Current Approaches in Wound Healing: Role of Macro Nutrients

Abstract

A large body of evidence have shown that undernutrition affects wound healing, negatively. In order to clarify the complete role of nutrition in wound healing,  the steps of wound healing and the nutrients that act on these steps should be evaluated. Protein is the most underlined nutrient at wound healing because of its utilisation at every phase of wound healing. Along with protein, omega 3 fatty acids are stated to be precursors of some mediators which take active role at inflammation resolving phase and therefore contribute to wound healing by inhibiting chronic inflammation. Carbonhydrates promotes wound healing indirectly by taking part in glycoproteins like hyaluronan and lactoferrin. In this review, the mechanisms by which macro-nutrients used in wound healing influence the healing process is discussed.

Keywords

• wound healing,nutrition

Yara İyileşmesinde Güncel Yaklaşımlar: Makro Besin Ögelerinin Rolü

Abstract

Yetersiz beslenmenin yara iyileşmesini olumsuz yönde etkilediğini gösteren pek çok çalışma vardır. Ancak, yara iyileşmesinde beslenmenin rolünün tam olarak açıklanabilmesi için yara iyileşmesi fizyolojisinin aşamaları ve bu aşamalarda rol oynayan besin ögelerinin her boyutuyla değerlendirilmesi gereklidir. Protein, yara iyileşmesinin her aşamasında kullanıldığı için yara iyileşmesi üzerinde en fazla durulan besin ögesidir. Bunun yanı sıra, omega 3 yağ asitlerinin inflamasyonun çözülme aşamasında aktif rol oynayan bazı maddelerin öncüsü olduğu ve kronik inflamasyonu önleyerek yara iyileşmesini desteklediği belirtilmektedir. Karbonhidratlar ise, dolaylı olarak laktoferrin ve hiyaluronan gibi glikoproteinlerin yapısına katılarak, yara iyileşmesine katkıda bulunabilmektedir. Bu derlemede yara iyileşmesinde kullanılan makro besin ögelerinin iyileşme sürecine hangi mekanizmalarla etki ettiğinden bahsedilmiştir.  

Keywords

• yara iyileşmesi,beslenme

References

1. Al-Ghazzewi F., Elamir A., Tester R.,& Elzagoze A. (2015) Effect of depolymerised konjac glucomannan on wound healing. Bioactive Carbohydrates and Dietary Fibre.,5,125-8.
2. Alexander J. W., Supp D. M. (2014) Role of Arginine and Omega-3 Fatty Acids in Wound Healing and Infection. Adv Wound Care (New Rochelle);3:682-90.
3. Alsan Cetin I., Atasoy B. M., Cilaker S., Arican Alicikus L. Z., Karaman M., Ersoy N. ve diğerleri. (2015) A Diet Containing Beta-Hydroxy-Beta-Methylbutyrate, L-Glutamine and L-Arginine Ameliorates Chemoradiation-Induced Gastrointestinal Injury in Rats. Radiation Research. 2015;184,411-21.
4. Babaei S., Ansarihadipour H., Nakhaei M., Darabi M., Bayat P., Sakhaei M. ve diğerleri. (2017). Effect of Omegaven on mast cell concentration in diabetic wound healing. Journal of Tissue Viability.,26,125-30.
5. Babajafari S., Akhlaghi M., Mazloomi S. M., Ayaz M., Noorafshan A., Jafari P. ve diğerleri. (2018). The effect of isolated soy protein adjunctive with flaxseed oil on markers of inflammation, oxidative stress, acute phase proteins, and wound healing of burn patients; a randomized clinical trial. Burns.,44,140-9.
6. Badr G. (2013) Camel whey protein enhances diabetic wound healing in a streptozotocin-induced diabetic mouse model, the critical role of β-Defensin-1, -2 and -3. Lipids in Health and Disease.,12.
7. Badr G., Sayed L. H., Badr B. M., Omar H. M.,& Selamoglu Z. (2017) Why whey? Camel whey protein as a new dietary approach to the management of free radicals and for the treatment of different health disorders. Iranian Journal of Basic Medical Sciences; 20:338-49.
8. Berdal M.,& Jenssen T. (2013) No Association between Glycemia and Wound Healing in an Experimental db/db Mouse Model. ISRN Endocrinology.,2013,1-6.

9. Bohr S., Patel S. J., Sarin D., Irimia D., Yarmush M. L.,& Berthiaume F. (2013) Resolvin D2 prevents secondary thrombosis and necrosis in a mouse burn wound model. Wound Repair and Regeneration.,21,35-43.
10. Burd A, Huang L. Carbohydrates and Cutaneous Wound Healing. In: Garg H. G., Cowman M. K., Hales C. A., editor. Carbohydrate Chemistry, Biology and Medical Applications. Oxford: Elsevier; 2008. p. 253-74.
11. Cardoso C. R., Favoreto Jr S., Oliveira L. L., Vancim J. O., Barban G. B., Ferraz D. B. ve diğerleri. (2011) Oleic acid modulation of the immune response in wound healing, A new approach for skin repair. Immunobiology. 2011;216,409-15.
12. Chen Q., Hou H., Wang S., Zhao X.,& Li B. (2017) Effects of early enteral nutrition supplemented with collagen peptides on post-burn inflammatory responses in a mouse model. Food & Function.;8:1933-41.
13. Chiang N.,& Serhan C. N. (2017) Structural elucidation and physiologic functions of specialized pro-resolving mediators and their receptors. Molecular Aspects of Medicine.,58,114-29.
14. Chow O.,& Barbul A. (2014) Immunonutrition, Role in Wound Healing and Tissue Regeneration. Advances in Wound Care.,3,46-53.
15. Corsetti G., Romano C., Pasini E., Marzetti E., Calvani R., Picca A. ve diğerleri. (2017) Diet enrichment with a specific essential free amino acid mixture improves healing of undressed wounds in aged rats. Experimental Gerontology.,96,138-45.
16. Coşkun Ö., Uzun G., Dal D., Yıldız Ş., Sönmez Y. A., Yurttaş Y. ve diğerleri. (2016) Kronik yarada tedavi yaklaşımları. Gülhane Tıp Dergisi;58: 207-228
17. Demling H. R. (2009). Nutrition, Anabolism, and the Wound Healing Process, An Overview. ePlasty.,9,65-94.
18. Devi P. B., Vijayabharathi R., Sathyabama S., Malleshi N. G.,& Priyadarisini V. B. (2011) Health benefits of finger millet (Eleusine coracana L.) polyphenols and dietary fiber, a review. Journal of Food Science and Technology.,51,1021-40
19. Ebaid H., Ahmad O. M., Mahmoud A. M.,& Ahmed R R. (2013) Limiting prolonged inflammation during proliferation and remodeling phases of wound healing in streptozotocin-induced diabetic rats supplemented with camel undenatured whey protein. BMC Immunology.,14.
20. Ellinger S. (2014). Micronutrients, Arginine, and Glutamine, Does Supplementation Provide an Efficient Tool for Prevention and Treatment of Different Kinds of Wounds? Advances in Wound Care. 3,691-707.
21. Goswami S., Kandhare A., Zanwar A. A., Hegde M. V., Bodhankar S. L., Shinde S., ve diğerleri.(2016). Oral L-glutamine administration attenuated cutaneous wound healing in Wistar rats. International Wound Journal.;13:116-24.
22. Gündoğdu R. H., Temel H., Bozkırlı B. O., Ersoy E., Yazgan A.,& Yıldırım Z. (2017) Mixture of Arginine, Glutamine, and β-hydroxy-β-methyl Butyrate Enhances the Healing of Ischemic Wounds in Rats., Journal of Parenteral and Enteral Nutrition., 41,1045 –50.
23. He L., Weber K.,& Schilling J. (2016) Glutamine Modulates Macrophage Lipotoxicity. Nutrients.,8.
24. Hellmann J., Tang Y.,& Spite M. (2012) Pro-resolving lipid mediators and diabetic wound healing. Current Opinion in Endocrinology, Diabetes and Obesity.,19,104–8.
25. Holecek M. (2017) Beta-hydroxy-beta-methylbutyrate supplementation and skeletal muscle in healthy and muscle-wasting conditions. Journal of Cachexia, Sarcopenia and Muscle.;8:529-41.
26. Homayouni-Tabrizi M., Asoodeh A., Abbaszadegan M. R., Shahrokhabadi K.,& Nakhaie Moghaddam M. (2015) An identified antioxidant peptide obtained from ostrich (Struthio camelus) egg white protein hydrolysate shows wound healing properties. Pharmaceutical Biology.;53:1155-62
27. Kiecolt-Glaser J. K., Glaser R.,& Christian L. M. (2014) Omega-3 Fatty Acids and Stress-Induced Immune Dysregulation, Implications for Wound Healing. Military Medicine.,179,129-33.
28. Ktari N., Trabelsi I., Bardaa S., Triki M., Bkhairia I., Ben Slama-Ben Salem R. ve diğerleri. (2017) Antioxidant and hemolytic activities, and effects in rat cutaneous wound healing of a novel polysaccharide from fenugreek (Trigonella foenum-graecum) seeds. International Journal of Biological Macromolecules.,95,625-34.
29. Kuda O. (2017). Bioactive metabolites of docosahexaenoic acid. Biochimie.,136,12-20.
30. Kusabbi R., Kismet K., Kuru S., Barlas A. M., Duymus M. E., Hasanoglu A. ve diğerleri. (2015) Effects of the Oral Nutritional Supplement Containing
31. Arginine, Glutamine, and Hydroxymethylbutyrate (Abound®) on Healing of Colonic Anastomoses in Rats. Indian Journal of Surgery.,77,1242-7.
32. Landén N. X., Li D.,& Ståhle M. (2016) Transition from inflammation to proliferation, a critical step during wound healing. Cellular and Molecular Life Sciences.,73,3861-85.
33. MacKay D.,& Milller A. L. (2003). Nutritional Support for Wound Healing. Alternative Medicine Review,8,359-77.
34. Martin P., Nunan R.(2015); Cellular and molecular mechanisms of repair in acute and chronic wound healing; British Journal of Dermatology, 173, 370–378
35. McCusker M. M.,& Grant-Kels J. M. (2010) Healing fats of the skin, the structural and immunologic roles of the ω-6 and ω-3 fatty acids. Clinics in Dermatology., 28,440-51.
36. Mirza R. E., Fang M. M., Novak M. L., Urao N., Sui A., Ennis W. J. ve diğerleri. (2015) Macrophage PPARγ and impaired wound healing in type 2 diabetes. The Journal of Pathology., 236,433-44.
37. Mirza R. E.,& Koh T. J. (2015) Contributions of cell subsets to cytokine production during normal and impaired wound healing. Cytokine. ,71,409-12.
38. Molnar J. A., Underdown M. J.,& Clark W. A. (2014) Nutrition and Chronic Wounds. Advances in Wound Care. 2014;3,663-81.
39. Molnar J. A., Vlad L. G.,& Gumus T. (2016) Nutrition and Chronic Wounds. Plastic and Reconstructive Surgery.,138,71S-81S.
40. Najmi M., Vahdat Shariatpanahi Z., Tolouei M.,& Amiri Z. (2015) Effect of oral olive oil on healing of 10–20% total body surface area burn wounds in hospitalized patients. Burns.,41,493-6.
41. National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. (2014) Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. Emily Haesler (Ed.). Cambridge Media: Perth, Australia.
42. Parsak C. K. Sakman G.,& Çelik Ü. (2007) Yara İyileşmesi, Yara Bakımı ve Komplikasyonları. Arşiv.,16,145-59.
43. Pinto F. C., Campos-Silva P., Souza D. B., Costa W. S.,& Sampaio F. J. (2016). Nutritional supplementation with arginine protects radiation-induced effects. An experimental study. Acta Cirurgica Brasileira.;31:650-4
44. Posthauer M. E., Dorner I. B.,& Collins N. (2010) Nutrition, A Critical Component of Wound Healing. Advanced Skin and Wound Care.,23,560-72.
45. Powell J.,& Soon C. (2002). Physiology of the Skin. Surgery (Oxford). 2002;20,ii-vi.
46. Powers J. G., Higham C., Broussard K.,& Phillips T. J. (2016) Wound healing and treating wounds. Journal of the American Academy of Dermatology.,74,607-25.
47. Qing C.(2017) The molecular biology in wound healing & non-healing wound; Chinese Journal of Traumatology 20; 189-193.
48. Recchiuti A. (2013) Resolvin D1 and its GPCRs in resolution circuits of inflammation. Prostaglandins & Other Lipid Mediators.,107,64-76.
49. Recchiuti A. (2014) Immunoresolving Lipid Mediators and Resolution of Inflammation in Aging. Journal of Gerontology & Geriatric Research.,03.
50. Reynolds T. M. (2001) The future of nutrition and wound healing. Journal of Tissue Viability, 11,5-13.
51. Rodrigues H. G., Vinolo M. A. R. ,Sato F. T., Magdalon J., Kuhl C. M. C., Yamagata A. S. ve diğerleri. (2016) Oral Administration of Linoleic Acid Induces New Vessel Formation and Improves Skin Wound Healing in Diabetic Rats. Plos One.;11.
52. Rosa Ados S., Bandeira L. G., Monte-Alto-Costa A., Romana-Souza B. (2014); Supplementation with olive oil, but not fish oil, improves cutaneous wound healing in stressed mice; Wound Repair and Regeneration; 22(4): 537-47.
53. Rousseau A. F., Losser M. R., Ichai C., Berger M. M. (2013). ESPEN endorsed recommendations: nutritional therapy in major burns. Clinical Nutrition.;32:497-502
54. Salgado R. M., Cruz-Castañeda O., Elizondo-Vázquez F., Pat L., De la Garza A., Cano-Colín S, ve diğerleri. (2017) Maltodextrin/ascorbic acid stimulates wound closure by increasing collagen turnover and TGF-β1 expression in vitro and changing the stage of inflammation from chronic to acute in vivo. Journal of Tissue Viability.;26:131-7
55. Serhan C. N. (2007) Resolution Phase of Inflammation, Novel Endogenous Anti-Inflammatory and Proresolving Lipid Mediators and Pathways. Annual Review of Immunology.;25,101-37.
56. Serhan C. N. (2014) Pro-resolving lipid mediators are leads for resolution physiology. Nature.;510,92-101.
57. Skulas-Ray A. C. (2015) Omega-3 fatty acids and inflammation, A perspective on the challenges of evaluating efficacy in clinical research. Prostaglandins & Other Lipid Mediators.;116-117,104-11.
58. Soleimani Z., Hashemdokht F., Bahmani F., Taghizadeh M., Memarzadeh M. R.,& Asemi Z. (2017). Clinical and metabolic response to flaxseed oil omega-3 fatty acids supplementation in patients with diabetic foot ulcer: A randomized, double-blind, placebo-controlled trial. Journal of Diabetes and its Complications.;31:1394-400
59. Spite M., Clària J., Serhan C. N. (2014) Resolvins, Specialized Proresolving Lipid Mediators, and Their Potential Roles in Metabolic Diseases. Cell Metabolism.;19,21-36.
60. Stieber M. (2009) Chapter 14: Nutritional Aspects of Wound Healing in Marian M., Russell M., &Shikora S. A. (Eds). Clinical Nutririon in Surgical Patients; Jones & Barlett Publishers (pp-362), Sudburry, Massachusets.
61. Takayama Y. (2012) Lactoferrin and its Role in Wound Healing, Springer; 2012.
62. Tang Y., Zhang M. J., Hellmann J., Kosuri M., Bhatnagar A.,& Spite M. (2012) Proresolution Therapy for the Treatment of Delayed Healing of Diabetic Wounds. Diabetes.;62,618-27.
63. Tappenden K.A., Quatrara B., Parkhurst M. L., Malone A. M., Fanjiang G., Ziegler T. R. (2013) Critical Role of Nutrition in Improving Quality of Care, An Interdisciplinary Call to Action to Address Adult Hospital Malnutrition. Journal of the Academy of Nutrition and Dietetics. 2013;113,1219-37.
64. Thompson C., Fuhrman M. P. (2005) Nutrients and Wound Healing, Still Searching for the Magic Bullet. Nutrition in Clinical Practice;20,331–47.
65. Turk H. F., Monk J.M., Fan Y-Y, Callaway E. S., Weeks B., Chapkin R. S.(2013) Inhibitory effects of omega-3 fatty acids on injury-induced epidermal growth factor receptor transactivation contribute to delayed wound healing. American Journal of Physiology-Cell Physiology.;304,C905-C17.
66. Velnar T., Bailey T.,& Smrkolj V. (2009). The Wound Healing Process: An Overview Of The Cellular And Molecular Mechanisms; The Journal Of International Medical Research; 37, 1528 – 42.
67. Venus M., Waterman J.,& McNab I. (2011) Basic physiology of the skin. Surgery (Oxford). 2011;29,471-4.
68. Wang W., Wu Z., Dai Z., Yang Y., Wang J.,& Wu G. (2013) Glycine metabolism in animals and humans, implications for nutrition and health. Amino Acids. 2013;45,463-77.
69. Williams J. Z., Barbul A. (2002) Effect of a Specialized Amino Acid Mixture on Human Collagen Deposition. Annals of Surgery.;236,369-75.
70. Xuan Y. H., Huang B. B., Tian H. S., Chi L. S., Duan Y. M., Wang X., ve diğerleri. (2014) High-Glucose Inhibits Human Fibroblast Cell Migration in Wound Healing via Repression of bFGF-Regulating JNK Phosphorylation. Plos One.;9.
71. Zhang M. (2014) Inflammation-resolving lipid mediators promote revascularization to enhance wound healing. Louisville, Kentucky, University of Louisville;.