Nutrition is of interest to everyone. For the impoverished, nutrition is an issue of obtaining enough food to survive. For some, it is a health concern in their fight against obesity and diabetes, hypertension, heart disease, and degenerative skeletal disorders that accompany this nutritional problem. For others, it is of interest so that they will not be embarrassed wearing their bathing suits. While these situations are apparent to all, we have become aware that some nutrients with less obvious outward manifestations, such as vitamins and minerals, may have consequences that are significant to our health and well-being.

Healing a wound is a high priority to the body. The complex system of wound healing presents an adaptive advantage that ensures the survival of the organism despite the decreased defense against microbial invasion. When injured, the wound is an effective parasite removing from the body what it needs. In 1794, Hunter stated that "There is a circumstance attending accidental injury which does not belong to disease — namely, that the injury done has, in all cases, a tendency to produce both the disposition and the means of cure," (Hunter, J.A., A Treatise on the Blood, Inflammation and Gunshot Wounds. Nicol, London, 1794, as quoted in Albina, J.E., Nutrition and wound healing, Journal of Parenteral and Enteral Nutrition, 18(4), 368, 1994). In this regard, the wound is not unlike the fetus during pregnancy. Indeed, pregnancy is also a condition that has a "tendency to produce both the disposition and the means of cure." Nonetheless, we have learned that pregnancy requires appropriate nutritional supplementation (i.e., folic acid) to avoid fetal distress. In a similar fashion, despite the fact that most wounds heal well without special nutritional supplementation, the clinician must be aware of those circumstances where intervention is necessary.

Malnutrition may be simply defined as a condition of too much or too little nutrition. While conditions of too little nutrition, such as starvation or total protein and calorie deprivation (marasmus), are obvious malnutrition, many often forget the opposite extreme of this — obesity is also malnutrition. Although total protein-calorie deprivation is often well tolerated, a similar condition of excessive calories with inadequate protein (kwashiorkor) is poorly tolerated and is associated with a higher mortality rate. Similarly, obesity, while not necessarily associated with any nutritional deprivation, may have serious health consequences. It is apparent that proper nutritional support of the patient with a wound requires attention to not only provide enough nutrition but also to avoid nutrient excess to avoid the "toxic" effects of the nutrient.

In the following pages, the importance of each nutrient, both macronutrients and micronutrients, to the healing wound will be systematically described. Also discussed will be the role of pharmacologic manipulation of wound healing and specific conditions associated with challenges in wound healing. The approach taken is similar with each nutrient. A discussion of the role of each nutrient in the healing process is provided, including the dangers of nutrient excess. Finally, recommendations are made for providing the nutrient in appropriate quantities for the patient with a healing wound, and directions for future research are provided. In this manner, it is hoped that this book will provide needed information for the experienced researcher, the novice, or the practicing clinician just wishing to know what to do.

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