Pressure Ulcer Management, Obesity and SCI: Selecting an Appropriate Oral Nutritional Supplement to Promote Wound Healing Without Incurring Unwanted Weight Gain

Objective: To develop a reference tool/criteria to aide clinicians in selecting oral supplements to support the nutritional needs of the obese individual with SCI and pressure ulcer(s).

Design: Experiential-based findings.

Participants/Methods: Development of a reference tool based on current literature, supplement package inserts, and clinical experience in an acute rehabilitation hospital.Discussion/Results: Chronic SCI is associated with an advanced aging process with earlier onset of cardiovascular disease and diabetes—adding to the nutritional pressure ulcer risks in this group, such as decreased muscle mass and malnutrition with obesity. The presence of a pressure ulcer can trigger the inflammatory response, resulting in increased insulin resistance with maintenance of fat stores and loss of lean body mass. In the obese individual with SCI and pressure ulcer(s), the use of high calorie supplements to meet the increased protein needs for wound healing seems illogical and can result in unwanted weight gain with poor wound healing. Products that are high in simple carbohydrates contribute to hyperglycemia and diarrhea, and further loss of protein stores. Not all oral supplements are created equal and therefore, not universally appropriate.  
Conclusion: This reference tool provides clinicians with criteria on how to select an appropriate nutritional intervention for the obese individual with SCI and pressure ulcer(s) along with a product comparison of oral nutritional supplements.