Malnutrition, including protein-energy and micronutrient deficiencies, continues to be a major public health problem, particularly in developing countries. It affects also the rapidly growing elderly population in high-income countries (1, 2). Nutritional status can have a profound impact on the immune system (3) as documented by some studies (2-4). These alterations in host immunity may make patients more susceptible to postoperative infections and malnutrition was reported as a threat to surgical outcome, such as delayed recovery, higher rates of morbidity and mortality, prolonged hospital stay, increased health care costs and a higher early readmission rate (2-7). Some studies showed that early nutritional support can improve the outcome following major surgery and decrease the incidence of infectious complications in selected malnourished or severely injured patients. The hypothesis is that the immune system may be modulated by the use of specific types of nutritional support. Given the role of nutrition in the host response to surgery, many researchers believe that nutritional interventions would reduce SSI and the related morbidity. However, an epidemiological association between incisional SSI and malnutrition has been difficult to demonstrate consistently for all surgical subspecialties. There is very little consensus on the optimal timing and dosage of multiple nutrient-enhanced nutrition, especially
