Protein deficiency contributes to poor healing rates through reduced collagen formation and wound dehiscence. High exudate loss can result in a deficit of as much as 100 g of protein in 1 d. There is a correlation between low serum albumin and body mass index (BMI) and the development of pressure ulcers. Also, low serum albumin and high Waterlow score have a positive association. The body automatically renews tissue while we are asleep, but this does not mean that protein synthesis does not take place during our wakeful hours. Glucose provides the body with its power source for wound healing, and this gives energy for angiogenesis and the deposition of new tissue. Therefore, it is vital that the body receives adequate amounts of glucose to provide additional energy for wound healing. Fatty acids are essential for cell structure and play an important role in the inflammatory process. Vitamins, particularly those associated with skin integrity (vitamins A, D, and C), are also important in wound healing.9

Protein synthesis at the wound site must be increased for collagen deposition and healing to occur. Patients with protein-calorie malnutrition have diminished hydoxyproline accumulation (an index of collagen deposition) in subcutaneously implanted polytetrafluoroethylene catheters compared with normally nourished controls.10

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