Estimation of protein requirements according to nitrogen balance for older hospitalized adults with pressure ulcers according to wound severity in Japan.

Abstract

OBJECTIVES:

To estimate protein requirements in older hospitalized adults with pressure ulcers (PrU) according to systemic conditions and wound severity.

DESIGN:

Secondary nitrogen balance study over 3 days.

SETTING:

Long-term care facility.

PARTICIPANTS:

Twenty-eight older adults with PrU using a urinary catheter.

MEASUREMENTS:

Nitrogen balance over 3 days was evaluated from habitual nitrogen intake measured using a food weighing record and nitrogen excretion from urine, feces and wound exudate. Nitrogen intake required to maintain nitrogen equilibrium was estimated as an average protein requirement using a linear mixed model.

RESULTS:

Nitrogen intake at nitrogen equilibrium was 0.151 gN/kg per day (95% confidence interval = 0.127-0.175 gN/kg per day) for all participants. The amount of protein loss from wound exudate contributed little to total nitrogen excretion. A Charlson comorbidity index of 4 or greater (the median value) was related to lower nitrogen intake at nitrogen equilibrium (P = .005). Severe PrU with heavy exudate amounts and measured wound areas of 7.9 cm(2) or greater (the median value) were related to higher nitrogen intake at nitrogen equilibrium in individuals with a Charlson comorbidity index of 3 or less (both P = .04). Larger wound area (correlation coefficient (r) = 0.55, P = .003) and heavier exudate volume (r = 0.53, P = .004) were associated with muscle protein hypercatabolism measured according to 3-methylhistidine/creatinine ratio.

CONCLUSION:

The average protein requirement is 0.95 g/kg per day for older hospitalized Japanese adults with PrU, but protein requirements depend on an individual's condition and wound severity and range from 0.75 to 1.30 g/kg per day. Severe PrU can require higher protein intakes because of muscle protein hypercatabolism rather than direct loss of protein from wound exudate.

• Authors: Shinji Iizaka, Junko Matsuo, Chizuko Konya, Rie Sekine, Junko Sugama, Hiromi Sanada
• Journal: Journal of the American Geriatrics Society (J Am Geriatr Soc) Vol. 60 Issue 11 Pg. 2027-34 (Nov 2012) ISSN: 1532-5415 [Electronic] United States
• PMID: 23110319 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

Chemical References

• Dietary Proteins
• Nitrogen

Topics

• Aged
• Aged, 80 and over
• Cross-Sectional Studies
• Dietary Proteins
• Female
• Hospitalization
• Humans
• Japan
• Male
• Nitrogen (metabolism)
• Nutritional Requirements
• Pressure Ulcer (metabolism)
• Severity of Illness Index