THE IMPORTANCE OF DIETARY-PROTEIN IN HEALING PRESSURE ULCERS

Objective: To determine the effect of dietary protein on healing of pressure ulcers in malnourished patients. Design: Nutritional intervention trial with the non-randomized assignment of patients by pressure ulcer stage and bed type. Setting: Long-term care facility. Patients: Twenty-eight malnourished patients (age = 72 18 years, mean +/- SD) with a total of 33 truncal pressure ulcers. Nine patients had stage II ulcers, eight had stage III ulcers, and 16 had stage IV ulcers. Methods: Patients received liquid nutritional formulas as tubefeedings or meal supplements containing either 24% protein (61 g protein/L; n = 15) or 14% protein (37 g protein/L; n = 13) for 8 weeks. Results: There was a significant decrease in total truncal pressure ulcer surface area of the 15 patients in the 24% protein group (-4.2 +/- 7.1 cm2, P < 0.02), but not in the 13 patients in the 14% protein group (-2.1 +/- 11.5 cm2, P = NS). The change in total ulcer area correlated with both dietary protein intake per kg body weight (r(s) = -0.50, P < 0.01) and caloric intake per kg body weight (r(s) = -0.41, P < 0.03). The decrease in stage IV ulcer area in eight patients in the 24% protein group (-7.6 +/- 5.8 cm2, P < 0.02) was significantly greater (P < 0.05) than in eight patients in the 14% protein group (-3.2 +/- 16.4, P = NS). In these 16 patients, the decrease in ulcer size also correlated with dietary protein intake per kg body weight (r(s) = -0.63, P < 0.01). Conclusion: High protein diets may improve the healing of pressure ulcers in malnourished nursing home patients.