Effects of nutritional status on wound healing.

Malnutrition causes an array of metabolic alterations that affect wound healing. Stressed starvation, in which essential protein stores in lean body mass and viscera are utilized, is of utmost concern. Hospital-related malnutrition usually presents as a combination of both protein and energy malnutrition. Key nutrients play specific roles in wound healing. For example, vitamin C is essential for collagen synthesis, vitamin A enhances epithelialization, and zinc is necessary for cell mitosis and cell proliferation. Modern methods are available to determine an array of serum nutrient levels; however, these investigations are often inadequate, because serum levels of specific nutrients frequently do not reflect the total body content. Therefore the common association between generalized malnutrition and deficiencies of specific nutrients must be recognized. By using current nutritional techniques such as anthropometrics, albumin, transferrin, and immune status, one could determine nutritional deficiencies and thereby could replete all nutrients, including protein, carbohydrate, fat, vitamins, and minerals, through either parenteral or enteral support.