Wound nutrition

Nutrition is an essential consideration when treating pressure ulcers (Friedrich, 2022). Macronutrients, micronutrients and fluid are necessary for the repair of body tissues in patients with any form of skin breakdown. Reduced oral intake associated with weight loss contributes to the development of ulcers and delays wound healing (Munoz et al, 2020).

Nutritional assessment is essential for early identification of patients at risk of skin breakdown and delayed wound healing (Ghaly et al, 2021). This article outlines the steps involved in conducting a nutritional assessment in patients with wounds according to the Malnutrition Universal Screening Tool (MUST).

Wound healing is a high-energy process, which requires a significant number of macronutrients and micronutrients to effectively reinstate skin integrity (Seth et al, 2024). Nutritional deficiencies and/or malnutrition can have implications for wound healing by impeding normal healing processes through various mechanisms, such as: 

• prolonging the inflammatory phase
• decreasing fibroblast proliferation
• altering collagen synthesis
• decreasing wound tensile strength
• increasing risk of infection (Kamat et al, 2021)

Wound healing requires energy for collagen synthesis. Therefore, it is essential to support wound healing nutritionally, by ensuring that macronutrients (Table 1) and micronutrients (Table 2) are being consumed.

Malnutrition is a medical condition with measurable side effects on tissue, body structure and function, all of which can have significant clinical outcomes (European Pressure Ulcer Advisory Panel et al, 2019). Malnutrition often occurs over a continuum of inadequate oral intake and impaired absorption. Patients with malnutrition will often have two or more of the

The Malnutrition Universal Screening Tool involves five steps (British Association of Parenteral and Enteral Nutrition, 2011): 

Step 1: body mass index

Divide the patient’s weight (kg) by their height (m) to produce a body mass index score.

Step 2: weight loss

Measure percentage of unplanned weight loss in the past 3–6 months, then score according to Table 3.

Step 3: acute disease score

Score 2 = acutely ill and if there has been or is likely to be no nutritional intake for more than 5 days.

Score 0 = not acutely ill.

Step 4: add scores

Add scores from steps 1, 2 and 3 to get the overall risk of malnutrition. The higher the score, the greater the risk of malnutrition.

Step 5: care plan

Use existing

Malnutrition management involves six steps (PrescQIPP, 2021):

Step 1: identification of nutritional risk

Complete the Malnutrition Universal Screening Tool assessment and act according to guidance. A score of 2 or above indicates a high risk of malnutrition, therefore follow local or national care pathways.

Step 2: issues that can affect food intake 

Assess issues that could affect food intake, such as swallowing problems and long-term conditions. Refer to relevant departments.

Step 3: set a goal

Create a care plan and set specific goals with the patient.

Step 4: provide food advice

Aim to increase intake of calories, protein and vitamins or minerals in order to promote wound healing. This can include increased intake of:

• Fortified milk: whole milk, this can be in in hot chocolates, coffee, thick milkshakes, creamy smoothies and fortified soups
• Nourishing snacks: two snacks per day
• Fortified meals: patients can add cream or non-dairy alternatives, evaporated milk, fortified

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British Association of Parenteral and Enteral Nutrition. Managing malnutrition to improve lives and save money. 2018. https://www.bapen.org.uk/pdfs/reports/mag/managing-malnutrition.pdf (accessed 3 February 2025)

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