VITAMIN D SUPPLEMENTATION IN BURN PATIENTS: EFFECTS ON WOUND HEALING AND CLINICAL OUTCOMES — A NARRATIVE REVIEW
DOI:
https://doi.org/10.31435/ijitss.3(51).2026.6032Keywords:
Vitamin D, Burn Injury, Wound Healing, Cholecalciferol, Critical Care, SupplementationAbstract
Background: Burn injury induces profound metabolic, endocrine, and immunologic disturbances associated with impaired wound healing, increased infection risk, and prolonged recovery. Vitamin D deficiency is highly prevalent in patients with moderate-to-severe burns due to impaired cutaneous synthesis and altered metabolism.
Objective: This narrative review summarizes current evidence regarding vitamin D deficiency and supplementation in burn patients, with emphasis on wound healing, infectious complications, and clinical outcomes.
Methodology: A literature review was conducted using PubMed, Scopus, Web of Science, and Google Scholar databases. Clinical trials, observational studies, reviews, and meta-analyses published primarily between 2000 and 2025 were evaluated.
Results: Available evidence demonstrated that vitamin D deficiency is common in burns involving ≥20% total body surface area and is associated with delayed wound healing, increased infectious complications, prolonged ICU and hospital stay, and long-term musculoskeletal abnormalities.
Conclusion: Vitamin D appears to contribute to wound repair, immune modulation, and systemic recovery after burn injury; however, standardized burn-specific supplementation protocols remain unavailable.
References
Al-Tarrah, K., Hewison, M., Moiemen, N., & Lord, J. M. (2018). Vitamin D status and its influence on outcomes following major burn injury and critical illness. Burns & Trauma, 6, 11. https://doi.org/10.1186/s41038-018-0113-4
Amrein, K., Schnedl, C., Holl, A., et al. (2014). Effect of high-dose vitamin D3 on hospital length of stay in critically ill patients with vitamin D deficiency: The VITdAL-ICU randomized clinical trial. JAMA, 312(15), 1520–1530. https://doi.org/10.1001/jama.2014.13204
Bikle, D. D. (2014). Vitamin D and the skin: Physiology and pathophysiology. Physiological Reviews, 94(4), 1093–1132. https://doi.org/10.1152/physrev.00044.2013
Carlberg, C., & Campbell, M. J. (2013). Vitamin D receptor signaling mechanisms: Integrated actions of a well-defined transcription factor. Steroids, 78(2), 127–136. https://doi.org/10.1016/j.steroids.2012.10.019
Church, D., Elsayed, S., Reid, O., Winston, B., & Lindsay, R. (2006). Burn wound infections. Clinical Microbiology Reviews, 19(2), 403–434. https://doi.org/10.1128/CMR.19.2.403-434.2006
de Haan, K., Groeneveld, A. B. J., de Geus, H. R. H., Egal, M., & Struijs, A. (2014). Vitamin D deficiency as a risk factor for infection, sepsis and mortality in the critically ill. Critical Care, 18, 660. https://doi.org/10.1186/s13054-014-0660-4
Eming, S. A., Martin, P., & Tomic-Canic, M. (2014). Wound repair and regeneration: Mechanisms, signaling, and translation. Science Translational Medicine, 6(265), 265sr6. https://doi.org/10.1126/scitranslmed.3009337
Finnerty, C. C., Jeschke, M. G., Branski, L. K., Barrow, R. E., & Herndon, D. N. (2013). Hypertrophic response and hypermetabolism after burn injury. Clinical Nutrition, 32(5), 749–755. https://doi.org/10.1016/j.clnu.2013.05.001
Garner, K. M., Zavala, S., Pape, K. O., et al. (2022). Association of vitamin D deficiency and replacement with infectious outcomes in burn patients. Burns, 48(6), 1319–1324. https://doi.org/10.1016/j.burns.2021.10.020
Ghadimi, E., Rahbar, R., Jafarzade, E., & Mansoori, A. (2025). Effects of vitamin D3 supplementation on the recovery of hospitalized burn patients: A randomized controlled trial. BMC Nutrition, 11, 37. https://doi.org/10.1186/s40795-025-01024-2
Guo, S., & DiPietro, L. A. (2010). Factors affecting wound healing. Journal of Dental Research, 89(3), 219–229. https://doi.org/10.1177/0022034509359125
Han, J., et al. (2020). Vitamin D supplementation in critically ill patients: A meta-analysis of randomized controlled trials. Critical Care, 24, 1–10. https://doi.org/10.1186/s13054-020-03323-x
Haussler, M. R., Whitfield, G. K., Kaneko, I., Haussler, C. A., Hsieh, D., Hsieh, J.-C., & Jurutka, P. W. (2013). Molecular mechanisms of vitamin D action. Calcified Tissue International, 92(2), 77–98. https://doi.org/10.1007/s00223-012-9619-0
Herndon, D. N., & Tompkins, R. G. (2004). Support of the metabolic response to burn injury. The Lancet, 363(9424), 1895–1902. https://doi.org/10.1016/S0140-6736(04)16360-5
Hewison, M. (2010). Vitamin D and immune function. Endocrinology and Metabolism Clinics of North America, 39(2), 365–379. https://doi.org/10.1016/j.ecl.2010.02.010
Jeschke, M. G., Chinkes, D. L., Finnerty, C. C., et al. (2008). Pathophysiologic response to severe burn injury. Annals of Surgery, 248(3), 387–401. https://doi.org/10.1097/SLA.0b013e3181856241
Jeschke, M. G., van Baar, M. E., Choudhry, M. A., Chung, K. K., Gibran, N. S., & Logsetty, S. (2020). Burn injury. Nature Reviews Disease Primers, 6(1), 11. https://doi.org/10.1038/s41572-020-0145-5
Klein, G. L., Chen, T. C., Holick, M. F., et al. (2004). Synthesis of vitamin D in skin after burns. The Lancet, 363(9405), 291–292. https://doi.org/10.1016/S0140-6736(03)15390-7
Klein, G. L., et al. (2004). Altered vitamin D metabolism following burn injury. Bone, 35(3), 806–810. https://doi.org/10.1016/j.bone.2004.05.013
Klein, G. L. (2006). Burn-induced bone loss: Importance, mechanisms, and management. Journal of Burns and Wounds, 5, e5.
Klein, G. L. (2016). Burns: Where has all the calcium (and vitamin D) gone? Advances in Nutrition, 7(1), 153–158. https://doi.org/10.3945/an.115.009589
Langlois, P. L., Szwec, C., D’Aragon, F., et al. (2018). Vitamin D supplementation in the critically ill: A systematic review and meta-analysis. Clinical Nutrition, 37(4), 1238–1246. https://doi.org/10.1016/j.clnu.2017.05.029
Lee, J. O., et al. (2016). Low vitamin D levels are associated with increased length of stay in burn patients. Journal of Burn Care & Research, 37(6), e547–e552. https://doi.org/10.1097/BCR.0000000000000407
Madarshahian, D., Kaur, A., Parekh, J., & Wilson, Y. (2025). Vitamin D deficiency and clinical outcomes in adult burn patients: A systematic review and meta-analysis. Cureus, 17(12), e99123. https://doi.org/10.7759/cureus.99123
National Heart, Lung, and Blood Institute PETAL Clinical Trials Network. (2019). Early high-dose vitamin D3 for critically ill, vitamin D–deficient patients. New England Journal of Medicine, 381, 2529–2540. https://doi.org/10.1056/NEJMoa1911124
Pastar, I., Stojadinovic, O., Yin, N. C., et al. (2014). Epithelialization in wound healing: A comprehensive review. Advances in Wound Care, 3(7), 445–464. https://doi.org/10.1089/wound.2013.0473
Piotrowska, A., Wierzbicka, J., Żmijewski, M. A., & Tuckey, R. C. (2016). Vitamin D in the skin physiology and pathology. Acta Biochimica Polonica, 63(1), 17–29. https://doi.org/10.18388/abp.2015_1104
Porter, C., Herndon, D. N., Børsheim, E., et al. (2007). Long-term skeletal and vitamin D abnormalities after severe burn injury. Journal of Clinical Endocrinology & Metabolism, 92(2), 451–456. https://doi.org/10.1210/jc.2006-1409
Porter, C., Herndon, D. N., Børsheim, E., Chondronikola, M., Saraf, M. K., Sidossis, L. S., & Suman, O. E. (2013). Long-term metabolic and skeletal sequelae of burn injury: A review. Current Opinion in Clinical Nutrition and Metabolic Care, 16(6), 688–694. https://doi.org/10.1097/MCO.0b013e328365bdfd
Putzu, A., Belletti, A., Cassina, T., et al. (2017). Vitamin D and outcomes in adult critically ill patients: A systematic review and meta-analysis of randomized trials. Journal of Critical Care, 38, 109–114. https://doi.org/10.1016/j.jcrc.2016.10.029
Rousseau, A. F., Damas, P., Ledoux, D., Cavalier, E., & Gadisseur, R. (2013). Vitamin D deficiency in critically ill burn patients. Burns, 39(4), 674–682. https://doi.org/10.1016/j.burns.2012.11.008
Rousseau, A.-F., Losser, M.-R., Ichai, C., & Berger, M. M. (2013). ESPEN endorsed recommendations: Nutritional therapy in major burns. Clinical Nutrition, 32(4), 497–502. https://doi.org/10.1016/j.clnu.2013.02.012
Schauber, J., Dorschner, R. A., Yamasaki, K., Brouha, B., & Gallo, R. L. (2006). Control of the innate epithelial antimicrobial response is cell-type specific and dependent on relevant microenvironmental stimuli. Immunology, 118, 509–519. https://doi.org/10.1111/j.1365-2567.2006.02399.x
Süntar, I. (2021). Regulatory role of Nrf2 signaling pathway in wound healing and skin regeneration. Molecules, 26(9), 2424. https://doi.org/10.3390/molecules26092424
Tarcin, O., Yavuz, D. G., Ozben, B., et al. (2009). Effect of vitamin D deficiency and replacement on endothelial function and oxidative stress. Endocrine Research, 34(1–2), 33–40. https://doi.org/10.1210/jc.2008-1212
Wang, T. T., et al. (2004). 1,25-Dihydroxyvitamin D3 is a direct inducer of antimicrobial peptide gene expression. Journal of Immunology, 173(5), 2909–2912. https://doi.org/10.4049/jimmunol.173.5.2909
Williams, F. N., Herndon, D. N., & Jeschke, M. G. (2009). The hypermetabolic response to burn injury and interventions to modify this response. Clinics in Plastic Surgery, 36(4), 583–596. https://doi.org/10.1016/j.cps.2009.05.011
Zhang, X., Zhou, M., Guo, Y., et al. (2021). Vitamin D and wound healing: An updated review. Journal of Tissue Viability, 30(4), 425–432. https://doi.org/10.1016/j.jtv.2021.07.003
Zheng, W.-H., Shi, J.-H., Yu, D.-X., & Huang, H.-B. (2025). Vitamin D supplementation in critically ill patients: A meta-analysis. Frontiers in Nutrition, 12, Article 1505616. https://doi.org/10.3389/fnut.2025.1505616
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Copyright (c) 2026 Urszula Jarzęcka, Anna Świerczek, Oskar Mikołajczyk, Irmina Grygutis, Sonia Pawełkiewicz, Kornelia Julia Fimiarz,, Aleksandra Serafin, Maja Podolak, Karolina Baran, Marta Kaczorek

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