https://doi.org/10.1177/1534734619876779 The International Journal of Lower Extremity Wounds 2020, Vol. 19(1) 27–33 © The Author(s) 2019 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/1534734619876779 journals.sagepub.com/home/ijl Original Research Introduction Micronutrient deficiency is increasingly recognized as a factor in poor healing patients with diabetic foot ulcer (DFU). 1 There is a developing literature base highlighting that despite this cohort potentially having a adequate caloric intake, they are lacking in the micronutrients essen- tial for wound healing. 2,3 The contribution of poor nutritional status to chronic wounds has been long established, 4 and in recent years, the contribution of nutrition to DFU development and healing has been an increasing area of clinical and academic interest. 5,6 It is estimated that between 5% and 10% of older persons living independently are malnourished, and that in 876779IJL XX X 10.1177/1534734619876779The International Journal of Lower Extremity WoundsBrookes et al research-article 2019 1 Dandenong Hospital, Monash Health, Dandenong, Melbourne, Victoria, Australia 2 Monash University, Melbourne, Victoria, Australia Corresponding Author: John Deakin Lees Brookes, Department of Surgery, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3168, Australia. Email: jdlbrookes@gmail.com Broad-Ranging Nutritional Deficiencies Predict Amputation in Diabetic Foot Ulcers John Deakin Lees Brookes, MBBS, MSc 1 , Joseph Swaminadan Jaya, MBBS 1 , Henley Tran, MBBS 1 , Ashish Vaska, MBBS 1 , Keagan Werner-Gibbings, MBBS, FRACS 1 , Andre C. D’Mello, MBBS 1 , Jennifer Wong, MBBS, FRACP, MIH 1,2 , Chris N. Lemoh, MBBS, FRACP, PhD 1,2 , Alan C. Saunder, MBBS, FRACS 1,2 , and Ming Kon Yii, MBBS, FRACS, MPH 1,2 Abstract Diabetic foot ulcers present across the spectrum of nonhealing wounds, be it acute or many months duration. There is developing literature highlighting that despite this group having high caloric intake, they often lack the micronutrients essential for wound healing. This study reports a retrospective cohort of patients’ micro- and macro-nutritional state and its relationship to amputation. A retrospective cohort was observed over a 2-month period at one of Australia’s largest tertiary referral centers for diabetic foot infection and vascular surgery. Patient information, duration of ulcer, various biochemical markers of nutrition and infection, and whether the patient required amputation were collected from scanned medical records. A cohort of 48 patients with a broad-spectrum of biochemical markers was established. Average hemoglobin A1c (HbA1c) was 8.6%. A total of 58.7% had vitamin C deficiency, including 30.4% with severe deficiency, average 22.6 Ł} 5.8 μmol/L; 61.5% had hypoalbuminemia, average albumin 28.7 Ł} 2.5 g/L. Average vitamin B12 was 294.6 Ł} 69.6 pmol/L; 57.9% had low vitamin D, average 46.3 Ł} 8.3 nmol/L. Basic screening scores for caloric intake failed to suggest this biochemical depletion. There was a 52.1% amputation rate; biochemical depletion was associated with risk of amputation with vitamin C (P < .01), albumin (P = .03), and hemoglobin (P = .01), markedly lower in patients managed with amputation than those managed conservatively. There was no relation between duration of ulceration and nutrient depletion. Patients with diabetic foot ulceration rely on multidisciplinary care to optimize their wound healing. An important but often overlooked aspect of this is nutritional state, with micronutrients being very important for the healing of complex wounds. General nutritional screening often fails to identify patients at risk of micronutrient deficiency. There is a high prevalence of vitamin deficiency in patients with diabetic foot ulcers. This presents an excellent avenue for future research to assess if aggressive nutrient replacement can improve outcomes in this cohort of patients. Keywords vascular, wound infection, diabetic foot ulcers, wound management