Malnutrition as a Precursor of Pressure Ulcers

Abstract

Numerous studies have reported associations between declining nutrition status and risk for pressure ulcers. Oral eating problems, weight loss, low body weight, undernutrition, and malnutrition are associated with an increased risk for pressure ulcers. Moreover, inadequate nutrient intake and low body weight are associated with slow and nonhealing wounds. However, the biologic significance of deterioration in nutrition status and consistent methodologies to quantify malnutrition and diminished micronutrient stores as predictors of skin breakdown remains controversial. The Academy of Nutrition and Dietetics (Academy) and the American Society for Parenteral and Enteral Nutrition (ASPEN) Consensus Statement: Characteristics Recommended for the Identification and Documentation of Adult Malnutrition provide a standardized and measureable set of criterion for all health professionals to use to identify malnutrition. The Agency for Healthcare Research and Quality identified malnutrition as one of the common geriatric syndromes associated with increased risk for institutionalization and mortality that may be impacted by primary and secondary preventions. The purpose of this article is to examine the Academy/ASPEN consensus statement on characteristics of adult malnutrition in the context of the National Pressure Ulcer Advisory Panel (NPUAP)/European Pressure Ulcer Advisory Panel (EPUAP) Guidelines on the Prevention and Treatment of Pressure Ulcers. Moreover, clinicians, and in particular, registered dietitians have the opportunity to integrate the Characteristics of Malnutrition with the NPUAP/EPUAP 2009 Prevention and Treatment Clinical Practice Guidelines, into clinical assessment and documentation using the Nutrition Care Process. Consensus guidelines will provide consistent research criteria yielding more useful data than presently available.

High prevalence of skin and wound care of hospitalized elderly in Brazil: a prospective observational study

“…One may infer that aging worsens swallowing capacity in this sample and may cause dysphagia and anorexia. On the other hand, aging may associate to malnutrition in this sample, which is a risk factor for skin problems [17, 18]. …”

Pressure ulcer is associated with malnutrition as assessed by Nutritional Risk Screening (NRS 2002) in a mixed hospital population

“…Malnutrition is recognized as one of the major systemic risk factors for poor wound healing and developing PUs [3,18]. European estimates of malnutrition indicate a prevalence of 20–50% among hospital patients [19–21].…”

The Role of Nutrition for Pressure Ulcer Management

“…12 During periods of inflammatory stress, albumin and prealbumin levels drop because they are negative acute-phase reactants. Historically, clinicians used serum protein levels, including albumin and prealbumin, to determine nutritional status.…”