Introduction

As clinicians know, wound healing is a complex biological process that involves the migration and proliferation of cells along with other molecular events like extracellular matrix deposition.¹ Regardless of the process for healing a wound at the cellular level, a patient’s ability to get adequate nutrition can also play a role in this healing process.² It has been shown that malnutrition can cause increased levels of infection, along with a decrease in tensile strength.

As a result, the lack of nutritious foods further delays the wound healing process, potentially putting a patient at risk of developing a non-healing wound.² As simple as it may sound for clinicians to recommend their patients eat more nutritious foods, they need to understand that many other factors go into a patient's ability to purchase these nutritious foods. Factors like inflation or job/income loss can decrease a patient's ability to purchase the foods necessary for optimal healing.

WoundSource had the opportunity to talk with Dr. Nancy Collins, PhD, RDN, LD, NWCC, FAND, about her presentation, "Meeting Nutritional Needs for Wound Healing During Inflationary Times," for WoundCon Spring 2023. In her session, she shared how clinicians can help their patients get the nutrition they need despite the increased cost of food.

1. What are you hoping to cover in this session?

   This session will address how the recent price increases for groceries, utilities, gasoline, and housing have forced many wound care patients to sacrifice their nutritional needs in order to make ends meet. I will offer ideas on how to get patients adequate protein and nutrition to help wounds heal while still allowing them to stick to a budget, whether in the inpatient or outpatient setting.

2. What inspired you to create and present on this topic?

   I love nutrition science, and I most often talk about that, but I also think it is important to talk about real-life concerns. Lately, all I hear from family, friends, and patients is how much they spent at the grocery store, the gas pump, and big box stores. You can’t watch the news without seeing something about the high cost of living and the financial concerns facing almost everyone. It is a timely and important topic that we can’t ignore because the very best wound care will not heal wounds if there isn’t adequate nutritional substrate from which to build new tissue.

3. Why do you feel like it is a crucial topic for clinicians?

   During this period of high inflation, wound care clinicians can help their patients by listening, answering questions, and providing helpful suggestions for eating well on a limited budget. Wound care patients need adequate calories and protein, but recently, even formerly inexpensive sources of protein, such as eggs, have risen in price. Clinicians can help by offering suggestions to their patients, so they can afford the nutrition they need to heal. I am well aware that this circumstance is beyond the typical duties and scope of practice for most of us; we are not trained financial advisors. That said, we just can’t ignore this financial reality and look away when a patient says they are having a tough time. Many patients simply need common sense advice, reassurance, and empathy. Inadequate nutrition and protein affect the body’s ability to build new tissue. If patients have concerns about how they can manage to get protein and adequate nutrition, clinicians can offer helpful advice and suggestions about getting more for their dollar. Community and government programs are options for some, as well as learning how to plan menus, shop wisely, and look for coupons and sales.

4. What do you feel are the leading innovations in the field regarding wound care, healing, and nutrition?

   Medical nutrition therapy products continue to evolve just like traditional medications such as insulins, and antibiotics have advanced. For example, there are new medical nutrition products containing citrulline, which is a different way for the body to produce arginine endogenously. In addition, efficacious products are now available in a 2-fl-oz serving vs multiple 8-fl-oz servings, which is the typical serving size. Less to drink translates to more adherence and better healing. It is cash in the trash if your patient doesn’t consume his or her nutrition supplement, and it ends up down the drain. That obviously does nothing for healing.

5. What are some common roadblocks that you’ve seen when it comes to a patient’s ability to meet their nutritional needs, and how can clinicians address them? What are some common roadblocks for clinicians?

   The common roadblock for clinicians is not being prepared to have this type of discussion. It is not something we are used to doing. During these high inflation times, clinicians need to prepare for difficult conversations that patients may raise about how they can possibly afford the nutrition and protein they need to heal their wounds. Practitioners should provide patients with information about foods that are high in protein and lower cost and even suggest some less expensive meatless options, such as peanut butter, Greek yogurt, black beans, and edamame. They also must know what community resources are available, and for those working in the inpatient setting, perhaps now is the time to reevaluate the formulary to see if the current nutrition products are truly consumed and working well or try some of the newer products.

6. What one thing do you feel clinicians can do tomorrow to improve their understanding of nutritional practices when it comes to wound healing?

   Listening to patients is key. Outpatient clinicians need to answer their patient’s concerns with useful suggestions to promote wound healing—everything from shopping tips to meal planning and even to help them meet their nutritional needs through budgeting and smart shopping. Inpatient clinicians should evaluate their nutrition programs, speak to product representatives about what is new, conduct waste studies, and make any necessary changes to their formularies and/or vendors.

7. What do you hope clinicians will take away from this session?

   I hope clinicians come away with some new ideas and the confidence to deal with this issue if it is brought up. Sometimes all a patient or their family needs is someone to listen and understand. Wound care is also people care.

Conclusion

Adequate nutrition plays a large role in helping patients heal. In her session at WoundCon, Dr. Collins gave clinicians the tools they need to encourage their patients to come up with strategies for ensuring their nutritional needs are met.

References

1. Barchitta M, Maugeri A, Favara G, et al. Nutrition and Wound Healing: An Overview Focusing on the Beneficial Effects of Curcumin. Int J Mol Sci. 2019;20(5):1119. Published March 5, 2019. doi:10.3390/ijms20051119
2. Stechmiller JK. Understanding the role of nutrition and wound healing. Nutr Clin Pract. 2010;25(1):61-68. doi:10.1177/0884533609358997

Author Disclosures Consultant Abbott Nutrition and Medtrition, Inc. Speakers Bureau Abbott Nutrition, Medtrition, Inc., and Nutricia. The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, HMP Global, its affiliates, or subsidiary companies.