The geometric framework reveals that a moderate-protein, high-carbohydrate intake is optimal for severe burn injury in mice.

Nutritional therapy is a cornerstone of burns management. The optimal macronutrient intake for wound healing after burn injury has not been identified, although high-energy, high-protein diets are favoured. This study aimed to identify the optimal macronutrient intake for burn wound healing. The Geometric Framework (GF) was used to analyse wound healing after a 10% TBSA contact burn in mice ad libitum fed one of 11 high-energy diets, varying in macronutrient composition with protein (P5%-60%), carbohydrate (C20%-75%) and fat (F20%-75%). In the GF study, the optimal ratio for wound healing was identified as a moderate-protein, high-carbohydrate diet with a protein:carbohydrate:fat (P:C:F) ratio of 1:4:2. High-carbohydrate intake was associated with lower mortality, improved body weight and a beneficial pattern of body fat reserves. Protein intake was essential to prevent weight loss and mortality, but a protein intake target of ~7 kJ/day (~15% of energy intake) was identified, above which no further benefit was gained. High-protein intake was associated with delayed wound healing and increased liver and spleen weight. As the GF study demonstrated that an initial very high-protein intake prevented mortality, a very high-protein, moderate-carbohydrate diet (P40:C42:F18) was specifically designed. The dynamic diet study was also designed to combine and validate the benefits of an initial very high-protein intake for mortality, and subsequent moderate-protein, high-carbohydrate intake for optimal wound healing. The dynamic feeding experiment showed switching from an initial very high-protein diet to the optimal moderate-protein, high-carbohydrate diet accelerated wound healing whilst preventing mortality and liver enlargement.