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

Indian perspective on childhood malnutrition: Prevalence, pathophysiology, risk factors, and prevention

BACKGROUND

Childhood malnutrition contributes over half of the childhood mortality around the world, predominantly in South-Asian and sub-Saharan countries.

AIM

To summarize the childhood malnutrition epidemiology along with the comorbid factors associated with it and its management within the community.

METHODS

The data collection process involved conducting a comprehensive search using specific keywords such as child nutrition disorders and India with Boolean operators. The search was conducted in the Scopus and PubMed electronic databases.

RESULTS

Inadequate energy consumption initiates pathological alterations in the form of growth retardation, fat, visceral, and muscle loss, a reduction in basal metabolic rate, and a significant reduction in total energy expenditure. It has become evident that malnutrition shows an increased prevalence and incidence rate, despite available guidelines for the management of malnutrition.

CONCLUSION

Malnutrition can be a major player in the establishment of severe infections that result in significant post discharge mortalities in children. Future trials are required to fill the prime gaps in knowledge regarding the identification of other contributory factors in the pathogenesis of malnutrition and post-discharge infection. New biomarkers for early detection of malnutrition should be the priority of the scientific community for the early management of malnutrition.

Pattern of intestinal parasitic infections in children with malnutrition in Somalia

Objectives

Children living in conflict zones plagued with adverse climatic conditions often suffer from acute malnutrition. Being coinfected with intestinal parasites could worsen the prognosis if adequate interventions are not promptly instituted. We determined the pattern of intestinal parasitic infections (IPIs) in children with acute malnutrition in the Bay and Banadir regions of Somalia.

Methods

A hospital-based cross-sectional study was conducted from August to October 2023 in 222 children with acute malnutrition aged 6-59 months, using a structured questionnaire and stool examination by a trained laboratorian. The prevalence of IPI was estimated and the pattern of IPI was explored. The relationship between the presence of IPI and demographic characteristics was examined with multiple logistic regression at a 95% level of confidence.

Results

The mean age was 20.4 ± 12.3 months, 125 (56.3%) were females, and 41.9% were internally displaced. The prevalence of IPI was 82.9% (95% confidence interval: 77.4-87.3), Of the infected, 73.9% (136 of 184) had single parasitic infection and 23.4% (43 of 184) had double parasitic infections. Ascaris lumbricoides (46.6%), Giardia lamblia (22.1%), and Entamoeba histolytica (17.6%) were the most common parasites identified. The age of 13-36 months (adjusted odds ratio: 1.13, P = 0.02) and eating once a day (adjusted odds ratio: 1.13, P = 0.06) were associated with being infected with intestinal parasites.

Conclusions

The prevalence of intestinal parasitic infection was high in children with malnutrition in the Bay and Banadir regions. Deworming should be extended to all children with malnutrition. Food, sanitation, and water provision initiatives should be improved at the community level.

Percutaneous endoscopic gastrostomy helped to normalise feeding problems and gastrointestinal symptoms in Silver-Russell syndrome

AIM

This study evaluated feeding problems and gastrointestinal symptoms in children with Silver-Russell syndrome (SRS), which is a rare epigenetic disorder. It also compared the symptoms experienced during different feeding methods, including percutaneous endoscopic gastrostomy (PEG).

METHODS

The national expert team for children with SRS at Queen Silvia Children's Hospital, Gothenburg, studied 46 referrals (63% male) who were born with SRS in Sweden from 1984 to 2018. Patient data were extracted from the Paediatric National Growth Hormone Registry.

RESULTS

The medical records covered a median of 68% of the time of the patients' childhood, with a median follow-up of 9 years. Their symptoms were most prevalent during infancy and decreased when they were toddlers. Feeding problems and gastrointestinal symptoms were reported in 91% of the 46 patients, with vomiting in 57% and constipation in 46%. There were 19 children who relied on enteral feeding for their nutrition and 13 of those received PEG. Their body mass index (BMI) increased significantly 2 years after PEG started (p = 0.005).

CONCLUSION

Feeding problems and gastrointestinal symptoms were very common in children with SRS, but partly disappeared during childhood. Providing treatment, such as PEG, normalised the BMIs of children with SRS and reduced their symptoms.

Novelties on Neuroinflammation in Alzheimer's Disease-Focus on Gut and Oral Microbiota Involvement

Recent studies underscore the role of gut and oral microbiota in influencing neuroinflammation through the microbiota-gut-brain axis, including in Alzheimer's disease (AD). This review aims to provide a comprehensive synthesis of recent findings on the involvement of gut and oral microbiota in the neuroinflammatory processes associated with AD, emphasizing novel insights and therapeutic implications. This review reveals that dysbiosis in AD patients' gut and oral microbiota is linked to heightened peripheral and central inflammatory responses. Specific bacterial taxa, such as Bacteroides and Firmicutes in the gut, as well as Porphyromonas gingivalis in the oral cavity, are notably altered in AD, leading to significant changes in microglial activation and cytokine production. Gut microbiota alterations are associated with increased intestinal permeability, facilitating the translocation of endotoxins like lipopolysaccharides (LPS) into the bloodstream and exacerbating neuroinflammation by activating the brain's toll-like receptor 4 (TLR4) pathways. Furthermore, microbiota-derived metabolites, including short-chain fatty acids (SCFAs) and amyloid peptides, can cross the blood-brain barrier and modulate neuroinflammatory responses. While microbial amyloids may contribute to amyloid-beta aggregation in the brain, certain SCFAs like butyrate exhibit anti-inflammatory properties, suggesting a potential therapeutic avenue to mitigate neuroinflammation. This review not only highlights the critical role of microbiota in AD pathology but also offers a ray of hope by suggesting that modulating gut and oral microbiota could represent a novel therapeutic strategy for reducing neuroinflammation and slowing disease progression.

Localized Pneumocystis jirovecii pneumonia in a malnourished, non-HIV-infected man in the absence of any established or diagnosed immunosuppressive condition: a case report

BACKGROUND

Pneumocystis jirovecii infection is an opportunistic infection that mostly affects patients with immunosuppressive conditions like human immunodeficiency virus (HIV) infection or medications, like corticosteroids. This study reports a rare case of Pneumocystis Jiroveci infection in a relatively immunocompetent patient which presented with uncommon radiological findings.

CASE PRESENTATION

A 46-year-old man with a malnourished appearance and a history of opium dependence presented with dry cough, dyspnea, and weight loss to the hospital. There was no evidence of an immunocompromised condition or use of any immunosuppressive medication in the history of the patient. A lung high-resolution computed tomography (HRCT) scan revealed a crazy-paving appearance and localized infiltration. Methenamine silver staining and the histopathological findings in the transbronchial lung biopsy confirmed the diagnosis of PJP. Antibiotics and bronchodilators were administrated and the patient was discharged after 6 days of hospitalization. HIV testing and immunoglobulin levels were normal in the hospital course as well as his follow-up visits. After a 2-month follow-up, the patient was in good condition despite of mild remaining infiltration in his lung.

CONCLUSIONS

PJP typically affects HIV-infected patients, but due to excessive use of immunosuppressive medications, its prevalence is increasing in non-HIV-infected patients. Malnutrition may predispose the patients to PJP, even in the absence of immunosuppressive conditions.

The Climate Change Burden on Immune Health: Are Persons Living with HIV More at Risk?

Climate change poses one of the most significant modern threats to overall human health,especially for vulnerable populations including persons living with HIV (PLWH). In this perspective, we specifically explore the concept of immune resilience in human health and how climate change phenomena - including extreme weather events, food insecurity, pollution, and emerging diseases - may exacerbate immune dysfunction and comorbidities faced by PLWH and hinder access to HIV treatment and prevention services. Multidisciplinary, collaborative efforts are urgently needed to quantify these impacts, develop mitigation strategies, and strengthen policies and funding to bolster immune resilience for PLWH in the face of accelerating climate change.

Double burden of malnutrition among women and children in Zimbabwe: a pooled logistic regression and Oaxaca-Blinder decomposition analysis

Background

The double burden of malnutrition (DBM) is a public health issue characterised by the coexistence of undernutrition and overnutrition within the same population, household, or individual. Undernutrition, manifesting as stunting, wasting, or being underweight, results from insufficient nutrient intake while overnutrition, manifesting as overweight or obesity, results from excessive caloric intake, poor diet quality, and sedentary lifestyles. This dual burden poses significant challenges for health systems due to lost productivity and increased healthcare expenditure.

Methods

This study utilised data from the Demographic and Health Surveys (DHS) conducted in Zimbabwe for 2010-2011 and 2015, which provided information on women's and children's health and nutritional status, household characteristics, and socio-economic status. Pooled logistic regression was used to analyse the association between various sociodemographic factors and DBM among women and children. The Oaxaca-Blinder decomposition method explored differences in DBM between 2010-2011 and 2015.

Results

The average age of mothers was approximately 31 years, and children's ages averaged around 32 months. From 2010 to 2015, there was a notable socio-economic improvement, with a decrease in the percentage of mothers in the poorest quartile from 20 to 16% and an increase in the richest quartile from 22 to 23%. The study found a slight decrease in overall household DBM among women from 34% in 2010 to 32% in 2015, while DBM among children increased from 12 to 14%. Pooled logistic regression analysis indicated that children in rural areas had statistically significantly higher odds of experiencing DBM than their urban counterparts. The Oaxaca-Blinder decomposition showed that changes in residence status significantly impacted the increase in DBM among children. At the same time, the coefficient effect accounted for most of the unexplained differences in DBM among women.

Conclusion

The growing DBM among women and children in Zimbabwe is significantly influenced by changes in residence status. The findings highlight the need for targeted public health interventions to address urban-rural disparities and emphasise the importance of considering socio-economic, environmental, and behavioural factors. Context-specific public health strategies, aligned with WHO's Double Duty Actions, are essential to improve the nutritional health of Zimbabwe's population.

Zinc Deficiency and Zinc Supplementation in Allergic Diseases

In recent decades, it has become clear that allergic diseases are on the rise in both Western and developing countries. The exact reason for the increase in prevalence has not been conclusively clarified yet. Multidimensional approaches are suspected in which diet and nutrition seem to play a particularly important role. Allergic diseases are characterized by a hyper-reactive immune system to usually harmless allergens, leading to chronic inflammatory diseases comprising respiratory diseases like asthma and allergic rhinitis (AR), allergic skin diseases like atopic dermatitis (AD), and food allergies. There is evidence that diet can have a positive or negative influence on both the development and severity of allergic diseases. In particular, the intake of the essential trace element zinc plays a very important role in modulating the immune response, which was first demonstrated around 60 years ago. The most prevalent type I allergies are mainly based on altered immunoglobulin (Ig)E and T helper (Th)2 cytokine production, leading to type 2 inflammation. This immune status can also be observed during zinc deficiency and can be positively influenced by zinc supplementation. The underlying immunological mechanisms are very complex and multidimensional. Since zinc supplements vary in dose and bioavailability, and clinical trials often differ in design and structure, different results can be observed. Therefore, different results are not surprising. However, the current literature suggests a link between zinc deficiency and the development of allergies, and shows positive effects of zinc supplementation on modulating the immune system and reducing allergic symptoms, which are discussed in more detail in this review.

Nutritional and Inflammatory Markers Associated with SARS-CoV-2 Infection in the Elderly

The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has posed unprecedented challenges to global health systems, particularly among vulnerable populations such as the elderly. Understanding the interplay between anthropometric markers, molecular profiles, and disease severity is crucial for effective clinical management and intervention strategies. We conducted a cohort study comprising 43 elderly COVID-19 patients admitted to São Lucas Hospital, PUCRS, Brazil. Anthropometric measurements, including calf circumference (CC) and abdominal circumference (AC), were assessed alongside molecular analyses of peripheral blood samples obtained within 48 h of hospital admission. Sociodemographic data were collected from electronic medical records for comprehensive analysis. Our findings revealed a possible relationship between overweight status, increased abdominal adiposity, and prolonged hospitalization duration, alongside heightened disease severity. We also found no significant correlations between BMI, vitamin D levels, and clinical outcomes. Elevated oxygen requirements were observed in both normal and overweight individuals, with the latter necessitating prolonged oxygen therapy. Molecular analyses revealed changes in the inflammatory profile regarding the outcome of the patients. Our study highlights the critical importance of both anthropometric and molecular markers in predicting disease severity and clinical outcomes in elderly individuals with COVID-19.

Immunological Insights Into Nutritional Deficiency Disorders

Essential nutrients play a vital role in influencing immune cell development. This chapter explores the crucial relationship between nutrition and the immune system, delving into the profound impact of dietary choices on overall health. Research highlights the benefits of nutrient-rich foods in supporting optimal immune function, while deficiencies in key nutrients (vitamins A, D, zinc, and iron) compromise immune responses, increasing susceptibility to infections. The bidirectional nature of the relationship is emphasized, underscoring the critical role of a balanced diet in supporting immune cell development, activation, and function. Case studies illustrate immunological vulnerabilities linked to inadequate nutritional status, stressing the importance of maintaining optimal nutrient levels for a robust immune system. In summary, an individual's nutritional status significantly influences immune response effectiveness. Addressing deficiencies through supplementation, dietary interventions, and public health initiatives is crucial for improving immune function.

Predictive significance of systemic immune-inflammation index combined with prealbumin for postoperative pneumonia following lung resection surgery

BACKGROUND

We aimed to determine whether systemic immune-inflammation index (SII) combined with prealbumin can provide better predictive power for postoperative pneumonia in patients undergoing lung resection surgery.

METHODS

We identified eligible patients undergoing lung resection surgery at the Affiliated Hospital of Nantong University from March 2021 to March 2022. Demographic characteristics, clinical data, and laboratory information were collected and reviewed from the electronic medical records of the patients. To test the effect of the combined detection of SII and prealbumin, we made an equation using logistic regression analysis. The receiver operating characteristic curve (ROC) was plotted to evaluate the predictive powers, sensitivity, and specificity of prealbumin, SII, and SII combined with prealbumin. Decision curve analysis (DCA) was used to determine the clinical validity and net benefit of different methods of detection.

RESULTS

Totally 386 eligible patients were included with a median age of 62.0 years (IQR: 55.0, 68.0), and 57 (14.8%) patients presented with postoperative pneumonia within 7 days after surgery. The multivariate regression analysis showed that preoperative SII as continuous variable was associated with an increased risk of postoperative pneumonia (OR: 1.38, 95% CI: 1.19-2.83, P = 0.011), whereas the prealbumin as continuous variable remained as an independent protective predictor of postoperative pneumonia in the adjusted analysis (OR: 0.80, 95% CI: 0.37-0.89, P = 0.023). Compared to SII or prealbumin, the combined detection of preoperative SII and prealbumin showed a higher predictive power with area under curve of 0.79 (95% CI: 0.71-0.86, P < 0.05 for all). Additionally, DCA indicated that the combined detection was superior over preoperative SII or prealbumin alone in clinical validity and net benefit.

CONCLUSION

Both preoperative SII and prealbumin are independent influencing factors for postoperative pneumonia after lung resection surgery. The combined detection of preoperative SII and prealbumin can significantly improve prediction capability to identify potential postoperative pneumonia-susceptible patients, facilitating early interventions to improve postoperative quality of life for surgical lung resection patients.

Malnutrition and Its Influence on Sepsis Outcomes in Elderly Patients

BACKGROUND

Malnutrition is common among the elderly and has significant implications for hospitalization outcomes. This is particularly true for severe illnesses such as sepsis, given age-related physiological changes and comorbidities.

OBJECTIVE

This study examined how malnutrition affected hospitalization outcomes in older adults admitted for sepsis.

MATERIALS & METHODS

 A prospective cohort study was conducted at Lady Reading Hospital in Peshawar, Pakistan, from January to December 2023, focusing on 390 sepsis patients aged 55 years and older. Data on clinical history, length of stay, mortality rates, comorbidities, and nutritional assessments were collected using standardized forms. After controlling for confounding variables, statistical analysis using SPSS version 23 (IBM Corp., Armonk, NY) examined the relationship between hospitalization outcomes and nutritional status.

RESULTS

The research included 390 elderly sepsis patients and showed significant variations in the demographics, comorbidities, and severity of disease between the well-nourished and malnourished groups. Malnourished patients had higher rates of ICU admission (52.82% vs. 29.23%), mechanical ventilation (45.13% vs. 16.41%), mortality (27.18% vs. 14.87%), and 30-day readmission (28.21% vs. 12.82%) as compared to the well-nourished group. They also had longer hospital stays (18.1 days vs. 12.6 days). Malnutrition significantly influenced outcomes, with multivariate analysis indicating it as a predictor of longer stays (β = 2.8, p < 0.001) and increased mortality risk (OR = 3.2, 95% CI: 1.9-5.4, p < 0.001).

CONCLUSION

Malnutrition significantly worsens outcomes for elderly sepsis patients, increasing ICU admissions, ventilation needs, mortality rates, and readmissions, emphasizing the need for proactive nutritional interventions.

Knowledge and practices of traditional management of child malnutrition and associated pathologies in Benin

BACKGROUND

Child malnutrition is a major public health challenge, affecting millions of children worldwide, with alarming proportions of children under five in Benin. The complexity of managing this condition is increased by its potential association with opportunistic pathologies. An interesting approach arises from the use of medicinal plants, to address child malnutrition and its associated pathologies. This study aimed to document the knowledge and practices of Beninese mothers and traditional practitioners with regard to the use of medicinal plants to treat child malnutrition and associated diseases.

METHODS

A total of 844 Beninese mothers and 201 traditional healers were surveyed between March 2022 and August 2023 in the communes of Karimama, Bopa and Za-Kpota in Benin. The respondents' knowledge of child malnutrition and associated pathologies was explored. The ethnobotanical data collected from the subjects concerned the medicinal recipes used to treat child malnutrition, the medicinal plants that make them up and the methods of use. These data were analyzed using ethnobotanical indices such as the Informant Consensus Factor, the frequency of citation of medicinal recipes types and medicinal plants, and the contribution of plants to medicinal recipes.

RESULTS

All respondents cited a total of 82 plant species used to treat child malnutrition and associated diseases. These plants were grouped into 37 botanical families, the most common of which were Fabaceae, Malvaceae and Annonaceae. The leaves were the most commonly used part of the plant species identified. The mothers shared 122 medicinal recipes, ranging from recipes based on a single plant to more complex compositions involving five plants. The most notable plants were Moringa oleifera Lam, Phyllanthus amarus Schumach & Thonn, Senna siamea (Lam.) H.S.Irwin & Barneby, Carica papaya L. and Ocimum gratissimum L. Traditional healers provided 52 plants in 71 recipes, with Moringa oleifera featuring prominently in both single-plant and multiplant formulations.

CONCLUSION

This study made it possible to constitute a rich base of medicinal recipes used against malnutrition and associated pathologies, with the preponderant involvement of certain plant species. It is therefore necessary to deepen research on these different identified species in order to scientifically assess their potential.

Impact of Body Mass Index on All-Cause Mortality in Adults: A Systematic Review and Meta-Analysis

Background: Obesity is a risk factor for many diseases, diagnosed by calculating body mass index (BMI). Methods: To find an association between BMI and mortality in adults, we searched PubMed for articles published in the 21st century. Our review included 82 original studies, comprising 2.7 million patients and 23.4 million patient years. Results: The meta-analysis showed a U-shaped relationship between BMI and all-cause mortality risk, with the lowest mortality in the BMI range of 25-30 kg/m2. Subgroup analysis showed a J-shaped relationship, with greater risk in the highest BMI range (>35 kg/m2). Among the elderly, BMI values <20 kg/m2 were associated with the highest risk. Among diabetic patients, a U-shaped relationship was noticed, again with the highest risk in the lowest (<20 kg/m2) and highest BMI range (>35 kg/m2). Among patients with cardiovascular disease, the risk increased with BMI values <25 kg/m2 but did not noticeably change for BMI exceeding that value. Among cancer patients, the relationship was less pronounced than in other subgroups, with a slightly higher risk (>35 kg/m2). Conclusions: Our results show that the lowest mortality is observed among patients with BMI 25-30 kg/m2. Reduction of body mass should not be a universal recommendation in clinical practice, but it should be individualized.