Pathophysiology-guided nutritional strategies for persistent inflammation, immunosuppression, and catabolism syndrome: an immunometabolic perspective
- 1Department of Critical Care Medicine, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University
Abstract
Persistent inflammation, immunosuppression, and catabolism syndrome (PICS) is a phenotype of chronic critical illness characterized by unresolved inflammation, impaired immune competence, sustained catabolism, skeletal muscle loss, recurrent infections, and poor functional recovery. Although guideline-based nutritional support remains fundamental, persistent immunometabolic abnormalities may limit responsiveness to nutrient delivery and contribute to anabolic resistance, impaired substrate utilization, and defective tissue repair. This mini-review examines biological mechanisms limiting nutritional responsiveness in PICS and evaluates evidence for pathophysiology-guided nutritional strategies. A structured literature search of PubMed/MEDLINE, Embase, and Web of Science was conducted from database inception through September 6, 2026, prioritizing English-language clinical guidelines, clinical studies, and mechanistic or translational evidence relevant to PICS, critical illness, nutritional responsiveness, and immunometabolic nutrition. We propose a framework addressing major barriers to recovery through strategies to restore anabolic responsiveness with protein, leucine, and rehabilitation; modulate inflammatory resolution and immune dysfunction with omega-3 fatty acids and arginine; optimize nutrient timing and circadian-metabolic regulation; and maintain a metabolic milieu conducive to nutrient utilization. Because direct interventional evidence in well-defined PICS populations remains limited, these strategies should complement rather than replace guideline-based nutritional support. The framework is conceptual and hypothesis-generating, and prospective PICS-specific studies incorporating biological stratification and clinically meaningful recovery outcomes are needed to determine its translational value.
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BibTeX
@article{wu2026pathophysiologyguided,
title = {{Pathophysiology-guided nutritional strategies for persistent inflammation, immunosuppression, and catabolism syndrome: an immunometabolic perspective}},
author = {Zhiyang Wu and Bo Yao},
journal = {Frontiers in Immunology},
year = {2026},
month = oct,
doi = {10.3389/fimmu.2026.1968812},
url = {https://www.frontiersin.org/articles/10.3389/fimmu.2026.1968812/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Pathophysiology-guided nutritional strategies for persistent inflammation, immunosuppression, and catabolism syndrome: an immunometabolic perspective
AU - Zhiyang Wu
AU - Bo Yao
PY - 2026
DA - 2026/10/20
JO - Frontiers in Immunology
DO - 10.3389/fimmu.2026.1968812
UR - https://www.frontiersin.org/articles/10.3389/fimmu.2026.1968812/full
AB - Persistent inflammation, immunosuppression, and catabolism syndrome (PICS) is a phenotype of chronic critical illness characterized by unresolved inflammation, impaired immune competence, sustained catabolism, skeletal muscle loss, recurrent infections, and poor functional recovery. Although guideline-based nutritional support remains fundamental, persistent immunometabolic abnormalities may limit responsiveness to nutrient delivery and contribute to anabolic resistance, impaired substrate utilization, and defective tissue repair. This mini-review examines biological mechanisms limiting nutritional responsiveness in PICS and evaluates evidence for pathophysiology-guided nutritional strategies. A structured literature search of PubMed/MEDLINE, Embase, and Web of Science was conducted from database inception through September 6, 2026, prioritizing English-language clinical guidelines, clinical studies, and mechanistic or translational evidence relevant to PICS, critical illness, nutritional responsiveness, and immunometabolic nutrition. We propose a framework addressing major barriers to recovery through strategies to restore anabolic responsiveness with protein, leucine, and rehabilitation; modulate inflammatory resolution and immune dysfunction with omega-3 fatty acids and arginine; optimize nutrient timing and circadian-metabolic regulation; and maintain a metabolic milieu conducive to nutrient utilization. Because direct interventional evidence in well-defined PICS populations remains limited, these strategies should complement rather than replace guideline-based nutritional support. The framework is conceptual and hypothesis-generating, and prospective PICS-specific studies incorporating biological stratification and clinically meaningful recovery outcomes are needed to determine its translational value.
SN - 1664-3224
ER -