The Effect of Immunonutrition Supplements on Pressure Ulcers and Malnutrition Status among Spinal Cord Injury Patients Under Rehabilitation

A total of 18 outpatients (aged 18-75 years) with grade II, III, and IV pressure sores, 15% had malnutrition, and 75% were at risk of malnutrition, were screened and recruited. The intervention group received 250 ml immunonutrition supplements (3.12 g arginine, 1.56 g glutamine, 1.4 g fish oil, 3.5 g medium-chain triglycerides (MCT), and 83 g vitamin C per serving) twice daily, along with 1-hour advice on a high-calorie diet and a high protein diet for 56 days. The solution was prepared by mixing 60 grams of the study product with 250 ml of water at room temperature until it was dissolved and consumed orally. The patients started the consumption of the supplements a day after the consultation. The control group was given dietary advice for one hour for two sessions; during baseline (before starting the supplement) and 14 days later. The dietary guidelines were also provided to the control group (Ministry of Health, 2014). The calorie and protein for each patient are calculated according to their needs and requirements. They are also advised to consume a lot of fruits and vegetables to meet their vitamin and mineral needs. A dietician will deliver a face-to-face dietary consultation for each participant (one-to-one) with a minimum of five years of experience at the outpatient clinic (Rehabilitation Clinic, Pusat Perubatan UKM). The compliance was assessed by instructing the participants to record the intake of the product in the Supplement Intake Compliance Form on a daily basis. The packaging of the product was kept after consumption, or the participants must return the product if they had forgotten or were reluctant to take the supplements during the follow-up visits. The investigator also made a weekly phone call to each participant to ensure adherence and monitor compliance.