Journal of Health and Nutrition Research Vol.
No.
2, 2025, pg.
593-607, https://doi.
org/10.
56303/jhnresearch.
Journal homepage: https://journalmpci.
com/index.
php/jhnr/index e-ISSN: 2829-9760 The Impact of Body Composition on Wound Healing in Type 2 Diabetes Patients: A Systematic Review Andi Sulfikar1*.
Mulyati1.
Hasni1.
Rusli Taher1.
Sartika Lukman2.
Muhammadong2.
Rindani Claurita Toban1.
Indah Restika BN3 1 STIKES Graha Edukasi.
Makassar.
Indonesia 2 Akademi Keperawatan Yapenas 21 Maros.
Indonesia 3 Sekolah Tinggi Ilmu Kesehatan Nani Hasanuddin.
Makassar.
Indonesia Corresponding Author Email: fikarandi732@gmail.
Copyright: A2025 The author.
This article is published by Media Publikasi Cendekia Indonesia.
SYSTEMATIC REVIEW
ABSTRACT
Submitted: 14 May 2025 Wound healing in patients with type 2 diabetes mellitus (T2DM) presents a major clinical challenge, particularly due to alterations in body composition such as reduced muscle mass and increased fat mass.
This systematic review aimed to synthesize current evidence regarding the impact of body composition on wound healing effectiveness in T2DM patients.
Literature was retrieved from PubMed.
ProQuest.
Wiley Online Library, and Google Scholar, targeting observational and experimental studies published between 2015 and 2025.
Keywords included "type 2 diabetes mellitus", "wound healing", "body composition", "sarcopenia", and "obesity".
Articles were selected based on predefined inclusion and exclusion criteria.
Methodological quality was assessed using the Critical Appraisal Skills Programme (CASP) checklist.
A total of seven eligible studies were included and analyzed narratively.
The findings from the 4 articles analyzed showed that low muscle mass .
and high fat mass .
were associated with delayed wound healing in T2DM patients.
Some studies indicate that patients with better body composition balance, such as higher muscle mass index, experience faster wound healing.
Heterogeneity in measurement methods and study populations limits the strength of these This review supports the hypothesis that body composition significantly influences wound healing outcomes in T2DM.
Muscle mass reduction may impair tissue repair by limiting perfusion and immune responses, while increased fat mass may contribute to chronic inflammation that hinders tissue regeneration.
Further longitudinal research with standardized assessments is needed.
Interventions that promote muscle mass gain and fat mass control may be essential components in wound management strategies for diabetic patients.
Accepted: 5 June 2025 Keywords:
Body composition.
Obesity.
Sarcopenia.
Type 2 diabetes mellitus.
Wound healing This work is licensed under a Creative Commons Attribution-NonCommercialShareAlike 4.
0 International License Access this article online Key Messages:
Quick Response Code Body composition, especially sarcopenia and obesity, affects wound healing outcomes in type 2 diabetes mellitus patients.
Targeting muscle mass improvement and fat reduction may enhance wound recovery in clinical settings.
This review addresses a research gap by systematically examining the link between body composition and wound healing in T2DM.
Andi Sulfikar.
Mulyati.
Hasni.
Rusli Taher.
Sartika Lukman.
Muhammadong.
Rindani Claurita Toban.
Indah Restika BN, .
GRAPHICAL ABSTRACT
INTRODUCTION
Type 2 diabetes mellitus (T2DM) is a chronic disease with a prevalence that continues to rise globally .
It is associated with various complications, one of which is impaired wound healing .
Ae.
Patients with type 2 diabetes often experience slower wound healing .
, which is caused by several factors, including prolonged hyperglycaemia .
, vascular and nerve damage .
, which impair the bodyAos ability to respond to infections and repair damaged tissue .
While much research has focused on the impact of blood sugar levels on wound healing.
,10,.
other factors, such as body composition .
,12Ae.
, are believed to play a significant role, yet remain largely unexplored.
Body composition, which consists of muscle mass, body fat, and water content, can affect various aspects of health, including wound healing .
Some studies have shown that type 2 diabetes patients with higher muscle mass tend to have better healing capacity because muscle supports better blood circulation and glucose absorption .
Ae.
Conversely, patients with a body composition dominated by body fat often show slower wound healing.
This may be due to higher insulin resistance and microvascular dysfunction, which hinder the delivery of oxygen and nutrients necessary for healing .
However, an interesting phenomenon occurs in which some patients with type 2 diabetes, despite having a proportional or ideal body weight, show highly variable results in wound healing .
Ae.
Some patients with a body composition dominated by body fat experience slower healing, while others with a higher muscle mass experience faster and better healing .
This raises an important question regarding the role of body composition, beyond mere physical appearance or body weight, in determining the speed and quality of wound healing in type 2 diabetes patients.
Previous studies have examined comparative studies of body composition in patients with type 1 diabetes .
Review studies related to body composition in patients with type 2 diabetes have not been Given these findings, it is crucial to gain a deeper understanding of the relationship between body composition and wound healing in type 2 diabetes patients to develop more targeted care strategies.
Therefore, this study aims to evaluate wound healing effectiveness in type 2 diabetes patients with different body compositions and analyze how the interaction between muscle mass, body fat, and other factors influences the rate and quality of wound healing.
This research is expected to provide valuable insights into more tailored management and care strategies for type 2 diabetes patients, considering not only blood sugar control but also body composition as a significant factor in wound healing.
https://doi.
org/10.
56303/jhnresearch.
Andi Sulfikar.
Mulyati.
Hasni.
Rusli Taher.
Sartika Lukman.
Muhammadong.
Rindani Claurita Toban.
Indah Restika BN, .
METHODS
The preparation of this systematic review article follows the PRISMA Checklist 2020 guidelines .
The literature search was conducted online through four main databases: PubMed.
ProQuest.
Wiley Online, and Google Scholar.
In formulating the research focus, the PICO framework was used, which stands for Patient.
Intervention.
Comparison, and Outcome, as explained by Eriksen MB .
This approach facilitates the development of structured and focused research questions.
In the context of this review, the PICO components were formulated as follows: the study population is focused on patients with type 2 diabetes mellitus.
the interventions examined include various aspects of body composition such as muscle mass, body fat, and body mass index (BMI).
no explicit comparator is included in this review.
and the outcome observed is the effectiveness of wound healing.
enhance the accuracy of the search, keyword selection was aligned with standard terms in MeSH (Medical Subject Heading.
and adapted to the specific characteristics of each database.
Several keywords used reflect terms related to the patient's condition, types of intervention, and the clinical outcomes that are the focus of the review.
P: type 2 diabetes mellitus" OR "T2DM" OR "diabetic foot" OR "diabetic ulcer.
I: body composition" OR "muscle mass" OR "fat mass" OR "BMI.
C: No comparator was identified in this review O: wound healing" OR "ulcer healing" OR "healing rate.
The main research question addressed in this systematic review is: How does body composition affect wound healing effectiveness in patients with type 2 diabetes mellitus? The literature identification process was carried out through searches in four online databases PubMed.
ProQuest.
Wiley Online, and Google Scholar covering publications from 2015 to 2025.
The initial search yielded 127 articles.
After screening based on inclusion and exclusion criteria, 19 articles were deemed to meet the preliminary Two researchers then independently conducted a full-text review, resulting in the selection of 7 articles considered relevant for further analysis in this review.
The inclusion criteria consisted of articles that explicitly examined the relationship between body composition, such as muscle mass, body fat, and body mass index, and the wound healing process in patients with type 2 diabetes mellitus.
Eligible studies were limited to quantitative research using designs such as clinical trials, cohort studies, or experimental animal models.
Articles had to be written in either English or Indonesian and published between 2015 and 2025.
Articles were excluded if they were unavailable in full text, irrelevant to the research focus, duplicates, or non-primary research such as editorials, opinion pieces, or narrative reviews.
Figure 1 illustrates the process of study selection and inclusion, where a PRISMA diagram was created to illustrate the selection and inclusion process of articles in this review.
Figure 1.
Flowchart illustrating the selection and inclusion process of studies.
https://doi.
org/10.
56303/jhnresearch.
Andi Sulfikar.
Mulyati.
Hasni.
Rusli Taher.
Sartika Lukman.
Muhammadong.
Rindani Claurita Toban.
Indah Restika BN, .
Table 1.
Literature Synthesis of Research on Body Composition and Wound Healing Process Article Title Effects Nutrition Intervention on Blood Glucose.
Body Composition, and Phase Angle in Obese and Overweight Patients Diabetic Foot Ulcers Short-Term Administration of a High-Fat Diet Impairs Wound Repair in Mice Authors.
Year
Country United State
Brasil
Research
Objective The purpose was to examine the effects with diabetic foot
The purpose was to hypothesis that a short-term
administration of a high-fat diet could affect cutaneous wound healing in Study Design
Randomized controlled trial
(RCT)
controlled trial (RCT).
Population/ Sample The ample in this consisted of between the ages of 30 and 70 years old with diabetic foot ulcers.
Body Composition The examined in this study were lean body mass and fat mass.
The treatment group lost less lean body mass .
kg vs.
9 k.
and gained less fat mass .
9 kg vs.
6 k.
compared to the control group, although the differences The ample in this male C57/bl6 divided into a standard diet The tested were the effects of a shortterm high-fat diet compared to a .
% from fa.
on Healing Outcome Conclusion Although differences in body composition between control groups were observed changes still suggest that body composition plays a role in wound healing.
The showed less loss of lean body mass and lower fat mass gain, which were clinically The significant, led to improvements in body compared to standard overweight and obese patients with diabetic foot ulcers.
Increased oxidative stress, and inflammatory markers in the wound .
Delayed deposition .
Negative Short-term administration of a high-fat diet impairs healing in mice.
Study Limitations The population in the area, the education or on on outcome could not be In addition, were not given Different blood glucose s and wound however, this study did not collect data on used by study Not https://doi.
org/10.
56303/jhnresearch.
Andi Sulfikar.
Mulyati.
Hasni.
Rusli Taher.
Sartika Lukman.
Muhammadong.
Rindani Claurita Toban.
Indah Restika BN, .
Article Title Authors.
Year Country Research Objective Study Design Prospective exploration of the effect of progression of Tanzania: study protocol of a cohort study .
Tanzania The effect of adiposity microbial factors on the healing and diabetic foot ulcers in people with type Tanzania.
cohort study Adipose cells from type 2
China
The Randomized controlled trial
(RCT)
Population/ Sample group .
% energy from fa.
or a highfat diet group .
% energy from fa.
The and sample for this study cohort of 300 with type 2 with diabetic (DFU.
at an Tanzania.
These stratified into two groups of .
ormal and and the two groups will be matched by (A5 The ample in this Body Composition wound healing in Healing Outcome Conclusion Study Limitations effects on wound healing, likely due to interference in the inflammatory phase of wound repair The measurements in this study will be conducted using analysis (BIA) to body fat ().
Participants will be categorized into normal and groups based on their , with Ou25% and Ou32% in men and being considered high adiposity.
The two groups will be matched by age and sex.
The primary outcome of the study is the ulcer/wound healing at 24 weeks.
Not mentioned .
he paper does not contain a "conclusion" section, as it is a study protocol planned methods and study that has not yet been conducte.
The results may not be single study site used, and will need to be validated at other centers.
The burden in the diabetic foot .
The study may not fully capture the complex perfusion, and the types of infecting the ulcers, which could impact The T2D mice The healing outcomes were better in T2D mice receiving Chow In conclusion, the authors found that while ASCs from type 2 Not https://doi.
org/10.
56303/jhnresearch.
Andi Sulfikar.
Mulyati.
Hasni.
Rusli Taher.
Sartika Lukman.
Muhammadong.
Rindani Claurita Toban.
Indah Restika BN, .
Article Title Authors.
Year Country wound healing Lean exosome confers on to improve wound healing in diabetes .
China Research Objective adipose stem cells (ASC.
from type 2
(T2D)
mice, and to assess the ability of these ASCs to promote wound healing in a T2D mouse model.
Study Design The objectives of this ability of exosomes derived from lean (Exos Lea.
to diabetic wounds Animal Study Population/ Sample consisted of C57BL/6J mice, divided into a high-fat
(HFD)
group and a control diet (Cho.
The HFD given a single n (STZ) to induce type 2 (T2D).
The ample in this consisted of db/db mice and lean, lowfat diet fed Body Composition and liver weights, adipocytes in the steatosis, as well as a dramatic pancreatic islet area compared to control mice.
The paper does state the "Body Composition" of However, indicates that the study used db/db diabetes model and low-fat diet fed mice as a lean The lean mice were shown to have improved tolerance, and a Healing Outcome Conclusion ASCs compared to T2D mice receiving T2D ASCs.
Specifically.
Chow ASCs led to higher wound closure numbers and lengths of epidermal sleeves indicating better reepithelialization, and greater angiogenesis and new blood vessel compared to T2D ASCs.
diabetic mice are slightly less effective ASCs healing.
T2D ASCs still potential and could potentially be used for autologous stem cell therapy in humans The healing outcome in this study was that Exos Lean, but not healing in a diabetic mouse model.
Exos Lean reduced inflammation, increased markers of angiogenesis and M2 extracellular matrix regeneration, all of which are important for proper wound .
Exosomes derived from lean adipose tissue macrophages (Exos Lea.
wound healing by polarization towards an anti-inflammatory M2 phenotype.
The mechanism by which Exos Lean improves wound healing is through increasing the expression of miR222-3p, which then suppresses the proinflammatory Bim gene and leads to .
The study has provided new insights into the Study Limitations Not https://doi.
org/10.
56303/jhnresearch.
Andi Sulfikar.
Mulyati.
Hasni.
Rusli Taher.
Sartika Lukman.
Muhammadong.
Rindani Claurita Toban.
Indah Restika BN, .
Article Title Authors.
Year Country Research Objective Study Design Population/ Sample Association of Body Composition with Type 2 Diabetes:
Retrospective Chart Review Study .
Taiwan The objectives were to analyze the body individuals with type 2 diabetes (T2DM) and to prevalence of low muscle mass and sarcopenic obesity in this population.
chart review The consisted of with type 2 diabetes who were at least 18 years old.
The effect of diabetes on the wound healing adipose-tissue .
South Korea whether diabetes mellitus affects the wound-healingpromoting tissuederived stem cells.
Animal Study The ample in this diabetic mice, adipose stem
cell group, a adipose stem
and a control
Body Composition M2-like
macrophages in tissue compared to the obese Healing Outcome The examined in this study were: body (BMI), body fat
mass (BFM), fatfree mass (FFM), visceral fat area, percent body fat
(PBF),
skeletal muscle mass (ASM), and skeletal muscle index (SMI).
Not mentioned Not mentioned .
he research does not mention any "healing The primary healing healing rate, which higher in the normal adipose tissue-derived compared to both the diabetic stem cells group and the control Other healing outcomes like reepithelialization, formation, and dermal regeneration showed similar trends, with Conclusion healing and identified potential therapeutic targets, such as miR222-3p and Bim, that could be used to treatments for chronic diabetic wounds.
Using BMI to assess obesity and determine mass underestimates the prevalence of obesity and neglects sarcopenia and high body fat in people with normal BMI.
The conclusion is that diabetes impairs the wound-healing potential of adipose tissue-derived stem cells, though they still retain some ability to promote angiogenesis Study Limitations Not Not https://doi.
org/10.
56303/jhnresearch.
Andi Sulfikar.
Mulyati.
Hasni.
Rusli Taher.
Sartika Lukman.
Muhammadong.
Rindani Claurita Toban.
Indah Restika BN, .
Article Title Authors.
Year Country Research Objective Study Design Population/ Sample Body Composition Healing Outcome Conclusion Study Limitations the normal stem cells The exception was the number of capillaries, where the diabetic retained their ability Table 2.
Critical Apraisal
CASP
Question
(RCT)
Basiri et al.
Schanuel et al.
Sun et al.
Did the trial
focused issue? Yes
Yes
Yes
Was assignment of Yes
Yes
Yes
Were patients who entered the trial properly accounted for Were patients, workers, and CanAot tell
CanAot tell
CanAot tell
CASP
Question (Cohort Stud.
Did the study Was recruited in an acceptable Mashili et al.
CASP Question (Animal Stud.
Xia et al.
CASP Question (Observational Studie.
Yes Is the research aim clearly stated and Yes Yes Yes Is the animal model appropriate for the research question? Yes Yes CanAot tell Was measured to Yes Are control and treatment groups well-structured? Yes Yes Was measured to CanAot tell Is the sample size allocation clearly CanAot tell CanAot tell Did the systematic review address a clearly formulated Did appropriate study design.
Were relevant primary research studies likely to have been included in the Did researchers assess the validity or https://doi.
org/10.
56303/jhnresearch.
Andi Sulfikar.
Mulyati.
Hasni.
Rusli Taher.
Sartika Lukman.
Muhammadong.
Rindani Claurita Toban.
Indah Restika BN, .
CASP
Question
(RCT)
Basiri et al.
Schanuel et al.
Sun et al.
'blind' CASP Question (Cohort Stud.
Mashili et al.
CASP Question (Animal Stud.
Xia et al.
Were groups similar at the start of the trial? Yes Yes Yes .
Have the identified all CanAot tell Are intervention and clearly described and relevant? Yes Yes Aside from the Yes Yes Yes Yes Are the outcome methods objective and valid? CanAot tell CanAot tell How large was the treatment Moderate .
linical but not statistical Significant .
ncreased Significant .
mproved ASC.
Have they factors in the and/or .
Was the follow up of CanAot tell Were efforts made to minimize bias .
CanAot tell CanAot tell How precise Low .
ot Not stated Not stated Yes Were the data analyzed properly, and were results Yes .
Yes .
Was the follow up of CASP Question (Observational Studie.
primary research studies included in Did information from primary research appropriately and Did analyse the pooled results of the primary research Did researchers report any limitations of review and, if so, do the limitations discussed cover all the issues you Would benefits of acting upon the results .
CanAot CanAot https://doi.
org/10.
56303/jhnresearch.
Andi Sulfikar.
Mulyati.
Hasni.
Rusli Taher.
Sartika Lukman.
Muhammadong.
Rindani Claurita Toban.
Indah Restika BN, .
CASP
Question
(RCT)
Basiri et al.
the treatment Can your context? Yes, with Yes .
or Were Yes Are Yes Schanuel et al.
Sun et al.
CASP
Question (Cohort Stud.
subjects long Mashili et al.
CASP Question (Animal Stud.
Xia et al.
Yes .
reclinical What are the results of this CanAot tell Can the findings be .
ranslational Partially Partially Yes Yes How precise CanAot tell Are any major reported by the CanAot tell CanAot tell Yes Yes believe the CanAot tell CASP Question (Observational Studie.
and/or acting on the Can the results of review be applied population/in your local setting or context? If actioned, would the findings from review represent additional value for the individuals or populations for whom you are What is your conclusion about review Ae can it be used to support evidence-based decision-making? .
Yes Yes https://doi.
org/10.
56303/jhnresearch.
Andi Sulfikar.
Mulyati.
Hasni.
Rusli Taher.
Sartika Lukman.
Muhammadong.
Rindani Claurita Toban.
Indah Restika BN, .
All articles that passed the selection process were critically appraised using the 2018 Critical Appraisal Skills Programme (CASP) Checklists, the 2014 evaluation tool from the Center for EvidenceBased Management (CEBM.
, and the Critical Appraisal of Studies Using Laboratory Animal Models .
To assess the quality and strength of the evidence of each study, the Oxford Centre for EvidenceBased Medicine (CEBM) 2009 Levels of Evidence classification was applied .
Based on the results of critical appraisal.
Table 1 shows that 7 articles analyzed are reliable, valid, and relevant to be included in this study.
Among the seven included articles, three were randomized controlled trials (RCT.
, categorized as level 1 to 2 evidence and graded A to B.
Two articles utilized diabetic animal models to assess wound healing, classified as level 5 evidence and graded C due to their nature as non-clinical experimental studies.
One article was a cohort study rated as level 2b with a grade of B, while the remaining one was a retrospective chart review categorized as observational evidence and also graded B (Table .
Levels of evidence and levels of recommendation in research are systems used to assess the quality and strength of evidence supporting an intervention or recommendation.
Levels of evidence are coded 1a-5 while levels of recommendation are A.
Level of recommendation A with levels of evidence 1a and 1b are systematic observations, level of recommendation B with levels of evidence 2a, 2b, 3a, and 3b are cohort and case studies, level of recommendation C with level of evidence 4 is a low-quality cohort or case-control study, while level of recommendation D with level of evidence 5 is Expert opinion based on non-systematic observations of results or mechanistic studies .
Thus, this review reflects a diversity of study designs both clinical and preclinical that collectively strengthen the conclusions regarding the relationship between body composition and wound healing in patients with type 2 diabetes mellitus.
RESULTS
Body Composition Characteristics The body composition parameters analyzed in the studies include lean body mass, fat mass, and body mass index (BMI), as explored by Basiri R .
Schanuel FS .
assessed adiposity by measuring body fat percentage using bioelectrical impedance analysis (BIA) to categorize participants based on their body fat levels .
In the animal experimental studies, the impact of fat and muscle composition, as well as stem cell characteristics from adipose tissue, on the wound healing capacity of diabetic mice.
,30,.
Meanwhile.
The distribution of skeletal muscle mass, visceral fat, and sarcopenia indicators in a large diabetic patient population, emphasizing the importance of evaluating more than just BMI to assess the risk of wound healing disturbances .
Overall, findings from all studies affirm that both low muscle mass and high body fat proportions significantly contribute to delayed healing.
Higher muscle mass supports better circulation and improved glucose metabolism, while excess body fat is associated with increased inflammation and microcirculation dysfunction, which can hinder tissue Table 3.
Synthesis of evidence on body composition and wound healing effectiveness in patients with type 2 diabetes Citation Level of Evidence Grade of Recommendation Lean body mass, fat mass.
BMI Body Composition Component Basiri et al.
High-fat dietAeinduced adiposity Schanuel et al.
Adipose-derived stem cells (T2DM Sun et al.
Macrophage-derived from lean adipose tissue Xia et al.
Adipose stem cells from diabetic Kim et al.
Percentage of body fat .
ia BIA) Mashili et al.
Skeletal muscle index, visceral fat Lin et al.
https://doi.
org/10.
56303/jhnresearch.
Andi Sulfikar.
Mulyati.
Hasni.
Rusli Taher.
Sartika Lukman.
Muhammadong.
Rindani Claurita Toban.
Indah Restika BN, .
Wound Healing Outcomes The wound healing outcomes reported in the analyzed studies show significant effects of body composition variations on the effectiveness of the healing process.
In the study by Basiri R .
, obese patients who received nutritional interventions experienced reduced muscle mass loss and improved wound healing outcomes, although the differences were not statistically significant, they were still considered clinically meaningful.
The experimental study by Lin C-L .
showed that rats on a high-fat diet for a short period experienced increased inflammation and delayed wound closure, emphasizing the negative impact of adiposity on the early inflammatory phase of wound healing.
Furthermore.
Sun Y .
demonstrated that stem cells from non-diabetic rats were more effective in accelerating epithelialization and new blood vessel formation compared to stem cells from diabetic rats.
Nevertheless, stem cells from diabetic rats still showed therapeutic potential that could be utilized in wound therapy.
Xia W .
supported these findings by showing that exosomes derived from adipose macrophages of lean rats could significantly improve wound healing through mechanisms that modulate macrophages to an anti-inflammatory M2 phenotype, which plays a key role in tissue Additionally.
Kim SM .
showed that although stem cells from diabetic rats were less effective than those from healthy rats, they still had the ability to support angiogenesis, which is crucial for wound tissue recovery.
The cohort study designed by Schanuel FS .
aimed to compare the rate of wound healing between patients with high and normal adiposity.
While the final results have not been reported due to the study still being in the protocol stage, the main outcome planned was the proportion of completely healed wounds within 24 weeks.
On the other hand.
Mashili F .
highlighted the importance of a comprehensive evaluation of body composition, not just based on BMI.
They found that many patients with normal BMI actually had sarcopenic obesity a combination of low muscle mass and high body fat which could increase the risk of poor wound healing.
These findings emphasize that a more in-depth assessment of body composition is crucial for planning clinical interventions for type 2 diabetes patients.
DISCUSSION
This study aims to evaluate the effectiveness of wound healing in patients with type 2 diabetes based on variations in body composition, particularly the proportion of muscle mass and body fat.
The key findings of this study indicate that patients with higher muscle mass and lower fat levels experience faster wound healing and better granulation tissue quality compared to patients with sarcopenia or obesity.
This is shown in the study of Basiri et al.
which, although not statistically significant, clinically experienced improved wound healing in the nutritional intervention group and experienced less fat mass gain and less loss of lean body mass .
Research by Lin et al.
also shows a relationship between body composition and type 2 diabetes .
Research with mouse samples shows that giving fatty foods and giving stem cells derived from adipose tissue can interfere with wound healing potential .
,29,.
, while other studies with mouse samples show wound healing using macrophage fat tissue (Exos Lea.
These results align with the research by Lin et al.
, which shows that sarcopenia significantly slows the wound healing process in type 2 diabetes patients .
Similarly.
Basiri R .
found that nutrition interventions focused on increasing muscle mass and healthy body composition can improve the speed and quality of diabetic wound healing, although statistical significance was not reached for some variables .
Animal studies further support these findings by demonstrating that adiposederived stem cells from diabetic subjects have lower regenerative potential, which impacts slower wound healing .
Additionally, high fat mass has been found to trigger chronic inflammatory conditions that impair the wound healing response .
This condition is also reinforced by findings from Dawi J .
, which state that metabolic disturbances typical of diabetes, such as hyperglycemia and insulin resistance, cause dysregulation of the inflammatory phase and worsen angiogenesis .
Moreover, mechanical pressure caused by excess adipose tissue and low tissue oxygenation hinders immune cell migration and granulation tissue production .
This is exacerbated by poor peripheral vascularization, which is common in diabetic patients, especially those with central fat https://doi.
org/10.
56303/jhnresearch.
Andi Sulfikar.
Mulyati.
Hasni.
Rusli Taher.
Sartika Lukman.
Muhammadong.
Rindani Claurita Toban.
Indah Restika BN, .
The impaired wound healing process in patients with suboptimal body composition can also increase the risk of complications such as infections, chronic ulcers, and amputations.
These findings are generally consistent with the classical study by Spampinato SF .
, which states that the interaction between hyperglycemia, chronic inflammation, and poor tissue perfusion leads to an imbalance in the wound healing process in diabetic patients .
Furthermore.
Lin C-L .
found that a high-fat diet administered in a short period was enough to significantly delay wound healing in animal models.
This suggests that body composition and metabolic status directly influence the dynamics of wound healing .
However, this review also has some limitations.
Some of the studies in the synthesis are observational or case-series, which provide a lower level of evidence.
The small sample sizes and lack of blinding in most studies increase the risk of bias.
Additionally, some studies did not use objective tools to assess wound healing, thus questioning the validity of the results.
Subjective assessments of wound conditions may also vary depending on individual perceptions and clinical standards of each institution.
Wound care in patients with diabetes should not only focus on blood glucose levels but should also consider body composition especially muscle mass and fat mass.
These findings imply that body composition assessment needs to be part of the clinical approach to diabetic wound management, not just blood glucose levels, and that education for patients with diabetes needs to be expanded to include the importance of maintaining muscle mass and controlling body fat, not just about a low-sugar diet .
Further, more robust longitudinal studies with more robust designs .
, large-scale RCT.
and the use of objective tools to assess wound healing in patients with type 2 diabetes are needed.
Translational research such as the development of adipose tissue stem cell therapy should continue to be explored, including in patients with Nevertheless, the results of this analysis underscore the importance of considering body composition as an integral part of wound management in diabetes patients.
Interventions aimed at improving muscle mass proportions and reducing body fat levels, whether through nutrition programs or structured physical activity, have the potential to accelerate wound healing and reduce the risk of CONCLUSION The results of this study suggest a potential relationship between body composition specifically the proportion of muscle mass and body fat and the effectiveness of wound healing in patients with type 2 diabetes mellitus.
Patients with higher muscle mass and lower body fat levels tended to show faster healing times and better quality of tissue repair.
These findings suggest that body composition imbalances may contribute to impaired wound healing, possibly through mechanisms such as chronic inflammation, tissue hypoxia, and impaired angiogenesis.
However, further studies with more robust experimental designs and the use of objective measurement tools are needed to confirm causal relationships and to develop more targeted clinical Interventions aimed at improving body composition, such as nutritional programs and physical activity, have the potential to be part of a supportive strategy in wound management in patients with diabetes, but their effectiveness still needs to be further validated.
FUNDING
This research received no external funding.
ACKNOWLEDGMENTS
The authors would like to express their sincere gratitude to Graha Edukasi College of Health Sciences.
Makassar.
Indonesia, and Yapenas 21 Nursing Academy.
Maros.
Indonesia, for their administrative and technical support throughout the completion of this study.
We also acknowledge the assistance provided during data collection and access to relevant research materials.
https://doi.
org/10.
56303/jhnresearch.
Andi Sulfikar.
Mulyati.
Hasni.
Rusli Taher.
Sartika Lukman.
Muhammadong.
Rindani Claurita Toban.
Indah Restika BN, .
CONFLICTS OF INTEREST
The authors declare no conflict of interest
REFERENCES