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 ated metabolic alterations with risk for infection is discussed in
infections and nutrition during infection have attracted great relation to specific infectious diseases along with a careful evalua-
research attention recently. Experimental and pre-clinical studies tion of co-factors contributing to infection risk, such as age, food
have highlighted the metabolic changes occurring in the course and nutrient intake, co-existing nutritional deficiency, and regional
of host pathogen interaction, and have also elucidated how these and hygienic aspects.
alterations impact on antimicrobial host immune function and The second review covers the role of blood glucose control and
resistance to infection as well as on pathogen proliferation and macronutrient restriction for susceptibility and course of nosoco-
pathogenicity [1,2]. mial infection in critically ill patients [7]. The control of blood
Microbes can sense the nutrient content of their environment, glucose levels in critically ill patients was addressed first by the au-
which results in either a dormant or virulent behavior of the path- thors of this review. Their study showed that tight control of blood
ogen [3]. The availability and concentrations of different metabo- glucose levels, even in non-diabetic subjects, is associated with an
lites in the cell and the environment impact on the regulation of improved outcome in critically ill patients at the ICU [8]. Numerous
immune responses, resulting either in stimulation or inhibition of pre-clinical and clinical studies have then provided deeper insights
antimicrobial immune effector mechanism or establishment of dis- into the importance of blood glucose control in regard to risk of
ease tolerance to infection [4,5]. In addition, clinical studies have infection-associated morbidity and mortality in critically ill pa-
found associations of nutritional deficiencies and metabolic imbal- tients. which are nicely summarized in this review The second
ances with the risk and outcome of specific infections, and inter- part of this review discusses a clinically important issue, namely,
ventional trials then tried to elucidate the impact of metabolic whether or not macronutrients should be supplied or withheld
interventions on risk of infection (mostly in primary care settings) from patients during the early course of severe infection, given
or on disease outcome (mainly in critical ill subjects). Imbalances of that many specific metabolic alterations are induced by the im-
metabolic circuits and nutrient concentrations are often found in mune response to limit the access of pathogens to nutrients.
patients with infectious diseases, however, while some of these al- This leads over to the third review which covers the role of diva-
terations may predispose for infections, others originate from host lent metals with a focus on iron, copper, zinc, manganese, and se-
response mechanisms to limit the supply of certain nutrients to lenium in host pathogen interaction [9]. These divalent metals
invading pathogens (nutritional immunity). While the importance play important roles in different cellular and immunological pro-
of metabolic alterations for host control of infection, although cesses, and infections are often associated with subtle alterations
incompletely understood, is well accepted, controversy exists as of subcellular, cellular, and organ-specific metal distributions.
to whether specific metabolic imbalances should be corrected for This review thus discusses the role of infection-associated diversion
the benefit of patients. of metal homeostasis for disease outcomes and the impact of spe-
This theme issue of Clinical Microbiology and Infection deals with cific metal deficiencies and overloads toward the susceptibility and
three important aspects of the complicated network between host course of specific infectious diseases. Moreover, specific attention is
nutritional status and infection. These short reviews provide infor- given to question whether or not specific metals should be supple-
mation on the pathophysiological and immunological backgrounds mented either as prophylaxis or therapy. Clinical trials and meta-
but also focus on clinical aspects of specific metabolic imbalances analyses studying metal supplementation for prophylaxis or ther-
and host nutritional status in relation to the course of disease. apy are critically discussed.
They provide information on the clinical effects of therapeutic in- This special issue of CMI thus provides an insight into the impor-
terventions in these specific pathways for management of infec- tance of metabolic characteristics in infection. However, the influ-
tious diseases and suggest directions for future research. ence of metabolism goes far beyond the topics included herein.
The first review covers general aspects of nutritional status and Other important aspects of nutrition, metabolism, and infection
the association of underweight and obesity with infectious diseases include, for example, the role of vitamins in host response to infec-
[6]. Of note, the specific risk for infections is affected by age and tion as well as the evidence regarding the effects of vitamin supple-
both low and high body mass index appear to be associated with mentation for prevention and treatment of infections. In addition,
an altered risk of infections which impacts on the clinical course various metabolites originating from citric acid cycle or lipid ho-
of these diseases. The association between body weight and associ- meostasis have recently been found to be severely altered during

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.
 Editorial / Clinical Microbiology and Infection 24 (2018) 8e9 9

infection and to impact on host immune responses and pathogen [3] Mancio-Silva L, Slavic K, Grilo Ruivo MT, Grosso AR, Modrzynska KK, Vera IM,
et al. Nutrient sensing modulates malaria parasite virulence. Nature 2017;547:
control in different experiment models [10,11]. However, their
213e6.
role in human infectious diseases remains largely elusive. We [4] Weis S, Carlos AR, Moita MR, Singh S, Blankenhaus B, Cardoso S, et al. Meta-
remain unsure of the optimal mode of nutrition for critically ill pa- bolic adaptation establishes disease tolerance to sepsis. Cell 2017;169:
tients and which nutritional cocktails and metabolic control mea- 1263e75. e1214.
[5] Assmann N, Finlay DK. Metabolic regulation of immune responses: therapeu-
sures provide the largest benefit for patients with infectious tic opportunities. J Clin Invest 2016;126:2031e9.
diseases. The important issue of evaluating the risk-benefit ratio [6] Dobner J, Kaser S. Body mass index and the risk of infection - from under-
of the uncontrolled dietary supplementation of micronutrients weight to obesity. Clin Microbiol Infect 2018;24:24e8.
[7] Ingels C, Vanhorebeek I, Van den Berghe G. Glucose homeostasis, nutrition
and metals by nutritional supplementation programs in areas and infections during critical illness. Clin Microbiol Infect 2018;24:10e5.
with a high burden of infectious diseases should be addressed by [8] Van den Berghe G, Bouillon R, Mesotten D. Glucose control in critically ill pa-
further research. tients. N Engl J Med 2009;361:89. author reply 91e92.
[9] Weiss G, Carver PL. Role of divalent metals in infectious disease susceptibility
Thus, there is still a long way to go in terms of preclinical and and outcome. Clin Microbiol Infect 2018;24:16e23.
clinical research to find the optimized metabolic conditions and [10] Cheng SC, Scicluna BP, Arts RJ, Gresnigt MS, Lachmandas E, Giamarellos-
therapeutic intervention for patients to combat infectious diseases. Bourboulis EJ, et al. Broad defects in the energy metabolism of leukocytes un-
derlie immunoparalysis in sepsis. Nat Immunol 2016;17:406e13.
[11] Eisenreich W, Rudel T, Heesemann J, Goebel W. To eat and to be eaten: mutual
Transparency declaration metabolic adaptations of immune cells and intracellular bacterial pathogens
upon infection. Front Cell Infect Microbiol 2017;7:316.

Dr. Weiss has nothing to disclose. No external funding was

received. G. Weiss
Department of Internal Medicine II (Infectious Disease, Immunology,
Rheumatology, Pneumology), Medical University of Innsbruck, Austria
E-mail address: [email protected].
References
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