New guidelines published in the United States, endorsed by the American Limb Preservation Society, claim that personalised nutrition can go a long way in helping individuals living with diabetic foot ulcers (DFU), help them to heal and prevent malnutrition.
The guidelines indicate that DFU will develop in up to 34% of patients with diabetes at some point in their lives. Approximately 15-25% of those will require an amputation. Dr David Armstrong, co-author of the guidance, founding president of the American Limb Preservation Society and professor of surgery at the University of Southern California, also highlights how moderate or severe malnutrition has been identified in more than half of patients with DFU, and malnutrition in DFU is correlated with increased lower extremity amputation.
“Developing and implementing a personalised nutrition care plan and catering to a patient’s caloric, protein, hydration, micronutrient status and need for diet modifications will ensure patient nutrition is optimised and meet all essential needs for wound healing. The guidance reinforces nutrition therapy, which is an often-overlooked part of wound care that can help provide patients with early and aggressive intervention,” states Armstrong.
Furthermore, Armstrong notes that a proper diet is essential for tissue building for all stages of wound healing, and that sometimes a standard diet is not enough.
“An individualised nutrition care plan may include oral nutritional supplements and regular check-ins to ensure that their nutrition levels are where they should be.” He adds.
A key takeaway from the guidelines is the recommendation that individuals exercise, if possible, especially if their BMI is higher than 30. In a bid to ensure healing, individuals need to remain hydrated, have sufficient calories, macronutrients, and protein intake to provide amino acids for optimised wound healing.
Amino acids are beneficial to the diet, as they build and repair muscle, skin tissues, hormones, and enzymes. They also help regulate fluid balance and promote positive nitrogen balance; the guidelines note. Carbohydrates and fats can help support inflammatory responses, cellular activity, angiogenesis, and collagen deposition. Patients are also advised to have a 25 g intake of fibre per 2,000 calories consumed. Important fats that should be considered are EPA, which has been spotlighted for immunity and cell membrane integrity along with DHA. The omega 3s can impact body muscle mass and strength, aiding elderly patients with sarcopenia. Key vitamins highlighted include vitamin C for its role in tissue repair, as well as zinc for cell replication and growth.
“The future in this area is really bright, as guidelines like this can move the needle in helping to ultimately hyper-personalise a nutrition plan for everyone,” Armstrong tells NutritionInsight.