Pressure ulcers/injuries occur when prolonged pressure, friction, and/or shear causes localized skin and tissue damage. Certain populations are at higher risk of developing pressure injuries. This includes, but is not limited to, people with poor mobility, neurologic conditions, diabetes, and those with poor nutrition.
To help prevent and treat pressure ulcers/injuries clinical practice guidelines were developed by the National Pressure Injury Advisory Panel (NPIAP) in collaboration with the European Pressure Ulcer Advisory Panel (EPUAP) and the Pan Pacific Pressure Injury Alliance (PPPIA). There are currently 4 Editions of this guideline. The most recent edition was published in February of 2025. This edition serves as a living guideline with ongoing updates being made based on the latest research.
This guideline is extensive with chapters currently available on nutrition, repositioning, support surfaces, and considerations for seated patients for the prevention of pressure ulcer/injuries. Additional chapters are in the works, until they are completed recommendations from the 3rd edition should be used.
In this Guidelines Timeline we will discuss major changes and key takeaways in nutrition for the prevention of pressure ulcers/injuries. We encourage you to review the full guidelines available at the links below for more important information on this topic.
Guidelines Referenced:
- Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline
- Published: 2019
- Full-text
Major Changes and Key Takeaways (2019-2025)
Recommendations in the 2025 guideline were developed using a more rigorous analysis, allowing GRADE to be used to rate the strength of each recommendation. In addition, good practice statements were included.
Key takeaways for nutrition to prevent pressure ulcer/injuries are highlighted below.
- Screening
- Nutritional screening continues to be recommended as good practice for patients at risk of a pressure injury.
- Nutritional Assessment
- Patients at risk for pressure injuries whose screening identified them as being at risk for malnutrition should have a comprehensive nutritional assessment. The new guideline adds that this assessment should be used to develop an individualized nutritional care plan.
- Nutritional Care Plan
- Both recommendations encourage adequate hydration, additionally, the 2025 guideline encourages a balanced diet with nutrient dense foods.
Changes to nutrition for the prevention of pressure ulcers/injuries include:
- Tube Feeding
- The previous guideline advised shared decision making when it came to tube feeding, but the newer 2025 guideline strongly recommends against tube feeding for the purpose of preventing pressure ulcers/injuries.
- Energy and Supplementation
- The new guideline suggests carbohydrate based energy, protein supplementation to meet individual needs, and reserves micronutrient supplementation for patients with known malnutrition or micronutrient deficiencies.
- Pediatric Considerations
- Pediatric considerations for screening and supplementations were not addressed in the updated guideline.
In summary, proper nutrition is important in preventing pressure ulcers/injuries. Personalized nutritional care plans should ensure patients consume enough calories, protein, and micronutrients.
That concludes our Guidelines Timeline highlighting nutrition for the prevention and treatment of pressure ulcers/injuries.
We are grateful for your ongoing interest, and we encourage you to stay informed about upcoming segments in our series. We value your feedback and would like to hear your suggestions for future topics to be covered in our guideline series. Please feel free to contact us with any ideas or questions you may have.
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