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Immune dysfunction in surgical patients is reviewed. This immunologic impairment is clinically important since these patients are at greatest risk for sepsis and nonsurvival. Although the causes of impairment in immune responsiveness are most certainly multiple, a great deal of evidence suggests that malnutrition plays a major role. The effects of protein-calorie malnutrition on various components of the immune response are discussed, as is the result of careful nutritional intervention.