Proteins play a vital role in wound healing. Proteins synthesize collagen, antibodies and enzymes. Deficiencies in protein levels can complicate wound repair and lead to a prolonged inflammatory response. Maximizing nutritional levels are an important component of a comprehensive wound-healing program.
Types
Glutamine and l-arginine are important amino acids needed for wound repair. Glutamine is the body's most abundant amino acid. Glutamine binds free ammonia from the blood, allowing production of additional amino acids, amino sugars, nucleotides and urea, according to Paul J. Sheffield in his book, "Wound Care Practice." L-arginine assists in collagen formation to repair soft tissue, muscle, cartilage and tendons. Adequate l-arginine levels are also necessary for nitric oxide synthesis which cause vasodilation and, in turn, improved oxygen perfusion to tissue, according to Sheffield
Theories
Deficiencies in proteins can cause increased muscle and tissue breakdown, a weakened immune response and decreased elasticity of a scar. Studies of glutamine and l-arginine supplementation have shown improved wound healing and shorter re-epithelization time, according Sheffield. Several companies make supplements with these amino acids including Arginaid Extra by Novartis and Juven by Ross.
Requirements
Wound healing requires additional protein intake. A normal non-wounded individual requires approximately 0.8g of protein per kilogram each 24 hours, notes Sheffield. A shallow, partial-thickness wound that affects only the epidermis and dermal layers of the skin doubles your protein requirements. Deeper or multiple wounds require even more protein.
Tests
Albumin, prealbumin and transferrin are transport proteins synthesized by the liver and are common laboratory tests to monitor protein levels. Serum albumin has a long half-life of 21 days and reflects protein intake over several weeks. The normal range of serum albumin is 3.4 to 5.4g/dL, according to MedlinePlus. Serum albumin levels below 3.4g/dL is considered inadequate for wound healing. Prealbumin has a shorter half-life of two days and more accurately reflects protein intake over several days. The normal range of serum prealbumin is 15.7 to 29.6mg/dL. Prealbumin below 15mg/dL is a sign of malnutrition. Low levels of transferrin are associated with chronic inflammation and malnutrition. Transferrin has a half-life of eight to 10 days and a normal range of 200 to 400mg/dL.
Effects
Protein-energy malnutrition, or PEM, is a condition that occurs when there is an inadequate intake of energy and protein to meet the body's nutritional needs. PEM causes a decrease in lean body mass. A person with a loss of lean body mass of 15 percent is at increased risk for developing wounds, less than 20 percent spontaneous wounds can develop due to a loss of collagen in skin, according to Sheffield. A person with a loss of lean body mass of 25 percent is at an increased risk for life threatening infections and a higher mortality rate.
References
- "Wound Care Practice"; Paul J. Sheffield, 2004
- MedlinePlus: Albumin--Serum
