• Emanuele Cereda, Catherine Klersy, Marcella Serioli, Aldo Crespi, Federico D'Andrea, and OligoElement Sore Trial Study Group.
• Ann. Intern. Med. 2015 Feb 3; 162 (3): 167-74.

BackgroundTrials on specific nutritional supplements for the treatment of pressure ulcers (PUs) have been small, inconsistent in their formulations, or unsuccessful in controlling for total supplement calorie or protein content.ObjectiveTo evaluate whether supplementation with arginine, zinc, and antioxidants within a high-calorie, high-protein formula improves PU healing.DesignMulticenter, randomized, controlled, blinded trial. (ClinicalTrials.gov: NCT01107197).SettingLong-term care and home care services.Patients200 adult malnourished patients with stage II, III, and IV PUs.InterventionsAn energy-dense, protein-rich oral formula enriched with arginine, zinc, and antioxidants (400 mL/d) or an equal volume of an isocaloric, isonitrogenous formula for 8 weeks.MeasurementsThe primary end point was the percentage of change in PU area at 8 weeks. Secondary end points included complete healing, reduction in the PU area of 40% or greater, incidence of wound infections, the total number of dressings at 8 weeks, and the percentage of change in area at 4 weeks.ResultsSupplementation with the enriched formula (n = 101) resulted in a greater reduction in PU area (mean reduction, 60.9% [95% CI, 54.3% to 67.5%]) than with the control formula (n = 99) (45.2% [CI, 38.4% to 52.0%]) (adjusted mean difference, 18.7% [CI, 5.7% to 31.8%]; P = 0.017). A more frequent reduction in area of 40% or greater at 8 weeks was also seen (odds ratio, 1.98 [CI, 1.12 to 3.48]; P = 0.018). No difference was found in terms of the other secondary end points.LimitationParticipation was restricted to patients who were malnourished, were able to drink oral supplements, and were living in long-term care institutions or receiving home care services.ConclusionAmong malnourished patients with PU, 8 weeks of supplementation with an oral nutritional formula enriched with arginine, zinc, and antioxidants improved PU healing.Primary Funding SourceAzienda Ospedaliera Universitaria Maggiore della Carità.

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