NUTRITIONAL REQUIREMENTS

FOR

PRESSURE ULCER AND WOUND CARE

Pressure ulcer patients are:
• Usually protein deprived, often with protein energy
malnutrition (PEM) and muscle wasting
• Low in cysteine/glutathione, often due to concurrent
clinical conditions (e.g. COPD, cancer, cardiovascular
disease, liver disease, diabetes)
• Immune depressed (usually as a consequence of
low glutathione)
Wound healing involves:
• Inflammation and oxidative stress
• Manufacture of many new cells (angiogenesis, fibroblast proliferation, epithelialization) and
production of growth factors
• Connective tissue formation (collagen production, interstitial matrix synthesis)
• Wound contraction and wound remodeling
Nutritional requirements for wound healing:
• Protein with highest biological value to provide all of the essential, semi-essential and other
amino acids needed for cellular proliferation, growth factors, connective tissue formation, etc.
• Source of bioavailable cysteine for synthesizing glutathione
- To provide antioxidant and anti-inflammatory properties
- To regulate cell proliferation and tissue formation
- To restore and enhance normal immune function
• Source of bioavailable cysteine to promote positive nitrogen balance, for minimizing muscle
breakdown and rebuilding lean body mass (LBM)
• Protein with high content of branch chain amino acids – to rebuild muscle tissue
• Zinc, omega 3 & 6 fatty acids, vitamins A, C & E
ProNutra*
• The bio-active protein component of ProNutra is Immunocal, which is prepared from a highly
undenatured whey protein isolate. These isolates are now recognized as having the highest
biological value (BV), greatest protein efficiency ratio (PER), and highest amino acid score
(AAS) of all proteins 1. ProNutra provides all of the essential amino acids as well as those such
as arginine, cystine and glutamine that are essential in stressed patients who cannot synthesize
sufficient amounts to meet demands.
• ProNutra is rich in cystine (2 molecules of cysteine joined by a disulfide bond - “bio-active
cysteine”), which is preserved intact during manufacture by using a patented process. Cystine
is the bioavailable form of cysteine 2; it is rare in foodstuffs.
• ProNutra is clinically proven to raise intracellular glutathione 3.
• Animal experiments have shown that ProNutra enhances the response of the immune system
and exerts an anticancer effect 2.
• ProNutra is clinically proven to increase body weight 4,5.
• ProNutra has a significant quantity of branch chain amino acids (BCAA) (leucine, isoleucine
and valine) 6.
• ProNutra contains zinc, omega 3 & 6 fatty acids, vitamins A, C & E.
*
These effects of ProNutra are brought about by the protein component Immunocal.
Note
It is proposed that arginine in high doses (e.g. 7–21g/day) is helpful in wound healing, initially
generating nitric oxide (NO) and increasing blood flow to the area and subsequently (through its
metabolism to ornithine) promoting cell proliferation and collagen formation. This applies to acute
wounds. Chronic wounds like pressure ulcers present a different circumstance and the effect of dietary
arginine is not clear 7.
 Summary
ProNutra provides a full complement of the nutritional needs of the pressure ulcer patient including those present in Juven (leucine
is the precursor for HMB) and other arginine based products.
Arginaid and Juven have high levels of arginine, but neither provide all of the amino acids found in ProNutra that are so es-
sential for the wound healing process.
Moreover, ProNutra is the only supplement that provides bio-active cysteine which is essential for synthesizing glutathione.

PRODUCT NUTRITIONAL COMPARISON

Supplement ProNutraa Juven Resource Resource Pro-Stat IMPACT
Components Protein Not Protein Arginaid Arginaid 101 RECOVER
Not Protein Extrad Hydrolyzed Protein
Protein Protein
Protein Type Bio-active Two Amino One Amino One Amino Collagen Whey Protein
Cystine-rich Acids Acid Acid Isolate
Whey Protein and HMB Whey Protein
Isolate Concentrate
Pharmaceutical
Grade
Bio-active protein with highest BV,
yes 1 no no no no yes
PER, AAS
Complete protein
yes 1 no no yes 1 no yes 1
providing all amino acids
Rich source of cystine yes 2 no no no no no
Clinically proven to raise glutathione
-reducing oxidative stress yes 3 no no no no no
-promoting cell proliferation
Proven to enhance immune response
yes 2,3 no no no no no
in vivo in multiple publications

Provides arginine yes excess excess excess excess excess

Provides glutamine/glutamic acid yes excess no yes yes yes
Rich source of branched chain amino
acids (BCAA) leucine, isoleucine, and yes 6 Only HMB c
no yes 6 no yes 6
valine, to rebuild muscle tissue
Clinically proven to increase body
yes 4,5 yes b no no no no
weight or LBM
Vitamin A 1000 IU no no 1000 IU no 1600 IU
Vitamin C 250 mg no 155 mg 250 mg no 20 mg
Vitamin E 25 IU no 90 IU 90 IU no 15 IU
Zinc 8.3 mg no no 15 mg no 4.0 mg
Fructose-Low Sugar,
Sugar, Citric Acid, Sugar,
Carbohydrate Source Citric Acid Glycemic in- Hydrolyzed
Citric Acid Malic Acid Malic Acid
dex cornstarch
237 mL 30 mL
Serving Size 37 g 23 g 9.2 g 62 g
(8 fl oz) (1 fl oz)
184 mg 245 mg 10 mg 22 mg 11.7 mg 350 mg
Potassium/Serving (mg)
(4.7 mEq) (6.3 mEq) (0.3 mEq) (0.6 mEq) (0.3 mEq) (9.0 mEq)
Calories/Serving (kcal) 136 90 35 250 101 240
Protein/Serving (g) 18.13 (WPI) 0 0 6.5 (WPC) 15 (HP) 8 (WPI)
Carbohydrates/Serving (g) 11.1 2-3 4 52 10.2 26
Sodium/Serving (mg) 57.4 no 70 < 70 73.14 280
Lactose insignificant no no insignificant no insignificant

Note: cular performance. J Appl Physiol.1999;87:1381-5.

a. These effects of ProNutra are brought about by the protein component Immunocal.
b. Increase can only occur if sufficient amounts of other necessary amino acids are present.
c. HMB is metabolite of the BCAA leucine.
d. This is a high nitrogen and high phosphorus product that may not be appropriate for indi-
viduals with kidney problems.
e. The information given about these products was obtained from company websites and
product labels. ProNutra, Immunocal, Juven, Resource Arginaid, Resource Arginaid Extra,
Pro-Stat and Impact Recover are registered trademarks.
References:
1. Reference Manual for U.S. Whey Products, 2nd ed., U.S. Diary Export Council, 1999
2. Bounous G. Whey protein concentrate (WPC) and glutathione modulation in cancer treat-
ment. Anticancer Res. 2000;20(6C):4785-92.
3. Lands LC, Grey VL, Smountas AA. Effect of supplementation with a cysteine donor on mus-
4. Bounous G, Baruchel B, Gold P. Whey Proteins as a food supplement in HIV-seropositive
individuals. Clin Invest Med 1993; 16: 204-209.
5. Pacheco L, Goldart J, Guilford T, Kwyer T, Kongshavn, PAL. Bioactive, cysteine-rich dietary
supplement alleviates gastrointestinal side-effects, with associated weight gain and marked
improvement in HAART adherence in AIDS patients. Presented at 2002 International Meeting
of the Institute of Human Virology, September 9-13, 2002, Baltimore, Maryland.
6. Ha E, Zemel, MB. Functional properties of whey, whey components, and essential amino
acids: mechanisms underlying health benefits for active people. J Nutr Biochem
2003;14:251-258.
7. Stechmiller JK. Roundtable 107, Wound healing and arginine. A.S.P.E.N. Nutrition Week, Las
Vegas, February 9, 2004.
Ver: 100704
For Questions Call:
NuMedTec at 877.687.2277—numedtec.com or pronutra.us