Multinutrient Supplementation Increases Collagen Synthesis during Early Wound Repair in a Randomized Controlled Trial in Patients with Inguinal Hernia

Abstract

Background Inguinal hernia disease is associated with an imbalanced collagen metabolism. Surgical stress has a negative impact on nutrients important for collagen synthesis. Objective We hypothesized that supplementation with a combination of nutrients would enhance collagen biosynthesis in inguinal hernia disease patients when undergoing hernia repair. Methods In this exploratory randomized controlled trial, 21 men (age: 55.2 ± 2.8 y; BMI: 25.0 ± 0.7 kg/m2) scheduled for Lichtenstein inguinal hernia repair were assigned to multinutrient supplementation (n = 10; multinutrient group) or no multinutrient supplementation (n = 11; control group). The multinutrient group received 14 g l-arginine, 14 g l-glutamine, 1250 mg vitamin C, and 55 mg zinc daily starting 14 d before surgery and ending 14 d after surgery. The multinutrient and control groups received high-quality protein to ensure a daily intake of 1.5 g protein/kg. Collagen biosynthesis was measured by the biomarkers type I procollagen propeptide (CICP), type III procollagen propeptide (PRO-C3), and type V procollagen propeptide (PRO-C5) in the sera on days −14, 0, and 1, and in the wound fluids on postoperative days 1 and 2. Compliance was recorded after the 28-d intervention period. Results Serum PRO-C5 concentrations decreased (P < 0.05) postoperatively in the control but not the multinutrient group. Neither CICP nor PRO-C3 serum concentrations differed significantly between the 2 groups. In wound fluid, the CICP concentrations increased (P < 0.05) from days 1 to 2 in the multinutrient group and were 49% higher (P = 0.10) than those in the control group on day 2. Wound fluid concentrations PRO-C3 and PRO-C5 showed no significant time or group differences. The 28-d compliance was similar (P = 0.27) in the 2 groups. Conclusion Oral supplementation with arginine, glutamine, vitamin C, and zinc augment collagen synthesis during the first 2 d after inguinal hernia repair. This trial was registered at clinicaltrials.gov as NCT03221686.

A Systematic Review on the Role of Vitamin C in Tissue Healing

“…In addition, there was one study that involved 128 patients receiving treatment for dental implants, and one with 10 patients receiving treatment for gingivitis [ 19 , 20 ]. One study involved 336 patients treated for acute fractures [ 21 ], one study considered the treatment of 32 children for burns [ 22 ], one involved 20 patients receiving treatment for unspecified trauma [ 23 ], one involved 21 patients receiving treatments for a hernia and the remaining study involved 40 patients undergoing a tattoo resection [ 24 , 25 ] ( Table 2 and Table 3 ).…”

The wound healing effect of local leukocyte platelet‐rich plasma after total hip arthroplasty: A randomized controlled trial

“…We are not aware of clinical trials that have combined L‐PRP treatment with a specific wound dietary supplement composed of protein, L‐arginine, vitamin C and zinc 17 . On the other hand, the value of nutritional supplementation is unclear, as none of our patients were malnourished according to the selection of clinical metrics.…”

“…We are not aware of clinical trials that have combined L-PRP treatment with a specific wound dietary supplement composed of protein, L-arginine, vitamin C and zinc. 17 On the other hand, the value of nutritional supplementation is unclear, as none of our patients were malnourished according to the selection of clinical metrics. The lack of incisional surgical site infections in the L-PRP and control groups could possibly be attributed to beneficial effects of dietary supplementation on host defense mechanisms.…”

“…Starting on postoperative day 1, the patients were given 1.5 g/kg body weight of a milk-based protein drink (Arla Protino; Arla Foods, Viby, Denmark), 5 g L-arginine powder (Proteinfabrikken AS, Stokke, Norway), 500 mg vitamin C (Apovit; Takeda Pharma A/S, Taastrup, Denmark) and two tablets that each contained 22 mg zinc as zinc sulfate (Zinklet; Gunnar Kjems ApS, Copenhagen, Denmark) daily for 4 weeks per os. 16,17 The patients were seen at the outpatient clinic at postoperative weeks 1, 2, 3 and 4.…”

The relationship between glycine levels in collagen in the anterior rectus sheath tissue and the onset of indirect inguinal hernia: A cross-sectional study

“…Kjaer et al (2020) reported that malnutrition was associated with high infection rates and reduced resistance of local tissues in the transverse fascia. Therefore, the administration of multi-nutrient supplements in the control group was reported to increase collagen synthesis [ 33 ]. Another study reported that a high BMI is a protective factor against the incidence of hernias, whilst also showing that other factors, such as a cough, constipation, prostatism, and physical activity involving heavy weights, increase the risk of hernia [ 26 , 34 ].…”