Table 1.
Effect of supplements on the prevention of pressure ulcers
| References | Number of subjects (n) | Patient population characteristics | Intervention; additional intake of nutrient/day | Period of supplementation (days) | Study design | Pressure ulcer risk and incidence | Results |
|---|---|---|---|---|---|---|---|
| Delmi et al.14 | 59 | Patients with femoral neck fractures Age:82±0.3 BMI: n.d. |
Verum ONS Energy: 254 kcal Protein: 20.4 g Fat: 5.8 g Carbohydrates: 29.5 g Vit A: 750 IU Vit D: 25 IU Vit B, C, E: n.d. Control No supplementation |
32 days (mean) | Randomized, controlled | Incidence of PU At orthopedic unit At recovery At 6 months |
n=2 (V), n=3 (C) n=0 (V), n=3 (C) n=0 (V), n=2 (C) (no statistical evaluation) |
| Bourdel-Marchasson et al.13 | 672 | Critically ill patients, unable to move themselves and to eat independently, several comorbiditiesa Age: 83±0.3 BMI: n.d. |
Verum Three different ONS (Nutricia, Jacquemaire-Santé, Clintec-Sopharga) Energy: 400 kcal Protein: 30 g Fat: 8.6 g Carbohydrates: 48.8 g Vit C: 30 mg Zinc: 3.6 mg Control No supplementation |
Up to 15 days or until discharge if patients stayed fewer than 15 days | Randomized (wards), controlled, multicenter study (19 wards) | Incidence of PU Risk for PU Norton score Kuntzmann score |
V<C V<C V<C |
| Houwing et al.15 | 103 | Hip-fracture patients, not at terminal care, without metastatic hip fracture, insulin-dependent diabetes, renal or hepatic disease, and morbid obesity Age: 81±1 BMI: 24.0±0.4 |
Verum ONS (Cubitan®; Nutricia) Intakeb Energy: 385 kcal Protein: 31 g Arginine: 4.6 g Vit C: 385 mg Vit E: 154 mg TE Zinc: 15 mg Carotenoids: 4 mg Placebo Caloric-free, water-based placebo |
28 days or until discharge 10 days (median) | Double-blind, randomized, placebo-controlled, multicenter study (three centers) | Incidence of PU PU stage Stage I Stage II First day PU Days PU (sum) Total maximum wound size |
V=P V=P V=P V=P V=P V=P |
| Hommel et al.16 | 420 | Patients with hip-fractures at risk for PU, ≥comorbidities in V (36%) and in C (20%) Age: 81±1 BMI: 24.3±0.2 |
Verum ONS Energy: 300 kcal Vit A, B, C, E, β-carotene, zinc, selenium: n.d. Control No supplementation |
Until discharge 11 days (mean) | Not randomized, controlled | Incidence of PU at discharge PU stage Stage I Stage II Stage III |
V<C 46% V vs. 48% C 39% V vs. 66% C 14% V vs. 4% C (no statistical evaluation) |
| Theilla et al.17 | 95 | Patients with acute lung injury, but without head trauma, cerebral bleeding, and coagulation disorders Age: 59±2 BMI: 27.7±0.6 |
Verum Enteral formula (Pulmocare, Ross Laboratories, Abbott) enriched with lipids (EPA, GLA), Vit A, C, E (Opexa, Ross Laboratories) Intakeb Energy: 1,624 kcal Protein: 114 g Vit C: 914 mg Vit E: 230 mg TE β-carotene: 5.4 mg Control Enteral formula (Pulmocare, Ross Laboratories, Abbott) Intakeb Energy: 1,420 kcal Protein: 59 g Vit C: 300 mg Vit E: 54 mg TE β-carotene: 0 mg |
14 days | Randomized, controlled | Incidence of PU PU healing |
V<C (d4, d7) V=C |
Data on age (years) and BMI (kg/m2) are means±SEM if not indicated otherwise. Means were calculated as weighted means from the data of individual groups if not provided by the authors. Missing SEMs were calculated by SDs or SEMs of individual groups.
Comorbidities: stroke, heart failure, dyspnea, infectious diseases, digestive diseases, delirium, dehydratation, lower limb fractures, cancer, neurological diseases, painful arthritis, deep venous thrombosis, miscellaneous medical diseases.
Based on mean intake of 77% of target dose.
BMI, body mass index; C, control group; EPA, eicosapentanoic acid; GLA, gamma-linolenic acid; n.d., no data available; ONS, oral nutritional supplement; P, placebo group; PU, pressure ulcers; TE, tocopherol equivalents; V, verum group; Vit, vitamin; SD, standard deviation; SEM, standard error of the mean.