Disease-Specific, Versus Standard, Nutritional Support for the Treatment of Pressure Ulcers in Institutionalized Older Adults: A Randomized Controlled Trial

OBJECTIVES To investigate whether a disease-specific nutritional approach is more beneficial than a standard dietary approach to the healing of pressure ulcers (PUs) in institutionalized elderly patients. DESIGN Twelve-week follow-up randomized controlled trial (RCT). SETTING Four long-term care facilities in the province of Como, Italy. PARTICIPANTS Twenty-eight elderly subjects with Stage II, III, and IV PUs of recent onset (< 1-month history). INTERVENTION All 28 patients received 30 kcal/kg per day nutritional support; of these, 15 received standard nutrition (hospital diet or standard enteral formula; 16% calories from protein), whereas 13 were administered a disease-specific nutrition treatment consisting of the standard diet plus a 400-mL oral supplement or specific enteral formula enriched with protein (20% of the total calories), arginine, zinc, and vitamin C (P <.001 for all nutrients vs control). MEASUREMENTS Ulcer healing was evaluated using the Pressure Ulcer Scale for Healing (PUSH; 0=complete healing, 17=greatest severity) tool and area measurement (mm(2) and %). RESULTS The sampled groups were well matched for age, sex, nutritional status, oral intake, type of feeding, and ulcer severity. After 12 weeks, both groups showed significant improvement (P <.001). The treatment produced a higher rate of healing, the PUSH score revealing a significant difference at Week 12 (-6.1 +/- 2.7 vs -3.3 +/- 2.4; P <.05) and the reduction in ulcer surface area significantly higher in the treated patients already by Week 8 (-1,140.9 +/- 669.2 mm(2) vs -571.7 +/- 391.3 mm(2); P <.05 and similar to 57% vs similar to 33%; P <.02). CONCLUSION The rate of PU healing appears to accelerate when a nutrition formula enriched with protein, arginine, zinc, and vitamin C is administered, making such a formula preferable to a standardized one, but the present data require further confirmation by high-quality RCTs conducted on a larger scale.