Indirect calorimetry has been employed to demonstrate that fever and infection result in increased metabolic heat production. This response contributes, with reduced dietary energy intake, to negative energy balance in the infected host and constitutes a metabolic "cost". Clinical and experimental studies concerning quantitative aspects of metabolic heat production during fever are summarized. The possible adaptive value of increased heat production in the context of host defence reactions is discussed. The magnitude of increased heat production varies with the severity and duration of the insult, the nutritional and metabolic status of the host, treatment with various drugs, and the ambient temperature at which the measurements are made. More information about these factors is required to assess the metabolic and nutritional needs of individual patients during a febrile illness and subsequent recovery.