The Role of Glutamine and Arginine in Wound Healing of Pressure Ulcers: A Systematic Review

Pressure ulcers pose a significant health challenge, requiring effective management strategies. Nutrition, particularly arginine and glutamine, supports collagen synthesis and tissue repair. This review evaluates the role of enteral glutamine and arginine supplementation on wound healing outcomes, addressing gaps in previous research. A PRISMA-guided systematic search of five databases identified studies published between 2004 and 2024 on adults with pressure ulcers receiving these supplements. Outcomes assessed included healing time, wound size reduction, local infection, recurrence, and pain. A narrative synthesis was performed due to heterogeneity, with bias assessed via Cochrane RoB2 and JBI checklists. Fifteen studies involving 1085 participants were included. Findings indicated a trend toward improved healing with arginine or combined arginine/glutamine supplements, with relative wound size reductions of 18.6% to 98.2% over 2 to 20 weeks. However, inconsistencies were noted, with seven studies showing non-significant or unreported differences in wound size, and six studies with similar issues for healing time. Glutamine was examined only in combination with arginine, limiting insights into its isolated effects. None of the studies reported on recurrence or pain outcomes. While arginine shows potential for enhancing healing, evidence remains inconclusive. Future research should emphasise follow-up until complete wound closure and explore the independent effects of glutamine on wound healing outcomes.