By: Arturo Perea Martínez, Internal Medicine-Pediatrics Hospital Nutrition Unit. National Institute of Pediatrics. Lilia Mayrel Santiago Lagunes, Nutritionist. Specialist in Pediatric Clinical Nutrition. Hospital Nutrition Unit. National Institute of Pediatrics. Paul Tadeo Ríos Gallardo, Nutritionist. Hospital Nutrition Unit. National Institute of Pediatrics. María José Pecero Hídalgo, Pediatrician Hospital Nutrition Unit. National Institute of Pediatrics. Sis Eunice Arce Monroy, Nutritionist. Obesity and Non-Communicable Diseases Clinic. National Institute of Pediatrics Aranza Lilián Perea Caballero, Nutritionist. Fundación de investigaciones sociales, A. C.
Introducción
The interaction between nutritional status and systemic immune response has been established for decades. Optimal nutritional status is associated with a better immune response, while conditions that compromise nutritional health contribute to a higher risk of infectious diseases, their clinical course, and prognosis.
Globally, children experience one or more forms of malnutrition that affect their health and development (1 – 3).
The immune system integrates two fundamental response mechanisms: the innate and the adaptive immune responses. Various factors regulate these functions, with adequate nutritional status being crucial for the development, maintenance, and expression of the immune response (4 – 6).
Vitamins and minerals regulate and modulate all stages of the immune response, so a deficiency in one or more of these micronutrients can affect both, favoring a state of greater vulnerability of the host to infections of any type (7 – 9).
The immune system and its association with nutritional status.
Children with undernutrition have an increased risk of dying from infectious diseases. Undernutrition has been considered the underlying cause of 45% of child deaths; that is, it is estimated to be a direct or indirect factor in just over 3 million deaths of children under 5 years of age.
Immune deficiency associated with malnutrition leads to (10):
a. Impaired intestinal barrier function
b. Reduced exocrine secretion of protective substances
c. Low levels of plasma complement
d. Structural changes in lymphatic tissue
e. Retarded delayed-type hypersensitivity responses
f. Reduced levels of antibodies produced after vaccination
g. Cytokine patterns skewed toward a Th2 response
Immunizations are considered the most effective public health intervention strategy for containing morbidity and mortality from infectious causes (10). The humoral and cellular immune response achieved with immunizations has an individual profile that is determined, among other things, by the following factors:
a. Host. Age, sex, genetics, and the presence of any acute or chronic condition.
b. Vaccine. Vaccine-related factors include type, schedule, dose, adjuvants, route of administration, and quality of the biological product.
c. Perinatal stage. The pregnant woman’s biological and nutritional status, gestational age, birth weight, breastfeeding, and maternal immunity.
d. Microbiological regulation. Pre-existing immunity, microbiota, infections, and antimicrobial use.
e. Habits. Alcohol or tobacco consumption, stress, physical exercise, and sleep quality.
f. Environment and culture. Seasonality, geography, and family size.
g. Nutrition. The influence of nutritional status on immunity and response to vaccination is mediated by factors such as body mass index (BMI), nutritional status, and micronutrient intake (zinc, vitamins A, D, E, and C).
Impact of nutritional status on vaccine-induced immunity
Undernutrition
The type and severity of undernutrition affect various immunological pathways. Protein-energy malnutrition affects both innate and adaptive immunity by reducing lymphocyte proliferation, impairing T-cell function, and decreasing the production of specific antibodies and the memory response.
Deficiencies in vitamin A, zinc, and iron further impair host immunity by altering mucosal integrity, modifying cytokine production, and reducing the synthesis of neutralizing antibodies.
Therefore, vaccines against poliomyelitis, measles, and rotavirus exhibit reduced immunogenicity and lower seroconversion rates in children with these nutritional conditions (11-15).
Seroconversion rates for oral polio vaccine (OPV) in undernutrition (undernutrition) children versus well-nourished children (14).
Other studies have shown that malnourished children have lower antibody responses to the hepatitis B, MPVS, measles, polio, pertussis, salmonella and tetanus vaccines (16-19).
Micronutrients
In a prospective study of 300 infants aged 6 months to 5 years, the effect of micronutrient supplementation prior to immunization with various vaccines was evaluated. Serum levels of vitamin A, zinc, vitamin D, and iron were measured before and after supplementation. Antibody titers against the DTP, MMR, hepatitis B, and pneumococcal vaccines were assessed by ELISA before and between 4 and 6 weeks after vaccination. The results showed that children in the intervention group exhibited significantly greater improvements in serum micronutrient levels and increased seroconversion rates for all vaccines studied (DTP: 90% vs. 77%; MMR: 91% vs. 72%; Hepatitis B: 95% vs. 79%; Pneumococcal: 88% vs. 71%; p < 0.01). Mean antibody titers after vaccination were between 30% and 40% higher in the intervention group. Regression analysis confirmed that vitamin A and zinc are strong positive predictors of vaccine response (20).
Studies in children have not found any association between vitamin D levels or supplementation with antibody responses to the trivalent influenza vaccine; however, they do show a tendency towards a decrease in antibody responses following administration of the measles, mumps, and rubella vaccine.
Supplementation with vitamins A and D results in more intense tuberculin skin reactions and a lower interferon response following BCG vaccination.
Vitamin A administered concurrently with the measles vaccine at 6 months of age leads to a decrease in the seroconversion rate only in infants with maternal antibodies (21-47).
Overweight and Obesity
Numerous studies in adults demonstrate that an increase in BMI is inversely correlated with antibody responses to hepatitis A and hepatitis B vaccination (47). Following vaccination with the trivalent influenza vaccine, initially, an increase in BMI correlated with greater antibody responses. However, twelve months after vaccination, a higher BMI was associated with a lower antibody response, and obese individuals also showed fewer specific CD8 T cells and less interferon-gamma production (47).
Conclusions
The immune response is influenced by various external and internal factors.
Nutrition is one of the most important regulatory factors of the immune system and its functions.
Integrating nutritional assessment and support into immunization programs could improve outcomes in resource-limited settings and strengthen herd immunity.
Micronutrient supplementation and improved nutrition significantly increase the immunogenicity of vaccines in early childhood.
References
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