Clinical Microbiology and Infection 24 (2018) 8e9
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Clinical Microbiology and Infection
journal homepage: www.clinicalmicrobiologyandinfection.com
Editorial
Nutrition and infection
The association of nutritional status with the risk and course of
infections and nutrition during infection have attracted great
research attention recently. Experimental and pre-clinical studies
have highlighted the metabolic changes occurring in the course
of host pathogen interaction, and have also elucidated how these
alterations impact on antimicrobial host immune function and
resistance to infection as well as on pathogen proliferation and
pathogenicity [1,2].
Microbes can sense the nutrient content of their environment,
which results in either a dormant or virulent behavior of the path-
ogen [3]. The availability and concentrations of different metabo-
lites in the cell and the environment impact on the regulation of
immune responses, resulting either in stimulation or inhibition of
antimicrobial immune effector mechanism or establishment of dis-
ease tolerance to infection [4,5]. In addition, clinical studies have
found associations of nutritional deficiencies and metabolic imbal-
ances with the risk and outcome of specific infections, and inter-
ventional trials then tried to elucidate the impact of metabolic
interventions on risk of infection (mostly in primary care settings)
or on disease outcome (mainly in critical ill subjects). Imbalances of
metabolic circuits and nutrient concentrations are often found in
patients with infectious diseases, however, while some of these al-
terations may predispose for infections, others originate from host
response mechanisms to limit the supply of certain nutrients to
invading pathogens (nutritional immunity). While the importance
of metabolic alterations for host control of infection, although
incompletely understood, is well accepted, controversy exists as
to whether specific metabolic imbalances should be corrected for
the benefit of patients.
This theme issue of Clinical Microbiology and Infection deals with
three important aspects of the complicated network between host
nutritional status and infection. These short reviews provide infor-
mation on the pathophysiological and immunological backgrounds
but also focus on clinical aspects of specific metabolic imbalances
and host nutritional status in relation to the course of disease.
They provide information on the clinical effects of therapeutic in-
terventions in these specific pathways for management of infec-
tious diseases and suggest directions for future research.
The first review covers general aspects of nutritional status and
the association of underweight and obesity with infectious diseases
[6]. Of note, the specific risk for infections is affected by age and
both low and high body mass index appear to be associated with
an altered risk of infections which impacts on the clinical course
of these diseases. The association between body weight and associ-
https://doi.org/10.1016/j.cmi.2017.10.028
1198-743X/© 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
ated metabolic alterations with risk for infection is discussed in
relation to specific infectious diseases along with a careful evalua-
tion of co-factors contributing to infection risk, such as age, food
and nutrient intake, co-existing nutritional deficiency, and regional
and hygienic aspects.
The second review covers the role of blood glucose control and
macronutrient restriction for susceptibility and course of nosoco-
mial infection in critically ill patients [7]. The control of blood
glucose levels in critically ill patients was addressed first by the au-
thors of this review. Their study showed that tight control of blood
glucose levels, even in non-diabetic subjects, is associated with an
improved outcome in critically ill patients at the ICU [8]. Numerous
pre-clinical and clinical studies have then provided deeper insights
into the importance of blood glucose control in regard to risk of
infection-associated morbidity and mortality in critically ill pa-
tients. which are nicely summarized in this review The second
part of this review discusses a clinically important issue, namely,
whether or not macronutrients should be supplied or withheld
from patients during the early course of severe infection, given
that many specific metabolic alterations are induced by the im-
mune response to limit the access of pathogens to nutrients.
This leads over to the third review which covers the role of diva-
lent metals with a focus on iron, copper, zinc, manganese, and se-
lenium in host pathogen interaction [9]. These divalent metals
play important roles in different cellular and immunological pro-
cesses, and infections are often associated with subtle alterations
of subcellular, cellular, and organ-specific metal distributions.
This review thus discusses the role of infection-associated diversion
of metal homeostasis for disease outcomes and the impact of spe-
cific metal deficiencies and overloads toward the susceptibility and
course of specific infectious diseases. Moreover, specific attention is
given to question whether or not specific metals should be supple-
mented either as prophylaxis or therapy. Clinical trials and meta-
analyses studying metal supplementation for prophylaxis or ther-
apy are critically discussed.
This special issue of CMI thus provides an insight into the impor-
tance of metabolic characteristics in infection. However, the influ-
ence of metabolism goes far beyond the topics included herein.
Other important aspects of nutrition, metabolism, and infection
include, for example, the role of vitamins in host response to infec-
tion as well as the evidence regarding the effects of vitamin supple-
mentation for prevention and treatment of infections. In addition,
various metabolites originating from citric acid cycle or lipid ho-
meostasis have recently been found to be severely altered during
 Editorial / Clinical Microbiology and Infection 24 (2018) 8e9
infection and to impact on host immune responses and pathogen
control in different experiment models [10,11]. However, their
role in human infectious diseases remains largely elusive. We
remain unsure of the optimal mode of nutrition for critically ill pa-
tients and which nutritional cocktails and metabolic control mea-
sures provide the largest benefit for patients with infectious
diseases. The important issue of evaluating the risk-benefit ratio
of the uncontrolled dietary supplementation of micronutrients
and metals by nutritional supplementation programs in areas
with a high burden of infectious diseases should be addressed by
further research.
Thus, there is still a long way to go in terms of preclinical and
clinical research to find the optimized metabolic conditions and
therapeutic intervention for patients to combat infectious diseases.
Transparency declaration
Dr. Weiss has nothing to disclose. No external funding was
received.
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G. Weiss
Department of Internal Medicine II (Infectious Disease, Immunology,
Rheumatology, Pneumology), Medical University of Innsbruck, Austria
E-mail address: Guenter.weiss@i-med.ac.at.
20 October 2017
Available online 3 November 2017
Editor: Professor L. Leibovici