Deficiencies in Nutritional Intake in Patients with Diabetic Foot Ulcers
Keywords:Diabetes, Diabetic Foot, Wounds, Nutrition, Malnutrition, Protein.
Aims: This study examined the dietary and anthropometric components of diabetic patients with or without diabetic foot ulcers (DFU).
Methods: Eighty-two adult subjects were recruited in Tallahassee, FL (USA) and categorized into one of three groups: subjects without diabetes, patients with Diabetes Mellitus (DM) but not foot ulcers, and patients with DFU. Twenty-four hour food recalls, foot ulcer history and blood samples were collected from each subject. Dietary intake was evaluated with Food Processor. Biomarkers of inflammation and oxidative stress were measured with ELISA kits.
Results: DFU subjects in this study were mostly overweight or obese. DFU had inadequate intakes in protein, fiber, vitamin B1, B2, B3, B6, C, D, and E; calcium, magnesium, phosphorus, potassium, selenium, and zinc. They had excessive intakes in saturated fat, trans fat, and sodium.
Conclusions: Malnutrition is very common in the DM and DFU subjects. Protein and vitamin supplementation may be beneficial in prevention and management of DM as well as DFU.
 Bloomgarden ZT. American Diabetes Association 60th Scientific Sessions, 2000: the diabetic foot. Diabetes Care 2001; 24(5): 946-51.
 Moss SE, Klein R, Klein BEK. Long-term incidence of lower-extremity amputations in a diabetic population. Archives of Family Medicine 1996; 5(7): 391-8.
 Agrawal S, Pandey SS, Shukla VK, Kaur P. Nutritional and vitamin status of non-healing wounds in patients attending a tertiary hospital in India. J Dermatol 2003; 30(2): 98-103.
 Wong MW, Leung PC, Wong WC. Limb salvage in extensive diabetic foot ulceration-a preliminary clinical study using simple debridement and herbal drinks. Hong Kong Med J 2001; 7(4): 403-7.
 Moulik PK, Mtonga R, Gill GV. Amputation and mortality in new-onset diabetic foot ulcers stratified by etiology. Diabetes Care 2003; 26(2): 491-4.
 Chadwick P, Acton C. The use of amelogenin protein in the treatment of hard-to-heal wounds. Br J Nurs 2009; 18(6): S22, S4, S6, passim.
 Eldor R, Raz I, Ben Yehuda A, Boulton AJ. New and experimental approaches to treatment of diabetic foot ulcers: a comprehensive review of emerging treatment strategies. Diabet Med 2004; 21(11): 1161-73.
 Steed DL, Webster MW, Ricotta JJ, Luterman A, Brown S, Comerota AJ, et al. Clinical-Evaluation of Recombinant Human Platelet-Derived Growth-Factor for the Treatment of Lower-Extremity Diabetic Ulcers. Journal of Vascular Surgery 1995; 21(1): 71-81.
 Falanga V. Wound healing and its impairment in the diabetic foot. Lancet 2005; 366(9498): 1736-43.
 Cartwright MM. The metabolic response to stress: a case of complex nutrition support management. Crit Care Nurs Clin North Am 2004; 16(4): 467-87.
 Shepherd AA. Nutrition for optimum wound healing. Nurs Stand 2003; 18(6): 55-8.
 MacKay D, Miller AL. Nutritional support for wound healing. Altern Med Rev 2003; 8(4): 359-77.
 Arnold M, Barbul A. Nutrition and wound healing. Plastic and Reconstructive Surgery 2006; 117(7): 42S-58S.
 Brown KL, Phillips TJ. Nutrition and wound healing. Clinics in Dermatology 2010; 28(4): 432-9.
 Maritim AC, Sanders RA, Watkins JB. Diabetes, oxidative stress, and antioxidants: A review. Journal of Biochemical and Molecular Toxicology 2003; 17(1): 24-38.
 Rigalleau V, Barbe M, Garuz F, Baillet-Blanco L, Beauvieux MC, Gin H. Nutritional factors and diabetic foot: a role for vitamin E? Diabet Med 2004; 21(8): 951-2.
 Cohen J. Statistical power analysis for the behavioral sciences. second edition ed. Hillsdale, Newy Jersey1988.
 ADA. Choose Your Foods: Exchange Lists for Diabetes. American Diabetes Association and American Dietetic Association 2011.
 Maier HM, Ilich JZ, Kim J-S, Levenson CW, Arjmandi BH, Spicer MT. Dietary advanced glycation end-products exacerbate oxidative stress in patients with diabetic foot ulcers. Journal of Diabetes Research and Clinical Metabolism 2014; 3(1).
 Pannemans DL, Westerterp KR. Energy expenditure, physical activity and basal metabolic rate of elderly subjects. Br J Nutr 1995; 73(4): 571-81.
 Evans E. Nutritional assessment in chronic wound care. J Wound Ostomy Continence Nurs 2005; 32(5): 317-20.
 Liu S, Serdula M, Janket SJ, Cook NR, Sesso HD, Willett WC, et al. A prospective study of fruit and vegetable intake and the risk of type 2 diabetes in women. Diabetes Care 2004; 27(12): 2993-6.
 Bazzano LA, Li TY, Joshipura KJ, Hu FB. Intake of fruit, vegetables, and fruit juices and risk of diabetes in women. Diabetes Care 2008; 31(7): 1311-7.
 Pitt S, May K, Colman P, Wraight P. Deficiencies in nutritional intake in patients admitted with diabetes-related foot complications. Nutrition & Dietetics 2007; 64(3): 186-91.
 Shukla A, Rasik AM, Patnaik GK. Depletion of reduced glutathione, ascorbic acid, vitamin E and antioxidant defence enzymes in a healing cutaneous wound. Free Radic Res 1997; 26(2): 93-101.
 Pittas AG, Lau J, Hu FB, Dawson-Hughes B. The role of vitamin D and calcium in type 2 diabetes. A systematic review and meta-analysis. J Clin Endocrinol Metab 2007; 92(6): 2017-29.
 Via M. The malnutrition of obesity: micronutrient deficiencies that promote diabetes. ISRN Endocrinol 2012; 2012: 103472.
 Schwalfenberg GK. A review of the critical role of vitamin D in the functioning of the immune system and the clinical implications of vitamin D deficiency. Mol Nutr Food Res 2011; 55(1): 96-108.
 Lansdown ABG, Mirastschijski U, Stubbs N, Scanlon E, Agren MS. Zinc in wound healing: Theoretical, experimental, and clinical aspects. Wound Repair and Regeneration 2007; 15(1): 2-16.
 Salgueiro MJ, Krebs N, Zubillaga MB, Weill R, Postaire E, Lysionek AE, et al. Zinc and diabetes mellitus: is there a need of zinc supplementation in diabetes mellitus patients? Biol Trace Elem Res 2001; 81(3): 215-28.
 Wojcik A, Atkins M, Mager DR. Dietary intake in clients with chronic wounds. Can J Diet Pract Res 2011; 72(2): 77-82.
 Ekinci EI, Cheong KY, Dobson M, Premaratne E, Finch S, MacIsaac RJ, et al. High sodium and low potassium intake in patients with Type 2 diabetes. Diabetic Medicine 2010; 27(12): 1401-8.
 Fats and Oils: AHA Recommendation [database on the Internet] 2011 [cited 1/20/2013].
 Sarwar N, Gao P, Seshasai SR, Gobin R, Kaptoge S, Di Angelantonio E, et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet 2010; 375(9733): 2215-22.
 Doell D, Folmer D, Lee H, Honigfort M, Carberry S. Updated estimate of trans fat intake by the US population. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2012; 29(6): 861-74.
Policy for Journals/Articles with Open Access
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under aÂ Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are permitted and encouraged to post links to their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work
Policy for Journals / Manuscript with Paid Access
Authors who publish with this journal agree to the following terms:
- Publisher retain copyright .
- Authors are permitted and encouraged to post links to their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work .