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Undernutrition, the Acute Phase Response to Infection, and Its Effects on Micronutrient Status Indicators
Open accessAbstract
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 [50].”
From Immune function and micronutrient requirements change over the life course (2018) · cites this paper as [50]
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“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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Metadata
- Authors
- Bresnahan, K. A., & Tanumihardjo, S. A.
- Affiliations
- University of Wisconsin–Madison (US)
- Corresponding author
- 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
- 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
- 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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