Cultural Diversity Impacts Nutrition Interventions in Wound Management
by Mary Ellen Posthauer RDN, CD, LD, FAND
As the ethnic diversity in the United States continues to increase, clinicians should understand how food, culture and religious practices impact the nutrition interventions we recommend. According to the Census Bureau in 2010 Hispanics were the largest minority group in the US followed by African Americans and then Asians. Estimates are that by 2050 the minority population will reach 54% of the US population. The Hispanic population is anticipated to triple and the number of Asians will double.
Each ethnic group does have a traditional diet pattern that may be followed and many of these “favorite” foods may not be on the menu in your hospital or nursing home. The first step an organization should take is to determine the ethnic diversity or population mix of their clients/patients. Once that is determined, the food service department should evaluate their menus and determine if they are meeting the expectations of their clientele. Surveys compiled after discharge should address the question of satisfaction with the type/variety of menu selections.
A major food staple of the Hispanic Mexican-American diet is complex carbohydrate, such as corn, corn products, beans and rice. The protein requirement for wound healing can be achieved since eggs, fish, beans, meat, and poultry are included in this diet. Essential nutrients important for wound healing that maybe missing in their diet include calcium, iron, vitamin A, folacin, and vitamin C. Menus usually include liberal quantities of tomatoes and fruits, which are common components of Mexican recipes, which can increase the vitamin C intake. Cheese added to dishes increases calcium component. Sweet potatoes along with deep orange and green vegetables and fruits increase the vitamin A in the diet. This population may not enjoy the milk-based supplements often recommended for wound healing so food first should be the goal.
Because the traditional African American diet includes different types of dark green and yellow vegetables, plus beans, rice, and potatoes, it is high in vitamin A, iron, and fiber. Clinicians should be sensitive to the fact that many African Americans are lactose intolerant and may not even accept the lactose-free supplements recommended for wound healing. If a supplement is part of the wound healing care plan, offer juice-based products available. Lean meats, fish, poultry, beans, and legumes provide adequate protein for wound healing.
Asians originate from several counties, including Japan, China, India, and Pakistan. While each country has diverse food habits and traditions, the cooking techniques and composition of meals from these areas are similar. The typical preparation methods include boiling, steaming and stir-frying that are all quick-cooking techniques that conserve nutrients. These techniques may require some equipment and meal preparations adjustments for the food service department. Protein on these menus may come from fish, pork, and poultry, in addition fruits and vegetables which are plentiful in this diet. Many Asians are also lactose intolerant; so prior to recommending lactose-free supplements for wound healing, the registered dietician (RD) should explain that the supplement is appropriate and will not cause gastrointestinal distress.
Incorporating cultural values of the individual into the decision-making process and nutritional components of care helps everyone achieve the desired positive outcome in a wound care regimen.
Collins N, Friedrich L. Posthauer ME. The Nutritional Melting Pot: Understand the Influence of Food, Culture, and Religion on Nutrition Interventions for Wound Healing. Ostomy Wound Management 2009(5)14-21.
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 Academy of Nutrition and Dietetics’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.