11
Protein
• Protein intake is essential to provide amino acids for optimized wound
healing.
• These amino acids build and repair muscle, skin tissues, hormones, and
enzymes, and help to regulate fluid balance and promotes positive nitrogen
balance.
• Protein is important in all stages of the healing process from hemostasis to
remodeling.
• Increased protein levels have been linked to improved wound healing rates.
• Many guidelines recommend 1.25–1.5 g/kg body weight per day of protein for
malnourished patients with pressure injuries.
• Quality of protein consumed is also important to provide adequate essential
amino acids which cannot be synthesized in the human body.
• Protein intake is particularly important for collagen production. Collagen is
the major protein of scar tissues that:
▶ Provides tensile strength in the healing wound.
▶ Modifies cellular activities to optimize mitogenesis, differentiation and migration.
▶ Is involved in interactions between enzymes which remodel the extracellular matrix,
including matrix metalloproteinases and their tissue inhibitors.
Table 6. Protein Requirements
Patient with T2DM* Protein Requirements
No risk of malnutrition 0.8–1.0 g/kg/d of ABW or use IBW if patient is obese
Have or are at risk of
malnutrition
1.25–1.5 g/kg/ d of ABW or use IBW if patient is obese
During stress or illness Up to 2 g/kg/d of ABW or use IBW if patient is obese
Critically ill with BMI 30–40 Up to 2 g/kg/d of IBW
Critically ill with BMI >40 Up to 2.5 g/kg/d of IBW
* In adults with chronic kidney disease who are not critically ill, it is reasonable to prescribe, under
close clinical supervision, a dietary protein intake of 0.6–0.8 g/kg/d of ABW per day to maintain a
stable nutritional status and optimize glycemic control.
