Diet, wound healing

Malnutrition is a significant but reversible risk factor. High-protein diets have been shown in multiple studies to improve wound healing in patients with pressure sores.37... 

Consumption of fish oil in excess can generate immunotoxic effects in laboratory animals. Rats fed a 17% fish oil diet had reduced wound-healing responses when compared to com oil [59], In a mouse model of bacterial resistance to S. typhimurium, lower survival rates were reported for those animals that ingested a 20% fish oil diet over 15 days [59], Similar fish oil-induced effects in guinea pigs were noted in a study of experimental tuberculosis leading the authors to conclude that this treatment resulted in decreased resistance to infectious disease. The consumption of fish oil has also been reported to result in alterations of hemostatic parameters such as platelet production and function. However, there is no indication that at doses normally consumed by humans, immunotoxicity will occur. 

Albina, J.E., Gladden, P, and Walsh, W.R., Detrimental effects of an omega-3 fatty acid-enriched diet on wound healing, J. Parenter. Enteral. Nutr., 17, 519, 1993. 

Toxicity Zinc and its compounds are relatively nontoxic, but very large doses can produce acute gastroenteritis characterized by nausea, vomiting, and diarrhea. The recommended dietary allowance (RDA) for zinc is 15 mg/day for men, 12 mg/day for women, 10 mg/day for children, and 5 mg/day for infants. Not enough zinc in the diet can result in a loss of appetite, a decreased sense of taste and smell, skin sores and slow wound healing, or a damaged immune system. 

Deficiency in vitamin C leads to the disease scurvy due to the role of the vitamin in the post-translational modification of collagens. Scurvy is characterized by easily bruised skin, muscle fatigue, soft swollen gums, decreased wound healing and hemorrhaging, osteoporosis, and anemia. Vitamin C is readily absorbed and so the primary cause of vitamin C deficiency is poor diet and/or an increased requirement. The primary physiological state leading to an ihcreased requirement for vitamin C is severe stress (or trauma). This is due to a rapid depletion in the adrenal stores of the vitamin. The reason for the decrease in adrenal vitamin C levels is unclear but may be due either to redistribution of the vitamin to areas that need it or an overall increased utilization. 

Vitamin A. Vitamin A is a generic term representing several related retinyl chemicals with vitamin properties. Deficiency of vitamin A in your diet can lead to impaired night and sunlight vision, delayed wound healing, skin diseases such as eczema, abnormal skeletal development in children, and increased risk of infection, particularly of respiratory or viral origin. 

Copper occurs in many foods particularly good sources are liver, kidney, shellfish, nuts, raisins, and dried legumes. Copper deficiency due to diet is rare except in malnutrition and in children with chronic diarrhea. It occurs in total parenteral nutrition with fluids low in copper, particularly following intestinal resection and in patients who receive large amounts of zinc to improve wound healing or for management of sickle cell anemia. Copper is often removed from prepared foods to increase their shelf life. 

Many patients with liver failure have a malabsorption syndrome and chronic diarrhea. Chronic diarrhea causes zinc deficiency because stool contains substantial quantities of zinc. Cytokines such as tumor necrosis factor, interleukin-1, and interleukin-6 may stimulate metal-lothionein, an intestinal zinc-binding protein, thereby inhibiting zinc absorption. Considering the importance of zinc in metalloenzyme reactions, wound healing, immunocompetence, and the senses of taste and smell, patients with chronic diarrhea or large ostomy losses should be suspected of having zinc deficiency measurement of serum concentrations may be used to confirm such deficiencies. Patients receiving a protein-restricted diet may be at additional risk because substantial amounts of zinc are found in red meat. 

Water-Soluble Vitamins. Vitamin G (ascorbic acid) functions in the formation of collagen, wound healing, metabolic functions, and other roles. Foods high in vitamin G include citrus fruits, strawberries, cantaloupe, and cruciferous vegetables. B vitamins are important in energy metabolism. Thiamin (Bj) is called the antineuritic vitamin. Riboflavin (B ), rarely deficient in the diet, is found most abundantly in milk and dairy products. Niacin (Bj) is prevalent in meats, poultry, fish, peanut butter, and other foods. Other major B vitamins include folic acid (B ), B, and Bj2-... 

When the vitamin is not present in the diet, lesions appear on the skin, severe bleeding occurs about the gums, in the joints, and under the skin, and any wound heals slowly. 

Linoleic acid is an essential fatty acid that must be consumed for proper health. A lack of linoleic acid and other n-6 fatty acids in the diet causes dry hair, hair loss, and poor wound healing. 

A water soluble vitamin which cannot be synthesized by man and therefore has to be obtained from the diet. It is found extensively in vegetables and fruit, especially the citrus varieties. Since the vitamin is carried mainly in the leukocytes, its measurement in these cells gives some indication of the vitamin C status of the body. The ascorbic acid saturation test can also be used to assess the vitamin status. The biochemical role of the vitamin is obscure although it does seem to be required for collagen formation. Deficiency of the vitamin causes scurvy, the symptoms of which can be related to poor collagen formation. These include poor wound-healing, osteoporosis (due to bone matrix deficiency), a tendency to bleed (due to deficiences in the vascular walls) and anaemia. 

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