Supplementation of Vitamin E, Vitamin C, and Zinc Attenuates Oxidative Stress in Burned Children: A Randomized, Double-Blind, Placebo-Controlled Pilot Study

Abstract

The aim of this study was to investigate the effect of supplementation of vitamin E, vitamin C, and zinc on the oxidative stress in burned children. In a prospective double-blind placebo controlled pilot study, 32 patients were randomized as no supplementation (n = 15) or antioxidant supplementation (n = 17) groups. Supplementation consisted of the antioxidant mixture of vitamin C (1.5 times upper intake level), vitamin E (1.35 times upper intake level), and zinc (2.0 times recommended dietary allowance) administered during 7 days starting on the second day of admittance into the hospital. Energy requirement was calculated by the Curreri equation, and protein input was 3.0 g/kg of ideal body mass index (percentile 50). Total antioxidant capacity of plasma and malondialdehyde were used to monitor oxidative stress. The time of wound healing was evaluated as the main clinical feature. Patients (age 54.2 +/- 48.9 months, 65.6% males), who exhibited 15.5 +/- 6.7% of total burn area, showed no differences in age and sex, when compared with controls. Intake of the administered antioxidants was obviously higher in treated subjects (P = .005), and serum differences were confirmed for vitamin E and C, but not for zinc (P = .180). There was a decrease in lipid peroxidation (malondialdehyde level) (P = .006) and an increase in vitamin E concentrations in the antioxidant supplementation group (P = .016). The time of wound healing was lower in the supplemented group (P < .001). The antioxidant supplementation through vitamin E and C and the mineral zinc apparently enhanced antioxidant protection against oxidative stress and allowed less time for wound healing.

Effect of Therapeutic Dietary Regimen on Wound Healing For Patients with Moderate Degree Burn

“…In addition, Barbosa (2009) reported that there were clinical benefits have been shown with reduction of oxidative stress, and improved wound healing using doses of vitamin C and E 1.5-3 times higher than recommended daily intakes. So, these findings strongly support the use of anti-oxidants in nutritional therapy for burned patients (65)(66)(67) . Moreover, Prins (2009) illustrated that, patients with TBSA greater than 30% lose 20 to 40% of copper and 10% of selenium and zinc in the first week post burns.…”

“…Again, MacKay (2003) reported that vitamin C supplementation enhanced neutrophils mortility to chemotactic stimulus and stimulation of lymphocyte transformation and decrease the length of wound healing time. This corresponds to the work done by Barbosa et al (2009) and Sahib et al (2010) who noted that the supplementation of vitamin C reduced wound healing time (25,29,68) .…”

“…Furthermore, Dorner (2013) recommend zinc supplementation for up to 10 days enhance wound healing (71) . Also, Berger et al (2007) who found that adequate intake of trace element enhance wound healing and the recovery of burn patients as evidenced by reduced length of hospital stay (67) . In addition, the study done byWilliams (2003) reported that deficiency of zinc may decrease rates of fibroplasia, epithelialization, and collagen synthesis as well as wound strength and impair immune response, increasing susceptibility to recurrent infections (43) .…”

“…Additionally, in the presence of inhalational injury, there was a decrease in Vitamin E. Similarly, Berger (2007) stated that supplementation of micronutrient in a burned patient is known to increase the rate of wound healing and reduce infections. Furthermore, Berger et al (2006) noted that there were multiple micronutrient used as an intervention had a positive effect on wound healing, infection rate, protein turn over and protein catabolism (28,35,67) . In addition, MacKay et al (2003) illustrated that vitamin C (ascorbic acid) influences all phases of wound healing such as the inflammatory phase, proliferative phase, and maturation, synthesis, and degradation of collagen.…”

α-Tocopherol adipose tissue stores are depleted after burn injury in pediatric patients

“…It is not clear from the available data whether the a-tocopherol is being redistributed to other sites or whether it is being depleted (oxidized) as a result of lipid peroxidation. A study in pediatric burn patients supplemented with a combination of antioxidants (average intakes of 900 mg vitamin C/d, 400 mg vitamin E/d, and 7 mg Zn/d) resulted in a significant increase in circulating vitamin E, a decrease in malondialdehyde, and a decrease in wound healing time (36). Our previous mechanistic studies in an ovine model of burn and smoke injury showed that the injury to the lung and skin is reflected in a higher depletion of liver a-tocopherol, which suggests mobilization of vitamin E from the liver (37).…”