10
Dietary Factors in Healing and Specific Nutrients
Calories
• Caloric needs are high when a diabetic foot ulcer is present. Calories
provide energy to aid in wound healing and energy demand increases with
the patient's nutrition risk factors and the severity of wound(s).
▶ Adequate energ y aids in collagen formation, anabolism, cell metabolism, and
development of new tissue such as blood vessels.
• Generally, the recommended daily calorie intake is 2,000 for women and
2,500 for men.
• Overweight patients with a BMI >30 are at risk of malnutrition, yet patients
with significant unintentional weight loss over a specific amount of time
are also at risk.
• Conducting 24-hour recalls and food frequency questionnaires should be
practiced at every visit when treating a patient to ensure the patient is
meeting estimated caloric needs.
• Utilize indirect calorimetry as the gold standard for identifying energy
needs. If indirect calorimetry is not available, there are other formulas that
can provide a standard starting point.
Table 5. Kcal Recommendations
BMI Range Kcal Recommendations
<30, or under 130% of IBW 25–30 kcal of ABW
30–50 11–14 kcal per kg of ABW
>50 22–25 kcal per kg of IBW
ABW, actual body weight; BMI, body mass index; IBW, ideal body weight
Macronutrients
• Carbohydrates, protein, and fats are the three essential food groups known
as macronutrients.
• Specific macronutrient needs are high when a patient has a DFU, especially
if the patient is malnourished or is at risk of malnutrition, because the body
may be at or close to a catabolic state.
• When in a catabolic state, the body will utilize its own skeletal muscle as its
energy source. This results in a loss of lean body mass and worsening of the
patient's wound healing process.
