title: Treatment with supplementary arginine, vitamin C and zinc in patients with pressure ulcers: a randomised controlled trial.
abstract: OBJECTIVE
  Nutrients putatively implicated in pressure ulcer healing were evaluated in a clinical setting.
  
  
  METHODS
  Sixteen inpatients with a stage 2, 3 or 4 pressure ulcer randomised to receive daily a standard hospital diet; a standard diet plus two high-protein/energy supplements; or a standard diet plus two high-protein/energy supplements containing additional arginine (9 g), vitamin C (500 mg) and zinc (30 mg). Nutritional status measurements (dietary, anthropometric and biochemical) and pressure ulcer size and severity (by PUSH tool; Pressure Ulcer Scale for Healing; 0=completely healed, 17=greatest severity) were measured weekly for 3 weeks.
  
  
  RESULTS
  Patients' age and BMI ranges were 37-92 years and 16.4-28.1 k g/m2) respectively. Baseline PUSH scores were similar between groups (8.7+/-0.5). Only patients receiving additional arginine, vitamin C and zinc demonstrated a clinically significant improvement in pressure ulcer healing (9.4+/-1.2 vs. 2.6+/-0.6; baseline and week 3, respectively; P<0.01). All patient groups presented with low serum albumin and zinc and elevated C-reactive protein. There were no significant changes in biochemical markers, oral dietary intake or weight in any group.
  
  
  CONCLUSIONS
  In this small set of patients, supplementary arginine, vitamin C and zinc significantly improved the rate of pressure ulcer healing. The results need to be confirmed in a larger study.
authors.affiliation: Department of Nutrition and Dietetics, Austin Health, Studley Road, Heidelberg 3084, and School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia.
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Desneves
authors.forename: Bree E
authors.initials: BE
authors.lastname: Todorovic
authors.forename: Ann
authors.initials: A
authors.lastname: Cassar
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Crowe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000886:Anthropometry; D000975:Antioxidants / Q000627:therapeutic use; D001120:Arginine / Q000627:therapeutic use*; D001205:Ascorbic Acid / Q000627:therapeutic use*; D001774:Blood Chemical Analysis; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D003668:Pressure Ulcer / Q000188:drug therapy*; D012720:Severity of Illness Index; D014131:Trace Elements / Q000627:therapeutic use; D016896:Treatment Outcome; D014945:Wound Healing / Q000187:drug effects*; D015032:Zinc / Q000627:therapeutic use*
chemical_list: D000975:Antioxidants; D014131:Trace Elements; D001120:Arginine; D015032:Zinc; D001205:Ascorbic Acid