59%), but incidence of PU stage II showed a 9% difference (difference: 0.091; 95% CI: 0.07-0.25) between supplement (18%) and placebo (28%). Of patients developing PU 57% developed it by the second day. Time of onset (days) showed a trend (P=0.090) towards later onset of PU with supplement (3.6+/-0.9) than placebo (1.6+/-0.9).


CONCLUSIONS
Hip-fracture patients develop PU at an early stage. Nutritional supplementation may not prevent PU at this stage, but contributes possibly to a delayed onset and progression of PU. Nutritional supplementation may be more effective if initiated earlier.
Houwing
R H
RH
Deventer Ziekenhuis, Department of Dermatology, Deventer, The Netherlands.
Rozendaal
M
M
Wouters-Wesseling
W
W
Beulens
J W J
JW
Buskens
E
E
Haalboom
J R
JR
D000368:Aged; D000369:Aged, 80 and over; D000975:Antioxidants / Q000008:administration & dosage*; D001120:Arginine / Q000008:administration & dosage; D001510:Bed Rest / Q000009:adverse effects; D004044:Dietary Proteins / Q000008:administration & dosage*; D018450:Disease Progression; D004311:Double-Blind Method; D005260:Female; D015577:Geriatric Assessment; D006620:Hip Fractures / Q000150:complications*; D006801:Humans; D015994:Incidence; D008297:Male; D044342:Malnutrition / Q000150:complications / Q000517:prevention & control; D018529:Nutritional Support / Q000379:methods*; D003668:Pressure Ulcer / Q000453:epidemiology / Q000473:pathology / Q000517:prevention & control*; D012307:Risk Factors; D012720:Severity of Illness Index; D015032:Zinc / Q000008:administration & dosage
D000975:Antioxidants; D004044:Dietary Proteins; D001120:Arginine; D015032:Zinc