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11 Thoughts to “How dietary protein intake promotes wound healing”

  1. Very informative and a great review for those of us who are seeing many geriatric patients daily who are almost always protein depleted. Thank you, Nancee Drone R.N. W.C.C.

  2. Shane Dahl

    When assessing patients protein needs for would healing you didn’t mention whether this is recommended based off current weight, ideal weight, or adjusted weight. Are there any recommendations? I currently base protein intake based on adjusted weight when they are morbidly obese. The idea to get someone to consume 3500 calories get get sufficient protein when they are morbidly obese isn’t feasible with our Elderly, most can’t consume that much food.

  3. Christina Cullen

    I too found this very interesting. I have read that protein requirements should be based on the patients acutal body weight (as per the TranTasminDietitan Wound Care Group Guidelines for Pressure Ulcers), though I can not find justification for this especially in our obese patients. In practice (i work in a regional plastics unit) I often use an obesity adjusted calculation for protein to first establish an estimated protein requirement and then adjust it based on healing rate, weight change, urea, and albumin. These calculations provide guestimations only and they should only be a starting point, as we gain a clearer clincial picture we can adjust our practice.
    Would be very interested to hear others views on obesity adjustments for protein requirements.

  4. Christina Cullen,
    You wrote “I often use an obesity adjusted calculation for protein to first establish an estimated protein requirement and then adjust it based on healing rate, weight change, urea, and albumin.” Can you explain how to determine an obesity adjusted calculation for protein. I’m new to dealing with wound related nutrition.

    And how do you make adjustments from the initial protein determination using lab work. Is healing rate something the RN would determine? I’m going into Home Health.

    Thank you!

    1. Christina Cullen

      Hi Lori,
      I use an obesity adjusted weight, then times that by the amount of protein (g) per kg that I’ve assessed a patient requires.
      For example: 100kg, 1.55cm, Pressure ulcer stg3
      BMI = 41.6kg/m2
      idealBW = ~60kg,
      adjustedBW = ~70kg
      70kg x 1.25g-1.5g = 87.5g-105g/protein/day

      In terms of biochem adjustments; this differs on the patients co-morbidities of course and needs to be assessed on an individual patient bases, but in general if i note that the urea has elevated above the normal range since I increased the protein intake and the patient does not have renal disease or an acute kidney injury but is suffering from ureamic symptoms then perhaps the protein intake is to high. Alternatively if the urea decreases I consider that the protein intake is inadequate.

      Wound healing is of course determined by the doctors and as we all know there are many factors that contribute to good or poor wound healing and nutrition is only one factor but if the wound is healing well and within the expected time frame as indicated by the doctors and the patients weight is relatively stable then you can assume that the patient is receiving adequate protein and calories.

      On that note, to ensure that amino acids are used for healing and immunity, rather then as a energy source it is essential that a patient receives adequate calories from carbohydrates and fat. I use the MJS equation as a calorie predictor and find it is appropriate for overweight and obese patients.

      I would love to here others views and opinions too!

  5. Ron Chally, RN

    Excellent article. Is there a specific type of instant protein supplement that is easier to digest for elderly patients?

    1. Dr Collins

      There are many reputable brands of protein powder available – some common names includes ProMod, Unjury, Proteinex and ProStat. Please viit the web sites to learn more about each product and decide what works for you as far as flavors, liquid or powder, costs, etc.

  6. Sharon

    I have used this a guide I found it very informative as I have upgraded the proteins in my husbands diet he had a toe amputated and it has increased the healing time.

  7. When a woman of early twenties who has suffered sulfuric acid burns to her face, body and internal/esophagus tract can not eat during the healing and recovery and is given medication and supplements as a substitute that is administered through a tube to the esophagus. What would be the highest strength protein powder/supplements that would be given. In cases where very thick and healthy hair is grown as a result? Not regrowth, as the hair was not damaged – what would have been responsible?

    1. Dr Collins

      Tube feedings can provide up to 2.0 calories per mL with varying protein content depending on the specific product.

  8. Kathy garza

    I had a major MVI in January and having trouble healing my tibia plateau.
    I am overweight (lost 20 lbs since the accident) and am working on small 10% losses at a time
    I now weigh 208, how much protein per day, due you recommend?

    thanks
    kathy

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