Nutritional Status and Interventions in Diabetic Foot Ulcers: An Umbrella Review of Prognostic Associations and Treatment Evidence

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Abstract
This umbrella review synthesized evidence on associations between nutritional status and DFU outcomes and on the effects of nutritional interventions on wound healing and related clinical parameters. We conducted an umbrella review of systematic reviews evaluating (1) the associations between nutritional status and DFU outcomes and (2) the effects of nutritional interventions on DFU healing and related outcomes. PubMed, Scopus, Web of Science, and Embase were searched from inception to October 2026. Ten systematic reviews were included. Poor nutritional status and micronutrient deficiencies were consistently associated with impaired healing, greater ulcer severity, and increased risks of amputation and mortality. Exploratory cross-intervention pooling showed favorable effects on ulcer healing (eOR = 1.46; 95% CI: 1.17-1.81), C-reactive protein (eG = −0.76; 95% CI: −1.15 to −0.37), glycated hemoglobin (eG = −1.59; 95% CI: −2.93 to −0.24), and ulcer area (eG = −0.99; 95% CI: −1.94 to −0.05), but not erythrocyte sedimentation rate. Poor nutritional status and micronutrient deficiencies are consistently associated with adverse DFU outcomes. Although nutritional interventions showed favorable pooled effects on selected outcomes, limited evidence certainty and heterogeneity preclude identifying a specific supplement, dose, or formulation that reliably improves DFU healing.
Funding Information
  • Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
  • Fundação para a Ciência e a Tecnologia
  • Fundação de Amparo à Pesquisa do Estado do Piauí

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