United States Department of Agriculture. Food security in the US. Key statistics and graphics. 2021. (accessed 21 April 2022)

Jackson RT. Some factors influencing variation in nutritional needs and requirements of children. J Child Health. 2003; 1:(2)173-180

Cai S, Rahman M, Intrator O. Obesity and pressure ulcers among nursing home residents. Med Care. 2013; 51:(6)478-486

Kay SP, Moreland JR, Schmitter E. Nutritional status and wound healing in lower extremity amputations. Clin Orthop Relat Res. 1987; (217)253-256

Molnar JA, Underdown MJ, Clark WA. Nutrition and chronic wounds. Adv Wound Care. 2014; 3:(11)663-681

Wound healing phases. 2021. (accessed 21 April 2022)

Bowden LG, Byrne HM, Maini PK, Moulton DE. A morphoelastic model for dermal wound closure. Biomech Model Mechanobiol. 2016; 15:(3)663-681

Barchitta M, Maugeri A, Favara G Nutrition and wound healing: an overview focusing on the beneficial effects of curcumin. Int J Mol Sci. 2019; 20:(5)

Demling RH. Nutrition, anabolism, and the wound healing process: an overview. Eplasty. 2009; 9

Brown KL, Phillips TJ. Nutrition and wound healing. Clin Dermatol. 2010; 28:(4)432-439

Bergmeier W, Hynes RO. Extracellular matrix proteins in hemostasis and thrombosis. Cold Spring Harb Perspect Biol. 2012; 4:(2)

Quain AM, Khardori NM. Nutrition in wound care management: a comprehensive overview. Wounds. 2015; 27:(12)327-335

Volpato S, Leveille SG, Corti MC The value of serum albumin and high-density lipoprotein cholesterol in defining mortality risk in older persons with low serum cholesterol. J Am Geriatr Soc. 2001; 49:(9)1142-1147

Saper RB, Rash R. Zinc: an essential micronutrient. Am Fam Physician. 2009; 79:(9)768-772

Borkow G. Using copper to improve the well-being of the skin. Curr Chem Biol. 2015; 8:(2)89-102

Essential fatty acid deficiency. 2017. (accessed 21 April 2022)

US Food and Drug Administratiion. Daily value on the New Nutrition Facts Label. 2021. (accessed 27 April 2022)

Bailly C, Drèze S, Asselineau D Retinoic acid inhibits the production of collagenase by human epidermal keratinocytes. J Invest Dermatol. 1990; 94:(1)47-51

Brown KL, Phillips TJ. Nutrition and wound healing. Clinics in Dermatology. 2010; 28:(4)432-439

Duriancik DM, Lackey DE, Hoag KA. Vitamin A as a regulator of antigen presenting cells. J Nutr. 2010; 140:(8)1395-1399

Pehlivan FE. Vitamin C: an antioxidant agent. IntechOpen. 2017;

National Institutes of Health. Office of Dietary Supplements. Strengthening knowledge and understanding dietary supplements. (accessed 21 April 2022)

Ringsdorf WM, Cheraskin E, Cheraski N. Vitamin C and human wound healing. Oral Surg Oral Med Oral Pathol. 1982; 53:(3)231-236

Almerighi C, Sinistro A, Cavazza A 1α,25-Dihydroxyvitamin D3 inhibits CD40L-induced pro-inflammatory and immunomodulatory activity in human monocytes. Cytokine. 2009; 45:(3)190-197

Aranow C. Vitamin D and the immune system. J Investig Med. 2011; 59:(6)881-886

Zhang Y, Wu S, Sun J, Vitamin D Vitamin D receptor and tissue barriers. Tissue Barriers. 2013; 1:(1)

Momen-Heravi M, Barahimi E, Razzaghi R The effects of zinc supplementation on wound healing and metabolic status in patients with diabetic foot ulcer: a randomized, double-blind, placebo-controlled trial. Wound Repair Regen. 2017; 25:(3)512-520

Marcinowska-Suchowierska E, Kupisz-Urbańska M, Łukaszkiewicz J Vitamin D toxicity–a clinical perspective. Front Endocrinol. 2018; 9

Caley MP, Martins VL, O'Toole EA. Metalloproteinases and wound healing. Adv Wound Care. 2015; 4:(4)225-234

Kogan S, Sood A, Garnick MS. Zinc and wound healing: a review of zinc physiology and clinical applications. Wounds. 2017; 29:(4)102-106

Nakamura H, Sekiguchi A, Ogawa Y Zinc deficiency exacerbates pressure ulcers by increasing oxidative stress and ATP in the skin. J Dermatol Sci. 2019; 95:(2)62-69

Savasky BM, Mascotti DP, Patel N, Rodriguez-Collazo E. Nutritional and pharmacological effects on oxidative stress in soft tissue and bone remodeling. J Nutr Metab. 2018; 2018:1-9

Nazem MR, Asadi M, Jabbari N, Allameh A. Effects of zinc supplementation on superoxide dismutase activity and gene expression, and metabolic parameters in over-weight type 2 diabetes patients: a randomized, double-blind, controlled trial. Clin Biochem. 2019; 69:15-20

National Institutes of Health. Zinc. Fact sheet for health professionals. 2021. (accessed 27 April 2022)

Molnar JA, Underdown MJ, Clark WA. Nutrition and chronic wounds. Adv Wound Care. 2014; 3:(11)663-681

Wilkinson EA, Hawke CI. Does oral zinc aid the healing of chronic leg ulcers? A systematic literature review. Arch Dermatol. 1998; 134:(12)1556-1560

Kornblatt AP, Nicoletti VG, Travaglia A. The neglected role of copper ions in wound healing. J Inorg Biochem. 2016; 161:1-8

Alizadeh S, Seyedalipour B, Shafieyan S Copper nanoparticles promote rapid wound healing in acute full thickness defect via acceleration of skin cell migration, proliferation, and neovascularization. Biochem Biophys Res Commun. 2019; 517:(4)684-690

Arendsen LP, Thakar R, Sultan AH. The use of copper as an antimicrobial agent in health care, including obstetrics and gynecology. Clin Microbiol Rev. 2019; 32:(4)e00125-e18

Li J, Zhai D, Lv F Preparation of copper-containing bioactive glass/eggshell membrane nanocomposites for improving angiogenesis, antibacterial activity and wound healing. Acta Biomater. 2016; 36:254-266

Chen G, Yu Y, Wu X Microfluidic electrospray niacin metal-organic frameworks encapsulated microcapsules for wound healing. Research (Wash DC). 2019;

Nethi SK, Das S, Patra CR, Mukherjee S. Recent advances in inorganic nanomaterials for wound-healing applications. Biomater Sci. 2019; 7:(7)2652-2674

Vijayakumar V, Samal SK, Mohanty S, Nayak SK. Recent advancements in biopolymer and metal nanoparticle-based materials in diabetic wound healing management. Int J Biol Macromol. 2019; 122:137-148

Mirastschijski U, Martin A, Jorgensen LN Zinc, copper, and selenium tissue levels and their relation to subcutaneous abscess, minor surgery, and wound healing in humans. Biol Trace Elem Res. 2013; 153:(1–3)76-83

Livingstone C. Review of copper provision in the parenteral nutrition of adults. Nutr Clin Pract. 2017; 32:(2)153-165

National Institutes of Health. Copper. Fact sheet for consumers. 2021. (accessed 27 April 2022)

The role of macronutrients and micronutrients in wound healing: a narrative review

02 December 2022


There is an extensive amount of research and literature discussing the role of various nutrients throughout the wound healing process. Despite the importance of nutrition in wound healing, dietary protocols often remain absent from wound care standards. This may be due to a lack of comprehensive literature that summarises the complexities and considerations associated with nutrient deficiency and supplementation into an easily accessible and inclusive reference tool. The purpose of this review is to assess the nutrients with key roles in the wound healing process, and subsequently provide information that enables optimisation of nutrition in wound healing. The goal is to consolidate the complexities associated with this topic into a simple, easy-to-use reference tool. We have identified the most important nutrients required for optimal wound healing and condensed the findings into an inclusive chart to be utilised in a clinical setting. This reference tool will include patient populations at risk of deficiency, the stage of wound healing in which each nutrient is required, delivery method and recommended daily intake, outpatient recommendations for rich food sources of each nutrient, and considerations associated with each nutrient.

According to the US Department of Agriculture (USDA), 88.9% (114.9 million) of US households were food secure throughout 2018, with food security defined as ‘having access, at all times, to enough food for an active, healthy life for all household members.’1 While this statistic implies that the majority of citizens have access to enough food, it fails to define the food as not only calorically sufficient, but nutritionally sufficient. It also suggests that 14.3 million households are not food secure. Thus malnutrition, the imbalance of nutrients and lack of micronutrients, remains a widespread problem in the US.

Screening for malnutrition is a challenge for physicians. A number of factors can contribute to patients' nutritional status: diet, age, sex, genetic makeup, and history of disease are just a few examples.2 While there is an obvious nutritional deficit in patients who are severely underweight, the potential for severe malnutrition in patients of normal weight or who are obese is often overlooked.3,4 This is of particular concern because patients who are obese frequently present with poorly-healing wounds and are susceptible to macronutrient imbalances.5 Direct risks associated with obesity include increased likelihood of developing pressure ulcers (PU) or general wound dehiscence. Indirect risks of obesity in developing hard-to-heal wounds are associated with comorbidities such as diabetes. For this reason, the importance of in-depth nutritional assessments for all patients with wounds, as opposed to only visibly underweight patients, is of utmost importance. This article will attempt to promote this idea through providing recommendations for specific patient populations at risk for both macronutrient and micronutrient deficiencies.

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