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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

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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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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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