Malnutrition, tube feeding and pressure sores: data are incomplete

To review data about the relationship between pressure sores and (1) nutritional status, (2) nutrient intake, and (3) tube feeding.

Medline search of terms associated with "decubitus ulcer" combined with terms associated with "pressure sore" from 1985 through August 1994. Hand review of all issues of the journal Decubitus (now Advances in Wound Care) through June 1994 and the Journal of Parenteral and Enteral Nutrition from January 1987 through May-June 1994. Review of bibliography of pertinent articles. A small survey of experts.

Articles where the title, Me SH terms, or abstract suggested an examination of the relationship between nutrition and pressure sores, and those suggested by the experts, were reviewed.

Study designs were disparate. Results were simply tabulated.

In seven studies, low serum albumin was associated with development or presence of pressure sores; in five it was not. Most measures of nutritional status were not associated with pressure sore outcomes. Poor nutritional intake was associated with poor pressure sore outcome in four of seven studies. Tube feeding was positively associated with presence of pressure sores in one study. Special nutrition support was ineffective in improving pressure sore outcome in a second. Two studies showed better healing in patients receiving high-protein formula: in one, all patients were tube fed; in the other, route of feeding was not stated.

Data about the relationship between malnutrition and pressure sores are incomplete and contradictory. No randomized trials of tube feeding as prevention or treatment of pressure sores has been done. Routine use of tube feeding to prevent or treat pressure sores is not clearly supported by data.