The importance of good nutrition in the healing of wounds and the promotion of health is widely accepted, but remains of low priority in health care and insufficient numbers of patients receive nutritional assessment.
There are a number of nutrients which have key roles in the healing process:
Protein depletion can affect the rate and quality of wound healing. There is an increase in demand for protein in the presence of a wound, a requirement further increased in the event of sepsis or stress. Protein is required as part of the inflammatory process, in the immune response and in the development of granulation tissue. The main protein synthesised during the healing process is collagen, and the strength of the collagen determines wound strength. Even short periods of low protein intake can result in significantly delayed wound healing. Protein inadequacy has also been shown to affect remodelling of the wound. In extreme cases of hypoalbuminaemia (i.e. low levels of the serum protein albumin) from long periods of insufficient protein intake, oedema may develop.
The amino acid arginine becomes essential during severe stress. It is abundant in the structure of collagen, and increases its tensile strength. Arginine metabolism is also related to the production of nitric oxide, which is bactericidal, and also aids wound healing through microvascular and haemodynamic changes.
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