Pathophysiology-guided nutritional strategies for persistent inflammation, immunosuppression, and catabolism syndrome: an immunometabolic perspective
Year: 2026
Type: review
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.
Source: Frontiers in Immunology
Authors: Zhiyang Wu, Bo Yao
Institutions: Shandong University, Qilu Hospital of Shandong University
Language: English
Subfield: Nutrition and Dietetics
Field: Nursing
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7223066924