Impact of oral nutritional supplement composition on healing of different chronic wounds: A systematic review

Chronic wounds are characterized by prolonged non-healing which significantly impact patients' quality of life. Oral formulas may not only enhance the wound healing process but also contribute to cost reduction in care. This review aims to evaluate the impact of oral nutritional supplementation on chronic wound healing and provide insights into formula characteristics. A comprehensive search across Cinahl, Embase, PubMed, and Web of Science databases yielded nine studies from the last decade, involving 741 patients aged 52-81.7, across various care settings: hospitals, long-term care facilities, and home care. The primary wound types included pressure injuries (58%), diabetic foot ulcers (40%), and venous ulcers (2%). The intervention duration ranged from 2 to 16 weeks, with sample sizes varying from 24 to 270 patients. Notably, four studies reported a reduction in wound area and an increased healing rate with a hypercaloric, hyperproteic formula enriched with zinc, vitamins A, C, and E. However, two studies found no significant differences compared to control groups. Two other studies investigated a combination of arginine, glutamine, and HMB but did not yield significant results, and one study favoured a hyperproteic formula over a hyperproteic formula with arginine. This review provides evidence supporting the potential of oral nutritional supplementation to enhance the healing process of chronic wounds. Based on our findings, a desirable formula should be characterized by high caloric and protein content, and the inclusion of antioxidant micronutrients, including but not limited to vitamin A, vitamin E, vitamin C, and zinc.