- Meeting abstract
- Open Access
Effects of nutritional supplements in healing of laparotomic dehiscences in obese patients with metabolic syndrome: a randomized prospective controlled study
© Galeotalanza et al; licensee BioMed Central Ltd. 2011
- Published: 24 August 2011
- Nitric Oxide
- Wound Dehiscence
- Venous Insufficiency
- Enhance Insulin Sensitivity
Chronic venous insufficiency, infection, diabetes mellitus, excess malnutrition, exposure to pressure and shear, all conditions included in obesity, prolong the healing process. Moreover, a growing body of evidence clearly indicates that dietary supplementation or intravenous administration of Arg is beneficial in facilitating wound healing, enhancing insulin sensitivity, and maintaining tissue integrity. Arginine produces physiologic effects via nitric oxide dependent and independent pathways. Nitric oxide is important for the modulation of vascular tone, inflammation, immune function, endothelial function, platelet and leukocyte adherence, and neurotransmission. Nitric oxide modulates many biochemical processes important for the response to sepsis. Arginine, independent of nitric oxide, is important for growth, wound healing, cardiovascular function, immune function, inflammatory responses, energy metabolism, urea cycle function, and other metabolic processes. Arginine supplementation improves outcomes in animals with sepsis, wounds, ischemia-reperfusion injury, and following thermal injury. Enteral administration of arginine improves endothelial function but has little effect upon hemodynamics during human sepsis. An analysis of clinical studies using enteral formulas with supplemental arginine suggests benefits upon outcome, with no evidence of significant detrimental effects. The aim of this study was to evaluate the healing effects of a normocaloric diet enriched in arginine, eicosapentanoic acid (EPA) and gamma-linolenic acid (GLA) and vitamins (vitamins A, C and E) on laparotomies wound dehiscence.
Thirty obese (BMI > 35 kg/m2) patients with acute wound infections were included in a study evaluating the effects of protein, lipids and vitamins on healing of wound dehiscence. A diet enriched with nutritional supplements of arginine, lipids (EPA, GLA) and vitamins (vitamins A, C and E) was compared with a diet not enriched. The healing of wound dehiscence was evaluated weekly. Nutritional assessment included levels of serum albumin, C-reactive protein.
Patient's age, severity of disease and gender distribution were similar in the two groups. The study group had a higher body mass index. At baseline, the wound dehiscences were similar in the two groups. A significant reduction of healing time of existing wounds was observed in the study group compared to the control group (p<0.05). There was no significant difference in the nutritional parameters between the two groups.
A diet enriched with arginine, EPA, GLA and vitamins A, C and E is associated with a significantly lower healing time of wound dehiscences in critically obese patients
- Velioglu Ogünç A, Manukyan M, Cingi A, Eksioglu-Demiralp E, Ozdemir Aktan A, Süha Yalçin A: Dietary whey supplementation in experimental models of wound healing. Int J Vitam Nutr Res. 2008, 78 (2): 70-73. 10.1024/0300-9818.104.22.168.View ArticlePubMedGoogle Scholar
- McDaniel JC, Belury M, Ahijevych K, Blakely W: Omega-3 fatty acids effect on wound healing. Wound Repair Regen. 2008, 16 (3): 337-345. 10.1111/j.1524-475X.2008.00388.x.PubMed CentralView ArticlePubMedGoogle Scholar
- Hankenson KD, Watkins BA, Schoenlein IA, Allen KG, Turek JJ: Omega-3 fatty acids enhance ligament fibroblast collagen formation in association with changes in interleukin-6 production. Proc Soc Exp Biol Med. 2000, 223 (1): 88-95. 10.1046/j.1525-1373.2000.22312.x.View ArticlePubMedGoogle Scholar
- Zhang XJ, Chinkes DL, Wolfe RR: The anabolic effect of arginine on proteins in skin wound and muscle is independent of nitric oxide production. Clin Nutr. 2008, 27 (4): 649-656. 10.1016/j.clnu.2008.01.006. Epub 2008 Mar 7View ArticlePubMedGoogle Scholar
- Zhang XJ, Chinkes DL, Wolfe RR: Leucine supplementation has an anabolic effect on proteins in rabbit skin wound and muscle. J Nutr. 2004, 134 (12): 3313-8.PubMedGoogle Scholar
- Garlick PJ: The role of leucine in the regulation of protein metabolism. J Nutr. 2005, 135 (6 Suppl): 1553S-1556S.PubMedGoogle Scholar
- Stechmiller JK, Childress B, Cowan L: Arginine supplementation and wound healing. Nutr Clin Pract. 2005, 20 (1): 52-61. 10.1177/011542650502000152.View ArticlePubMedGoogle Scholar
- Shi HP, Efron DT, Most D, Tantry US, Barbul A: Supplemental dietary arginine enhances wound healing in normal but not inducible nitric oxide synthase knockout mice. Surgery. 2000, 128 (2): 374-378. 10.1067/msy.2000.107372.View ArticlePubMedGoogle Scholar
- Shi HP, Most D, Efron DT, Witte MB, Barbul A: Supplemental L-arginine enhances wound healing in diabetic rats. Wound Repair Regen. 2003, 11 (3): 198-203. 10.1046/j.1524-475X.2003.11308.x.View ArticlePubMedGoogle Scholar
- Shi HP, Wang SM, Zhang GX, Zhang YJ, Barbul A: Supplemental L-arginine enhances wound healing following trauma/hemorrhagic shock. Wound Repair Regen. 2007, 15 (1): 66-70. 10.1111/j.1524-475X.2006.00186.x.View ArticlePubMedGoogle Scholar
- Ord H: Nutritional support for patients with infected wounds. Br J Nurs. 2007, 16 (21): 1346-8. 1350-1352View ArticlePubMedGoogle Scholar
- Collins N: Arginine and wound healing: a case study. Adv Skin Wound Care. 2004, 17 (2): 59-60. 10.1097/00129334-200403000-00007.View ArticlePubMedGoogle Scholar
- Wilmore DW: The effect of glutamine supplementation in patients following elective surgery and accidental injury. J Nutr. 2001, 131 (9 Suppl): 2543S-9S. discussion 2550S-1SPubMedGoogle Scholar
- Boelens PG, Nijveldt RJ, Houdijk AP, Meijer S, van Leeuwen PA: Glutamine alimentation in catabolic state. J Nutr. 2001, 131 (9 Suppl): 2569S-2577S. discussion 2590SPubMedGoogle Scholar
- Ayello EA, Thomas DR, Litchford MA: Nutritional aspects of wound healing. Home Healthc Nurse. 1999, 17 (11): 719-729. 10.1097/00004045-199911000-00007.View ArticlePubMedGoogle Scholar
- Shashidharan M, Lin KM, Ternent CA, Smyrk TC, Thorson AG, Blatchford GJ, Christensen MA: Influence of arginine dietary supplementation on healing colonic anastomosis in the rat. Dis Colon Rectum. 1999, 42 (12): 1613-1617. 10.1007/BF02236217.View ArticlePubMedGoogle Scholar
- Wallace E: Feeding the wound: nutrition and wound care. Br J Nurs. 1994, 3 (13): 662-667.PubMedGoogle Scholar
- Campos AC, Groth AK, Branco AB: Assessment and nutritional aspects of wound healing. Curr Opin Clin Nutr Metab Care. 2008, 11 (3): 281-288. 10.1097/MCO.0b013e3282fbd35a.View ArticlePubMedGoogle Scholar
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