Interaction of nutrition and infection in the hospital setting.

A substantial portion of hospitalized patients suffer from protein-calorie malnutrition acquired as a result of their illness, their semistarvation dietary regimens, or the combination of both insults together. When energy needs are not met by the diet, the deficient calories must come from body stores, muscle, or visceral protein and fat. The status of these stores can be assessed clinically by easily performed measurements. In adult kwashiorkor-like syndromes, the insulin response to the combined stimulus of catabolic stress and carbohydrate feedings reduces the mobilization of fat and protein stores. In adult marasmus there is hypoaminoacidemia and loss of skeletal muscle. Both forms of malnutrition have a profound impact on immune function. Nutritional support should be given preeminent consideration as an additional necessary form of these patients.