[Systematic review of nutritional support in pressure ulcer]

Pressure ulcer is an area of localised damage to the skin and underlying tissue caused by pressure, shear, friction and/or combination of these things. Prevalence of this entity is between 3 and 66%, depending of the patients and the pathology. Pressure ulcer is associated with an increased risk of morbidity and mortality. One of the most important risk factors to develop a pressure ulcer is nutritional status. We can use different interventional strategies, first of all (primary intervention) before the patient has developed a ulcer and secondly, the treatment of a established ulcer (secondary prevention). In the most important primary prevention study with 662 patients, two oral nutritional supplements per day were given to the patients. The incidence of pressure ulcer was 40% (118/295) in the interventional group and 48% (181/377) in control group. A relative risk to develop a pressure ulcer with supplementation of 0.83 (CI95%: 0.70 a 0.99). In the studies with secondary prevention, when we analyze in an individual way the different nutrients, zinc has not demonstrated the utility in an independent way. Vitamin C shows contradictory data in two randomized clinical trial with the same dose (500 mg each 12 hours). Recently, some randomized clinical trials have demonstrated an improvement in healing rates with enhanced enteral formulas (zinc, arginine, vitamin C). Oral supplementation without taking account micronutrients decreases risk of pressure ulcer. However, studies of secondary prevention due to heterogeneity have not let clear conclusions. However, enteral enhanced formula could improve ulcer healing.