Disease-specific, versus standard, nutritional support for the treatment of pressure ulcers in institutionalized older adults: a randomized controlled trial.
OBJECTIVE
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.


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


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


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


METHODS
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).


METHODS
Ulcer healing was evaluated using the Pressure Ulcer Scale for Healing (PUSH; 0=complete healing, 17=greatest severity) tool and area measurement (mm(2) 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 mm(2) vs -571.7+/-391.3 mm(2); P<.05 and approximately 57% vs approximately 33%; P<.02).


CONCLUSIONS
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.
Cereda
Emanuele
E
International Center for the Assessment of Nutritional Status, University of Milan, Milan, Italy. emanuele.cereda@virgilio.it
Gini
Anna
A
Pedrolli
Carlo
C
Vanotti
Alfredo
A
D000368:Aged; D000704:Analysis of Variance; D000886:Anthropometry; D000975:Antioxidants / Q000627:therapeutic use; D001120:Arginine / Q000627:therapeutic use*; D001205:Ascorbic Acid / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D002149:Energy Intake; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy; D008134:Long-Term Care; D008297:Male; D015596:Nutrition Assessment; D009752:Nutritional Status; D018529:Nutritional Support; D003668:Pressure Ulcer / Q000178:diet therapy*; D012044:Regression Analysis; D016896:Treatment Outcome; D014945:Wound Healing / Q000187:drug effects*; D015032:Zinc / Q000627:therapeutic use*
D000975:Antioxidants; D001120:Arginine; D015032:Zinc; D001205:Ascorbic Acid