By Mary Ellen Posthauer RDN, CD, LD, FAND
Previously, I discussed the value of protein for wound healing. Protein is responsible for cell multiplication, repair, and synthesis of enzymes involved in wound healing. Protein supplies the binding material of skin, cartilage, and muscle. The 2009 National Pressure Ulcer Advisory Panel/European Pressure Ulcer Advisory Panel (NPUAP/EPUAP) guidelines recommend 1.2-1.5 grams of protein/kilogram of body weight for individuals with pressure ulcers, when compatible with goals of care.
After completing a nutrition assessment, the dietitian determines the calorie, fluid, and protein requirements for the individual with pressure ulcers. However, there are times when increasing total caloric intake to achieve the recommended protein level would not be beneficial. For example, an individual on enteral nutrition may be receiving adequate calories and fluids per his requirements, and could not tolerate the additional volume required to meet his protein needs. An obese individual with wounds requires additional protein, but excessive calories would not be beneficial. These are two examples when modular protein should be considered.
Modular Protein Supplements
There are many modular protein supplements on the market today including powdered and liquid products. Modular protein supplements may have soy, whey protein isolate, casein, or a hydrolyzed collagen fortified with tryptophan. The protein ranges from 7-20 grams per ounce or serving and 25-100 calories. They can be added to an enteral feeding or taken orally. An advantage of the liquid supplement is that is can be taken orally without mixing it into a food or beverage. When selecting a modular protein supplement consider the following:
- Protein source (does the product contain all of the essential amino acids?)
- Grams of protein per serving (can you achieve the protein goal with one or two servings?)
- Taste, if taken orally (consider testing products for taste and mouth feel)
- Ease of mixing (a prime consideration for a powdered product)
- Ability to mix into both hot and cold foods/beverages (powdered products state the hot beverage should not be greater than 180 degrees)
- Lactose free
- Cost per gram of protein
The dietitian should discuss the recommendation for a modular protein supplement with the wound care team and the patient prior to requesting a physician’s order. The intake of the supplement should be tracked in the patient’s medical record as part of the monitoring process. When the skin is intact, consider discontinuing the supplement.
National pressure Ulcer Advisory panel and European Pressure Ulcer Advisory Panel. Prevention and treatment of pressure ulcers: clinical practice guidelines. Washington DC: National Pressure Ulcer Advisory Panel; 2009.
About The Author
Mary Ellen Posthauer RDN, CD, LD, FAND is an award winning dietitian, consultant for MEP Healthcare Dietary Services, published author, and member of the Purdue University Hall of Fame, Department of Foods and Nutrition, having held positions on numerous boards and panels including the National Pressure Ulcer Panel and the American Dietetic Association’s Unintentional Weight Loss work group.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.