Posted January 18, 2022
Eat, Drink and Be Wary
How Malnutrition and Cachexia Contribute to Pressure Injuries
Clinicians need to understand and account for the body’s inflammatory response and its connection to inadequate nutrition. Frail and elderly patients with compromised nutritional intake are at a considerably higher risk for skin breakdown.
Nutrition. It’s a risk factor on the Braden Scale, but is it really that important? Yes! Nutritional insufficiency is a key contributor in the development of pressure injuries. Identified in the mid-1970s as an indicator of poor health and a barrier to recovery, malnutrition is an unhealthy condition resulting from inadequate intake or absorption of food and liquid. It’s estimated that between 30 and 50% of hospitalized patients are malnourished, leading to higher morbidity and mortality rates. In addition, regarding pressure injuries, poor nutritional intake can impede healing and increase hospital lengths of stay.
But truly diagnosing malnutrition is tricky. Relying solely on albumin and prealbumin levels as indicators is no longer enough. Clinicians need to understand and account for the body’s inflammatory response and its connection to inadequate nutrition. Frail and elderly patients with compromised nutritional intake are at a considerably higher risk for skin breakdown. Although studies vary on the true cause and effect of malnutrition, diets lacking protein are often devoid of the amino acids necessary for fast and effective wound healing. And while pressure and shear over bony prominences are at the root of pressure injury formation, poor oxygenation, increased friction, and reduced blood and nutrient flow can significantly weaken skin integrity.
Of course, malnutrition isn’t the only force at work. Chronic illnesses can also wreak havoc on a person’s ability to maintain a healthy body weight. Cachexia. Cachexia is a complex metabolic wasting syndrome linked to chronic diseases, resulting in an involuntary loss of muscle and adipose tissue (fat mass). Cachexia is often associated with certain cancers, renal disease, and other chronic conditions. Unlike malnutrition, which can usually be reversed with adequate nutritional intake, there are no specific treatments for patients suffering from Cachexia. Care plans typically center on treating the actual disease.
So where does that leave the skin? According to the NPIAP, Cachexic individuals are at considerable risk for developing unavoidable pressure injuries. Rapid weight loss can render the skin loose and more susceptible to shearing forces, while muscle atrophy has been linked to increased falls. So, is proper nutrition really that important? Yes! But there is a little more involved than just finishing a meal. At the end of the day, malnutrition is still only one factor in the development of pressure injuries. Preventing skin breakdown is really a calculated balance between multiple strategies — adequate nutrition, safe mobility, moisture management, and effective support surfaces. Click here for more information on pressure injury prevention solutions.
Saghaleini, S. H., Dehghan, K., Shadvar, K., Sanaie, S., Mahmoodpoor, A., & Ostadi, Z. (2018). Pressure Ulcer and Nutrition. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine, 22(4), 283–289. https://doi.org/10.4103/ijccm.IJCCM_277_17
McNichol, L., Mackey, D., Watts, C., & Zuecca, N. (2020). Choosing a support surface for pressure injury prevention and treatment. Nursing, 50(2), 41–44. https://doi.org/10.1097/01.NURSE.0000651620.87023.d5
Litchford, M. D., Dorner, B., & Posthauer, M. E. (2014). Malnutrition as a Precursor of Pressure Ulcers. Advances in wound care, 3(1), 54–63. https://doi.org/10.1089/wound.2012.0385
https://www.frontiersin.org/articles/10.3389/fphys.2020.597675/full
