Elsevier

Burns

Volume 46, Issue 1, February 2020, Pages 156-163
Burns

The effect of a hydrolyzed collagen-based supplement on wound healing in patients with burn: A randomized double-blind pilot clinical trial

https://doi.org/10.1016/j.burns.2019.02.015Get rights and content

Highlights

  • In this RCT, 30 patients with 20–30% burn received either a collagen based supplement or an isocaloric placebo for 4 weeks.

  • Serum pre-albumin was significantly higher at week 2 and 4 in collagen than control group.

  • The Hazard ratio of wound healing was 3.7 times in collagen compared to control group.

  • Hospital stay was clinically, but not statistically, lower in collagen than control group.

Abstract

Introduction

Burn is among the most severe forms of critical illness, associated with extensive and prolonged physical, metabolic and mental disorders. The aim of this study was to assess the effect of an oral, low-cost, and accessible collagen-based supplement on wound healing in patients with burn.

Methods

In this randomized double-blind controlled pilot clinical trial, 31 men, 18–60 years, with 20–30% total body surface area burn were studied. Patients were randomly assigned to receive either a collagen-based supplement (1000 kcal) or an isocaloric placebo, for 4 weeks. Serum pre-albumin, rate of wound healing, length of hospital stay, and anthropometries were assessed at baseline, and the end of week 2 and 4.

Results

Serum pre-albumin was significantly higher at week 2 (29.7 ± 13.6 vs. 17.8 ± 7.5 mg/dL, P = 0.006) and week 4 (35.1 ± 7.6 vs. 28.3 ± 8.2 mg/dL, P = 0.023) in collagen than control group. Changes in pre-albumin concentration were also significantly higher in collagen group at week 2 (13.9 ± 9.8 vs. −1.9 ± 10.3 mg/dL, P < 0.001) and week 4 (19.2 ± 7.5 vs. 8.5 ± 10.1 mg/dL, P = 0.002). The Hazard ratio of wound healing was 3.7 times in collagen compared to control group (95% CI: 1.434–9.519, P = 0.007). Hospital stay was clinically, but not statistically, lower in collagen than control group (9.4 ± 4.6 vs. 13.5 ± 7 days, P = 0.063). There were no significant differences in weight, body mass index, dietary energy and protein intakes between the two groups.

Conclusion

The findings showed that a hydrolyzed collagen-based supplement could significantly improve wound healing and circulating pre-albumin, and clinically reduce hospital stay in patients with 20–30% burn.

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.

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