Wound healing: Don't underestimate nutrition

In hard-to-heal wounds, HCPs must look beyond the wound at other factors including comorbidities, socioeconomic challenges, mental health and nutrition. As indicated in the ‘Monitor’ step of the Wound Hygiene Proactive Healing Framework, nutrition status is a key treatment parameter to be tracked to keep the whole person in mind.¹

Wounds undergo three healing phases: inflammatory, proliferative, and remodelling. The inflammatory phase involves clotting and cleaning the wound. The proliferative phase builds the wound bed through tissue growth. In the remodelling phase, collagen strength increases. Proper nutrition is crucial throughout.²

People with hard-to-heal wounds are often malnourished, or underweight. Conversely, people with a high BMI can have nutrient deficiencies, often observed in those with an unbalanced diet.

During the wound healing process, overall metabolism increases, increasing demand for calories and proteins.²

Nutrition for hard-to-heal wounds: more energy, plenty of water

In hard-to-heal wounds, the body needs nutrients necessary for cell regeneration and collagen synthesis. These include, primarily, proteins, zinc, vitamin A and vitamin C, as well as sufficient calories. Micronutrients that counteract inflammatory processes are also necessary, including B vitamins, selenium, and vitamin D. The elderly often lack sufficient trace elements such as folate or calcium.³

Energy requirements for hard-to heal wounds and other conditions⁴

• normal: 24 kcal/kg body weight/day
• when bedridden: 25–30 kcal/kg body weight/day
• for tumours, pressure ulcers and other wounds: 30–35 kcal/kg body weight/day
• for severe burns, polytrauma: 35–45 kcal/kg body weight/day 

A protein-rich diet is particularly important

Wound healing requires a sufficient supply of protein and amino acids. The highly stressed immune system also requires proteins: immune cells, which the body forms in response to wounds and inflammation, are made of proteins. Hence, best practice recommendations state at least 1.0 grams of protein per kilogram of body weight for adults over 65 years old, instead of the usual 0.8 grams for adults under 65.⁵

In wounds such as inflamed pressure ulcers, the requirement may be higher, up to 1.5 grams of protein per kilogram of body weight.¹^,² Good sources of protein include meat, fish, eggs, and dairy products, especially cottage cheese and cheese. Lentils, beans, peas, tofu, and soy provide plant-based proteins.

Essential Micronutrients for cells and the immune system

In people with impaired wound healing, special attention should be paid to vitamins A, C, and E, as well as zinc. First, vitamin status should be assessed and, if possible, supplemented with natural foods. Zinc is involved in many processes: It has anti-inflammatory effects, increases cell division, supports the immune system, and promotes collagen synthesis.²

In general, a nutrient-rich, varied, and tasty diet promotes recovery. Sufficient fluid intake is also important for wound healing: Weeping wounds, inflammation, and fever increase fluid requirements. Those affected should therefore drink sufficient fluids—at least about 1.5 liters per day. Consuming favourite beverages, such as herbal tea, can encourage fluid intake.⁶

Poor nutritional status is a major barrier to recovery in chronic, hard‑to‑heal wounds.

Various nutrients affect wound healing depending on the wound stage; therefore, having all the necessary nutrients and fluid intake for wound healing at the appropriate time is important.

Nutrition plays a central role in the healing of wounds because the body relies on adequate energy, protein, vitamins, and minerals to repair damaged tissue. Hard-to-heal wounds involve prolonged inflammation, impaired cell regeneration, and increased metabolic demands — all of which require strong nutritional support to maintain optimal cell maintenance and repair to support effective healing.

A nutritional assessment and interventions tailored to the wound and the individual’s nutritional status are essential. This comprehensive strategy ensures the best wound care outcomes.