What are the nutrition considerations for burn patients?

January 2, 2026 •

5 min read

Severe burn injury triggers a profound hypermetabolic and hypercatabolic response, increasing resting energy expenditure by 40% to 100% or more, which can persist for months to years post-injury. This heightened metabolic state necessitates aggressive and specialized nutritional support to prevent severe muscle wasting, control inflammation, and promote effective wound healing.

Quick Summary

Severe burns induce a hypermetabolic and catabolic state, requiring aggressive nutritional intervention. Strategies focus on early enteral feeding, high protein and carbohydrate intake, specific micronutrient supplementation, and controlling metabolic complications like hyperglycemia.

Key Points

Hypermetabolism is Key: Severe burns trigger a prolonged hypermetabolic and catabolic state, drastically increasing energy needs and protein breakdown.
Early Enteral Feeding is Preferred: Initiating enteral nutrition within 24 hours of injury is the standard of care to preserve gut health and reduce infection risk.
High Protein and Carbohydrate Diet: Nutritional support must include high levels of protein to combat muscle wasting and carbohydrates to serve as the primary energy source for wound healing.
Micronutrient Supplementation is Crucial: Vitamins C, A, E, and minerals like zinc and selenium are vital for supporting immune function and wound healing and often require therapeutic supplementation.
Manage Blood Glucose: Burn patients often experience insulin resistance, requiring close monitoring and management of hyperglycemia to avoid complications.
Avoid Overfeeding: Excessive caloric intake, especially from carbohydrates, can lead to complications like increased ventilator dependence and should be carefully avoided.
Individualized Care: Nutritional plans must be tailored to each patient's specific needs, considering the size and depth of the burn, age, and individual responses to therapy.

The Hypermetabolic Response in Burn Injury

Following a severe burn, the body enters a state of hypermetabolism, characterized by significantly elevated metabolic rates, increased whole-body oxygen consumption, and rapid depletion of energy stores. This response is driven by a massive release of stress hormones, such as catecholamines, cortisol, and glucagon, which mobilizes energy reserves for the body's survival. However, if unchecked, this leads to profound catabolism and the breakdown of muscle tissue, severely compromising immune function, delaying wound healing, and increasing susceptibility to infections. Early and adequate nutritional support is the primary intervention to counteract this destructive cycle and mitigate its long-term consequences.

Macronutrient Requirements

Addressing the macronutrient needs of a burn patient is central to supporting recovery. The body's energy demands skyrocket, requiring precise and timely caloric provision, typically determined by a specialized medical team based on the patient's weight, height, and burn severity.

Protein

Protein requirements are substantially increased to counteract muscle catabolism and provide the building blocks for wound repair. Burn patients lose significant protein through wounds and urine. Adults generally require 1.5–2.0 g of protein per kg of body weight per day, while pediatric patients may need even more (2.5–4.0 g/kg/day). Adequate protein intake helps rebuild lost muscle and supports immune function.

Carbohydrates

High-carbohydrate, low-fat diets are recommended for burn patients. Carbohydrates are the body's preferred energy source and are crucial for providing fuel for the burn wound, sparing protein from being used for energy. This approach can also decrease protein breakdown and may reduce infectious morbidity. However, careful glucose control is essential, as the stress response can cause insulin resistance and hyperglycemia.

Fats

While essential for preventing fatty acid deficiencies, fat intake should be limited, often comprising less than 15% of total energy intake. Excessive fat can impair the immune system. Some evidence suggests that omega-3 fatty acids may help modulate the inflammatory response, but overall fat content is kept low to avoid complications like fatty liver and to optimize carbohydrate utilization.

Micronutrient Needs and Supplementation

Burn injuries deplete the body's antioxidant defenses and specific vitamins and minerals are vital for immune function and wound healing. Since standard diets or multivitamins are often insufficient, supplementation is typically necessary.

Vitamin C: High doses of vitamin C are often administered due to increased oxidative stress. It is crucial for collagen synthesis and supports immune function.
Zinc: A common deficiency in burn patients, zinc is essential for protein synthesis, immune response, and wound healing. Supplementation helps reduce healing time and infection rates.
Vitamin A: Important for epithelial cell differentiation, immune function, and wound healing, although routine supplementation is not always necessary if multivitamin is provided and can lead to toxicity if overused.
Selenium: This antioxidant mineral is often depleted after burn injury. Supplementation can support antioxidant defense mechanisms and improve healing rates.
Vitamin D: Deficiency is common in severe burn patients due to loss of skin synthesis and changes in metabolism. Supplementation is needed to support bone health and immune function.

Enteral vs. Parenteral Nutrition

The route of nutrition delivery is a crucial decision, particularly for patients with severe burns.


Feature	Enteral Nutrition (EN)	Parenteral Nutrition (PN)
Route	Via the gastrointestinal (GI) tract, typically through a feeding tube (nasogastric or post-pyloric).	Intravenous (IV), bypassing the GI tract.
Gut Health	Preserves gut mucosal integrity, reduces bacterial translocation, and supports the gut's immune function.	Does not stimulate gut function, leading to mucosal atrophy and increased risk of infection.
Infection Risk	Associated with a lower risk of infection compared to PN.	Higher risk of systemic infection due to catheter placement and bypassing the gut barrier.
Complications	Feed intolerance, diarrhea, vomiting, aspiration risk (especially with gastric feeding).	Hyperglycemia, liver dysfunction, electrolyte abnormalities.
Cost	Less expensive than PN.	Significantly more expensive due to specialized solutions and delivery equipment.
Timing	Should be initiated early, within 24 hours of admission, once the patient is hemodynamically stable.	Reserved for when EN is not feasible or fails to meet nutritional needs, typically after 5–7 days of inadequate EN.

Enteral nutrition is overwhelmingly the preferred method due to its safety, cost-effectiveness, and benefits for gut health. Early initiation of EN is standard practice and has been shown to improve outcomes, including shorter ICU stays. Parenteral nutrition is reserved for specific cases where the GI tract is compromised or inaccessible, and its use is typically minimized.

The Role of Timing and Monitoring

The timing of nutritional intervention is critical for modulating the hypermetabolic response. Early initiation of enteral feeding, within 24 hours of admission, is consistently recommended to reduce stress hormone levels, preserve gut integrity, and improve patient outcomes. Once feeding is started, close monitoring is required to prevent both underfeeding and overfeeding.

Achieving Goal Intake: The target enteral rate should be advanced to meet estimated needs, often within 48 hours. This helps to rapidly provide necessary calories and protein.
Preventing Overfeeding: Excess calories, particularly from carbohydrates, can increase carbon dioxide production, making it difficult to wean patients from ventilators. It can also cause hyperglycemia and fatty liver.
Managing Hyperglycemia: Burn patients are prone to insulin resistance. Blood glucose levels must be monitored and controlled, often with insulin therapy, to prevent the complications associated with hyperglycemia.
Fluid Management: Nutritional delivery must be balanced with fluid resuscitation, especially in the initial phase. Over-resuscitation, or fluid creep, is a known risk and can worsen outcomes.

Conclusion

Specialized nutritional support is a cornerstone of effective burn patient care, directly addressing the profound hypermetabolic and catabolic changes that follow severe injury. By providing early and aggressive enteral feeding with high protein and carbohydrate content, coupled with targeted micronutrient supplementation, clinicians can help mitigate muscle wasting, enhance immune function, and significantly improve wound healing outcomes. Managing complications like hyperglycemia and carefully balancing fluid intake are also vital components of this comprehensive strategy. While the principles are well-established, ongoing research continues to refine best practices, emphasizing the importance of individualized and closely monitored nutritional plans throughout the patient's recovery journey.

For more detailed information on the metabolic and hormonal changes following a burn injury, consult resources like the National Institutes of Health(https://pmc.ncbi.nlm.nih.gov/articles/PMC3776603/).

Frequently Asked Questions

Severe burns cause a massive hypermetabolic response, significantly increasing the body's energy expenditure. This heightened state requires a large number of calories to prevent the body from breaking down its own muscle and fat stores for energy, which would hinder healing.

Enteral nutrition, where nutrients are delivered through a feeding tube directly into the gastrointestinal tract, is the preferred method. It helps maintain gut health, lowers infection risk, and is generally safer and less expensive than parenteral nutrition.

Yes, high-protein diets are essential for burn patients. The body experiences severe protein loss and muscle breakdown, so increased protein intake is necessary to aid in tissue repair, support immune function, and minimize the loss of lean body mass.

Vitamins C, E, A, and D, along with minerals like zinc, selenium, and copper, are particularly important. They act as antioxidants and cofactors for critical enzymes involved in immune response and wound healing.

Burn patients often develop insulin resistance due to the hormonal stress response. High blood glucose levels (hyperglycemia) can impair wound healing, increase the risk of infection, and worsen overall outcomes. Close glucose monitoring and management are crucial.

For smaller burns, oral intake may be sufficient. However, for severe burns, the body's metabolic demand is so high that oral intake alone is often inadequate. Specialized nutritional formulas, delivered via a feeding tube, are usually necessary to meet caloric and protein goals.

The hypermetabolic and catabolic state can persist for months to years, especially after severe burns. Nutritional needs and considerations will change throughout recovery, from the acute phase in the hospital to the long-term rehabilitation phase at home.