Nutripro – Health And Sports Nutrition

The Role of Iron in Wounds

The presence of pressure ulcers in the nutritionally compromised, institutionalized elderly is not a new problem. The recent increased focus on the devastating effects of this condition, especially in long-term care, has elevated its status among healthcare providers and families alike. The importance of nutrition in general for wound healing is well recognized. However, the role of trace elements, such as iron is less well known. Iron and Wound Healing Iron is a mineral involved with several enzymatic oxidation-reduction reactions.

Iron is a cofactor for prolyl and lysyl hydroxylase, vital enzymes for the synthesis of collagen. The function of these enzymes is essential for inter-and intra-molecular cross-linking of collagen and elastin molecules , and without adequate iron, the wound healing process may be slowed by a

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Zinc

The newly established dietary reference intake (DRI) for daily zinc intake in healthy adults is 8 mg for females and 11 mg for males. An upper limit (UL) has also been established at 40 mg/day as the highest level likely to pose no risk to the general population.

Zinc losses related to chronic diarrhea or malabsorptive diseases often require zinc supplementation to prevent deficiency. In adults, diarrhea or ileostomy effluent contains 17 mg/kg. Proximal small intestinal fluid effluent via fistula or stoma contains 12 mg/l.Oral multivitamin/multimineral supplements containing 10–20 mg elemental zinc on average may suffice or zinc sulfate may be required. Adults on parenteral nutrition with outputs <300 g/day typically receive 3–5 mg/day zinc and those with outputs>300 g/day, 10–25 mg respectively.

Little is known about the amount of additional zinc needed to support pharmacologic functions, i.e., wound healing. Caution is prudent, as zinc interacts with copper and a normal copper status is also necessary for optimal wound healing. Data shows 50 mg of elemental zinc given for 10 weeks can induce copper deficiency. Clearly, the dose of supplemental zinc given for wound healing and the time period over which supplementation occurs must be carefully considered.

A general guideline commonly used in clinical practice when supplementing wound patients is up to 50 mg of elemental zinc (220 mg zinc sulfate) three times a day for approximately two weeks. This amount of zinc is in addition to a typical oral diet but part of the daily total ingested for a tube-fed patient. Standard tube feedings provide 10–19 mg zinc/1000 calories and those for healing support provide 24–30 mg zinc/1000 calories.

As always, there is no substitute for good clinical judgment exercised according to an individual assessment of the patient’s wounds, nutritional status and conditions predisposing to zinc deficiency. An ongoing assessment by the wound care team for zinc supplementation is a must.

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The clinical studies below reference the relationship between zinc and wounds.

Clinical studies

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Measuring zinc Status 

Eighty-five percent of absorbed zinc is bound to albumin and travels via the portal circulation to the liver for distribution to the tissues. A broad range of normal exists for serum zinc (95-130 mcg/dl)14 and hemolysis, fasting and variations in albumin concentration will create variations in measured serum zinc. Assays of zinc in granulocytes and lymphocytes are more sensitive in diagnosing marginal zinc deficiency, but these tests are not widely used.1 20% of the zinc pool also exists within the skin, and even if tissue biopsy was practical, tissue concentration varies as well.

Measurements of alkaline phosphatase levels have been

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Zinc and Wound Healing: Who Needs It and How Much?

Over the past decade, zinc, an essential catalyst in over 300 enzymatic reactions has been linked to a spectrum of functions in health and disease.1 Seventy of these reactions involve metalloenzymes, which play a central role in reconstruction of the wound matrix. In fact, collagen, the principal component of skin granulation tissue and the scar is dependent on zinc for synthesis.

A review of the literature illustrates the elements that affect zinc absorption, the factors to consider when assessing zinc status and the challenge of appropriately supplementing wound healing patients who are zinc deficient or at risk for deficiency.

Bioavailability

Zinc is absorbed in the duodenal and jejunal portions of the small intestine, primarily via a specific carrier-mediated transport mechanism.4,5 Low zinc status is associated with an increased rate of absorption, but absorption does not down-regulate when normal zinc status is supplemented over the long term.

Older persons absorb less zinc but also excrete less to compensate.

Absorption of elemental zinc in supplement form is 60–65 percent when taken with water on an empty stomach, whereas that from a mixed diet is estimated at 30%. If a vegan diet is consumed, absorption drops off further, and more so if the diet is high in phytate. It follows that zinc bioavailability is lower from soy-based formulas relative to milk-based formulas.5-8 The amount of protein and presence of peptides, amino acids and unsaturated fatty acids are positively correlated with zinc absorption.9-13 Inadequate zinc absorption causes an immediate decrease in protein turnover and cell growth to preserve the body pool, and muscle may be broken down in order to sustain plasma levels.

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Protein Sources

Protein is important but so are carbohydrates, fats, and total calories, says Katherine Tallmadge, MA, RD, a spokeswoman for the American Dietetic Association.

“This is about balance,” says Tallmadge, author of Diet Simple. While she recommends including lean and low-fat sources of protein at every meal, she says it should be part of a calorie-controlled diet that’s also rich in ‘smart carbs’ such as fruits, vegetables, and whole grains, along with healthy fats like

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