A nutritional assessment may be performed to evaluate nitrogen balance. To promote wound healing a positive nitrogen balance suggests adequate protein for wound repair. Edema can develop secondary to hypoalbuminemia, and the effects may cause hypoxia to the non-healing wounded tissue. Protein is associated with collagen synthesis; inadequate protein can slow down collagen synthesis, as well as prolonging the inflammatory response, and delay the healing process.
Inadequate caloric intake can promote catabolism (the breakdown of protein for energy instead of carbohydrates) and can adversely affect wound healing. Weight loss with associated subcutaneous fat loss can potentially cause further wounding of tissue.
Glucose is the primary fuel for cellular metabolism and if its not available the body catabolizes protein. This will occur in diabetic individuals if there is not enough insulin to allow glucose to be used by the cells.