Estimation of Protein Requirements According to Nitrogen Balance for Older Hospitalized Adults with Pressure Ulcers According to Wound Severity in Japan

• Autores: Shinji Iizaka, Junko Matsuo, Chizuko Konya, Rie Sekine, Junko Sugama, Hiromi Sanada
• Localización: Journal of the American Geriatrics Society, ISSN 0002-8614, Vol. 60, Nº. 11, 2012, págs. 2027-2034
• Idioma: inglés
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• Resumen

  • 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 cm2 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.