Does Diet Have a Relationship with the Recovery of Diabetic Foot Ulcer Wounds?

(Wound Care)

Previous studies have shown that "malnutrition" and "underweight" are common problems in patients with diabetic foot ulcers (DFUs), and may be related to the worsening of wounds and even an increase in mortality rates1. Besides the core DFU treatments like surgery and wound care, whether daily diet and nutritional supplements can also help in the repair of DFU wounds is a common question among patients with diabetes.

The relationship between nutrition and wounds

The loss of tissue fluid from DFU wounds may lead to the loss of nutrients in the patient's body, affecting the function of immune cells and increasing the risk of infection. In addition, the wound healing process requires a large amount of nutrients to support the synthesis of tissue proteins and cell metabolism1. Therefore, Australian expert societies recommend that clinicians should perform nutritional assessments on DFU patients and consider using oral nutritional supplements when oral nutritional needs are not met2. However, to date, there is still limited evidence on the actual efficacy of nutritional supplements in improving wound healing in DFU patients, and they cannot replace core DFU treatments.

Appropriate supplementation of vitamins may help in wound repair

Vitamin C is a water-soluble vitamin involved in collagen production, immune system regulation, and the maintenance of cartilage and bone functions. Small studies have shown that compared to DFU patients who did not additionally supplement with vitamin C, those who took 500 mg of vitamin C daily for eight weeks had better wound recovery1. The Taiwan Health Promotion Administration recommends that the public can obtain an adequate amount of vitamin C through the principle of "three servings of vegetables and two servings of fruits" daily, such as oranges, tangerines, grapefruits, and other fresh fruits as well as light-colored vegetables3.

In vitamin D research, vitamin D deficiency has also been observed to be related to inflammatory responses, oxidative stress, and impaired wound healing. After taking vitamin D for twelve weeks, the size and depth of DFU wounds can be reduced, and redness can be improved1. Since the synthesis of vitamin D through skin exposure to sunlight is the main source for humans, the Health Promotion Administration advises the public to maintain an adequate amount of exercise and sunlight exposure, as well as to supplement with fish and dairy products to maintain the body's vitamin D level4.

Balanced diet + good nutritional status = great helpers for DFU wound repair

In addition to optimizing wound healing through core DFU treatments like surgery and wound care, the nutritional status of DFU patients is also one of the issues that need attention. Current studies also show that a good nutritional status can reduce the concentration of inflammatory factors in the body, further promoting wound healing5. However, more definitive evidence is still needed to tell us the actual benefits of nutritional supplementation. Nonetheless, a balanced diet + good nutritional status should be considered part of the best standard care for DFU.

Reference：
• Da Porto A, et al. World J Diabetes. 2022;13(11):940-948.
• Chen P, et al. J Foot Ankle Res. 2022 May 25;15(1):40.
• 衛福部國健署_國人膳食營養素參考攝取量及其說明 第七版(100年修訂)
• 衛福部國健署_國人膳食營養素參考攝取量及其說明 第八版(111年修訂)
• Basiri R, et al. Nutrients. 2022 Jun 9;14(12):2393.