Skip to main content Accessibility help

Nutritional demands in acute and chronic illness

  • Rosemary A. Richardson and H. Isobel M. Davidson (a1)

Common to both acute and chronic disease are disturbances in energy homeostasis, which are evidenced by quantitative and qualitative changes in dietary intake and increased energy expenditure. Negative energy balance results in loss of fat and lean tissue. The management of patients with metabolically-active disease appears to be simple; it would involve the provision of sufficient energy to promote tissue accretion. However, two fundamental issues serve to prevent nutritional demands in disease being met. The determination of appropriate energy requirements relies on predictive formulae. While equations have been developed for critically-ill populations, accurate energy prescribing in the acute setting is uncommon. Only 25–32% of the patients have energy intakes within 10% of their requirements. Clearly, the variation in energy expenditure has led to difficulties in accurately defining the energy needs of the individual. Second, the acute inflammatory response initiated by the host can have profound effects on ingestive behaviour, but this area is poorly understood by practising clinicians. For example, nutritional targets have been set for specific disease states, i.e. pancreatitis 105–147 KJ (25–35 kcal)/kg; chronic liver disease 147–168 kj (35–40 kcl)/kg, but given the alterations in gut physiology that accompany the acute-phase response, targets are unlikely to be met. In cancer cachexia attenuation of the inflammatory response using eicosapentaenoic acid results in improved nutritional intake and status. This strategy poses an attractive proposition in the quest to define nutritional support as a clinically-effective treatment modality in other disorders.

    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Nutritional demands in acute and chronic illness
      Available formats
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Nutritional demands in acute and chronic illness
      Available formats
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Nutritional demands in acute and chronic illness
      Available formats
Corresponding author
*Corresponding author: Dr Rosemary Richardson, Present address: Department of Dietetics and Nutrition, Victoria Infirmary, Langside, Glasgow G42 9TY, UK, fax +44 141 201 5572,
Hide All
Bannerman, E, Davidson, I, Conway, C, Culley, D, Aldhous, M & Ghosh, S (2001) Altered subjective appetite parameters in Crohn's disease. Clinical Nutrition 20, 399405.
Barber, MD, Ross, JA, Voss, AC, Tisdale, MJ & Fearon, KC (1999) The effect of an oral supplement enriched with fish oil on weight-loss in patients with pancreatic cancer. British Journal of Cancer 81, 8086.
Burrowes, JD, Bluestone, PA, Wang, J & Pierson, RN (1999) The effects of moderate doses of megestrol acetate on nutritional status and body composition in a hemodialysis patient. Journal of Renal Nutrition 9, 8994.
Calder, PC & Grimble, RF (2002) Polyunsaturated fatty acids, inflammation and immunity. European Journal of Clinical Nutrition 56, Suppl. 3, S14S19.
Curtis, E, Krech, R & Declan-Walsh, T (1991) Common symptoms in patients with advanced cancer. Journal of Palliative Care 7, 2529.
Davidson, HIM, Pattison, RM & Richardson, RA (1998) Clinical undernutrition states and their influence on taste. Proceedings of the Nutrition Society 57, 633638.
Davidson, HIM, Richardson, RA, Sutherland, D & Garden, OJ (1999) Macronutrient preference, dietary intake and substrate oxidation among stable cirrhotic patients. Hepatology 29, 13801386.
DeWys, WD & Walters, K (1975) Abnormalities of taste sensation in cancer patients. Cancer 36, 18881896.
French, SJ & Cecil, JE (2001) Oral, gastric and intestinal influences on human feeding. Physiology and Behavior 74, 729734.
Friedman, MI (1997) An energy sensor for control of energy intake. Proceedings of the Nutrition Society 56, 4150.
Holden, CM (1991) Anorexia in the terminally ill cancer patient: the emotional impact on patient and the family. Hospital Journal 7, 7384.
Holmes, S & Dickerson, WT (1991) Food intake and quality of life in cancer patients. Journal of Nutritional Medicine 2, 359368.
Horn, CC, Addis, A & Friedman, MI (1999) Neural substrate for an integrated metabolic control of feeding behavior. American Journal of Physiology 276, R113R119.
Ireton-Jones, CS, Turner, WW, Leipa, GU & Baxter, C (1992) Equations or the estimation of energy expenditures in patients with burns with special references to ventilatory status. Journal of Burn Care and Rehabilitation 13, 330333.
Kondrup, J & Müller, MJ (1997) Energy and protein requirements of patients with liver disease. Journal of Hepatology 27, 239247.
Konsman, JP & Dantzer, T (2001) How the immune and nervous systems interact during disease-associated anorexia. Nutrition 17, 664668.
McClave, SA, Sinder, H, Owens, N & Sexton, L (1997) Clinical nutrition in pancreatitis. Digestive Diseases and Science 42, 20352044.
Madden, A, Bradbury, W & Morgan, M (1997) Taste perception in cirrhosis: its relationship to circulating micronutrients and food preferences. Hepatology 26, 4048.
Maier, SF, Goehler, LE, Fleshner, M & Watkins, LR (1998) The role of the vagus nerve in cytokine to brain communication. Annals of the New York Academy of Sciences 840, 289300.
Nygren, J, Soop, M, Thorell, A, Efendic, S, Nair, KS & Ljungqvist, O (1998) Preoperative oral carbohydrate administration reduces postoperative insulin resistance. Clinical Nutrition 17, 6571.
Phillips, LM & Hill, DL (1997) Novel regulation of peripheral gustatory function by the immune system. American Journal of Physiology 271, R857R862.
Rigaud, D, Angel, LA, Cerf, M, Carduner, MJ, Melchior, JC, Sautier, C, Rene, E, Apfelbaum, M & Mignon, M (1994) Mechanisms of decreased food intake during weight loss in adult Crohn's disease patients without obvious malabsorption. American Journal of Clinical Nutrition 60, 775781.
Roubenoff, R, Grinspoon, S, Skolink, PR, Tchetgen, E, Abad, L, Spiegelman, P, Knox, T & Gorbach, S (2002) Role of cytokines and testosterone in regulating lean body mass and resting energy expenditure in HIV-infected men. American Journal of Physiology 283, E138E145.
Schols, AMWJ (2001) Nutrition and respiratory disease. Clinical Nutrition 20, Suppl. 1, 173179.
Simopolous, AP (2002) Omega-3 fatty acids in inflammation and autoimmune diseases. Journal of the American College of Nutrition 21, 495505.
Soop, M, Nygren, J, Myrefors, P, Thorell, A & Ljungqvist, (2000) Preoperative oral carbohydrate treatment attenuates immediate postoperative insulin resistance. American Journal of Physiology 280, E567E583.
Wigmore, S, Ross, J, Falconer, JS, Plester, CE, Tisdale, MJ, Carter, DC & Fearon, KC (1996) The effect of polyunsaturated fatty acids on the progress of cachexia in patients with pancreatic cancer. Nutrition 12, 2730.
Wilson, MM, Purushothaman, R & Morely, JE (2002) Effect of liquid dietary supplement on energy intake in the elderly. American Journal of Clinical Nutrition 75, 944947.
Yanagisawa, K, Bartoshuk, LM, Catalanotto, FA, Karrer, TA & Kveton, JF (1998) Anaesthesia of the chorda tympani nerve and taste phantoms. Physiology and Behavior 63, 2935.
Yeh, SS, Wu, SY, Lee, TP, Olson, JS, Stevens, MR, Dixon, T, Porcelli, RJ & Schuster, MW (2000) Improvement in quality-of-life measures and stimulation of weight gain after treatment with megestrol acetate oral suspension in geriatric cachexia: results of a double-blind, placebo-controlled study. Journal of the American Geriatrics Society 48, 485492.
Yuill, KA, Parks, R, Richardson, RA, Davidson, HIM & Garden, OJ (2002) Oral administration of carbohydrate-containing fluids prior to major elective surgery preserves lean tissue post-operatively. British Journal of Surgery 89, Suppl. 1, 92.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Proceedings of the Nutrition Society
  • ISSN: 0029-6651
  • EISSN: 1475-2719
  • URL: /core/journals/proceedings-of-the-nutrition-society
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed