Intake

Carbohydrates are necessary in the diet for the maintenance of good health. As with other nutrient groups, excessive intake of certain carbohydrates (i.e., refined carbohydrates; high in starch/glucose and low in fiber) can have deleterious effects on health in general as well as on wound healing. Recently, the relationship between dietary fat and obesity has been questioned. Mean fat intake has decreased in the United States for the past three decades, while obesity has continued to rise (38). During this same time period, an increased intake of refined carbohydrates has been documented (39). It has been suggested that a high intake of refined carbohydrates may be a contributor to the national trend toward obesity. Ludwig et al. have suggested that high glycemic index (GI) foods that rapidly increase the body's sugar level (i.e., white bread and waffles) induce hormonal and metabolic changes that lead to overeating (40). Obesity, in turn, has been associated with increases in coronary heart disease, adult onset diabetes, and hypertension, as well as poor wound healing. In general, obese patients have an increased frequency of wound infections and impaired healing. This is thought to be due to the fact that adipose tissue is poorly vascularized, resulting in a decrease in blood flow to the wound and impairment in the delivery of nutrients. Obese patients have also been shown to have a higher incidence of surgical wound dehiscence, possibly because their operations can be more technically difficult, and they are prone to hematoma formation (41). Clearly, prevention of obesity is key; however, practitioners should be aware of the effects of obesity on wound healing.

Excessive quantities of carbohydrates can also have a negative impact in the hospital setting. Even moderate degrees of hyperglycemia may result in an increased incidence of infection and adverse outcomes (42). Persistent hyperglycemia has been associated with poor wound healing and immunity (7). Excessive amounts of glucose have been positively correlated with increased carbon dioxide production and hepatic steatosis in traumatized and septic patients (12,13). Diabetic subjects who suffer from wounds need to be especially careful in regard to the regulation of glucose intake and the maintenance of euglycemia (17).

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