Cytokine control of nutrition and metabolism in critical illness.

During the last two decades, major advances in technology and in our fundamental understanding of the biologic aspects of sepsis and cancer cachexia have dramatically affected the therapeutic strategies available to the surgeon to care for critically ill patients. It is clear, however, that cytokines affect whole body nutrition and metabolism and are responsible for many of the clinically observed nutritional effects of injury, infection, and cancer, including fever, hypermetabolism, anorexia, protein catabolism, cachexia, and altered fat, glucose, and trace mineral metabolism. These metabolic and nutritional effects of cytokines are influenced by the nutritional status of the host, which is generally altered during the course of the critical illness. In the future, the use of specialized diets and the use of selective cytokine blockade are likely to be important components of the overall care of the catabolic patient.