Burns Research and Reconstructive Surgery, ANZAC Research Institute, Concord Hospital, University of Sydney, Sydney, NSW2139, Australia.
Burns and Reconstructive Surgery Unit, Concord Repatriation General Hospital, Concord, NSW2173, Australia.
Br J Nutr. 2020 May 14;123(9):1056-1067. doi: 10.1017/S0007114520000276. Epub 2020 Jan 27.
Nutritional therapy is a cornerstone of burns management. The optimal macronutrient intake for wound healing after burn injury has not been identified, although high-energy, high-protein diets are favoured. The present study aimed to identify the optimal macronutrient intake for burn wound healing. The geometric framework (GF) was used to analyse wound healing after a 10 % total body surface area contact burn in mice ad libitum fed one of the eleven high-energy diets, varying in macronutrient composition with protein (P5-60 %), carbohydrate (C20-75 %) and fat (F20-75 %). In the GF study, the optimal ratio for wound healing was identified as a moderate-protein, high-carbohydrate diet with a protein:carbohydrate:fat (P:C:F) ratio of 1:4:2. High carbohydrate intake was associated with lower mortality, improved body weight and a beneficial pattern of body fat reserves. Protein intake was essential to prevent weight loss and mortality, but a protein intake target of about 7 kJ/d (about 15 % of energy intake) was identified, above which no further benefit was gained. High protein intake was associated with delayed wound healing and increased liver and spleen weight. As the GF study demonstrated that an initial very high protein intake prevented mortality, a very high-protein, moderate-carbohydrate diet (P40:C42:F18) was specifically designed. The dynamic diet study was also designed to combine and validate the benefits of an initial very high protein intake for mortality, and subsequent moderate protein, high carbohydrate intake for optimal wound healing. The dynamic feeding experiment showed switching from an initial very high-protein diet to the optimal moderate-protein, high-carbohydrate diet accelerated wound healing whilst preventing mortality and liver enlargement.
营养治疗是烧伤管理的基石。虽然高能量、高蛋白饮食受到青睐，但烧伤后伤口愈合的最佳宏量营养素摄入量仍未确定。本研究旨在确定烧伤伤口愈合的最佳宏量营养素摄入量。使用几何框架 (GF) 分析了在自由进食的小鼠中，10%总体表面积接触烧伤后，11 种高能量饮食中的一种对伤口愈合的影响，这些饮食的宏量营养素组成在蛋白质 (P5-60%)、碳水化合物 (C20-75%) 和脂肪 (F20-75%) 方面存在差异。在 GF 研究中，确定了伤口愈合的最佳比例为中等蛋白质、高碳水化合物饮食，其蛋白质：碳水化合物：脂肪 (P:C:F) 比例为 1:4:2。高碳水化合物摄入与较低的死亡率、改善的体重和有益的体脂储备模式有关。蛋白质摄入对于防止体重减轻和死亡是必不可少的，但确定了一个约 7 kJ/d（约能量摄入的 15%）的蛋白质摄入目标，超过该目标就不会再有额外的益处。高蛋白摄入与伤口愈合延迟和肝脾重量增加有关。由于 GF 研究表明最初非常高的蛋白质摄入可预防死亡，因此特别设计了一种高蛋白、中等碳水化合物饮食（P40:C42:F18）。动态饮食研究还旨在结合和验证初始高蛋白质摄入对死亡率的益处，以及随后的中等蛋白质、高碳水化合物摄入对最佳伤口愈合的益处。动态喂养实验表明，从最初的高蛋白饮食切换到最佳的中等蛋白质、高碳水化合物饮食可加速伤口愈合，同时预防死亡和肝脏肿大。
