| Major illness and trauma are often associated with a degree of starvation and they are also characterised by a specific metabolic response to injury, which is an adaptive response known as the acute-phase reaction. It is characterized by a major shift in the hepatic pattern of protein synthesis: proteins, such as C-reactive protein (CRP), α1-antitrypsin, haptoglobin, α1-acid glycoprotein, components of the complement system, and others, are produced at a greater rate (see Chapter 3). The acute phase reaction also results in changes in the plasma concentration of trace elements: for instance, plasma copper concentration increases and zinc concentration decreases (see Chapter 10).
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| Importantly, surgical procedures performed on the GI tract may affects the nutritional status. There might be an impaired nutrient adsorption after removal of segments of the gut, or nutrient losses induced, for instance, by the drainage of intestinal fistulas. Some radical surgery creates the need for long-term nutritional support.
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