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Morales F, Montserrat-de la Paz S, Leon MJ, Rivero-Pino F. Effects of Malnutrition on the Immune System and Infection and the Role of Nutritional Strategies Regarding Improvements in Children's Health Status: A Literature Review. Nutrients 2023; 16:1. [PMID: 38201831 PMCID: PMC10780435 DOI: 10.3390/nu16010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/15/2023] [Accepted: 12/17/2023] [Indexed: 01/12/2024] Open
Abstract
Malnutrition refers to a person's status as under- or overnourished, and it is usually associated with an inflammation status, which can subsequently imply a different health status, as the risk of infection is increased, along with a deterioration of the immune system. Children's immune systems are generally more susceptible to problems than adults. In the situation of malnutrition, because malnourished children's immune systems are compromised, they are more likely to die. However, little is known about the underlying mechanism of altered immune functioning and how it relates to starvation. Nutritional interventions have been reported as cost-effective strategies to prevent or treat the development of malnourishment, considering the link between food intake and health, especially in children, and also the susceptibility of this population to diseases and how their health status during childhood might affect their long-term physiological growth. The ingestion of specific nutrients (e.g., vitamins or oligoelements) has been reported to contribute to the proper functioning of children's immune systems. In this review, we aim to describe the basis of malnutrition and how this is linked to the immune system, considering the role of nutrients in the modulation of the immune system and the risk of infection that can occur in these situations in children, as well as to identify nutritional interventions to improve their health.
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Affiliation(s)
- Fátima Morales
- Department of Preventive Medicine and Public Health, School of Medicine, University of Seville, 41009 Sevilla, Spain;
- Sbarro Institute for Cancer Research and Molecular Medicine, Center of Biotechnology, College of Science and Technology, Temple University, Philadelphia, PA 19122, USA
| | - Sergio Montserrat-de la Paz
- Department of Medical Biochemistry, Molecular Biology, and Immunology, School of Medicine, University of Seville, Av. Sanchez Pizjuan s/n, 41009 Seville, Spain
- Instituto de Biomedicina de Sevilla, IBiS, Hospital Universitario Virgen del Rocío, CSIC, University of Seville, 41013 Seville, Spain
| | - Maria J. Leon
- Department of Microbiology and Parasitology, School of Pharmacy, University of Seville, C. Profesor Garcia Gonzalez 2, 41012 Seville, Spain;
| | - Fernando Rivero-Pino
- Department of Medical Biochemistry, Molecular Biology, and Immunology, School of Medicine, University of Seville, Av. Sanchez Pizjuan s/n, 41009 Seville, Spain
- Instituto de Biomedicina de Sevilla, IBiS, Hospital Universitario Virgen del Rocío, CSIC, University of Seville, 41013 Seville, Spain
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Mutsaerts EA, Nunes MC, van Rijswijk MN, Klipstein-Grobusch K, Grobbee DE, Madhi SA. Safety and Immunogenicity of Measles Vaccination in HIV-Infected and HIV-Exposed Uninfected Children: A Systematic Review and Meta-Analysis. EClinicalMedicine 2018; 1:28-42. [PMID: 31193646 PMCID: PMC6537570 DOI: 10.1016/j.eclinm.2018.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 06/08/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND HIV-infected and HIV-exposed uninfected (HEU) children have an increased risk of measles that may be due to altered immune responses or suboptimal timing of measles vaccination. We aimed to evaluate the safety and immunogenicity of measles vaccination in HIV-infected and HEU children. METHODS For this systematic review and meta-analysis, we searched PubMed, Embase, Cochrane Library, CINAHL, Global Health Library and IndMED on May 9, 2018. Studies were included if they reported on safety or seroresponse (either seroprotection/seropositivity/seroconversion) after measles vaccination in HIV-infected or HEU children. We calculated pooled estimates to compare immunogenicity outcomes between HIV-infected, HEU and HIV-unexposed children, using risk ratios [RRs] (with 95%CIs). PROSPERO registration number: CRD42017057411. FINDINGS Seventy-one studies met the inclusion criteria (15,363 children). Twenty-eight studies reported on safety; vaccine-associated adverse events and deaths were uncommon. Sixty-two studies reported on immunogenicity, 27 were included in the meta-analysis. HIV-infected children had lower seroresponse rates after primary vaccination compared with HIV-unexposed (RR 0.74; 95%CI: 0.61-0.90, I 2 = 85.9%) and HEU children (0.78; 0.69-0.88, I 2 = 77.1%), which was mitigated by antiretroviral therapy and time interval between vaccination and serology. HEU and HIV-unexposed children had similar seroresponses. Vaccination at 6-months resulted in similar proportions of HIV-infected children having seroresponse compared with HIV-unexposed (0.96; 0.77-1.19) and HEU children (1.00; 0.73-1.37, I 2 = 63.7%). INTERPRETATION Primary measles vaccination at 6-months of age may provide protection against measles during early infancy in settings with high prevalence of maternal HIV-infection, however, further studies are needed to evaluate this strategy in HEU children and HIV-infected children receiving antiretroviral therapy. FUNDING South African Research Chairs Initiative of the Department of Science and Technology and National Research Foundation in Vaccine Preventable Diseases; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit.
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Affiliation(s)
- Eleonora A.M.L. Mutsaerts
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Marta C. Nunes
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Martijn N. van Rijswijk
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Kerstin Klipstein-Grobusch
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Diederick E. Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Clinical Epidemiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Shabir A. Madhi
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Jallow S, Cutland CL, Masbou AK, Adrian P, Madhi SA. Maternal HIV infection associated with reduced transplacental transfer of measles antibodies and increased susceptibility to disease. J Clin Virol 2017; 94:50-56. [PMID: 28759772 DOI: 10.1016/j.jcv.2017.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 06/08/2017] [Accepted: 07/16/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Transplacental transfer of measles antibodies from mother to fetus is important in protecting against measles during early infancy. Changes in population immunity against measles in adults, including waning of immunity among HIV-infected pregnant women, could affect passive immunity acquired in utero by newborns. OBJECTIVES To evaluate the effect of maternal HIV infection on transplacental transfer of measles antibody in mother-newborn dyads in a setting of high maternal HIV prevalence. STUDY DESIGN Serum at birth was obtained from 303 mother-newborn dyads, including 196 HIV-infected and 107 HIV-uninfected women, and tested for measles IgG antibodies by ELISA. Seronegativity was defined as antibody levels <150mIU/ml and seroprotective titers as ≥330mIU/ml. RESULTS HIV-infected and -uninfected women had similar measles antibody titers, however, cord-blood titers were lower among HIV-exposed (788.06mIU/ml) compared to HIV- unexposed newborns (1306.6mIU/ml; p≤0.001), due to lower transplacental antibody transfer ratio in HIV-exposed (0.63) than in HIV-unexposed newborns (0.97; p≤0.001). Maternal age <25years of age was associated with lower antibody titers and lower percentage with seroprotective titer, as well as less likelihood of their newborns having seroprotective titers (70.2% vs. 86.5%; p=0.001). CONCLUSIONS Lower levels of measles antibody in HIV-exposed newborns and in younger women <25years old, increases the susceptibility of their newborns to developing measles. This suggest a need to re-evaluate measles immunization of women of child bearing age and the timing of measles vaccination among infants in settings with a high prevalence of maternal HIV-infection.
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Affiliation(s)
- Sabelle Jallow
- Respiratory and Meningeal Pathogens Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Centre for Vaccines and Immunology, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.
| | - Clare L Cutland
- Respiratory and Meningeal Pathogens Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | | | - Peter Adrian
- Respiratory and Meningeal Pathogens Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Shabir A Madhi
- Respiratory and Meningeal Pathogens Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Centre for Vaccines and Immunology, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
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