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Enteral nutritional support in prevention and treatment of pressure ulcers: a systematic review and meta-analysis.

Abstract

BACKGROUND

There have been few systematic reviews and no meta-analyses of the clinical benefits of nutritional support in patients with, or at risk of developing, pressure ulcers. Therefore, this systematic review and meta-analysis was undertaken to address the impact of enteral nutritional support on pressure ulcer incidence and healing and a range of other clinically relevant outcome measures in this group.

METHODS

Fifteen studies (including eight randomised controlled trials (RCTs)) of oral nutritional supplements (ONS) or enteral tube feeding (ETF), identified using electronic databases (including Pub Med and Cochrane) and bibliography searches, were included in the systematic review. Outcomes including pressure ulcer incidence, pressure ulcer healing, quality of life, complications, mortality, anthropometry and dietary intake were recorded, with the aim of comparing nutritional support versus routine care (e.g. usual diet and pressure ulcer care) and nutritional formulas of different composition. Of these 15 studies, 5 RCTs comparing ONS (4 RCTs) and ETF (1 RCT) with routine care could be included in a meta-analysis of pressure ulcer incidence.

RESULTS

Meta-analysis showed that ONS (250-500 kcal, 2-26 weeks) were associated with a significantly lower incidence of pressure ulcer development in at-risk patients compared to routine care (odds ratio 0.75, 95% CI 0.62-0.89, 4 RCTs, n=1224, elderly, post-surgical, chronically hospitalised patients). Similar results were obtained when a combined meta-analysis of ONS (4 RCT) and ETF (1 RCT) trials was performed (OR 0.74, 95% CI 0.62-0.88, 5 RCTs, n=1325). Individual studies showed a trend towards improved healing of existing pressure ulcers with disease-specific (including high protein) versus standard formulas, although robust RCTs are required to confirm this. Although some studies indicate that total nutritional intake is improved, data on other outcome measures (quality of life) are lacking.

CONCLUSIONS

This systematic review shows enteral nutritional support, particularly high protein ONS, can significantly reduce the risk of developing pressure ulcers (by 25%). Although studies suggest ONS and ETF may improve healing of PU, further research to confirm this trend is required.

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  • Authors+Show Affiliations

    ,

    Institute of Human Nutrition, University of Southampton, MP 113 F Level, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK. R.J.Stratton@soton.ac.uk

    , , , , ,

    Source

    Ageing research reviews 4:3 2005 Aug pg 422-50

    MeSH

    Aged
    Aged, 80 and over
    Dietary Proteins
    Enteral Nutrition
    Female
    Food, Formulated
    Humans
    Male
    Nutritional Status
    Outcome Assessment (Health Care)
    Pressure Ulcer
    Randomized Controlled Trials as Topic

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Research Support, Non-U.S. Gov't
    Review
    Systematic Review

    Language

    eng

    PubMed ID

    16081325

    Citation

    Stratton, Rebecca J., et al. "Enteral Nutritional Support in Prevention and Treatment of Pressure Ulcers: a Systematic Review and Meta-analysis." Ageing Research Reviews, vol. 4, no. 3, 2005, pp. 422-50.
    Stratton RJ, Ek AC, Engfer M, et al. Enteral nutritional support in prevention and treatment of pressure ulcers: a systematic review and meta-analysis. Ageing Res Rev. 2005;4(3):422-50.
    Stratton, R. J., Ek, A. C., Engfer, M., Moore, Z., Rigby, P., Wolfe, R., & Elia, M. (2005). Enteral nutritional support in prevention and treatment of pressure ulcers: a systematic review and meta-analysis. Ageing Research Reviews, 4(3), pp. 422-50.
    Stratton RJ, et al. Enteral Nutritional Support in Prevention and Treatment of Pressure Ulcers: a Systematic Review and Meta-analysis. Ageing Res Rev. 2005;4(3):422-50. PubMed PMID: 16081325.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Enteral nutritional support in prevention and treatment of pressure ulcers: a systematic review and meta-analysis. AU - Stratton,Rebecca J, AU - Ek,Anna-Christina, AU - Engfer,Meike, AU - Moore,Zena, AU - Rigby,Paul, AU - Wolfe,Robert, AU - Elia,Marinos, PY - 2004/12/23/received PY - 2005/03/07/revised PY - 2005/03/11/accepted PY - 2005/8/6/pubmed PY - 2005/10/21/medline PY - 2005/8/6/entrez SP - 422 EP - 50 JF - Ageing research reviews JO - Ageing Res. Rev. VL - 4 IS - 3 N2 - BACKGROUND: There have been few systematic reviews and no meta-analyses of the clinical benefits of nutritional support in patients with, or at risk of developing, pressure ulcers. Therefore, this systematic review and meta-analysis was undertaken to address the impact of enteral nutritional support on pressure ulcer incidence and healing and a range of other clinically relevant outcome measures in this group. METHODS: Fifteen studies (including eight randomised controlled trials (RCTs)) of oral nutritional supplements (ONS) or enteral tube feeding (ETF), identified using electronic databases (including Pub Med and Cochrane) and bibliography searches, were included in the systematic review. Outcomes including pressure ulcer incidence, pressure ulcer healing, quality of life, complications, mortality, anthropometry and dietary intake were recorded, with the aim of comparing nutritional support versus routine care (e.g. usual diet and pressure ulcer care) and nutritional formulas of different composition. Of these 15 studies, 5 RCTs comparing ONS (4 RCTs) and ETF (1 RCT) with routine care could be included in a meta-analysis of pressure ulcer incidence. RESULTS: Meta-analysis showed that ONS (250-500 kcal, 2-26 weeks) were associated with a significantly lower incidence of pressure ulcer development in at-risk patients compared to routine care (odds ratio 0.75, 95% CI 0.62-0.89, 4 RCTs, n=1224, elderly, post-surgical, chronically hospitalised patients). Similar results were obtained when a combined meta-analysis of ONS (4 RCT) and ETF (1 RCT) trials was performed (OR 0.74, 95% CI 0.62-0.88, 5 RCTs, n=1325). Individual studies showed a trend towards improved healing of existing pressure ulcers with disease-specific (including high protein) versus standard formulas, although robust RCTs are required to confirm this. Although some studies indicate that total nutritional intake is improved, data on other outcome measures (quality of life) are lacking. CONCLUSIONS: This systematic review shows enteral nutritional support, particularly high protein ONS, can significantly reduce the risk of developing pressure ulcers (by 25%). Although studies suggest ONS and ETF may improve healing of PU, further research to confirm this trend is required. SN - 1568-1637 UR - https://www.unboundmedicine.com/medline/citation/16081325/Enteral_nutritional_support_in_prevention_and_treatment_of_pressure_ulcers:_a_systematic_review_and_meta_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1568-1637(05)00017-6 DB - PRIME DP - Unbound Medicine ER -