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Introduction

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Nutrition is extremely important to every aspect of our lives. The importance of food and nutrition has been documented throughout history, from Adam and Eve and the apple in the Bible to foods used as aphrodisiacs. Food plays a part in almost all social gatherings and has a major part in all holidays, as well as religious and ritualistic ceremonies. Therefore, it is only logical that nutrition plays a very important part in our overall health.

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Malnutrition is usually thought of as a deprivation of nutrients that causes major problems. The scope of malnutrition is much larger, however, encompassing situations of excess, as may be present in obesity, or an inability to tolerate or process certain nutrients, as in diabetes. Regarding the impact of nutrition on overall wound healing, much evidence is present in animal models showing the connection between nutrition and overall acute wound healing. Levenson et al and Crowley et al have documented decreased healing in cutaneous wounds in burned or wounded animal models when nutrition was inadequate.1,2,3,4 In humans we know that most minor wounds heal without any significant problems. The human body has the ability to prioritize wound healing so that mild or even moderate malnutrition may not adversely affect wound healing.5 We do know, however, that nutrition often plays a very important role in overall wound healing. While many feel that nutrition is one of the most important factors affecting wound healing, often little is done to provide any nutritional counseling, education, or intervention during the wound healing process.

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Most evidence on the benefits of nutrition in wound healing stem from research in the area of pressure ulcer management and prevention. It is known from Bergstrom et al,6 that pressure ulcer stages are directly proportional to the degree of malnutrition present and prevention of malnutrition leads to a reduction in pressure ulcer incidence.

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Conditions that lead to poor wound healing are threefold. The loss of lean body mass, the impairment of collagen and protein synthesis, and the overall impairment of the immune system all directly relate to a person's overall protein nutritional status.7 We can look at the overall effect of nutrition on wound healing in several areas. One such area is that of decreased caloric intake. Another is decreased specific nutritional intake, such as proteins, vitamins, or minerals. In decreased caloric intake, Spanheimer showed decreased collagen synthesis in rodents who were fed just half their required caloric intake.8 Yue showed a decrease in matrix deposition and glycosaminoglycans as well as an overall decrease in granulation tissue formation in a rodent experimental model fed a decreased calorie diet.9 In clinical medicine, patients with preoperative illnesses who had an overall decreased caloric intake showed that, even if they were not chronically malnourished, they had a decrease in collagen synthesis.10 Haydock and Hill note that in surgical ...

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