Monique Piderit, RD (SA)

The Role of Nutrition in ImmunityMonique Piderit, RD (SA)

▪ The Immune System

▪ Functions of the Immune System

▪ Innate vs Adaptive Immune System

▪ Layers of the Immune System

▪ Immunocompromised

▪ Chronic Inflammation

▪ The Role of Nutrition in Immunity

▪ Vitamin A

▪ Vitamin C

▪ Vitamin D

▪ Zinc

▪ Fibre

▪ Conclusion

OVERVIEW

White blood cells, proteins,

tissues and organs back up the

immune system should any

intruder get into the body.

The immune system is the body’s natural defence protecting you from

diseases and infections caused by bacteria, viruses and other disease-

causing germs.

The immune system is made up

of two parts:

• Innate (general) immune

system

• Adaptive (specialized)

immune system

UNDERSTANDING THE IMMUNE SYSTEM

The innate and adaptive immune systems. Updated 2020

Available from https://www.ncbi.nlm.nih.gov/books/NBK279396/

LAYE

RS O

F TH

E

IMM

MUN

E SY

STEM

Physical and Biochemical BarriersPhysical e.g. skin, GIT, respiratory tract,

nasopharynx, cilia, eyelashes, body hair

Biochemical e.g. secretions, mucus, bile,

gastric acid, saliva, tears, sweat.

General Immune responses e.g.

inflammation, antimicrobial substances, non-

specific cellular responses.

Complement system e.g. opsonisation,

chemotaxis, cell lysis, agglutination.

Immune CellsLeukocytes e.g. monocytes, neutrophils,

eosinophils, basophils, lymphocytes

Granulocytes – neutrophils, eosinophils,

basophils

Lymphocytes – B cells, T cells (cytotoxic,

helper e.g. Th1, Th2, Th17), memory, NKC

Phagocytes – neutrophils, monocytes,

macrophages, mast cells, dendritic cells

Cell surface proteins – MHC I, MHC II

Antibodies

Immunoglobulins

e.g. IgA, IgD, IgE,

IgG, IgM

THE BASIC COMPONENTS OF THE IMMUNE SYSTEM

Innate Immune System

Non-specific; fact (minutes to hours)

Physical barriers, biochemical mechanisms, inflammatory response, complement system, phagocytes

Adaptive Immune System

Highly specific; slow (days)

B lymphocytes, T lymphocytes, immunoglobulins, other body fluids

TYPE

S OF

IMM

UNIT

Y

Nutrients

Vitamins: A, D, C, E, B6, B12, B9; Minerals: Zinc, Iron, Copper, Selenium, Magnesium

Gombart et al; A review of micronutrients and the immune system working in harmony to reduce the risk of infection. Nutrients, 2020;12:236.

Many conditions and treatments can weaken a

person’s immune system making them

immunocompromised.

Immunosenescence

Age-related decline in

immunity

Environmental and lifestyle

factors

Smokers and alcoholicsAutoimmune disease

Type 1 DM, RA, SLE, MS

Immune Compromised

HIV, cancer, transplant patients

Use of oral or intravenous

corticosteroids and

immunosuppressants

THE IMMUNE COMPROMISED

Dietary restrictions Healthcare workers

Inflammation is the natural, healthy reaction of the immune system as it

responds to injury or infection.

Optimally, the immune system’s function is to keep the body healthy,

responding appropriately with inflammatory response to environmental

influences, and then returning to an alert system of defence.

Low-grade, chronic inflammation is a 2 – 3 fold increase in circulating

inflammatory mediators associated with the innate arm of the immune

system.

THE ROLE OF INFLAMMATION IN IMMUNITY

Mahan LK and Raymond JL. Krause’s Food and the Nutrition Care Process. 14th Edition

• Increase inflammatory biomarkers (exacerbated

by insulin resistance and hyperinsulinemia).

• Increase risk chronic lifestyle associated

diseases: heart disease, diabetes, autoimmune

diseases, Alzheimer's, possible cancers. FIBRINOGEN

CRP

TNF-α

IL-6

CHRONIC INFLAMMATION

CYTOKINES

Mahan LK and Raymond JL. Krause’s Food and the Nutrition Care Process. 14th

Edition

A varied and balanced diet provides

the nutrients needed for the healthy

functioning of the immune system.

Vitamins and minerals (nutrients) support the immune system for optimal

functioning.

Foods first, supplements second.

THE ROLE OF NUTRITION IN THE IMMUNE SYSTEM

Food has other bioactive

ingredients.

Risk of over supplementing is high,

especially with single nutrients.

Mahan LK and Raymond JL. Krause’s Food and the Nutrition Care Process. 14th

Edition

The Western-type dietary pattern (i.e. processed foods, sugar, salt, lacking

fibre, vitamins and minerals) associated with elevated markers of

inflammation, suggesting that the immune system responses to the

Western Diet directly and/or indirectly.

THE WESTERNISED DIET AND THE IMMUNE SYSTEN

Christ et al. Wester Diet and the Immune System: An Inflammatory Connection.

Immunity. 2019;51(19):794-811.

Benefit

✓ Omega-3

✓ Polyphenols

✓ Fibre

✓ Short chain fatty acids

✓ Energy restriction

Harmful

x Saturated fats

x Cholesterol

x Sugar

x Refined grains

x Purines

x High energy diets

Mozaffarian, D. Circulation, 2016

Christ et al. Wester Diet and the Immune System: An Inflammatory Connection. Immunity.

2019;51(19):794-811.

Gom

bart

et a

l; A

rev

iew

of m

icro

nutr

ient

s an

d th

e im

mun

e sy

stem

wor

king

in h

arm

ony

to r

educ

e th

e ris

k of

infe

ctio

n.

Nut

rient

s, 2

020;

12:2

36.

A, D, C, E, B6,

B12, folate, Fe,

Zn

C, E, Fe,

Zn, Cu,

Se, Mg

A, D, C, E,

B6, B12,

folate, Zn,

Fe, Cu,

Se, Mg

A, D,

C, Zn,

Fe, Cu,

Se

A, C, E,

B6, Zn,

Fe, Cu,

Se, Mg

A, D, C, E,

B6, B12,

folate, Zn,

Cu, Se,

Mg

A, D, C,

E, B6,

B12,

folate,

Zn, Fe,

Cu, Se

D, E, B6

A, D, C,

E, B6,

B12, Zn,

Fe, Cu,

Se

Vitamin DVitamin A Vitamin C Zinc Fibre

NUTRIENTS INVOLVED IN IMMUNE SUPPORT

▪ Fat soluble vitamin not synthesized by

the body and must be obtained through

the diet.

▪ Role in immunity:

▪ Strengthening the immune system

▪ Development and maintenance of

epithelial tissue

▪ Protective effect on the skin and

mucosa

▪ 4 in 10 South African children under 5

years of age suffer from vitamin A

deficiency.

▪ Leading cause of preventable

blindness in children

VITAMIN A


▪ Three active forms: retinal, retinol and retinoic acid.

▪ Storage form (liver): retinyl ester.

▪ Preformed vitamin A

▪ Absorbed as retinol and made into retinal and retinoic

acid.

▪ E.g. Dairy products (e.g., milk, yoghurt, and cheese),

liver

▪ Provitamin A

▪ Carotenoids e.g. beta-carotene, alpha carotene, beta-

cryptoxanthin

▪ E.g. carrots, pumpkin, kale, spinach, sweet potato,

papaya, mango, apricots

▪ Digestion and absorption of vitamin A requires fat

▪ Critically low fat diets (less than 5–10 g/day)

▪ Pancreatic and hepatic diseases

▪ Frequent gastroenteritis

▪ Steatorrhea


Bastos-Maia et al. Vitamin A and Pregnancy: A Narrative Review. Nutrients. 2019 1(3): 681.

Excessive vitamin A intake during pregnancy may exert teratogenic effects in the

first 60 days following conception.

High doses of vitamin A supplementation not advised during pregnancy. Between

prenatal vitamins and food, vitamin A intake is sufficient and additional

supplementation outside of prenatal vitamins is not advised.

Vitamin A deficiency is more frequent in the last quarter of pregnancy

(physiological increase in maternal blood volume and accelerated foetal

development).

VITAMIN A AND PREGNANCY

Bastos-Maia et al. Vitamin A and Pregnancy: A Narrative Review. Nutrients. 2019 1(3): 681.

Supplementation of at least 200 mg/ day reduces

the duration of common cold significantly in

children and adults.


Hemila et al. Vitamin C for preventing and treating the common cold, Cochrane Hermila Systematic Review. 2013.

Manfred Eggersdorfer. What is the optimal intake of vitamin C? 13th European Nutrition Conference, FENS 2019, 15–18 October 2019, Malnutrition in an Obese World: European

Perspectives. 79 - Issue OCE2 - 2020

Vitamin C is an essential nutrient which humans

can’t synthesise.

VITAMIN C

Anti-oxidant, regenerates other antioxidants (e.g.

vitamin E), required for synthesis of collagen which

plays a role in wound healing, and plays an

important role in immune function.

Fruit and vegetables e.g. citrus fruit, red and green

peppers, kiwi, tomatoes, broccoli, strawberries,

Brussel sprout, cauliflower.

Supplements with

Vitamin C

▪ Ascorbic acid

(bioequivalent to

natural occurring

vitamin C)

▪ Sodium ascorbate

▪ Calcium ascorbate

▪ Other mineral

ascorbates

▪ Ascorbic acid with

bioflavonoids

Fat soluble;

Produced in

the skin

through UVB

radiation

Increases

concentrations of

anti-inflammatory

cytokines


Grant WB et al. Evidence that Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths. Nutrients 2020, 12, 988.

Reduce pro-

inflammatory

cytokines (injures

lungs and leads to

pneumonia)

VITAMIN D

Vitamin D made

in the skin lasts

twice as long in

the blood than

vitamin D

consumed

Induces

cathelicdins and

defensins that

lower viral

replication rates

Vitamin D

Supplements

• D3 more

effective than

D2

• Smaller doses

better than

bolus doses

Reduces risk of

common cold

Physical barrier,

cellular natural

immunity,

adaptive

immunity

General guideline:

▪ Expose arms and

legs

▪ No sunblock

▪ Mid-day

▪ 15 min, 3x per week

Amount of sun needed

varies with amount of skin

exposed, time of day,

latitude, season, skin color

and sunscreen use

Cox J and Carney V. (2017). Nutrition for Reproductive Health and Lactation. Krause’s Food and Nutrition Care Process.

VITAMIN D FROM THE SUN

Above 37° latitude: at

risk for Vid D

deficiency

JHB: 26°

CT: 33.9°

Download Dminder

Cox J and Carney V. (2017). Nutrition for Reproductive Health Krause’s Food and Nutrition Care Process.

Phillips K & Rasor A 2013

VITAMIN D FROM FOOD DRI: 600 IU

447 IU

480 IU100 IU40 IU

30 IU 367 – 905 IU

Vitamin D deficiency

contributes to acute

respiratory distress syndrome

Outbreak occurred in winter

(vitamin D concentrations

lowest)

Number of cases in Southern

hemisphere at the end of summer

are low

Case-fatality rates increase with

age and chronic disease

comorbidity (both associated with

lower vitamin D concentrations)

VITAMIN D SUPPLEMENTATION

Evidence supportive of the role of vitamin D in reducing risk of

COVID-19 infection.


To reduce the risk of infection, it is

recommended that people at risk of flu

and/or COVID-19 consider taking 10

000IU of vitamin D daily for a few weeks

to rapidly raise concentrations

Followed by 5000IU daily

Goal: 40 – 60 ng/ml

VITAMIN D SUPPLEMENTATION, COVID AND INFLUENZA

Optimal Levels >20 – 30 ng/ml

1000 – 2000IU/day appears safe


Regulates immune cell function

Immune cell maturation

Immune cell differentiation

The Role

of Zinc

Zinc is crucial for the appropriate development and function of the whole immune

system (innate and adaptive immunity).

Zinc deficiency triggers apoptosis (B and T cells) and adversely affects cytokine

function and secretion.

ZINC

Zinc is found in almost every cell of the body and stimulates activity over 100 enzymes.

Zinc is a an essential mineral that is not made or stored by the body, which means that we

need to eat enough every day to meet our needs.

Gammon NZ, Rink L. Zinc in infection and inflammation. Nutrients. 2017;9:624; Wessels I et al. Zinc as a gatekeeper of immune

function. Nutrients. 2017;9:1286; Mahan LK and Raymond JL. Krause’s Food and the Nutrition Care Process. 14 th Edition

Second most abundant metal in human: 2-3g

Patients at risk of zinc deficiency:

▪ Chronic diarrhoea

▪ Patients being treated with penicillamine

▪ Patients receiving parenteral nutrition

without zinc

▪ Excessive alcohol consumption

High concentrations: prostate, pancreas, bone

Low concentrations: Heart, brain and plasma

Zinc deficiency difficult to diagnose as there is

no reliable biomarker to assess zinc status

ZINC

Mahan LK and Raymond JL. Krause’s Food and the

Nutrition Care Process. 14th Edition

2 billion people at risk of a zinc

deficiency.

In children under 5, 800 000

deaths each year are related to

zinc deficiency.

1 in 2 children (age 1–9 years)

in South Africa at risk of zinc deficiency.

Western Cape: poor zinc status is most common

in children.

ZINC DEFICIENCY

Zinc deficiency

causes severe

impairment of immune

function, comprising

the adaptative and

innate immune system.

Zinc excess

provides an

impairment in the

immune system

comparable to zinc

deficiency.

Therefore,

balanced zinc

homeostasis is

crucial.

ZINC DEFICIENCY


function. Nutrients. 2017;9:1286; Mahan LK and Raymond JL. Krause’s Food and the Nutrition Care Process. 14 th Edition

Nutritional zinc deficiency

often seen in vegetarians or

vegans

Avoid taking

supplements with foods

high in lignins and

phytates.

Lignins and

phytates influence

absorption:

• High fibre

cereals

• Legumes

• Plant parts

FACTORS AFFECTING ZINC DEFICIENCY


function. Nutrients. 2017;9:1286; Mahan LK and Raymond JL. Krause’s Food and the Nutrition Care Process. 14th Edition

Mixture of essential microbes

Differs from person-person

Evolves with us throughout

Gut

Microbiota

Starting before birth and continuing

through life, we live in harmony

with bacteria and other organisms

in our gut. Collado et al, 2016

Just as human DNA varies, so too

does the massive collection of

microbes in our gut. Each person

has his or her very own

composition of gut microbiota like

a unique fingerprint. Franzosa et al, 2015

65% of immune system found in

the gut

Maukonen, J and Sarela, M. Proceedings of the Nutrition Society, 2015: 74: 23-36 West, CE, et al.,

Clinical Reviews in allergy and immunology, 2015; 135:3-13

FIBRE AND THE GUT MICROBIOTA

Secretion of

Immune

Cells via

GALT

Oral food

antigens

The gut mucosal

immune system

(lymph nodes,

lamina propria and

epithelial cells)

constitutes a

protective barrier for

the integrity of the

intestinal tract.

The commensal microbiome regulates the maturation of the mucosal

immune system, while the pathogenic microbiome causes immunity

dysfunction, resulting in disease development.

IgA

production

Control of inflammation

Activation of

local immune

response

INFLAMMATION

Goulet O. Potential role of the intestinal microbiota in programming health and disease. Nutrition Reviews. 2015;73(S1):32–40.

Mayer EA, Tillisch K, Gupta A. Gut/brain axis and the microbiota. Journal of Clinical Investigation. 2015;125(3):926–38

Oriach CS. Robertson RC, Stanton C, Cryan JF, Dinan TG. Food for thought: The role of nutrition in the microbiota-gut-brain

axis. Clinical Nutrition Experimental. 2016;6:25-38.

Gut microbiota also have broader

effects contributing to innate and

adaptive immunity at multiple levels.

THE ROLE OF THE GUT IN IMMUNITY

Figure from Yang B, Hur KY and Lee M. 2017. Alterations in Gut Microbiota and Immunity by dietary

fat, Yonsei Medical Journal, 58 (6) 1083-1091

1g (100g serving)

3 Cups

2g (180g serving)

1 Cup

1g (124g serving)

1 Cup

3g (188g serving)

1 Cup

8.2g (90g serving)

½ Cup

5.2g (65g serving)

10.8g (65g serving)

FIBRE, SHORT CHAIN FATTY ACIDS AND THE GUT

(Cresci & Escuro 2016 pg 530).

✓Modifies intestinal immune and inflammatory processes

✓Aids with water and electrolyte absorption

✓Promotes gut epithelial integrity

✓ Inhibits growth of pathogenic organisms

✓Reduces disease causing bacteria

✓Reduces intraluminal pH

✓ Increases beneficial bacteria

- Lactobacilli

- Bifidobacteria

BENEFITS OF SHORT CHAIN FATTY ACIDS

Prebiotics and Probiotics

Anti-biotics and other drugs

Feeding Method:

Breast Milk vs Formula Milk

Environmental Modifiers

Pre-term Birth

Lifestyle: Diet, Sedentary

Lifestyle, Food Processing

Delivery Method

Sex and Genetic

Differences

Mohammadkhah et al. Development of the Gut Microbiome in Children and Lifetime Implications for Obesity and Cardiometabolic Disease. Children. 2018;5;160.

FACTORS THAT EFFECT THE GUT MICROBIOTA

Sleep

Children who sleep well have fewer infections and recover quicker from

illness.

Adds stress and inflammation to already busy lifestyles

Exercise

Being active has been shown to improve the body’s defence system

Other Factors Affecting the

Immune SystemGood Hygiene

As much as healthy eating is very

important, it does not take away the

need for good hygiene measures e.g.

regular handwashing/sanitising,

covering your mouth when coughing or

sneezing, etc.

Stress

Unresolved stress triggers the

immune system to response with

more pro-inflammatory cytokines

Mahan LK and Raymond JL. Krause’s Food and the Nutrition Care Process. 14th Edition; Nieman DC,

Wentz L. The compelling link between physical activity and the body's defence system. Journal of Sport

and Health Science. 2019;8(3);201-217.

▪ The immune system, made of the innate and adaptive responses, is the

body’s natural defence protecting from diseases and infections caused

by bacteria, viruses and other disease-causing germs.

▪ The Western-type dietary pattern (i.e. processed foods, sugar, salt,

lacking fibre, vitamins and minerals) associated with elevated markers of

inflammation, suggesting that the immune system responses to the

Western Diet directly and/or indirectly.

▪ Many micronutrients have key roles at every stage of the immune

response e.g. Vitamins: A, D, C, E, B6, B12, B9; Minerals: Zinc, Iron,

Copper, Selenium, Magnesium

CONCLUSION

▪ Vitamin A is primary involved in epithelial integrity, and the skin is the

body’s first line of defence.

▪ Vitamin C supplementation of at least 200 mg/ day reduces the duration of

common cold significantly in children and adults.

▪ To reduce the risk of infection, it is recommended that people at risk of flu

and/or COVID-19 consider taking 10 000IU of vitamin D daily for a few

weeks to rapidly raise concentrations, followed by 5000IU daily.

▪ Both zinc deficiency and zinc excess can cause immune deficiency.

▪ With 65% of immune system found in the gut, a high fibre diet is important

to maintain optimal gut microbiota.

CONCLUSION

www.nutritionalsolutions.co.za

@MoniquePiderit

@NSDietitiansSA

011 463 5502

[email protected]

THANK YOU

@nutritionalsolutionssa

Monique Piderit, RD (SA)

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