1. Ingestion of the fortified trial formula containing arginine, zinc, and antioxidants decreased pressure ulcer wound area more than the control formula after 8 weeks.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Pressure ulcers (PUs), a concern for wheelchair-bound and bed-ridden patients, are a major source of preventable disease burden in healthcare systems worldwide. This study sought to examine the effect of adding arginine, zinc and antioxidants to a nutritional supplement on PU healing in malnourished patients. After 8 weeks, patients who received the experimental formula had a greater average decrease in PU area than those who received the control formula. The enriched supplement also gave patients a greater chance of experiencing at least a 40% decrease in PU area at 8 weeks. None of the other study outcomes were significantly different between the two treatment groups. This study’s findings provide a novel strategy that home care or long-term care providers can use to improve their patients’ recovery from PUs. The study is limited in that its findings are only applicable to patients in the two aforementioned care settings, and the cost-effectiveness of this formula is still unknown. Overall, this fortified formula may improve PU healing in malnourished patients.
In-Depth [randomized controlled trial]: A total of 200 adult, malnourished patients with stage II, III or IV PUs were enrolled in this study. Both experimental patient groups were given the same dietary counseling and ulcer wound care regimens. The experimental and control oral nutrition formulas were randomly distributed to the patients, and PU healing was assessed at baseline, week 4 and week 8 of the study. All subjects and caretakers were unaware of the composition of the formula they had received. The primary endpoint was percentage change in PU area after 8 weeks. The experimental formula group had a mean reduction in PU area of 60.9% (95%CI 54.3%-67.5%) versus 45.2% (95%CI 38.4%-52.0%) in the control formula group at 8 weeks (p=0.017). Patients in the experimental group also had a greater chance of having at least a 40% reduction in PU area at 8 weeks (OR 1.98; 95%CI 1.12-3.48). This was the only secondary outcome with a significant difference between the two treatment groups.
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