Protein-Based Nutrition for Chronic Wounds: A Clinician’s Guide to Patient Selection,Dosing,Monitoring,and Outcomes

Abstract

Significance:

Chronic wounds remain a major global health burden and often stall despite guideline-based care because of persistent inflammation, oxidative stress, impaired perfusion, and dysregulated extracellular matrix remodeling. Protein-based nutrition is best positioned as an adjunct to, rather than a substitute for, standard wound care.

Recent Advances:

Human studies, supported by mechanistic rationale, suggest that optimizing total protein intake (commonly ∼1.25 to 1.5 g/kg/day in appropriate patients) and, in selected settings, adding functional components such as arginine, glutamine, and β-hydroxy-β-methylbutyrate (HMB) may improve wound-area reduction and healing trajectories when integrated with standard care. Reported signals vary by etiology, including improved wound-area reduction and Pressure Ulcer Scale for Healing outcomes in pressure injuries, possible benefit in selected high-risk diabetic foot ulcer subgroups, and reduced venous ulcer area when supplementation is paired with consistent compression.

Critical Issues:

Evidence remains heterogeneous across wound types and study designs, with inconsistent dosing, duration, endpoints, and patient-selection criteria that limit standardized implementation. Safety and feasibility are especially important in renal risk and diabetes, where renal function and glycemic control require monitoring. Clinical evidence was interpreted with attention to study design and reporting standards, including CONSORT, STROBE, or STARD, as applicable.

Future Directions:

This review translates current evidence into a clinician-oriented framework for patient selection, prescribing, monitoring, and treatment adjustment, emphasizing initiation triggers in stalled wounds and trajectory-based reassessment every 2–4 weeks. Future work should prioritize pragmatic, well-controlled trials comparing formulations and dosing windows by wound etiology, together with biomarker-informed stratification to improve personalization, safety, and real-world uptake.