Was hat die Ernährung mit der Wundheilung zu tun?

ZUSAMMENFASSUNG

Bei einer Störung im Ablauf der Wundheilung kann es zu einem verzögerten oder fehlenden Wundverschluss kommen. Als ein möglicher Störfaktor gilt die Ernährung. Man muss zwischen quantitativer und qualitativer Mangelernährung unterscheiden. Gerade übergewichtige Patienten leiden oft an einer qualitativen Mangelernährung und Sarkopenie.

Spezifische Erkrankungen machen eine entsprechende diätetische Nahrungsempfehlung notwendig. So findet man bei dialysepflichtigen Patienten, Dekubitus-Patienten und Ulcus cruris-Patienten oft einen Eiweißmangel. Auch niedrige Level an Vitamin C, Zink, Folsäure, Vitamin D oder Spurenelementen können die Wundheilung negativ beeinflussen.

Größere prospektive Studien sollten klären, ob eine Substitution dieser Mangelzustände den gewünschten positiven Effekt auf die Wundheilung hat. Es erscheint aber sinnvoll, eine ausgewogene Ernährung und an die individuellen Ernährungsgewohnheiten angepasste Verbesserung der Aufnahme von Vitaminen, Spurenelementen und Eiweißen anzustreben.

ABSTRACT

Interference during the complex wound healing process might lead to a delayed or absence of wound closure. One possible disruptive factor can be wrong nutrition. It is necessary to differentiate between quantitative and qualitative malnutrition. Preferential obese patients suffer from a qualitative malnutrition and sarkopenia.

Specific diseases require a specific nutritional recommendation. For example, patients with dialysis, decubitus, or leg ulcers often have a lack of proteins. In addition, other nutrient deficiencies with vitamin C, zinc, folate, vitamin D or trace elements might have a negative impact on wound healing.

Prospective studies should clarify if substitution of those nutrient deficiencies might improve wound healing. It seems to be reasonable to strive for an improvement in the consumption of vitamins, trace elements and proteins adopted to a balanced alimentation and adjusted to individual dietary habits.

Schlüsselwörter

quantitative Mangelernährung - qualitative Mangelernährung - Eiweißmangel - Vitamin-C-Mangel - Folsäuremangel - Wundheilungsstörungen

Keywords

quantitative malnutrition - qualitative malnutrition - protein deficiency - vitamin C deficiency - folate deficiency - wound healing disorders

Publikationsverlauf

Eingereicht: 15. Juli 2019

Artikel online veröffentlicht:
14. Juni 2022

• Literatur

• 1 Gosain A, DiPietro LA. Aging and wound healing. World J Surg 2004; 28: 321-326 DOI: 10.1007/s00268-003-7397-6. (PMID: 14961191)
• 2 Mathieu D, Linke JC, Wattel F. Non-healing wounds. In: Mathieu DE. Handbook on hyperbaric medicine. Netherlands: Springer; 2006: 401-427
• 3 Arnold M, Barbul A. Nutrition and wound healing. Plast Reconstr Surg 2006; 117: 42S-58S DOI: 10.1097/01.prs.0000225432.17501.6c. (PMID: 16799374)
• 4 Dissemond J, Bültemann A, Gerber V. et al. Standards des ICW e.V. für die Diagnostik und Therapie chronischer Wunden. Wund Management 2017; 11: 81
• 5 Demling RH. The role of anabolic hormones for wound healing in catabolic states. J Burns Wounds 2005; 4: e2 (PMID: 16921407)
• 6 Himes D. Protein-calorie malnutrition and involuntary weight loss: the role of aggressive nutritional intervention in wound healing. Ostomy Wound Manage 1999; 45: 46-51 (PMID: 10347519)
• 7 Barber GA, Weller CD, Gibson SJ. Effects and associations of nutrition in patients with venous leg ulcers: a systematic review. J Adv Nurs 2018; 74: 774-787 DOI: 10.1111/jan.13474. (PMID: 28985441)
• 8 Mojon P, Budtz-Jorgensen E, Rapin CH. Relationship between oral health and nutrition in very old people. Age Ageing 1999; 28: 463-468 DOI: 10.1093/ageing/28.5.463. (PMID: 10529041)
• 9 Projektgruppe 39: Medizinischer Dienst der Spitzenverbände der Krankenkassen (MDS). Grundsatzstellungnahme Ernährung und Flüssigkeitsversorgung älterer Menschen 2014. Available at (last accessed on 21 May 2019). https://www.mds-ev.de/fileadmin/dokumente/Publikationen/SPV/Grundsatzstellungnahmen/MDS_Grundsatzstellungnahme_EssenTrinken_im_Alter_Mai_2014.pdf
• 10 Wissing U, Unosson M. The relationship between nutritional status and physical activity, ulcer history and ulcer-related problems in patients with leg and foot ulcers. Scand J Caring Sci 1999; 13: 123-128 (PMID: 10633743)
• 11 Rolland Y, Lauwers-Cances V, Cristini C. et al. Difficulties with physical function associated with obesity, sarcopenia, and sarcopenic-obesity in community-dwelling elderly women: the EPIDOS (EPIDemiologie de l’OSteoporose) Study. Am J Clin Nutr 2009; 89: 1895-1900 DOI: 10.3945/ajcn.2008.26950. (PMID: 19369381)
• 12 Barber GA, Weller CD, Gibson SJ. Effects and associations of nutrition in patients with venous leg ulcers: a systematic review. J Adv Nurs 2017; DOI: 10.1111/jan.13474.
• 13 Tobon J, Whitney JD, Jarrett M. Nutritional status and wound severity of overweight and obese patients with venous leg ulcers: a pilot study. J Vasc Nurs 2008; 26: 43-52 DOI: 10.1016/j.jvn.2007.12.002. (PMID: 18492557)
• 14 Wipke-Tevis DD, Stotts NA. Nutrition, tissue oxygenation, and healing of venous leg ulcers. J Vasc Nurs 1998; 16: 48-56 DOI: 10.1016/s1062-0303(98)90001-2. (PMID: 9883147)
• 15 Sharma S, Sharma RK, Parashar A. Comparison of the nutritional status and outcome in thermal burn patients receiving vegetarian and non-vegetarian diets. Indian J Plast Surg 2014; 47: 236-241 DOI: 10.4103/0970-0358.138959. (PMID: 25190921)
• 16 Collins N. Vegetarian diets and wound healing. Adv Skin Wound Care 2003; 16: 65-66 DOI: 10.1097/00129334-200303000-00006. (PMID: 12690229)
• 17 Razzaghi R, Pourbagheri H, Momen-Heravi M. et al. The effects of vitamin D supplementation on wound healing and metabolic status in patients with diabetic foot ulcer: A randomized, double-blind, placebo-controlled trial. J Diabetes Complications 2017; 31: 766-772 DOI: 10.1016/j.jdiacomp.2016.06.017. (PMID: 27363929)
• 18 Armstrong DG, Hanft JR, Driver VR. et al. Diabetic Foot Nutrition Study Group: Effect of oral nutritional supplementation on wound healing in diabetic foot ulcers: a prospective randomized controlled trial. Diabet Med 2014; 31: 1069-1077
• 19 Soleimani Z, Hashemdokht F, Bahmani F. et al. Clinical and metabolic response to flaxseed oil omega-3 fatty acids supplementation in patients with diabetic foot ulcer: A randomized, double-blind, placebocontrolled trial. J Diabetes Complications 2017; 31: 1394-1400 DOI: 10.1016/j.jdiacomp.2017.06.010. (PMID: 28716357)
• 20 Daugirdas J, Blake P, Todd S. Handbook of Dialysis. In: . 4th ed.. Philadelphia: Lippincott Williams & Wilkins Publishers; 2007: 462-482
• 21 Kalantar-Zadeh K, Kopple J. Trace metals and vitamins in maintenance dialysis patients. Adv Ren Replace Ther 2003; 10: 170-182
• 22 National Pressure Ulcer Advisory Panel EPUAPaPPPIA. Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. Available at (last accessed on 21 May 2019). http://www.epuap.org/wp-content/uploads/2016/10/german_quick-reference-guide.pdf
• 23 Langer G, Fink A. Nutritional interventions for preventing and treating pressure ulcers. Cochrane Database Syst Rev 2014; 12: CD003216 DOI: 10.1002/14651858.CD003216.pub2. (PMID: 24919719)
• 24 Lahmann NA, Halfens RJ, Dassen T. Impact of prevention structures and processes on pressure ulcer prevalence in nursing homes and acute-care hospitals. J Eval Clin Pract 2010; 16: 50-56 DOI: 10.1111/j.1365-2753.2008.01113.x. (PMID: 20367815)
• 25 Gould L, Stuntz M, Giovannelli M. et al. Wound Healing Society 2015 update on guidelines for pressure ulcers. Wound Repair Regen 2016; 24: 145-162 DOI: 10.1111/wrr.12396. (PMID: 26683529)
• 26 Moores J. Vitamin C: a wound healing perspective. Br J Community Nurs 2013; S6: S8-S11 DOI: 10.12968/bjcn.2013.18.sup12.s6. (PMID: 24796079)
• 27 Graue N, Korber A, Cesko E. et al. Malnutrition in patients with leg ulcers. Results of a clinical trial. Hautarzt 2008; 59: 212-219 DOI: 10.1007/s00105-007-1465-z. (PMID: 18219470)
• 28 Balaji P, Mosley J. Evaluation of vascular and metabolic deficiency in patients with large leg ulcers. Ann R Coll Surg Engl 1995; 77: 270-272 (PMID: 7574318)
• 29 Ubbink DT, Santema TB, Stoekenbroek RM. Systemic wound care: a meta-review of cochrane systematic reviews. Surg Technol Int 2014; 24: 99-111 (PMID: 24700218)
• 30 Afifi AM, Ellis L, Huntsman RG. et al. High dose ascorbic acid in the management of thalassaemia leg ulcers – pilot study. Br J Dermatol 1975; 92: 339-341 DOI: 10.1111/j.1365-2133.1975.tb03085.x. (PMID: 1096927)
• 31 Bundesforschungsinstitut für Ernährung und Leben. Nationale Verzehrsstudie. 2008. Available at (last accessed on 05.01.2019) . https://www.bmel.de/SharedDocs/Downloads/Ernaehrung/NVS_ErgebnisberichtTeil2.pdf
• 32 Bagheri M, Jahromi BM, Zamani A. Folic acid may be a potential addition to diabetic foot ulcer treatment – a hypothesis. Int Wound J 2011; 8: 658-660 DOI: 10.1111/j.1742-481X.2011.00830.x. (PMID: 21854546)
• 33 de Franciscis S, De Sarro G, Longo P. et al. Hyperhomocysteinaemia and chronic venous ulcers. Int Wound J 2015; 12: 22-26 DOI: 10.1111/iwj.12042. (PMID: 23418772)
• 34 Burkievcz CJ, Skare TL, Malafaia O. et al. Vitamin D deficiency in patients with chronic venous ulcers. Rev Col Bras Cir 2012; 39: 60-63 (PMID: 22481708)
• 35 Burkiewicz CJ, Guadagnin FA, Skare TL. et al. Vitamin D and skin repair: a prospective, double-blind and placebo controlled study in the healing of leg ulcers. Rev Col Bras Cir 2012; 39: 401-407 DOI: 10.1590/s0100-69912012000500011. (PMID: 23174792)
• 36 Raffoul W, Far MS, Cayeux MC. et al. Nutritional status and food intake in nine patients with chronic low-limb ulcers and pressure ulcers: importance of oral supplements. Nutrition 2006; 22: 82-88 DOI: 10.1016/j.nut.2005.04.014. (PMID: 16455446)
• 37 Rojas AI, Phillips TJ. Patients with chronic leg ulcers show diminished levels of vitamins A and E, carotenes, and zinc. Dermatol Surg 1999; 25: 601-604
• 38 Gray M. Does oral zinc supplementation promote healing of chronic wounds?. J Wound Ostomy Continence Nurs 2003; 30: 295-299 DOI: 10.1016/S1071. (PMID: 14615757)
• 39 Wilkinson EA. Oral zinc for arterial and venous leg ulcers. Cochrane Database Syst Rev 2014; CD001273 DOI: 10.1002/14651858.CD001273.pub3.
• 40 Agren MS, Stromberg HE, Rindby A. et al. Selenium, zinc, iron and copper levels in serum of patients with arterial and venous leg ulcers. Acta Derm Venereol 1986; 66: 237-240 (PMID: 2426901)
• 41 Butnaru C, Pascu M, Mircea C. et al. Serum zinc and copper levels in some dermatological diseases. Rev Med Chir Soc Med Nat Iasi 2008; 112: 253-257 (PMID: 18677937)
• 42 Borkow G, Gabbay J, Zatcoff RC. Could chronic wounds not heal due to too low local copper levels?. Med Hypotheses 2008; 70: 610-613 DOI: 10.1016/j.mehy.2009.02.050. (PMID: 19559540)
• 43 Mirastschijski U, Martin A, Jorgensen LN. et al. Zinc, copper, and selenium tissue levels and their relation to subcutaneous abscess, minor surgery, and wound healing in humans. Biol Trace Elem Res 2013; 153: 76-83 DOI: 10.1007/s12011-013-9658-z. (PMID: 23595590)
• 44 Durmazlar SP, Akgul A, Eskioglu F. Hyperhomocysteinemia in patients with stasis dermatitis and ulcer: a novel finding with important therapeutic implications. J Dermatolog Treat 2009; 20: 336-339 DOI: 10.3109/09546630902775069. (PMID: 19954389)
• 45 Schwartzfarb EM, Romanelli P. Hyperhomocysteinemia and lower extremity wounds. Int J Low Extrem Wounds 2008; 7: 126-136 DOI: 10.1177/1534734608322490. (PMID: 18757388)
• 46 Studer M, Barbaud A, Truchetet F. et al. Hyperhomocysteinemia and leg ulcers: A prospective study of 68 patients. Ann Dermatol Venereol 2011; 138: 645-651 DOI: 10.1016/j.annder.2011.05.009. (PMID: 21978499)
• 47 Legendre C, Debure C, Meaume S. et al. Impact of protein deficiency on venous ulcer healing. J Vasc Surg 2008; 48: 688-693 DOI: 10.1016/j.jvs.2008.04.012. (PMID: 79333)