Table 12Effectiveness of nutritional supplementation for pressure ulcer prevention

Author, Year
Duration
Quality Rating
SettingInterventionsPatient CharacteristicsBaseline Ulcer Risk Scoreb
Pressure Ulcers at Baseline
Incident Pressure Ulcers
Bourdel-Marchasson et al, 2000136
15 days or until death or discharge
Poor
Hospital wards and geriatric inpatient units
France
  1. Nutritional intervention group (n=295): standard diet (1.8 kcal/d) and 2 oral supplements per day (with 200 mL; 200 kcal, 30% protein; 20% fat; 50% carbohydrate; minerals and vitamins such as 1.8 mg zinc and 15 mg vitamin C)
  2. Control group (n=377): standard diet (1.8 kcal daily).
N=672
Mean age: 84 vs. 83 years
Percent female: 68% vs. 63%
Percent white: NR
Norton Score
5–10: 28% vs. 36%
11–14: 40% vs. 47%
>14: 31% vs. 19%
Pressure ulcers at baseline: Excluded
Any pressure ulcer (90% stage 1): 40% (118/295) vs. 48% (181/377); RR 0.83 (95% CI, 0.70 to 0.99), adjusteda RR 0.64 (95% CI, 0.42 to 0.97)
Delmi et al, 1990137
Mean duration of supplement 32 days; outcomes assessed though 6 months after discharge
Poor
Orthopaedic unit of the University hospital of Geneva and “second (recovery)” hospital
Switzerland
  1. Standard hospital diet with daily oral nutrition supplement (250 mL; 254 kcal; 20.4 g protein; 29.5 g carbohydrate; 5.8 g lipid; 525 mg calcium; 750 IU vitamin A; 25 IU vitamin D3, vitamins E, B1, B2, B6, B12, C, nicotinamide, folate, calcium pantothenate, biotin, minerals), started on admission, continued throughout second hospital (mean period 32 days); given at 8 PM daily (n=27)
  2. Standard hospital diet (n=32)
N=59
Mean age: 80 vs. 83 years
Percent female: 88.9% vs. 90.6%
Pressure ulcer risk score at baseline: NR
Pressure ulcers at baseline: NR
Any pressure ulcer at discharge: 7.4% (2/27) vs. 9.4% (3/32); RR 0.79 (95% CI, 0.14 to 4.4)
Any pressure ulcer at 6 months: 0% (0/25) vs. 7.4% (2/27); RR 0.22 (95% CI, 0.01 to 4.3)
Ek et al, 1991138
26 weeks (mean NR)
Poor
Hospital
Sweden
  1. Nutritional supplement (200 ml; 838 kJ; 8 g protein; 8 g fat; 23.6 g carbohydrates; minerals and vitamins) twice daily in addition to hospital diet
  2. Standard hospital diet (2200 kcal)
N=495
Mean age: 80.1 years
Sex: 62% female
Race: NR

Demographics not reported by group
Norton score: NR
Malnourished at baseline: 28.5%
Pressure ulcers at baseline: 14.1%
Pressure ulcers among patients without prevalent ulcers: 9.9% vs. 12%; p=NS (sample size to calculate CI not reported)
Second or third pressure ulcer development: 11% vs. 25%; p=NS
Hartgrink et al, 1998140
2 weeks
Poor
Hospital
The Netherlands
  1. Nasogastric tube feeding (1 liter Nutrison Steriflo Energy-plus; 1500 kcal; 60 g protein) in addition to standard hospital diet
  2. Standard hospital diet
N=129
Mean age: 84.0 vs. 83.3
Sex: 83.9% vs. 91.0% female
Race: NR
Pressure-sore risk score: 9.0 vs. 9.2
Pressure ulcers at baseline (all grade I): 16% (10/62) vs. 15% (10/67)
Incidence of pressure sores (grade II or greater) at 1 week: 37% (20/54) vs. 48% (30/62);RR 0.77 (95% CI, 0.50 to1.2)
Incidence of pressure sores (grade II or greater) at 2 weeks: 52% (25/48) vs. 57% (30/53); RR 0.92 (95% CI, 0.64 to 1.3)
Houwing et al, 2003139
28 days or until discharge
Poor
3 centers
The Netherlands
  1. Nutritional supplement (400 mL; 500 kcal; 40 g protein; 6 g L-arginine; 20 mg zinc; 500 mg vitamin C; 200 mg vitamin E; 4 mg carotenoids) (n=51)
  2. Noncaloric, water-based placebo (n=52)
N=103
Mean age: 82 vs. 80 years
Percent female: 78% vs. 84%
Percent white: NR
Dutch Consensus Meeting scoring system (CBO-risk assessment tool):
11.1 vs. 11.2
Pressure ulcers at baseline: Not reported
Any pressure ulcer: 55% (27/49) vs. 59% (30/51); RR 0.94 (95% CI, 0.67 to 1.3)
Stage 1 ulcers: 37% (18/49) vs. 31% (16/51); RR 1.2 (95% CI, 0.68 to 2.0)
Stage 2: 18% (9/49) vs. 28% (14/51); RR 0.67 (95% CI, 0.32 to 1.4)
Theilla et al, 2007135
1 week
Fair
Hospital
Israel
  1. High fat, low carbohydrate enteral formula with eicosapentanoic acid, gamma-linolenic acid, and vitamins A, C, and E (n=46)
  2. High fat, low carbohydrate enteral formula (n=49)
N=95
Mean age: 57 vs. 62 years
Sex: 37% vs. 43% female
Race: NR
Pressure ulcer risk score at baseline: NR
Pressure ulcers at baseline: 15% (7/46) vs. 29% (14/49)
Any pressure ulcer: 33% (15/46) vs. 49% (24/49); RR 0.67 (95% CI, 0.40 to 1.10)

Note: CI=confidence interval, NR=not reported, PU=pressure ulcer, RR=relative risk.

a

Adjusted for intervention group, serum albumin, Kuntzman score, Norton score, and diagnosis.

b

Higher risk for pressure ulcers usually defined as Braden scores <15–18, Cubbin and Jackson scores <29, Norton scores <12–16, or Waterlow scores >10–15Waterlow scores >10–15. Higher scores indicate higher pressure ulcer risk.

From: Results

Cover of Pressure Ulcer Risk Assessment and Prevention: Comparative Effectiveness
Pressure Ulcer Risk Assessment and Prevention: Comparative Effectiveness [Internet].
Comparative Effectiveness Reviews, No. 87.
Chou R, Dana T, Bougatsos C, et al.

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