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      The effect of dietary intake of antioxidant micronutrients on burn wound healing: a study in a tertiary health institution in a developing country

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          Abstract

          Background

          Burn injury results in emotional stress affecting dietary intake and antioxidant micronutrient intake, which is known to have effects on recovery outcomes. The study aimed to assess dietary intake of antioxidant micronutrients and recovery outcomes of burn patients.

          Methods

          Questionnaires were administered to 40 burn patients at Komfo Anokye Teaching Hospital (Ghana) from January 1, 2014 to May 30, 2014. The data taken include anthropometric measurements and dietary assessment. Their nutrient intakes were assessed with the Nutrient Analysis Template. The average intakes were compared to the recommended daily allowance. Assessment of recovery was based on records of wound healing assessments and infection rates from the health practitioners.

          Results

          A cross-sectional study of 40 patients revealed an average total burn surface area (TBSA) of 31.4 %, where 70.0, 35.0, 75.0, 52.5, 12.5 and 32.5 % patients were deficient in vitamins A, C and E, zinc, copper and selenium, respectively and adequate amounts of vitamin C intake were related with significantly better wound healing progress. Positive wound healing outcomes were observed for patients with adequate vitamins A and E and zinc intake. Less infection presented among patients with adequate amount of vitamins A and C and zinc, but this was not observed for patients with adequate vitamin E, copper and selenium.

          Conclusions

          Most burn patients did not meet their dietary requirements for antioxidant micronutrients and this was due to meals not tailored to suit individual requirements. Adequacy of the antioxidants especially vitamin C resulted in positive wound healing outcomes. Hence, there is need for planned well-balanced meals of high vitamin C.

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          Most cited references17

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          Nutritional support for wound healing.

          Healing of wounds, whether from accidental injury or surgical intervention, involves the activity of an intricate network of blood cells, tissue types, cytokines, and growth factors. This results in increased cellular activity, which causes an intensified metabolic demand for nutrients. Nutritional deficiencies can impede wound healing, and several nutritional factors required for wound repair may improve healing time and wound outcome. Vitamin A is required for epithelial and bone formation, cellular differentiation, and immune function. Vitamin C is necessary for collagen formation, proper immune function, and as a tissue antioxidant. Vitamin E is the major lipid-soluble antioxidant in the skin; however, the effect of vitamin E on surgical wounds is inconclusive. Bromelain reduces edema, bruising, pain, and healing time following trauma and surgical procedures. Glucosamine appears to be the rate-limiting substrate for hyaluronic acid production in the wound. Adequate dietary protein is absolutely essential for proper wound healing, and tissue levels of the amino acids arginine and glutamine may influence wound repair and immune function. The botanical medicines Centella asiatica and Aloe vera have been used for decades, both topically and internally, to enhance wound repair, and scientific studies are now beginning to validate efficacy and explore mechanisms of action for these botanicals. To promote wound healing in the shortest time possible, with minimal pain, discomfort, and scarring to the patient, it is important to explore nutritional and botanical influences on wound outcome.
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            The hypermetabolic response to burn injury and interventions to modify this response.

            Severe burn injury is followed by a profound hypermetabolic response that persists up to 24 months after injury. It is mediated by up to 50-fold elevations in plasma catecholamines, cortisol, and inflammatory cells that lead to whole-body catabolism, elevated resting energy expenditures, and multiorgan dysfunction. All of these metabolic and physiologic derangements prevent full rehabilitation and acclimatization of burn survivors back into society. Modulation of the response by early excision and grafting of burn wounds, thermoregulation, early and continuous enteral feeding with high-protein high-carbohydrate feedings, and pharmacologic treatments have markedly decreased morbidity.
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              Practical guidelines for nutritional management of burn injury and recovery.

              Nutrition practice in burn injury requires a multifaceted approach aimed at providing metabolic support during a heightened inflammatory state, while accommodating surgical and medical needs of the patient. Nutritional assessment and determination of nutrient requirements is challenging, particularly given the metabolic disarray that frequently accompanies inflammation. Nutritional therapy requires careful decision making, regarding the safe use of enteral or parenteral nutrition and the aggressiveness of nutrient delivery given the severity of the patient's illness and response to treatment. With the discovery that specific nutrients can actually alter the course of disease, the role of nutrition support in critical illness has shifted from one of preventing malnutrition to one of disease modulation. Today the use of glutamine, arginine, essential fatty acids, and other nutritional factors for their effects on immunity and cell regulation is becoming more common, although the evidence is often lagging. An exciting dichotomy exits, forcing nutrition support specialists to make responsible choices while remaining open to new potential helpful therapeutic options.
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                Author and article information

                Contributors
                madjepong2020@gmail.com
                +233 24 459 9448 , pimagben@yahoo.com
                kwakaib@yahoo.co.uk
                ibok.oduro@gmail.com
                Journal
                Burns Trauma
                Burns Trauma
                Burns & Trauma
                BioMed Central (London )
                2321-3868
                2321-3876
                12 August 2015
                12 August 2015
                2015
                : 3
                : 12
                Affiliations
                [1 ]Department of Food Science and Technology, College of Science, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
                [2 ]Reconstructive Plastic Surgery & Burns Unit, Department of Surgery, Komfo Anokye Teaching Hospital, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
                Article
                12
                10.1186/s41038-015-0012-x
                4963941
                bf5d21b2-7f1a-4cec-bd3b-adfce2640d57
                © The Author(s) 2015

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 23 July 2015
                : 24 July 2015
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2015

                dietary intake,antioxidants,micronutrients,recovery,wound infection,wound healing

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