Undernutrition, the acute phase response to infection, and its effects on micronutrient status indicators

Bresnahan, Kara A.; Tanumihardjo, Sherry A.

doi:10.3945/an.114.006361

Cited by 134Child Nutrition and Water AccessIron Metabolism and DisordersTrace Elements in Health

Undernutrition, the acute phase response to infection, and its effects on micronutrient status indicators

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Bresnahan, Kara A., Tanumihardjo, Sherry A.·2014·Advances in Nutrition

DOI 10.3945/an.114.006361PMC PMC4224207

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Abstract

Infection and undernutrition are prevalent in developing countries and demonstrate a synergistic relation. Undernutrition increases infection-related morbidity and mortality. The acute phase response (APR) is an innate, systemic inflammatory reaction to a wide array of disruptions in a host's homeostasis, including infection. Released from immune cells in response to deleterious stimuli, proinflammatory cytokines act on distant tissues to induce behavioral (e.g., anorexia, weakness, and fatigue) and systemic effects of the APR. Cytokines act to increase energy and protein requirements to manifest fever and support hepatic acute phase protein (APP) production. Blood concentrations of glucose and lipid are augmented to provide energy to immune cells in response to cytokines. Additionally, infection decreases intestinal absorption of nutrients and can cause direct loss of micronutrients. Traditional indicators of iron, zinc, and vitamin A status are altered during the APR, leading to inaccurate estimations of deficiency in populations with a high or unknown prevalence of infection. Blood concentrations of APPs can be measured in nutrition interventions to assess the time stage and severity of infection and correct for the APR; however, standardized cutoffs for nutrition applications are needed. Protein-energy malnutrition leads to increased gut permeability to pathogens, abnormal immune cell populations, and impaired APP response. Micronutrient deficiencies cause specific immune impairments that affect both innate and adaptive responses. This review describes the antagonistic interaction between the APR and nutritional status and emphasizes the need for integrated interventions to address undernutrition and to reduce disease burden in developing countries.

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Micronutrient deficiencies cause specific immune impairments that affect both the innate and adaptive immune systems, such as impaired phagocyte and lymphocyte activity with zinc deficiency, or compromised development of neutrophils, macrophages and NK cells with vitamin A deficiency.
“micronutrient deficiencies cause specific immune impairments that affect both the innate and adaptive immune systems, such as impaired phagocyte and lymphocyte activity with zinc deficiency, or compromised development of neutrophils, macrophages and NK cells with vitamin A deficiency [50].”
From Immune function and micronutrient requirements change over the life course (2018) · cites this paper as [50]
Infection can cause a significant increase in the demand for micronutrients, met by endogenous or exogenous (i.e., the diet) supplies.
“In turn, infection can cause a significant increase in the demand for micronutrients, met by endogenous or exogenous (i.e., the diet) supplies [5,50].”
From Immune function and micronutrient requirements change over the life course (2018) · cites this paper as [50]

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twitter sharing button linkedin sharing button facebook sharing button whatsapp sharing button email sharing button print sharing button Xerophthalmia among hospitalized Iraqi children
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Khovidhunkit W, Kim MS, Memon RA, Shigenaga JK, Moser AH, Feingold KR, Grunfeld C. Effects of infection and inflammation on lipid and lipoprotein metabolism: mechanisms and consequences to the host. J Lipid Res 2004;45:1169-96.

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Modulation of Intestinal Immune and Barrier Functions by Vitamin A: Implications for Current Understanding of Malnutrition and Enteric Infections in Children
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Pathologic Inflammation in Malnutrition Is Driven by Proinflammatory Intestinal Microbiota, Large Intestine Barrier Dysfunction, and Translocation of Bacterial Lipopolysaccharide
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Pancreatic Exocrine Insufficiency as a Complication of Gastrointestinal Surgery and the Impact of Pancreatic Enzyme Replacement Therapy
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Assessment of Neurodevelopment, Nutrition, and Inflammation From Fetal Life to Adolescence in Low-Resource Settings
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ERS statement on the multidisciplinary respiratory management of ataxia telangiectasia
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Factors associated with inflammation in preschool children and women of reproductive age: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project
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Relationship between obesity and iron deficiency anemia: is there a role of hepcidin?
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The Potential of Toll-Like Receptors to Modulate Avian Immune System: Exploring the Effects of Genetic Variants and Phytonutrients
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Exocrine pancreatic insufficiency in type 1 and type 2 diabetes mellitus: do we need to treat it? A systematic review
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Toll‐like receptors in pathogenesis of neurodegenerative diseases and their therapeutic potential
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Parameters Influencing Zinc in Experimental Systems in Vivo and in Vitro
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Nutrition, malnutrition, and leishmaniasis
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Recent advancements in anti-leishmanial research: Synthetic strategies and structural activity relationships
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Influence of Malnutrition on the Pharmacokinetics of Drugs Used in the Treatment of Poverty-Related Diseases: A Systematic Review
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Biomarkers of carotenoid bioavailability
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Capromorelin: a ghrelin receptor agonist and novel therapy for stimulation of appetite in dogs
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Dietary Intake of Antioxidant Vitamins and Carotenoids and Risk of Developing Active Tuberculosis in a Prospective Population-Based Cohort Study
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Investigating the role of vitamin D in the prevention and control of dengue virus vectors and related diseases: a systematic review study
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Serum retinol concentrations demonstrate high specificity after correcting for inflammation but questionable sensitivity compared with liver stores calculated from isotope dilution in determining vitamin A deficiency in Thai and Zambian children
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Assessing the Safety of Vitamin A Delivered Through Large-Scale Intervention Programs
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Simultaneous assessment of iodine, iron, vitamin A, malarial antigenemia, and inflammation status biomarkers via a multiplex immunoassay method on a population of pregnant women from Niger
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Essential trace elements and progression and management of HIV infection
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Effective activation of antioxidant system by immune-relevant factors reversely correlates with apoptosis of Eisenia andrei coelomocytes
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Effects of folic acid supplementation on C-reactive protein: A systematic review and meta-analysis of randomized controlled trials
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A Decision Framework for Selecting Critically Important Nutrients from Aquatic Foods
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Differential Levels of Alpha-2-Macroglobulin, Haptoglobin and Sero-Transferrin as Adjunct Markers for TB Diagnosis and Disease Progression in the Malnourished Tribal Population of Melghat, India
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Research, policy, and programmatic considerations from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project
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Vitamin a Fortification Efforts Require Accurate Monitoring of Population Vitamin A Status to Prevent Excessive Intakes
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Vitamins and Minerals in Older Adults
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The correlation between vitamin a status and refractory Mycoplasma Pneumoniae pneumonia (RMPP) incidence in children
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Provitamin A-biofortified maize consumption increases serum xanthophylls and 13 C-natural abundance of retinol in Zambian children
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Nutritional Influences on Immunity and Infection
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Growth and nutrition in children with ataxia telangiectasia
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Micronutrients and many important factors that affect the physiological functions of toll-like receptors
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Pathways Linking Nutritional Status and Infectious Disease: Causal and Conceptual Frameworks
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Comparison of the Clinical Implications among Two Different Nutritional Indices in Hospitalized Patients with COVID-19Preprint
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Differences in maternal and early child nutritional status by offspring sex in lowland Nepal
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Micronutrients, Immunological Parameters, and Dengue Virus Infection in Coastal Ecuador: A Nested Case-Control Study in an Infectious Disease Surveillance Program
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Early Infectious Complications After Total Pancreatectomy with Islet Autotransplantation: a Single Center Experience
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Systematic Review and Meta-Analysis of the Relative Dose-Response Tests to Assess Vitamin A Status
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A qualitative and quantitative analysis of the human gingival crevicular fluid proteome and metaproteome
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Preoperative nutritional evaluation of patients with hepatic alveolar echinococcosis
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Primary Human Cardiomyocytes and Cardiofibroblasts Treated with Sera from Myocarditis Patients Exhibit an Increased Iron Demand and Complex Changes in the Gene Expression
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Guidance for Systematic Integration of Undernutrition in Attributing Cause of Death in Children
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Association of Malnutrition with Subsequent Malaria Parasitemia among Children Younger than Three years in Kenya: A Secondary Data Analysis of the Asembo Bay Cohort Study
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α1-Acid Glycoprotein and Dietary Intake in End-Stage Renal Disease Patients
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Multimicronutrient Biomarkers Are Related to Anemia during Infancy in Indonesia: A Repeated Cross-Sectional Study
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Under-nutrition and its associated factors among under-five children across urban and rural settings of Ethiopia: a cross-sectional comparative study
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From adaptation to exhaustion: defining exposure-related malnutrition as a bioenergetic phenotype of aging
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A retrospective analysis of malnutrition risk, nutritional support and outcomes in COVID-19 patients
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Vitamin D deficiency in dengue fever patients' coinfected with H. pylori in Pakistan. A case-control study
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Adherence to pancreatic enzyme replacement therapy among patients with chronic pancreatitis in East China: a mixed methods study
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Modeling historical tuberculosis epidemics among Canadian First Nations: effects of malnutrition and genetic variation
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Drug-Nutrition Interactions in Infectious Diseases
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13C Natural Abundance of Serum Retinol Is a Novel Biomarker for Evaluating Provitamin A Carotenoid-Biofortified Maize Consumption in Male Mongolian Gerbils
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Evidence Report: Risk Factor of Inadequate Nutrition
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Is Micronutrient Supplementation Helpful in Supporting the Immune System during Prolonged, High-Intensity Physical Training?
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Combating Malnutrition: Nutrient and Energy Composition of Locally Formulated Ready-to-Use Therapeutic Foods for Children
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Toll‐like receptor expression during inflammatory processes in human diseases
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A novel LC-MS/MS method for the simultaneous analysis of selected fat-soluble vitamins in serum obtained from pediatric patients with pneumonia
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Association between infection and nutritional status among infants in a cohort study of vitamin A in western Kenya
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Early Proteome Shift and Serum Bioactivity Precede Diesel Exhaust-induced Impairment of Cardiovascular Recovery in Spontaneously Hypertensive Rats
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Identification and functional characterization of the house finch interleukin-1β
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Association between 25-OH-vitamin D and C-reactive protein as a marker of inflammation and cardiovascular risk in clinical practice
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The early prognostic value of the 1–4-day BCM/PA trend after admission in neurocritical patients
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The relationship between the prognostic nutritional index and the clinical course of COVID-19: a single-center experience
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Circulating microRNAs and hepcidin as predictors of iron homeostasis and anemia among school children: a biochemical and cross-sectional survey analysis
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Sojourn of Nitrogenous Heterocycles as Promising Antileishmanial Agents: Medicinal Perspectives and Structure–Activity Relationship Studies
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Post-surgical exocrine pancreatic insufficiency
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Plasma and urine proteomics and gut microbiota analysis reveal potential factors affecting COVID-19 vaccination response
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Abordaje inmunológico del síndrome por deleción 22q11.2
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Vitamin A Metabolism in the Fetus and Neonate
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Vitamin C Status in Hospitalized Adults According to Subjective Global Assessment Method
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The Neuroimmune Endocrine Network and Emerging Pollutants During Mental Disorders
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Factors associated with recurrent malaria episodes among children under five at Kayunga Regional Referral Hospital in Kayunga District, Central Uganda
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Albumin and Serum Vitamin A Status of Malnourished Children
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A new insight into the immune regulatory functions of vitamin A in children and adolescents
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Vitamin A
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Understanding Undernutrition and Starvation: Epidemiology, Causes, and Consequences
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Role of enzyme replacement therapy for exocrine and nutritional insufficiency in patients with malignancies: A review
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Relationships between undernutrition, infection, and growth and development
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Authors: Bresnahan, K. A., & Tanumihardjo, S. A.
Affiliations: University of Wisconsin–Madison (US)
Corresponding author: Tanumihardjo, Sherry A.
ORCID: Tanumihardjo, Sherry A.
Venue: Advances in Nutrition
Publisher: Elsevier BV
Published: 2014-11
Volume: 5
Issue: 6
Pages: 702-711
ISSN: 2156-5376 (ISSN-L)
2161-8313
DOI: 10.3945/an.114.006361
PMC: PMC4224207
OpenAlex: W2018648438
Cited by: 132
References: 176
Citations by year: 2026: 7 · 2025: 11 · 2024: 12 · 2023: 10 · 2022: 9 · 2021: 13 · 2020: 12 · 2019: 13 · 2018: 12 · 2017: 11 · 2016: 13 · 2015: 9
FWCI: 1.26
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 2644 d)
Locations: Advances in Nutrition (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
Health Sciences › Medicine › Hematology › Iron Metabolism and Disorders
Health Sciences › Nursing › Nutrition and Dietetics › Trace Elements in Health
Keywords: malnutrition, acute phase response, infection, micronutrient status, inflammatory cytokines, acute phase proteins, iron status, zinc status, vitamin A status, protein-energy malnutrition, intestinal permeability, immune dysfunction, micronutrient uptake, anorexia, nutrition interventions, developing countries
MeSH terms: Acute-Phase Reaction, Developing Countries, Humans, Infections, Nutritional Requirements, Nutritional Status, Vitamin A, Vitamin A Deficiency, Zinc, Anemia, Iron-Deficiency, Micronutrients, Iron, Dietary, Malnutrition

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Undernutrition, the acute phase response to infection, and its effects on micronutrient status indicators

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