Estimation of Protein Requirements According to Nitrogen Balance for Older Hospitalized Adults with Pressure Ulcers According to Wound Severity in Japan

Abstract

Objectives: To estimate protein requirements in older hospitalized adults with pressure ulcers ( P r U ) according to systemic conditions and wound severity. Design: Secondary nitrogen balance study over 3 days. Setting: Long‐term care facility. Participants: Twenty‐eight older adults with P r U using a urinary catheter. Measurements: Nitrogen balance over 3 days was evaluated from habitual nitrogen intake measured using a food weighing record and nitrogen excretion from urine, feces and wound exudate. Nitrogen intake required to maintain nitrogen equilibrium was estimated as an average protein requirement using a linear mixed model. Results: Nitrogen intake at nitrogen equilibrium was 0.151 gN/kg per day (95% confidence interval = 0.127–0.175 gN/kg per day) for all participants. The amount of protein loss from wound exudate contributed little to total nitrogen excretion. A C harlson comorbidity index of 4 or greater (the median value) was related to lower nitrogen intake at nitrogen equilibrium ( P = .005). Severe P r U with heavy exudate amounts and measured wound areas of 7.9 cm 2 or greater (the median value) were related to higher nitrogen intake at nitrogen equilibrium in individuals with a C harlson comorbidity index of 3 or less (both P = .04). Larger wound area (correlation coefficient ( r ) = 0.55, P = .003) and heavier exudate volume ( r = 0.53, P = .004) were associated with muscle protein hypercatabolism measured according to 3‐methylhistidine/creatinine ratio. Conclusion: The average protein requirement is 0.95 g/kg per day for older hospitalized J apanese adults with P r U , but protein requirements depend on an individual's condition and wound severity and range from 0.75 to 1.30 g/kg per day. Severe P r U can require higher protein intakes because of muscle protein hypercatabolism rather than direct loss of protein from wound exudate.