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Introduction

Chronic wounds, defined as those that fail to heal within an expected timeframe, represent a significant clinical challenge often characterised by a persistent inflammatory phase. This stage is characterised by increased blood flow, enhanced blood vessel permeability, and migration of immune cells to combat potential infections and remove debris. Chronic wounds are frequently associated with underlying health conditions such as diabetes, chronic kidney disease, and poor blood supply.¹ These wounds present significant challenges to patients and healthcare systems worldwide, contributing to prolonged suffering, reduced quality of life, and increased economic burden. In the United States, the annual cost of wound care was estimated to be US$126 billion in 2019, with similarly high costs reported in other regions.² However, the actual global burden is likely underestimated due to underreporting and limited data availability, particularly in low-income countries, where traumatic injuries and chronic ulcers are more common but insufficiently documented.^3,4

Effective management of chronic wounds requires addressing the underlying causes and optimising local wound conditions through debridement, infection control, moisture balance, pressure offloading, and advanced therapies.⁵ Nonetheless, the healing process may be hindered without sufficient nutritional support. Nutrition is a critical yet frequently overlooked factor that influences every stage of wound repair. Adequate protein intake is essential for collagen synthesis and immune function.⁶ Vitamin C acts as a cofactor in the maturation of collagen and functions as an antioxidant.⁷ Vitamin A plays a role in the regulation of epithelial differentiation and immune responses,⁸ whereas vitamin E serves as a lipid-soluble antioxidant, protecting cellular membranes.⁹

Minerals, such as zinc and iron, are crucial for enzyme activity and oxygen transport. Proper hydration supports tissue perfusion and metabolic exchange.¹⁰ However, malnutrition disrupts these processes, prolongs inflammation, delays wound closure, and increases the risk of infection and hospital readmissions.¹¹ Therefore, systematic nutritional assessments and tailored interventions, including oral nutritional supplements, enteral or parenteral nutrition, and structured approaches, such as medical nutrition therapy (MNT), are vital components of comprehensive wound management.^12,13

This review consolidates the current evidence regarding the influence of macronutrients, micronutrients and hydration on chronic wound healing. It further examines the consequences of malnutrition, underscoring the significance of validated screening tools, and evaluated the impact of specific nutritional interventions. Additionally, it emphasises emerging research on novel bioactive compounds and personalised genetic-based nutrition strategies while addressing practical barriers to their effective implementation in clinical practice, providing clinicians and researchers with an updated synthesis of evidence to guide clinical practice.

To support this analysis, a comprehensive literature search was conducted in PubMed, Scopus, and Web of Science using the keywords nutrition, wound healing, chronic wounds, macronutrients, micronutrients, oral nutritional supplements, and malnutrition, with Boolean operators applied to refine the search results. The search was restricted to articles published in English, primarily from 2010 onwards to ensure contemporary relevance, while earlier seminal works were included where relevant. Eligible sources comprised randomised controlled trials, clinical studies, systematic and narrative reviews, and clinical guidelines, with reference lists also screened to identify further relevant publications.

Dietary factors affecting chronic wound healing

Macronutrients

Wound healing, particularly in chronic cases, is a multifaceted process significantly influenced by macronutrient intake. Proteins, carbohydrates, and fats have distinct, yet interconnected, roles in tissue repair (Figure 1). Ensuring adequate intake is critical for older adults and individuals with chronic conditions who are at an elevated risk of malnutrition. Protein requirements increase markedly in chronic wounds owing to continuous protein loss through wound exudates, potentially elevating needs by up to 250%.⁶ Proteins facilitate cell migration, proliferation, immune competence, and collagen synthesis, which are essential functions for the transition from inflammation to tissue remodeling.^13,14 Consequently, a daily intake of 1.2–1.5g/kg body weight is often recommended for patients with chronic wounds, particularly older adults.¹⁵ Specific supplements, such as cysteine-rich whey protein, may further enhance the antioxidant capacity and immune defence, thereby promoting improved healing in conditions such as pressure ulcers.¹⁶

 

Figure 1. Nutritional components, specifically macronutrients, micronutrients and hydration levels, are crucial in the process of chronic wound healing.

 

Carbohydrates primarily provide the energy necessary for cellular repair and regeneration.¹⁴ However, excessive or poorly controlled glucose levels can impair immune cell function and increase the risk of infection, particularly in individuals living with diabetes or immobile patients. A recommended intake, typically 1–2g/kg/day of complex carbohydrates, combined with strategies, such as moderate restriction can help maintain glucose homeostasis.¹⁷

In addition, essential fatty acids, especially polyunsaturated fatty acids (PUFAs) such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), play crucial roles in modulating inflammation and supporting tissue regeneration.^18,19 Omega‑3 supplementation has shown promise in reducing ulcer size, dampening systemic inflammation, and enhancing antioxidant defences.¹⁹ However, an excessive intake of total or saturated fat can be detrimental. A study reported that high-fat diets have been linked to prolonged inflammation and delayed wound closure due to increased lipid peroxidation.²⁰ These findings highlight that while healthy fats possess anti-inflammatory and antioxidant properties, an excess of dietary lipids, especially saturated fats, may hinder recovery.

Micronutrients

Micronutrients, including vitamins and minerals, play distinct, yet interconnected, roles in chronic wound healing (Figure 1). Both deficiencies and excess essential vitamins and minerals can significantly impede the healing process, particularly among older adults and individuals with chronic diseases. Vitamin A is crucial for collagen synthesis, macrophage activation, and the regulation of inflammatory responses.²¹ However, excessive intake poses risks of toxicity such as hypercalcemia, which can result in organ dysfunction.¹⁵ For instance, burn patients receiving prolonged high-dose vitamin A therapy develop hypercalcemia, underscoring the necessity for careful dosing.²² Short-term supplementation with 10,000–25,000IU daily is generally recommended for patients with chronic wounds.¹⁸ Vitamin C (ascorbic acid) is essential for collagen synthesis, stabilisation and maturation.^6,7,11

Vitamin D plays a crucial role in immune regulation, keratinocyte differentiation, and the modulation of inflammatory responses, all of which are essential for wound repair. Deficiency in vitamin D has been linked to impaired healing and an increased risk of infection. Clinical studies have shown that patients with diabetic foot ulcers and low serum vitamin D levels experience delayed healing, whereas supplementation enhances re-epithelialisation and reduces ulcer area.²³ Additionally, vitamin D promotes the expression of antimicrobial peptides and supports angiogenesis, thereby offering both immune and tissue-regenerative benefits.²⁴ Consequently, routine assessment of serum vitamin D levels and correction of deficiencies may constitute a significant adjunctive strategy in the nutritional management of chronic wounds.

Zinc is involved in all stages of wound healing, including membrane repair, oxidative stress response, coagulation, inflammation, immune defence, re-epithelialisation, angiogenesis and scar formation.²⁵ It regulates inflammatory cytokines, supports fibroblast migration, promotes collagen deposition and facilitates extracellular matrix remodeling by modulating matrix metalloproteinase (MMP) activity. In addition, zinc acts as an antioxidant that protects cells from oxidative damage.²⁶ Despite prescribing vitamins A and C and zinc for chronic pressure ulcers, recent evidence questions this practice. Bafna et al²⁷ found a strong association between zinc and albumin deficiency, supporting zinc supplementation in malnourished patients. However, vitamin A and C deficiencies were not significantly associated with albumin level. These findings suggest that micronutrient supplementation should be tailored to individual deficiencies rather than presumptive treatment to enhance wound healing while minimising the risks of toxicity and unnecessary healthcare costs.

Other nutrients of interest

In addition to the nutrients previously discussed, several other dietary factors have been implicated in the process of wound healing. Arginine, a conditionally essential amino acid, facilitates nitric oxide synthesis, supports immune function, and promotes collagen deposition. It has been incorporated into specialised oral nutrition supplements for pressure ulcer management, yielding positive outcomes.²⁸ Trace elements, such as copper and selenium, contribute to tissue repair through their roles in angiogenesis and antioxidant enzyme activity, while B-complex vitamins, particularly B6, B12, and folate, are essential for DNA synthesis and cellular proliferation.^29,30,31 Although these nutrients play significant roles, this review did not explore them in depth, as the focus was directed towards nutrients with the most consistent and clinically-validated evidence in chronic wound populations.

Hydration

Patients with chronic wounds are vulnerable to dehydration due to systemic fluid loss or excessive wound exudate, which disrupts the local moisture balance and impairs cellular migration, cytokine signalling and collagen synthesis.^14,32 Although fluid intake alone does not directly accelerate healing, adequate hydration is essential to maintain blood volume and ensure effective oxygen and nutrient transport to wound sites.¹⁴ Evidence suggests that improved hydration is associated with enhanced healing outcomes (Figure 1). A study on chronic lower-limb wounds demonstrated that patients consuming more than one litre of water daily exhibited significantly higher ulcer closure rates irrespective of other dietary factors.³³ Moreover, both the volume and quality of fluid intake are critical for the recovery processes. For instance, hydrogen-rich water (HW), which has anti-inflammatory and antioxidant properties, effectively reduces the levels of tumour necrosis factor-α (TNF-α), interleukin-6 (il-6) and oxidative stress markers. This contributes to enhanced healing and reduced hospitalisation duration in individuals with pressure ulcers and radiation-induced injuries.^34,35 A daily intake of approximately 600mL HW may provide additional benefits over regular water, particularly when combined with the avoidance of harmful substances such as alcohol and tobacco smoking, which have been shown to impair wound healing.^34,36,37 In addition to systemic hydration, the maintenance of local wound moisture is essential. Pioneering studies by Winter^38,39 in the 1960s revealed that wounds maintained in a moist environment heal significantly faster than those that are dry by promoting cell migration, angiogenesis, and formation of the extracellular matrix.^38,39,40 In contrast, alcohol and tobacco smoking hinder healing by disrupting antioxidant defences and depleting vital minerals, such as zinc and selenium.^14,36,37

Effective wound healing requires synergy among fluid intake, adequate macronutrient and micronutrient supply, and personalised nutritional care. Santo et al⁴¹ highlighted that optimal regimens must ensure protein, energy, and essential micronutrients, such as zinc and vitamins A, C, and E. Current interventions often overlook individual variations and risks of over-supplementation.⁴² Future research should prioritise precision nutrition through biomarker-guided plans to tailor hydration and nutrient support for better wound-healing outcomes.⁴³

Malnutrition and chronic wounds

Chronic wounds pose a significant challenge to both patients and healthcare systems and are often exacerbated by malnutrition. Protein-energy malnutrition (PEM) significantly disrupts the essential physiological processes necessary for tissue repair, thereby negatively affecting all stages of wound healing, specifically inflammation, proliferation, and remodeling. Adequate protein intake is crucial for fibroblast proliferation, collagen synthesis, and immune function, all of which are vital for effective wound closure.⁴⁴ Protein-deficient individuals frequently experience prolonged inflammatory phases and reduced tensile strength in healing tissues.¹¹

Energy availability is equally critical, as insufficient caloric intake compromises keratinocyte migration, angiogenesis, and re-epithelialisation while also hindering the metabolic pathways required for granulation tissue development. Concurrent micronutrient deficiencies further impair collagen cross-linking and antioxidant defences, exacerbating delays in healing and increasing the risk of complications.¹¹ Low serum albumin level, a PEM marker, has been strongly associated with extended healing times, higher infection rates, and increased susceptibility to complications.⁴⁴ Protein deficiency also limits the synthesis of matrix components, such as glycosaminoglycans and proteoglycans, compromising tissue integrity during remodeling.¹¹

Malnutrition among patients with chronic wounds is prevalent and influenced by systemic, demographic, and socioeconomic factors. Studies have estimated that up to 31% of patients with chronic wounds are malnourished or at risk, particularly older adults.⁴⁵ Contributing factors include poor dental health, chronic pain, immobility, and psychological stress, which collectively reduce food intake despite an increased metabolic demand.^12,44 For example, individuals with foot ulcers may encounter dietary limitations indirectly due to pain, reduced mobility, and complications related to infections, which impede their capacity to procure, prepare, or consume foods rich in nutrients.⁴⁶ Furthermore, the presence of concurrent diabetes often requires dietary adjustments, such as carbohydrate restriction, which, if not adequately balanced, can further contribute to nutritional deficiencies.^47,48 Additionally, age-related changes, such as reduced appetite and impaired gastrointestinal function, combined with low socioeconomic status and limited access to nutrient-dense foods, further elevate PEM risk.⁴⁹

Despite its significant impact, malnutrition often remains underdiagnosed because of inconsistent screening practices, leading to suboptimal management. Comprehensive nutritional care, which includes routine screening, individualised diets, high-protein oral supplements, and specialised nutritional interventions, is crucial for enhancing healing outcomes.^11,12 Early detection and targeted therapy can address collagen deficits, immune dysfunction, and metabolic imbalances, thereby improve wound healing and reduce complications. Ultimately, proactive, patient-centred nutritional management is essential to alleviate the burden of chronic wounds.

Nutritional assessment and screening

Tools and methods for identifying nutritional deficiencies

A range of validated screening tools are available to facilitate the early detection of malnutrition. Prominent examples include the malnutrition universal screening tool (MUST), mini-nutritional assessment short form (MNA-SF), malnutrition screening tool (MST), and nutritional risk screening 2002 (NRS-2002).⁵⁰ The MUST evaluates unintentional weight loss, body mass index (BMI), and the impact of acute illness on food intake.⁵¹ The MNA-SF, specifically designed for older adults, assesses dietary habits, self-perceived health, and nutritional status.⁵² MST serves as a practical entry point for routine nutritional screening and is incorporated into broader clinical guidelines to provide optimal nutritional support.⁵³ The NRS-2002 identifies patients at nutritional risk by considering impaired nutritional status along with disease severity, thereby guiding appropriate interventions.⁵⁴

The Subjective Global Assessment (SGA) is a widely utilised tool for assessing nutritional status. In contrast to screening tools such as MUST or MNA-SF, the SGA serves as a diagnostic instrument that integrates medical history (including weight change, dietary intake, gastrointestinal symptoms, and functional capacity) with a targeted physical examination (assessing muscle wasting, fat loss, oedema, and ascites). Patients are subsequently categorised as well-nourished, moderately malnourished, or severely malnourished. The SGA has been validated across diverse clinical settings and is particularly advantageous in managing complex chronic conditions where reliance on biochemical markers alone may be misleading.^55,56 Its incorporation into wound care enables clinicians to identify both clinical and nutritional deficits that may impact healing.

In addition, laboratory analyses and anthropometric measurements are crucial for comprehensive nutritional assessment. Serum proteins, such as albumin and prealbumin, are commonly used biomarkers for evaluating protein status and monitoring the progress of wound healing^.57 The assessment of macro- and micronutrient levels aids in detecting specific deficiencies that may delay healing. Macronutrient status, such as protein levels, can be evaluated through the measurement of serum proteins, including albumin, prealbumin, and transferrin, as well as through nitrogen balance studies and anthropometric indices. Meanwhile, micronutrient status is typically assessed using blood biomarkers, such as plasma levels of zinc, selenium, vitamin D, and vitamin C, in conjunction with dietary intake recalls and physical indicators like changes in skin, hair and nails. These assessments yield essential information for tailoring supplementation and optimising wound healing.^11,26,57 Standard anthropometric measurements, including BMI, height, weight, and mid-arm or mid-calf circumference, provide further insights into a patient’s nutritional status.⁵⁸

Importance of regular nutritional assessments in wound care

Nutritional status directly influences a patient’s ability to recover from chronic wounds. Deficiencies in essential nutrients can compromise immune function, prolong inflammation and impede tissue repair.¹⁴ As previously discussed, monitoring the levels of critical nutrients, such as protein, vitamin C, vitamin A, and zinc is particularly important, as these nutrients support collagen synthesis and enhance wound tensile strength.¹¹ Persistent deficiencies may increase the risk of infection, elevate morbidity and mortality rates, and result in extended hospital stays and increased healthcare costs.⁵⁹ Given the high prevalence of malnutrition among chronically ill and hospitalised patients,⁶⁰ regular nutritional assessments are essential to identify and address deficiencies early, thereby preventing complications. Evidence also underscores the value of frequent skin and wound assessment. For instance, daily skin evaluations have been shown to significantly improve pressure injury outcomes compared with standard weekly checks. Patients receiving daily assessments demonstrated greater reductions in Pressure Ulcer Scale for Healing (PUSH) scores than those following standard protocols, indicating better healing trajectories.⁶¹ This proactive approach facilitates early detection of skin changes, allowing timely interventions that can halt pressure injury progression. Such measures are especially critical in intensive care settings, where patients are at heightened risk due to immobility and comorbidities.⁶¹

Several studies have employed nutritional screening and assessment tools specifically targeting populations with chronic wounds. For example, Herberger et al⁴⁴ identified that up to 31% of patients with chronic wounds were either malnourished or at risk, as determined by routine nutritional screening. Similarly, Skórka et al⁴⁵ used bioelectrical impedance in conjunction with traditional screening methods to demonstrate a high prevalence of protein-energy malnutrition among patients with venous and diabetic foot ulcers. In older adults with pressure injuries, the MNA-SF has been shown to correlate with delayed healing outcomes.¹² Collectively, these studies underscore the necessity for systematic and repeated application of validated nutritional screening and diagnostic tools in wound care practice.

Specific nutritional interventions

Nutrition-based interventions have emerged as a crucial component of comprehensive wound care, with evidence supporting the efficacy of oral nutritional supplements (ONS), enteral and parenteral nutrition, and condition-specific dietary strategies. ONS enriched with proteins, amino acids such as arginine and glutamine, and essential micronutrients (zinc, vitamins A, C, and E) have been shown to expedite healing processes. For instance, wound-specific supplements can reduce wound size by up to 61% compared with standard hospital diets.⁶⁹ These are particularly beneficial for patients with pressure ulcers or diabetic foot ulcers, in which protein-energy malnutrition exacerbates wound chronicity. Hypercaloric, high-protein blends also contribute to enhanced collagen production and immune defences. Nevertheless, further clinical trials are necessary to refine optimal formulations for routine applications.^12,70

All interventions outlined in Table 1 were administered orally and consistently demonstrated improvements in wound healing outcomes, including a reduction in ulcer area, accelerated closure, and improved metabolic markers. These findings underscore the practicality and feasibility of oral supplementation in both outpatient and inpatient settings. Although none of the included studies evaluated enteral or parenteral nutrition, these approaches remain clinically significant for patients unable to meet nutritional requirements orally. Enteral feeding, delivered via nasogastric or percutaneous tubes, ensures continuous nutrient provision and has been associated with improved outcomes in malnourished patients with foot ulcers.⁷⁰ Parenteral nutrition, administered intravenously, is reserved for cases of severe gastrointestinal dysfunction, while it may support healing when combined with substrates such as arginine and zinc, it is resource-intensive and necessitates careful monitoring due to its cost and infection risks.^12,70 Therefore, while the current evidence base in chronic wound populations primarily evaluates oral interventions, clinicians should remain aware of the role of enteral and parenteral nutrition in selected patients with significant nutritional deficits or impaired oral intake.

 

Table 1. Nutritional interventions for chronic wound healing

 

Individualised diets are essential for addressing the pathophysiology of various types of wounds. Diets rich in proteins and antioxidants effectively mitigate oxidative stress in diabetic foot ulcers,⁵⁴ while omega-3 fatty acids may alleviate inflammation in venous ulcers.⁷¹ Pressure injuries necessitate elevated caloric intake (30–35kcal/kg/day) and protein consumption (1.25–1.5g/kg/day) to satisfy the heightened metabolic demands required for tissue repair.¹² Additionally, micronutrients such as zinc and vitamin D play crucial roles in supporting cellular regeneration and immune function, thereby expediting the healing process.⁷¹ Targeted nutritional interventions administered orally, enterally, or parenterally are crucial components of effective chronic wound management. When aligned with the patient’s specific condition and wound type, these interventions can markedly enhance the healing outcomes. Ongoing research and standardised clinical guidelines are imperative to optimise these strategies for wider application.

Nutrition education and behavioural interventions

In addition to supplementation and clinical nutrition support, patient education is crucial in enhancing dietary intake and wound healing outcomes. Nutrition education interventions aim to improve patient comprehension of protein requirements, micronutrient-rich food sources, and hydration practices. For instance, nutritional counselling for individuals with diabetic foot ulcers has been linked to improved dietary protein intake and better glycaemic control.⁴⁷ Similarly, structured nutrition education programs delivered by dietitians to older adults with pressure injuries have resulted in improved adherence to high-protein, high-calorie diets and enhanced healing rates.¹² Beyond the clinical environment, education facilitates long-term adherence beyond the clinical setting, empowering patients to incorporate nutritional recommendations into their daily routines. Therefore, integrating nutrition education into wound care practice may offer sustainable benefits, particularly in community and outpatient care.¹¹

Emerging research in nutrition and wound healing

Novel nutritional compounds and their potential benefits

Recent advances in nutritional science have identified novel therapeutic compounds as promising adjuncts for the treatment of chronic and complex wounds.⁷² For instance, omega-3 fatty acids, which are primarily sourced from fish and flaxseed oils, exhibit potent anti-inflammatory properties that facilitate granulation tissue formation and re-epithelialisation. Supplementation with omega-3 fatty acids has been demonstrated to significantly enhance healing rates, particularly in wounds characterised by prolonged inflammation.⁷³ Bioactive collagen peptides represent another emerging nutritional strategy with documented wound-healing benefits.⁷⁴ Collagen, a primary component of the extracellular matrix (ECM), plays a crucial role in wound repair from haemostasis and coagulation to tissue remodeling and maintenance of skin integrity during angiogenesis.⁷⁵ Collagen peptides derived from hydrolysed collagen promote tissue regeneration by mimicking collagen degradation fragments that signal fibroblasts to synthesise new collagen fibres and stimulate cellular proliferation, thereby accelerating healing.⁷⁶

Personalised nutrition approaches based on genetic factors

Personalised nutrition (PN) involves tailoring dietary guidance to each specific individual, referring to their unique genetic, epigenetic, and microbial profiles.⁷⁷ Genetic polymorphisms can significantly affect essential wound-healing processes, including ECM synthesis, cell proliferation, and migration.⁷⁸ For example, variations in genes encoding matrix proteins such as collagen type I alpha 1 chain (COL1A1), COL1A2, and COL3A1, which are responsible for fibrillar collagens, can influence ECM integrity and modulate wound repair in conjunction with growth factor pathways such as the epidermal growth factor (EGF) gene.⁷⁹ Individuals possessing such variants may benefit from an increased intake of collagen-enhancing nutrients, including vitamin C, proline, and glycine, to support optimal collagen synthesis and prevent impaired tissue regeneration.⁸⁰ Similarly, polymorphisms in genes regulating inflammatory cytokines such as IL-6 and TNF-α can disrupt macrophage infiltration and polarisation, increasing the risk of chronic inflammation, infection, and delayed wound closure.⁴⁸ Incorporating anti-inflammatory nutrients, such as omega-3 fatty acids, linoleic acid (LA), and gamma-linolenic acid (GLA), into personalised dietary regimens may help mitigate excessive inflammatory responses and promote balanced immune function.⁸¹

Collectively, these innovations highlight the potential of novel bioactive compounds and genetically tailored nutrition as emerging frontiers of chronic wound management. Future research should prioritise validating these strategies through well-designed clinical trials and developing practical frameworks for integrating personalised nutrition into standard wound-care practices.

Challenges in implementing nutritional interventions

Although nutritional therapy plays a vital role in managing chronic wounds, its implementation is often obstructed by systemic, resource-, and patient-related barriers. One significant issue is the lack of wound-type–specific standardised guidelines for nutritional assessment and intervention, resulting in inconsistent screening and delayed treatment.⁶⁹ For instance, while diabetes-related foot ulcers necessitate consideration of glycaemic control,⁷⁰ this is not directly applicable to pressure injuries in older adults, where nutritional interventions such as high-protein, high-calorie supplementation are emphasised.^12,69 Although dietitians are generally available in most Australian hospital wards,⁸² challenges persist in community-based care, rural and remote settings, and internationally, where access to trained nutrition professionals is limited.^83,84 In these contexts, the lack of standardised protocols and limited availability of dietitians or clinical nutritionists can lead to malnutrition being under-recognised, particularly in patients with complex conditions such as diabetes or advanced age.⁷⁰

Limited funding further restricts access to specialised nutritional support such as wound-specific supplements or tailored enteral feeding, particularly in resource-limited settings. These shortcomings prolong healing time and increase healthcare costs. Barriers related to healthcare providers include insufficient training and poor coordination among dietitians, physicians, and nursing staff, which undermines the delivery of comprehensive care.⁶⁸ Administrative challenges, such as lengthy licensing procedures and a lack of evidence-based implementation frameworks, hinder timely interventions.¹² Patient nonadherence adds to the complexity, often stemming from undervaluing the nutritional role, financial difficulties, and cultural or religious dietary restrictions.^66,67

To overcome these obstacles, integrated strategies are needed, including clear national guidelines, dedicated staff training, and enhanced resource allocation for specialised nutrition services. Educational programs that use plain language, visual aids, and culturally sensitive counselling can improve patients’ understanding and trust.⁴⁷ Individualised care plans that respect cultural preferences and financial constraints, along with affordable supplements and community support, can make nutritional therapy more accessible.¹² Addressing both systemic and patient-level challenges is essential to integrate nutritional interventions into routine chronic wound care. A coordinated approach that combines staff capacity building, practical guidelines, and patient-centred education can optimise the healing of chronic wounds.

Conclusion

This review highlights the critical role of nutrition in the treatment and management of chronic wounds. Evidence indicates that both macronutrients and micronutrients are essential for wound healing, whereas adequate hydration supports tissue perfusion and cellular functions necessary for repair. Malnutrition hinders timely wound healing, leading to prolonged inflammation, a higher risk of infection, extended hospital stays, and increased costs. Systematic nutritional assessment using validated screening tools is crucial to identify and address nutritional deficiencies in patients with chronic wounds. Tailored nutritional interventions ranging from oral supplements to enteral and parenteral nutrition improve wound healing outcomes when customised to individual needs. Emerging evidence on bioactive compounds and personalised nutritional approaches based on genetic profiles show promise for optimising nutritional support. However, translating these insights into practice is challenging due to systemic barriers, limited resources, and patient adherence. Addressing these gaps requires coordinated efforts including workforce training and patient education. Future research should focus on precise nutritional frameworks and nutrient combinations. The three priorities are: (1) integrating nutritional care as a standard component of wound management, (2) implementing patient-centred protocols that bridge evidence and practice, and (3) advancing precision nutrition through research frameworks that translate biomarker data into care. Evidence-based nutritional support can accelerate healing, reduce costs, and enhance patient quality of life.

Author contribution

The conceptualisation and design of the study were developed by SNES. NLD, PWQ and RPR wrote the manuscript. Subsequent reviews and editing were performed by SNES. All the authors have read and approved the final version of the manuscript.

Acknowledgements

The authors express their gratitude to the School of Science at Monash University Malaysia for their research internship collaboration with the Cell Biology Unit, Department of Biomedical Science, Faculty of Medicine, and Health Sciences, Universiti Putra Malaysia.

Conflict of interest

The authors declare no conflicts of interest in this work.

Ethics statement

Ethics approval was not required for this review.

Funding

This research was funded by the Ministry of Higher Education, Malaysia, under the Fundamental Research Grant Scheme (FRGS/1/2017/SKK08/UPM/02/11).

Author(s)

Seri Narti Edayu Sarchio¹*, Nur Liyana Daud¹, Puah Wei Qi², Rashmikah P Ravi^2
1Department of Biomedical Science, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM, Serdang, Selangor, Malaysia
²School of Science, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor, Malaysia

*Corresponding author email serinarti@upm.edu.my

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