How nutritional therapy may affect real clinical outcomes is not readily apparent from a superficial reading of current data. Despite great claims in reducing infectious incidence, many studies show little difference in meaningful clinical outcomes. This has led to confusion over the role of nutrition and nutrition practice in intensive care. However, the role that nutrition plays in preventing infection and later how nutrition aids long-term recovery perhaps explain many of the misconceptions and difficulty in understanding the evidence. Encouraging new evidence is starting to show that outcome can be improved by implementing relatively simple therapies well that have an impact on nutrition and metabolic control.