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“Feed a Cold, Starve a Fever?” A Review of Nutritional Strategies in the Setting of Bacterial Versus Viral Infections

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Abstract

Purpose of Review

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.

Recent Findings

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.

Summary

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.

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Authors and Affiliations

  1. Division of Pediatric Gastroenterology, UH Rainbow Babies & Children′s Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Senthilkumar Sankararaman

  2. Department Critical Care Medicine and Nutrition Support Team, Mayo Clinic, Jacksonville, FL, USA

    Carla Venegas

  3. Upstate Medical University, Syracuse, NY, USA

    Sonia Seth

  4. Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA

    Sonali Palchaudhuri

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  1. Senthilkumar Sankararaman
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Sankararaman, S., Venegas, C., Seth, S. et al. “Feed a Cold, Starve a Fever?” A Review of Nutritional Strategies in the Setting of Bacterial Versus Viral Infections. Curr Nutr Rep (2024). https://doi.org/10.1007/s13668-024-00536-w

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