title: Nutrition and skin ulcers.
abstract: OBJECTIVE
  Skin ulcerations cause significant morbidity and mortality, while driving up healthcare utilization and costs. Interventions to prevent ulcers and improve wound healing times are needed to reduce the burden on patients and healthcare systems. It has been well established that weight loss, protein-calorie malnutrition, and dehydration are risk factors for pressure ulcers. Many nutritional interventions have been studied, with studies being of variable quality and producing mixed results. This review aims to clarify the current evidence and highlights the recent advances in the area of nutrition for the prevention and management of skin ulceration.
  
  
  RESULTS
  Markers for assessing nutritional status will be reviewed first, followed by a discussion on the theoretical benefit of various nutritional interventions on wound healing. Recommendations for nutrient repletion are also included. Finally, the most recent or important literature will be highlighted and the risks and benefits of supplementation are debated. There is mixed evidence for most nutritional interventions, with most studies being of poor quality with variable study designs, lack of control groups, small sample sizes, and short study lengths.
  
  
  CONCLUSIONS
  Long-term randomized trials of individual nutrients and clinically relevant endpoints are needed to definitively show the benefit of additional nutritional supplementation over dietary interventions. Until those studies become available, best evidence suggests the importance of screening for malnutrition, calculating resting energy expenditure and caloric needs, and monitoring dietary intake of essential nutrients.
authors.affiliation: Division of Geriatric Medicine, Department of Internal Medicine, Saint Louis University Medical Center, Saint Louis, Missouri 63104, USA. mlittle6@slu.edu
authors.forename: Milta O
authors.initials: MO
authors.lastname: Little
mesh_terms: D000886:Anthropometry; D000975:Antioxidants / Q000008:administration & dosage; D015415:Biomarkers / Q000097:blood; D004044:Dietary Proteins / Q000008:administration & dosage; D019587:Dietary Supplements; D002149:Energy Intake; D004734:Energy Metabolism; D006801:Humans; D018977:Micronutrients / Q000008:administration & dosage; D015596:Nutrition Assessment; D009752:Nutritional Status; D003668:Pressure Ulcer / Q000209:etiology / Q000503:physiopathology* / Q000517:prevention & control; D011502:Protein-Energy Malnutrition / Q000150:complications / Q000503:physiopathology*; D012307:Risk Factors; D014945:Wound Healing / Q000187:drug effects
chemical_list: D000975:Antioxidants; D015415:Biomarkers; D004044:Dietary Proteins; D018977:Micronutrients