Division of Pediatric Gastroenterology, UH Rainbow Babies & Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Department Critical Care Medicine and Nutrition Support Team, Mayo Clinic, Jacksonville, FL, USA.
Curr Nutr Rep. 2024 Jun;13(2):314-322. doi: 10.1007/s13668-024-00536-w. Epub 2024 Apr 8.
Some data, mostly originally derived from animal studies, suggest that low glucose intake is protective in bacterial sepsis but detrimental in overwhelming viral infections. This has been interpreted into a broad belief that different forms of sepsis may potentially require different nutritional management strategies. There are a few mechanistic differences between the host interactions with virus and bacteria which can explain why there may be opposing responses to macronutrient and micronutrient during the infected state. Here, we aim to review relevant evidence on the mechanisms and pathophysiology of nutritional management strategies in various infectious syndromes and summarize their clinical implications.
Newer literature - in the context of the SARS-CoV-19 pandemic - offers some insight to viral infections. There is still limited clinically applicable data during infection that clearly delineate the role of nutrition during an active viral vs bacterial infections. Based on contrasting findings in different models of viruses and bacteria, the macronutrient and micronutrient needs may depend more on specific infectious organisms that may not be generalizable as bacterial versus viral. Overall, the metabolic effects of sepsis are context dependent, and various host-specific (e.g., age, baseline nutritional status, immune status, comorbidities) and illness variables (phase, duration, and severity of illness) play a significant role in determining the outcome besides pathogen-specific (virus or bacterial or fungi and combined infections) factors. Microbe therapy (probiotics and prebiotics) seems to have therapeutic potential in both viral and bacterial infected states, and this seems like a promising area for further practical research.
一些数据，主要来源于动物研究，表明低葡萄糖摄入对细菌败血症具有保护作用，但对病毒感染的影响是有害的。这被解释为一种广泛的信念，即不同形式的败血症可能需要不同的营养管理策略。宿主与病毒和细菌的相互作用存在一些机制上的差异，可以解释为什么在感染状态下，宏量营养素和微量营养素可能会产生相反的反应。在这里，我们旨在回顾各种感染综合征中营养管理策略的机制和病理生理学的相关证据，并总结其临床意义。
在 SARS-CoV-1 流行的背景下，新的文献提供了一些关于病毒感染的见解。在感染期间，仍缺乏明确阐明营养在活跃的病毒与细菌感染期间作用的有限的临床适用数据。基于病毒和细菌不同模型中的对比发现，宏量营养素和微量营养素的需求可能更多地取决于特定的感染病原体，而这些病原体可能无法像细菌与病毒那样具有普遍性。总的来说，败血症的代谢影响取决于具体情况，各种宿主特异性因素（如年龄、基线营养状况、免疫状态、合并症）和疾病变量（疾病的阶段、持续时间和严重程度）在决定结局方面起着重要作用，此外还有病原体特异性因素（病毒或细菌或真菌以及混合感染）。微生物治疗（益生菌和益生元）似乎对病毒和细菌感染状态都具有治疗潜力，这似乎是一个有前途的进一步实际研究领域。
