Mild/Moderate metabolic stress

Severe metabolic stress

• Minor and non‐life threatening infection (e.g. UTI, peritonitis, CVL infection, bronchiolitis, gastroenteritis) • Co‐morbidity or concurrent disease that increases energy demand (e.g. malabsorption or chronic enteropathy, chronic cardiomyopathy, cystic fibrosis, persistent increased respiratory rate, sickle cell anaemia, spastic CP) • Fracture of a short bone • Minor surgery • Excessive physical activity

• Severe trauma • Major surgery • Burns • Severe sepsis/inflammation • Long‐bone fractures • Multi‐organ failure • Chronic illness with acute deterioration (e.g. acute flare of Crohns or ulcerative colitis) • Malignancy • AIDS with a secondary infection • Genetic metabolic disorder • Hyperthyroidism • Severe depression