Vitamin C status of patients with chronic wounds.

Abstract

BACKGROUND: Vitamin C has long been one of the most significant and debated, and even controversial, vitamins. Increased vitamin C intake, from limited studies, has shown benefits from lowering the risk of cardiovascular events, gestational diabetes mellitus, to improving brain function. There is an increasing body of knowledge suggesting that vitamin C might be beneficial in wound healing through pleiotropic mechanisms. However, the association between vitamin C and wound healing is still unclear, and this is particularly the case with chronic, slow healing wounds. Are there predictable variations of vitamin C levels in patients with chronic wounds? What is the prevalence of vitamin C deficiency in patients with chronic wounds? This study assessed these questions. AIM: This study investigated the vitamin C status of patients with chronic wounds living in the community of Canterbury, New Zealand. The main research objective of this study was to determine the prevalence of hypovitaminosis C (vitamin C deficient [i.e. < 23 μmol/L] and severely deficient [i.e. < 11 μmol/L]) in patients with chronic wounds. METHODS: Within a cross-sectional study, the plasma vitamin C concentration of 54 chronic wound patients under the care of a specialty wound clinic was collected and analyzed. The plasma vitamin C results were compared to reference values to calculate the prevalence of hypovitaminosis C. Additionally, these values were compared against demographic data, smoking status, and wound characteristics. Finally, associations between these variables were statistically analyzed. RESULTS: The study found that 26.9% of the cohort had hypovitaminosis C, with 19.2% deficient (i.e. <23 μmol/L), and 7.7% severely deficient (i.e. <11 μmol/L) in vitamin C. There was no correlation between age, gender, smoking status, or wound characteristics (i.e. wound age, wound exudates, wound area) with plasma vitamin C concentrations. However, an increased BMI was found to be associated with low plasma vitamin C concentrations. Obese participants (i.e. ≥ 30 kg/m2) were found to have lower plasma vitamin C concentrations when compared to participants with normal BMI measure (i.e. 18.50–24.99 kg/m2), p = 0.0002. Overweight participants (i.e. 25.00–29.99 kg/m2) also had lower plasma vitamin C concentrations than those with a normal BMI, p = 0.01. CONCLUSION: Chronic wound patients, particularly with venous leg ulcers, were found to have vitamin C deficiency. The reduced plasma vitamin C concentrations were likely due to chronic inflammation, oxidative burden, which increase the vitamin C demand and turnover. As vitamin C might impact wound healing, further investigation is therefore recommended to investigate potential benefits of vitamin C in treating chronic wound healing.