Short-term specialized enteral diet fails to attenuate malnutrition impairment of experimental open wound acute healing

Alves, Claudia Cristina; Torrinhas, Raquel Susana; Giorgi, Ricardo; Brentani, Maria Mitzi; Logullo, Angela Flavia; Arias, Victor; Mauad, Thaís; da Silva, Luiz Fernando Ferraz; Waitzberg, Dan L.

doi:10.1016/j.nut.2010.05.003

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Volume 26, Issue 9 , Pages 873-879, September 2010

Short-term specialized enteral diet fails to attenuate malnutrition impairment of experimental open wound acute healing

Claudia Cristina Alves, M.Sc., Ph.D.
- Health Sciences Department, Federal University of Sao Paulo, Santos, Brazil
Raquel Susana Torrinhas, M.B.
- Laboratory of Nutrition and Metabolic Surgery of the Digestive System (LIM 35) - Metanutri Team, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil
- Corresponding author. Tel.: +55-11-3062-0841; fax: +55-11-3061-7459.
Ricardo Giorgi, M.B.
- Human Nutrition and Metabolic Diseases Laboratory (LIM 25), Endocrinology Discipline, Internal Medicine Department, University of São Paulo Medical School, São Paulo, Brazil
Maria Mitzi Brentani, Ph.D.
- Experimental Oncology Department (LIM 24), Radiology Department, University of São Paulo Medical School, São Paulo, Brazil
Angela Flavia Logullo, M.D., Ph.D.
- Pathology Department, Federal University of São Paulo, São Paulo, Brazil
Victor Arias, M.D.
- Pathology Department, Federal University of São Paulo, São Paulo, Brazil
Thaís Mauad, M.D., Ph.D.
- Pathology Department, University of São Paulo Medical School, São Paulo, Brazil
Luiz Fernando Ferraz da Silva, M.D.
- Pathology Department, University of São Paulo Medical School, São Paulo, Brazil
Dan L. Waitzberg, M.D., Ph.D.
- Laboratory of Nutrition and Metabolic Surgery of the Digestive System (LIM 35) - Metanutri Team, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil

Received 2 February 2010; accepted 3 May 2010.

Abstract

Objective

We assessed the effect of enteral refeeding on the morphology, gene expression, and contraction of acute open wounds in previously malnourished rats using two different enteral diets.

Methods

Adult male isogenic Lewis rats divided into two groups (eutrophic, n = 30; and previously malnourished, 12–15% body weight loss, n = 27) were subjected to cutaneous dorsal wounds and gastrostomy. Control rats received a standard oral diet (AIN-93M chow) plus enteral saline solution. Subject rats received chow plus a standard enteral diet or an enteral diet enriched with arginine and antioxidants. On post-trauma days 7 and 14, wound granulation tissue samples were collected for morphologic analysis using hematoxylin and eosin and picrosirius stain or immunohistochemistry slides and real-time polymerase chain reaction for collagen I and III gene expression. Wound contraction was also evaluated by comparing wound images from days 0, 7, and 14.

Results

Malnourished control rats had increased intensity and duration of wound inflammation, impaired increase of fibroblast cells contingent on post-trauma days 7 to 14, decreased expression of collagen III, and less wound contraction compared with eutrophic control rats. A specialized enteral diet did not improve wound healing of malnourished rats but did promote wound contraction at post-trauma day 7 in eutrophic rats.

Conclusion

Short-term enteral refeeding, even with a specialized diet, failed to protect previously wounded malnourished rats from a prolonged inflammatory phase and impaired healing.

Keywords: Wound healing, Malnutrition, Arginine, Antioxidants, Gene expression, Collagen, Macrophages