Treatment with supplementary arginine, vitamin C and zinc in patients with pressure ulcers: A randomised controlled trial

Background Et Aims: Nutrients putatively implicated in pressure ulcer heating were evaluated in a clinical setting. Methods: Sixteen inpatients with a stage 2, 3 or 4 pressure ulcer randomised to receive daily a standard hospital diet; a standard diet plus two high-protein/energy supplements; or a standard diet plus two high-protein/ energy supplements containing additional arginine (9 g), vitamin C (500 mg) and zinc (30 mg). Nutritional status measurements (dietary, anthropometric and biochemical) and pressure ulcer size and severity (by PUSH too[; Pressure Ulcer Scale for Heating; 0 = completely heated, 17 = greatest severity) were measured weekly for 3 weeks. Results: Patients' age and BMI ranges were 37-92 years and 16.4-28.1 kg/m(2), respectively. Baseline PUSH scores were similar between groups (8.7 +/- 0.5). Only patients receiving additional arginine, vitamin C and zinc demonstrated a clinically significant improvement in pressure ulcer heating (9.4 +/- 1.2 vs. 2.6 +/- 0.6; baseline and week 3, respectively; P < 0.01). All patient groups presented with low serum albumin and zinc and elevated C-reactive protein. There were no significant changes in biochemical markers, oral dietary intake or weight in any group. Conclusions: In this small set of patients, supplementary arginine, vitamin C and zinc significantly improved the rate of pressure ulcer heating. The results need to be confirmed in a larger study. (c) 2005 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.