The Effect of Starvation, Infection, and Injury on the Metabolic Processes and Body Composition*

Abstract

The purpose of this study was to determine the relative importance of various factors which lead to changes in the metabolism and composition of the body.The metabolic processes and body composition of the human organism are influenced to a great extent by an inadequate nutritional intake, infection, and injury and also by the patient's age, sex, their previous nutritional state, the coexistence of other diseases, and endocrine dysfunction.that most patients recover from a major surgical operation and/or infection when an inadequate or totally deficient diet is provided. The influence of various nutritional intakes on the mortality and morbidity rate following a specific operation has not been determined, but in general it is agreed that although an inadequate nutritional intake for a few days may not be harmful, a nutritional deficit over a more prolonged period, especially when associated with the catabolic effect of necrosis, fever, and/or infection can be quite detrimental. However, many surgeons still believe that following an operation the administration of water, sodium, potassium, and protein is of little value and in fact is contraindicated. On the other hand, data are available which indicate that the giving of a good nutritional intake causes a significant reduction in the morbidity and mortality rates during the convalescence of severely sick or injured patients.In past s t u d i e~~.~,~ we have determined the change in certain facets of the body composition and have also measured the insensible fluid loss, as well as the amount of energy used by subjects before and after a major surgical operation with or without a complication. In general, these studies showed that there was only a modest increase in the amount of energy used and in the insensible fluid loss after an uncomplicated operation over what the same subjects showed preoperatively. On the other hand, following an operation that was complicated by fever, infection, hypotension, etc., there was a much greater increase in the insensible fluid loss and energy consumption.Although the results we are reporting are limited to weight changes and the effect on sodium, potassium, and nitrogen balance, we believe that indirectly these data give us a fair estimate of the energy and nutritional needs of the individuals studied.