The effect of a hydrolyzed collagen-based supplement on wound healing in patients with burn: A randomized double-blind pilot clinical trial
Introduction
Burns are among the major traumatic events that usually require intensive care, and long hospitalization and rehabilitation. Based on WHO reports, around 180,000 annual deaths are attributed to burns, with a considerable fraction in low and middle-income countries. In addition, in 2004, around 11 million people required medical care due to major burns and consequent morbidities [1]. The extensive tissue injury in burn could lead to serious wounds, pain, depressed immunity, infections, hypermetabolism, muscle wasting, and scars, which in turn could cause major physical and mental distresses [2], [3]. Accelerating the rehabilitation phase and wound healing are of importance due to extensive physiological, psychological and social consequences of burn. Currently, wound dressings, different systemic and topical medications, wound excision and skin grafting, biological and synthetic skin substitutes, skin tissue engineering and surgical approaches are available in burn management [2]. Although recent advancements have substantially improved burn outcomes, there are still many challenges about their efficacy and these strategies are relatively costly and not attainable in all countries.
Nutritional support and dietary supplements are among the most essential interventions to comply the metabolic demands and alleviate persistent and profound hypermetabolism in burn [4]. Data from an international nutrition survey showed substantial energy and protein deficit in burn victims receiving enteral nutrition, which was dose-dependently associated with higher mortality, irrespective of disease severity [5]. Failure to supply sufficient energy and nutrients, especially protein, could interfere with wound healing and delay recovery [6]. Higher protein requirement is the result of urinary and wound protein losses, increased gluconeogenesis and tissue repair [7].
Collagen is the main structural component of bones, muscles, connective tissues and skin. Hydrolyzed collagen or gelatin is derived from partial hydrolysis of collagen [8]. Previous studies have confirmed the efficacy of hydrolyzed collagen on wound repair and improvement of skin and connective tissues [8]. It has been shown that an oral collagen supplement could improve the healing of pressure ulcers in residents of long-term-care facilities [9]. Experimental studies have reported the effect of oral collagen supplements on accelerating the healing of diabetic wounds [10], alleviating UV induced skin photo-aging [11], and reducing aging-related changes of the extracellular matrix [12]. A systematic review of studies in patients with diabetic foot ulcers showed the efficacy of collagen-based dressings on wound healing [13]. Collagen-based biological dressings are also widely applied for the management of burn wounds [14].
Most of previous studies investigating the effects of collagen were performed in experimental models or as topical treatments in clinical conditions other than burn. Thus, the aim of this preliminary study was to investigate the effect of an oral, inexpensive, and accessible collagen-based supplement on wound healing in patients with burn.
Section snippets
Patients
In this randomized double-blind controlled pilot clinical trial, 34 men were enrolled. To have a power of 90% to detect a 10 difference of change in pre-albumin (also known as transthyretin) between two groups, with a standard deviation (SD) of 8 and type I error of 5%, a sample size of 14 in each group seemed to be enough. To compensate for a probable 20% drop out, 17 patients were recruited to each group. The inclusion criteria were (1) male, (2) age 18–60 years, (3) 20–30% total body surface
Results
Thirty-one participants completed the study. One patient in the collagen and two patients in the placebo group were excluded (Fig. 1).
Discussion
Pre-albumin concentration and its improvement during the current study was considerably higher in the collagen compared to the control group. The wound healing rate was significantly higher (Hazard ratio: 3.7) following supplementation with a hydrolyzed collagen-based supplement. Hospital stay was not statistically different between the two groups, however, this difference seems to be clinically important. No significant changes were seen in weight and BMI throughout the study.
Based on our
Conclusion
The current findings showed that 4 weeks consumption of a hydrolyzed collagen-based supplement could significantly improve wound healing rate and serum pre-albumin concentration in men with 20–30% burn. The reduction in duration of hospital stay was also clinically of importance.
Conflict of interest
None.
Acknowledgements
This research has been funded by Tehran University of Medical Sciences & Health Services grant 33872. We should thank Dr Mahnoush Momeni (Assistant Professor of General Surgery, Burn Research Center, Iran University of Medical Science) for her support.
References (32)
- et al.
Burn injury: challenges and advances in burn wound healing, infection, pain and scarring
Adv Drug Deliv Rev
(2018) - et al.
Support of the metabolic response to burn injury
Lancet
(2004) - et al.
International observational study of nutritional support in mechanically ventilated patients following burn injury
Burns
(2015) - et al.
Nutritional therapy for burns in children and adults
Nutrition
(2009) - et al.
Functional and bioactive properties of collagen and gelatin from alternative sources: a review
Food Hydrocolloids
(2011) - et al.
Pressure ulcer healing with a concentrated, fortified, collagen protein hydrolysate supplement: a randomized controlled trial
Adv Skin Wound Care
(2006) - et al.
Assessment of the relation between prealbumin serum level and healing of skin-grafted burn wounds
Burns
(2010) - et al.
Clinical and protein metabolic efficacy of glutamine granules-supplemented enteral nutrition in severely burned patients
Burns
(2005) - et al.
Protective effect of gelatin polypeptides from Pacific cod (Gadus macrocephalus) against UV irradiation-induced damages by inhibiting inflammation and improving transforming growth factor-beta/Smad signaling pathway
J Photochem Photobiol B
(2016) - et al.
The effect of isolated soy protein adjunctive with flaxseed oil on markers of inflammation, oxidative stress, acute phase proteins, and wound healing of burn patients; a randomized clinical trial
Burns
(2018)