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The Effect of Nutrition in Healthy and Unhealthy Immune System

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutritional Immunology".

Deadline for manuscript submissions: closed (28 February 2023) | Viewed by 29798

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Prof. Dr. Dimitrios P. Bogdanos

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Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece
Interests: autoimmunity; autoimmune diseases; diet; immunosupression; immunoregulation; microbiome; nutrition; rheumatic diseases
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Nutrition plays an important role in the homeostasis of the immune system. A healthy diet participates in the fine balance of pro-inflammatory and anti-inflammatory mediators and immune cells and assists efforts of the immune system to fight infections, while at the same time protecting our organism from developing deleterious autoimmune, chronic inflammatory disorders or cancerous diseases. This fine balance between abnormal, destructive immune responses and normal, beneficial immunity is largely dependent by nutrients, diet habits, diet supplements and micronutrients, and nutraceuticals. This is widely evident in countries which have adopted the westernized type of diet, which largely affects the immune system of the affected individuals leading to a variety of diseases. On the other hand, a balanced, healthy diet restores the ability of the immune system to fight pathogens, exerts beneficial effects on intestinal microbiome-related immunity, and protects us from the induction of autoimmunity and cancer.

This Special Issue will tackle (but will not be limited to) the following topics:

All aspects related to the role, direct or indirect, of nutrition in the homeostasis of the immune system;
Clinical trials or interventional studies in healthy individuals under diets, diet supplements or diet components reporting on their effect on the immune system;
Microbiome or microbiota studies reporting on the effect on the immune system in humans and experimental models;
Studies on the changes in mediators, cytokines, chemokines, cell populations related to the immune system following nutritional interventions;
The direct and indirect effects of diet habits in the shaping of the immune system in healthy individuals and patients with inflammatory or chronic diseases;
Metanalyses and systematic reviews investigating the role of diet or nutrients in immune system homeostasis such as levels of inflammation markers, etc.;
Effect of diet in animal models of healthy animals or animal models of diseases;
Studies investigating the interplay between immune system and other systems of various specialties (neurology, endocrinology, renal, liver, gastroenterology, hematology, oncology, surgery, etc.);
Studies investigating the role of diet in inflammation and immune mediated inflammation in a state of health or a disease;
In vitro, in vivo and ex vivo studies of any kind thoroughly discussing any aspect of nutrition and immunity.

Prof. Dr. Dimitrios P. Bogdanos
Guest Editor

Manuscript Submission Information

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Keywords

autoimmunity
immunonutrition
diet and immunity
immunoregulation
microbiome
autoimmune diseases
impact of diet and fasting on the immune system

Published Papers (11 papers)

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Research

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20 pages, 1230 KiB

Open AccessArticle

Diet Quality and Nutritional Risk Based on the FIGO Nutrition Checklist among Greek Pregnant Women: A Cross-Sectional Routine Antenatal Care Study

by Maria G. Grammatikopoulou, Meletios P. Nigdelis, Anna-Bettina Haidich, Maria Kyrezi, Helga Ntine, Maria Papaioannou, Gesthimani Mintziori, Dimitrios P. Bogdanos, George Mavromatidis and Dimitrios G. Goulis

Nutrients 2023, 15(9), 2019; https://doi.org/10.3390/nu15092019 - 22 Apr 2023

Viewed by 2818

Abstract

The International Federation of Gynecology and Obstetrics (FIGO) nutrition checklist is a tool for everyday antenatal clinical practice, easy to use by most healthcare professionals, aiming to initiate a conversation regarding gestational weight gain (GWG) and nutrition and identify women who might require further assessment. The present cross-sectional study aimed to apply the FIGO nutrition checklist to pregnant women attending routine antenatal care and identify nutritional risk factors. Pregnant women (n = 200) were recruited from the outpatient pregnancy clinics of two hospitals in Thessaloniki and completed the checklist. The FIGO-diet quality score and the FIGO-nutritional risk score (NRS) were calculated. The results revealed that 99% of the women exhibited at least one nutritional risk factor based on the checklist. The median FIGO diet quality score of the sample was 4.0 (3.0–5.0), with 95% of the participants responding negatively to at least one question, indicating the need for improving diet quality. Improved diet quality was noted in cases of hyperemesis gravidarum and among those receiving vitamin D supplements. A large percentage of the participants (36%) exhibited five or more nutritional risk factors, as indicated by a total FIGO-NRS below 5. Women with low middle-upper arm circumference, indicative of protein-energy malnutrition (20.6% of the sample), exhibited more nutritional risk factors compared with the rest. On the other hand, being in the third trimester of pregnancy was associated with lower nutritional risk and, subsequently, better diet quality. Full article

(This article belongs to the Special Issue The Effect of Nutrition in Healthy and Unhealthy Immune System)

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14 pages, 319 KiB

Open AccessArticle

Olive Oil and Nuts in Rheumatoid Arthritis Disease Activity

by Roberta De Vito, Federica Fiori, Monica Ferraroni, Silvia Cavalli, Roberto Caporali, Francesca Ingegnoli, Maria Parpinel and Valeria Edefonti

Nutrients 2023, 15(4), 963; https://doi.org/10.3390/nu15040963 - 15 Feb 2023

Cited by 3 | Viewed by 2711

Abstract

Few observational studies investigated the relationship between single food groups and disease activity in rheumatoid arthritis (RA). Within a recent Italian cross-sectional study (365 patients, median age: 58.46 years, 78.63% females), we focused on two food groups, olive oil and nuts, representing vegetable sources of fatty acids. Disease activity was measured with Disease Activity Score on 28 joints based on C-reactive protein (DAS28-CRP) and the Simplified Disease Activity Index (SDAI). Robust linear and logistic regression models included tertile-based consumption categories of each food group and several confounders. Stratified analyses were performed by disease severity or duration. Higher consumption of both food groups exerted a favorable effect on disease activity, significant only for olive oil (Beta: −0.33, p-value: 0.03) in the linear regression on the overall sample. This favorable effect was stronger in the more severe or long-standing forms of RA (p-value for heterogeneity <0.05, especially for disease severity). Significant ORs were as low as ~0.30 for both food groups, strata (i.e., more severe and long-standing RA), and disease activity measures. Mean DAS28-CRP significantly decreased by ~0.70 for olive oil and ~0.55 for nuts in the two strata; mean SDAI significantly decreased by 3.30 or more for olive oil in the two strata. Globally, the beta coefficients doubled, and the ORs halved (in absolute values) for both food groups, reaching significance in 12 of the 16 available models fitted to the more severe or long-standing RA strata. More compromised forms of RA may benefit from increasing consumption of olive oil, olives, and nuts. Full article

(This article belongs to the Special Issue The Effect of Nutrition in Healthy and Unhealthy Immune System)

11 pages, 324 KiB

Open AccessArticle

Orthorexia Nervosa Practices in Rheumatoid Arthritis: The DORA Study

by Maria Sifakaki, Konstantinos Gkiouras, Helen M. Lindqvist, Georgios Marakis, Anastasia Petropoulou, Lorenzo M. Donini, Dimitrios P. Bogdanos and Maria G. Grammatikopoulou

Nutrients 2023, 15(3), 713; https://doi.org/10.3390/nu15030713 - 31 Jan 2023

Cited by 4 | Viewed by 2654

Abstract

Medical nutrition therapy (MNT) is an indisputable component of the multidisciplinary therapeutic approach in rheumatoid arthritis (RA). Previous research has suggested that in chronic disease where nutrition is an important effector of prognosis, healthy dietary choices might take an unhealthy turn, with patients developing disordered eating in the form of orthorexia nervosa (ON). ON is characterized by a pathological preoccupation with “healthy”, “pure” eating, associated with restrictive dietary patterns, nutrient deficiencies and worsening disease outcomes. The aim of the present cross-sectional study was to evaluate ON tendencies in a sample of adult patients with RA. A total of 133 patients with RA were recruited, and completed the ORTO-15 questionnaire for the assessment of ON tendencies. Most of the patients were overweight/obese (53.4%). The results revealed ON tendencies in the sample, with the median ORTO-15 score reaching 36 (IQR: 33–39). Greater ON tendencies were associated with the female gender, and lowered ON tendencies with increasing age and body mass index. The present findings highlight the need for health professional awareness regarding the problem of ON in patients with RA and the importance of screening patients. Full article

(This article belongs to the Special Issue The Effect of Nutrition in Healthy and Unhealthy Immune System)

15 pages, 728 KiB

Open AccessArticle

Mediterranean Diet and Physical Activity Nudges versus Usual Care in Women with Rheumatoid Arthritis: Results from the MADEIRA Randomized Controlled Trial

by Panos Papandreou, Aristea Gioxari, Efstratia Daskalou, Maria G. Grammatikopoulou, Maria Skouroliakou and Dimitrios P. Bogdanos

Nutrients 2023, 15(3), 676; https://doi.org/10.3390/nu15030676 - 28 Jan 2023

Cited by 6 | Viewed by 3889

Abstract

In rheumatoid arthritis (RA), diet quality and nutritional status have been shown to impact the disease activity and adherence to the Mediterranean diet (MD) has been suggested as an anti-inflammatory regime to improve disease status and reduce cardiovascular risk. The Mediterranean DiEt In Rheumatoid Arthritis (MADEIRA) was a single-blind (statistician), two-arm randomized clinical trial, investigating the effects of a 12-week lifestyle intervention, including a personalized isocaloric MD plan with the promotion of physical activity (PA), supported through a clinical decision support systems (CDSS) platform, versus usual care in women with RA. Forty adult women with RA on remission were randomly allocated (1:1 ratio) to either the intervention or the control arm. The intervention group received personalized MD plans and lifestyle consultation on improving PA levels, whereas the controls were given generic dietary and PA advice, based on the National Dietary Guidelines. The primary outcome was that the difference in the MD adherence and secondary outcomes included change in disease activity (DAS28), anthropometric indices (BodPod), dietary intake, PA, vitamin D concentrations, and blood lipid profiles after 12 weeks from the initiation of the trial. At 3 months post-baseline, participants in the MD arm exhibited greater adherence to the MD compared with the controls (p < 0.001), lower DAS28 (p < 0.001), favorable improvements in dietary intake (p = 0.001), PA (p = 0.002), body weight and body composition (p < 0.001), blood glucose (p = 0.005), and serum 1,25(OH)₂D concentrations (p < 0.001). The delivery of the MD and PA promotion through CDSS nudges in women with RA in an intensive manner improves the MD adherence and is associated with beneficial results regarding disease activity and cardiometabolic-related outcomes, compared with the usual care. Full article

(This article belongs to the Special Issue The Effect of Nutrition in Healthy and Unhealthy Immune System)

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17 pages, 831 KiB

Open AccessArticle

Relationship between the Dietary Inflammatory Index Score and Cytokine Levels in Chinese Pregnant Women during the Second and Third Trimesters

by Tingkai Cui, Jingchao Zhang, Liyuan Liu, Wenjuan Xiong, Yuanyuan Su, Yu Han, Lei Gao, Zhiyi Qu and Xin Zhang

Nutrients 2023, 15(1), 194; https://doi.org/10.3390/nu15010194 - 30 Dec 2022

Cited by 3 | Viewed by 2083

Abstract

The impact of dietary inflammatory potential on serum cytokine concentrations in second and third trimesters of Chinese pregnant women is not clear. A total of 175 pregnant women from the Tianjin Maternal and Child Health Education and Service Cohort (TMCHESC) were included. The dietary inflammatory index (DII) was calculated based on 24-h food records. Serum tumor necrosis factor-α (TNF-α), interleukin 1β (IL-1β), IL-6, IL-8, IL-10, C-reactive protein (CRP), and monocyte chemoattractant protein-1 (MCP-1) levels in the second and third trimesters were measured. The mean DII scores (mean ± SD) were −0.07 ± 1.65 and 0.06 ± 1.65 in the second and third trimesters, respectively. In the third trimester, IL-1β (p = 0.039) and MCP-1 (p = 0.035) levels decreased and then increased with increasing DII scores. IL-10 concentrations decreased in pregnant women whose DII scores increased between the second and third trimesters (p = 0.011). Thiamin and vitamin C were negatively correlated with MCP-1 (β = −0.879, and β = −0.003) and IL-6 (β = −0.602, and β = −0.002) levels in the third trimester. In conclusion, the DII score had a U-shaped association with cytokine levels during the third trimester. Changes in DII scores between the second and third trimesters of pregnancy were correlated with cytokine levels during the third trimester. Full article

(This article belongs to the Special Issue The Effect of Nutrition in Healthy and Unhealthy Immune System)

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11 pages, 2810 KiB

Open AccessArticle

IL-17A, IL-17E and IL-17F as Potential Biomarkers for the Intensity of Low-Grade Inflammation and the Risk of Cardiovascular Diseases in Obese People

by Ewelina Polak-Szczybyło and Jacek Tabarkiewicz

Nutrients 2022, 14(3), 643; https://doi.org/10.3390/nu14030643 - 02 Feb 2022

Cited by 9 | Viewed by 2684

Abstract

Low-grade inflammation is a factor that predisposes to many obesity-related comorbidities. The immune mechanisms controlling the inflammatory response related to the secretory activity of adipocytes and its consequences for the organism are still under investigation. Methods: 84 obese adult volunteers (BMI ≥ 30 kg/m²) were tested by BIA. Serum samples were collected to analyze the concentrations of interleukins IL-17A, IL-17E and IL-17F. The subjects completed the original questionnaire, the FFQ-6 food consumption frequency questionnaire and the food diary. Results: The level of IL-17E and IL-17F was positively correlated with the BMI value and the level of IL-17E increased with the content of subcutaneous fat. Its increased blood concentration was also observed in individuals who declared that they were diagnosed with atherosclerosis and/or were taking beta-blockers. Products that were related with a low level of the above-mentioned interleukins were vegetables, groats, eggs, red meat, fast-food and alcohol. The level of these interleukins was positively correlated with the frequent consumption of confectionery and breakfast cereals. Nutrients that decreased the concentrations of IL-17 isoforms were potassium, iron, vitamins B6 and C, and folic acid. Conclusions: Both IL-17E and IL-17F may be closely related to the intensity of low-grade inflammation and be biomarkers of cardiovascular disease risk. Food products or the nutrients they contain may affect the levels of the above-mentioned interleukins as well as IL-17A. Full article

(This article belongs to the Special Issue The Effect of Nutrition in Healthy and Unhealthy Immune System)

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Review

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30 pages, 655 KiB

Open AccessReview

Ceramides in Autoimmune Rheumatic Diseases: Existing Evidence and Therapeutic Considerations for Diet as an Anticeramide Treatment

by Ioanna Alexandropoulou, Maria G. Grammatikopoulou, Kalliopi K. Gkouskou, Agathi A. Pritsa, Tonia Vassilakou, Eirini Rigopoulou, Helen M. Lindqvist and Dimitrios P. Bogdanos

Nutrients 2023, 15(1), 229; https://doi.org/10.3390/nu15010229 - 02 Jan 2023

Cited by 10 | Viewed by 3786

Abstract

Autoimmune rheumatic diseases (AIRDs) constitute a set of connective tissue disorders and dysfunctions with akin clinical manifestations and autoantibody responses. AIRD treatment is based on a comprehensive approach, with the primary aim being achieving and attaining disease remission, through the control of inflammation. AIRD therapies have a low target specificity, and this usually propels metabolic disturbances, dyslipidemias and increased cardiovascular risk. Ceramides are implicated in inflammation through several different pathways, many of which sometimes intersect. They serve as signaling molecules for apoptosis, altering immune response and driving endothelial dysfunction and as regulators in the production of other molecules, including sphingosine 1-phosphate (S1P) and ceramide 1-phosphate (C1P). With lipid metabolism being severely altered in AIRD pathology, several studies show that the concentration and variety of ceramides in human tissues is altered in patients with rheumatic diseases compared to controls. As a result, many in vitro and some in vivo (animal) studies research the potential use of ceramides as therapeutic targets in rheumatoid arthritis (RA), ankylosing spondylitis, systemic lupus erythematosus, fibromyalgia syndrome, primary Sjögren’s syndrome, systemic sclerosis, myositis, systemic vasculitis and psoriatic arthritis. Furthermore, the majority of ceramide synthesis is diet-centric and, as a result, dietary interventions may alter ceramide concentrations in the blood and affect health. Subsequently, more recently several clinical trials evaluated the possibility of distinct dietary patterns and nutrients to act as anti-ceramide regimes in humans. With nutrition being an important component of AIRD-related complications, the present review details the evidence regarding ceramide levels in patients with AIRDs, the results of anti-ceramide treatments and discusses the possibility of using medical nutritional therapy as a complementary anti-ceramide treatment in rheumatic disease. Full article

(This article belongs to the Special Issue The Effect of Nutrition in Healthy and Unhealthy Immune System)

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28 pages, 2012 KiB

Open AccessReview

Immune Impairment Associated with Vitamin A Deficiency: Insights from Clinical Studies and Animal Model Research

by Joshua O. Amimo, Husheem Michael, Juliet Chepngeno, Sergei A. Raev, Linda J. Saif and Anastasia N. Vlasova

Nutrients 2022, 14(23), 5038; https://doi.org/10.3390/nu14235038 - 26 Nov 2022

Cited by 14 | Viewed by 3829

Abstract

Vitamin A (VA) is critical for many biological processes, including embryonic development, hormone production and function, the maintenance and modulation of immunity, and the homeostasis of epithelium and mucosa. Specifically, VA affects cell integrity, cytokine production, innate immune cell activation, antigen presentation, and lymphocyte trafficking to mucosal surfaces. VA also has been reported to influence the gut microbiota composition and diversity. Consequently, VA deficiency (VAD) results in the imbalanced production of inflammatory and immunomodulatory cytokines, intestinal inflammation, weakened mucosal barrier functions, reduced reactive oxygen species (ROS) and disruption of the gut microbiome. Although VAD is primarily known to cause xerophthalmia, its role in the impairment of anti-infectious defense mechanisms is less defined. Infectious diseases lead to temporary anorexia and lower dietary intake; furthermore, they adversely affect VA status by interfering with VA absorption, utilization and excretion. Thus, there is a tri-directional relationship between VAD, immune response and infections, as VAD affects immune response and predisposes the host to infection, and infection decreases the intestinal absorption of the VA, thereby contributing to secondary VAD development. This has been demonstrated using nutritional and clinical studies, radiotracer studies and knockout animal models. An in-depth understanding of the relationship between VAD, immune response, gut microbiota and infections is critical for optimizing vaccine efficacy and the development of effective immunization programs for countries with high prevalence of VAD. Therefore, in this review, we have comprehensively summarized the existing knowledge regarding VAD impacts on immune responses to infections and post vaccination. We have detailed pathological conditions associated with clinical and subclinical VAD, gut microbiome adaptation to VAD and VAD effects on the immune responses to infection and vaccines. Full article

(This article belongs to the Special Issue The Effect of Nutrition in Healthy and Unhealthy Immune System)

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3 pages, 489 KiB

Open AccessReply

Mind the Gap: Tools for the Diagnosis and Assessment of Orthorexia Nervosa Based on the Recent Consensus Definition. Reply to Meule, A. Comment on “Sifakaki et al. Orthorexia Nervosa Practices in Rheumatoid Arthritis: The DORA Study. Nutrients 2023, 15, 713”

by Maria G. Grammatikopoulou, Konstantinos Gkiouras, Georgios Marakis, Maria Sifakaki, Anastasia Petropoulou, Lorenzo M. Donini, Helen M. Lindqvist and Dimitrios P. Bogdanos

Nutrients 2023, 15(8), 1985; https://doi.org/10.3390/nu15081985 - 20 Apr 2023

Viewed by 936

Abstract

In a recent manuscript, our team published the results of an original pilot cross-sectional study assessing orthorexia nervosa (ON) tendencies among patients with rheumatoid arthritis (RA) [...] Full article

(This article belongs to the Special Issue The Effect of Nutrition in Healthy and Unhealthy Immune System)

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2 pages, 201 KiB

Open AccessComment

Comment on Sifakaki et al. Orthorexia Nervosa Practices in Rheumatoid Arthritis: The DORA Study. Nutrients 2023, 15, 713

by Adrian Meule

Nutrients 2023, 15(8), 1984; https://doi.org/10.3390/nu15081984 - 20 Apr 2023

Cited by 1 | Viewed by 748

Abstract

In a recently published article, Sifakaki and colleagues [...] Full article

(This article belongs to the Special Issue The Effect of Nutrition in Healthy and Unhealthy Immune System)

15 pages, 2763 KiB

Open AccessSystematic Review

Nutritional Support with Omega-3 Fatty Acids in Burn Patients: A Systematic Review with Meta-Analysis of Randomized Controlled Trials

by Tippawan Siritientong, Daylia Thet, Maneechat Buangbon, Pawinee Nokehoon, Nattawut Leelakanok, Janthima Methaneethorn, Apichai Angspatt and Jiraroch Meevassana

Nutrients 2022, 14(14), 2874; https://doi.org/10.3390/nu14142874 - 13 Jul 2022

Cited by 3 | Viewed by 2510

Abstract

Background: In burn patients, the profound effect of nutritional support on improved wound healing and a reduced rate of hospitalization and mortality has been documented. Fish oil as a primary source of omega-3 fatty acids in nutritional support may attenuate the inflammatory response and enhance immune function; however, unclear effects on the improvement of clinical outcomes in burn patients remain. Methods: The systematic literature review was conducted by searching the electronic databases: Cochrane Library, PubMed, ScienceDirect, and Scopus to assess the randomized controlled trials of nutritional support with omega-3 fatty acids compared to control diets in patients that presented with burns from any causes. Results: Seven trials were included in this meta-analysis. We found no significant differences in length of stay (LOS) (p = 0.59), mortality (p = 0.86), ventilation days (p = 0.16), gastrointestinal complications—e.g., constipation and diarrhea (p = 0.73)—or infectious complications—e.g., pneumonia and sepsis (p = 0.22)—between the omega-3-fatty-acid-receiving group and the control/other diets group. Conclusions: We did not find a benefit of omega-3 support in reducing the various complications, mortality and LOS in burn patients. Further studies are necessary to find the effect of nutritional support with omega-3 fatty acids over low-fat diets in this population. Full article

(This article belongs to the Special Issue The Effect of Nutrition in Healthy and Unhealthy Immune System)

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