Nutritional Intervention Improves the Dietary Intake of Essential Micronutrients in Patients with Diabetic Foot Ulcers

Abstract

Abstract Objectives Diabetic foot ulcer (DFU) is a chronic wound and a common cause of lower limb amputation. A majority of DFU patients are suffering from undernutrition or malnutrition. The purpose of this randomized trial was to evaluate the combined effects of complete nutrition supplementation and education on the dietary intake of DFU patients. Methods A total of 29 patients with at least one grade 1 A foot ulcer based on the University of Texas Diabetic Wound Classification were assigned to the treatment or control. Aside from the standard of care for DFU, participants in the treatment group were provided with a dietary supplement twice a day between meals and were educated about consuming better food sources of essential nutrients for wound healing. The supplement provided 500 kcal of energy and at least 50% of RDA recommendations for protein, vitamin C, E, A, zinc, and copper. Participants in the control group only received standard of care for wound healing from the clinic. Dietary intake data were recorded at baseline and every four weeks up to 12 weeks or until the complete wound closure using 24-hour food recall questionnaire. Results The mean age of the study population was 53.3 ± 11.1 years. There were no significant differences in age, ethnicity, body mass index, hemoglobin A1C, duration of diabetes, wound age estimation, indicators of socioeconomic status and other factors involved in dietary intake including cultural and religious dietary restrictions, appetite problems, and previous unintentional weight loss between groups at baseline. Having routine visits with a registered dietitian was not part of the standard care for this population. When compared with RDA, dietary intake of zinc (33.2% to 89.2%, P = 0.02), copper (26% to 114%, P < 0.001), vitamins A (30.6 to 72.9, P = 0.001), C (117% to 403%, P = < 0.001), and E (7.29% to 306%, P = < 0.001) was significantly improved in the treatment group during the study period but there were no significant changes in dietary intake of protein or energy. There were also no significant changes in the dietary intake of the mentioned nutrients in the control group. Conclusions Our findings showed that the dietary intake of essential nutrients in wound healing was alarmingly low in DFU patients. Hence, nutritional intervention is essential and should be a part of routine care in this population. Funding Sources Florida State University.