Specific nutrition as an integrated part of pressure ulcer care

Pressure ulcers are a common problem in all healthcare sectors, affecting quality of life and increasing healthcare costs. Providing sufficient amounts of protein and energy is a logical way to reduce the risk of developing pressure ulcers and improve the healing of ulcers. In addition, specific nutrients can help to strengthen tissue resistance, preserve tissue and promote tissue repair.

Cubitan®(Nutricia) is a specific nutritional supplement that is enriched with arginine, trace elements and vitamins (ie Zn, Cu, vit E, vit C, folic acid). Its effect on pressure ulcer healing in non-malnourished patients was assessed in a multi-country, doubleblind, randomized and controlled trial. Subjects with BMI ≥18.5 or ≥21 (if >70 years) and grade III/IV pressure ulcers were served 3×200ml per day of either Cubitan® or a non-caloric control product for a maximum of 8 weeks (Cubitan® 22 patients, Control 21 patients; ITT).

Supplementation with Cubitan® improved pressure ulcer healing, as indicated by a significant difference in ulcer surface area and severity compared to the control  group over the period of 8 weeks. Supplementation with Cubitan® is also likely to reduce the overall cost of pressure ulcer care; significantly fewer dressings were required per week in the intervention group and less time was spent changing the dressings compared to the control group.

This study proves that non-malnourished patients with pressure ulcers can benefit from a specific nutritional supplement intervention and that its benefit might reach beyond restoring caloric and protein deficiencies, as often is the case in malnourished patients.

This is a summary of the presentation given Professor Jos Schols at the recent Nutricia Satellite Symposium, ESPEN 2009 held in Vienna on Sunday 30th August 2009.

Professor Jos Schols is the chair in Nursing Home Medicine at Maastricht University Medical Centre and medical manager of a large nursing home organization. Professor Schols studied medicine at Maastricht University, Maastricht, The Netherlands, earning his PhD in 2000 on the subject, ‘In and from the nursing home; collaboration between nursing home physician and general practitioner’.