Nutrition and Immunity during COVID-19

Pandemic
4th June 2020
Abbe Maleyki Mhd Jalil (PhD)
School of Nutrition and Dietetics
Faculty of Health Sciences, Universiti Sultan Zainal Abidin
(UniSZA)
abbemaleyki@unisza.edu.my
KNOWLEDGE FOR THE BENEFIT OF HUMANITY

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 Presentation Outline
1.0 Basic Terminology/Concepts
2.0 Tasks of the Immune Function
3.0 How is the Immune System Activated
4.0 Type of Immunity
5.0 Conditions When We Have Low Immune Response
6.0 Nutrition and Immune Function
7.0 Specific Nutrients/supplements to Boost Immune Function
8.0 Conclusions

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 1.0 Basic Terminology/Concepts

• Immune (ih-MYOON) system - our body

protection against infections

1. Leukocytes (white blood cells).

2. Other type of WBC – phagocytes à chew up

invading organisms.

3. Lymphocytes – help body to remember the

invaders and destroy them (bone marrow à
thymus gland)
- Lymphocytes B – Bone marrow
- Lymphocytes T – Thymus gland

3. Neutrophil – a type of phagocytes which fights

bacteria

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 1.0 Basic Terminology/Concepts (cont.)

• Immunity- Innate, adaptive, passive.

• Innate – non-specific (general) à fight

harmful pathogens using natural killer
cells or phagocytes.

• Adaptive – specific (use antibodies), also

known as ‘acquired (learned) or specific
immune response.

• In real life – both systems work together

to fight harmful pathogens.

• Autoimmune – immune system

mistakenly attacks our body (eg. allergic
reaction, rheumatoid arthritis, IBD).

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 2.0 Tasks of the
Immune System

• Fight pathogens – bacteria,

parasites of fungi, and remove
them from our body.

• Recognize and neutralize

harmful substances from the
environment.

• Fight disease-causing changes

in the body eg. cancer cells.

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This Photo by Unknown Author is licensed under CC BY-SA-NC
 3.0 How is the Immune
System Activated?

• When our body does not

recognize as its own i.e
antigens binds to special
receptors of the immune cells (B
lymphocytes).

• Triggered immune response à

produce antibodies.

• Antibodies locks to antigen and

the next job is done by T
lymphocytes.

• T lymphocytes à destroy
antibodies + antigens.

• Our body store this info and if

the same thing happen next
time, it will response faster.
 4.0 Type of Immunity

• Innate (natural) immunity: Everyone is

born with innate (or natural) immunity. Eg
the skin acts as a barrier to block germs
from entering the body. Immune system
recognizes when certain invaders are
foreign and could be dangerous.

• Adaptive (or active) immunity: Develop

through our lives. We develop adaptive
immunity when we are exposed to
diseases or when we are immunized
against them with vaccines.

• Passive immunity: Passive immunity is

"borrowed" from another source and it
lasts for a short time. For example,
antibodies in a mother's breast milk give a
baby temporary immunity to diseases the
mother has been exposed to.

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 5.0 Conditions When We
Have Low Immune Response

• Ageing – Immunosenescence, weaken ability of

older individuals to response to infection or
vaccination.

• Type 2 Diabetes Mellitus – Impairment in the

function of B and T cells, impaired both innate
and adaptive immune response.

• Inadequate or poor sleep quality - Getting

adequate rest may strengthen our natural
immunity. We may sleep more when sick to allow
our immune system to better fight the illness.

• Chronic stress - Dysregulates innate and

adaptive immune responses by altering the Type
1-Type 2 cytokine balance, inducing low-grade
chronic inflammation, and suppressing numbers
and function of immunoprotective cells.

• Obesity – Altered leukocyte development and

altered innate and adaptive immune response.

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 5.1 Impact of
Obesity and MetS
on Immune
Function

Andersen et al. (2016)

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 6.1 Nutrition and Immune Function:
Current Knowledge

• No magic nutrients or supplements to

boost our immune system.

• National Institute of Health (US) (NIH) –

there is no evidence to support the use of
any supplement to prevent or treat
COVID-19.

• Complex interaction between diet and

host.

• Dietary patterns/nutrients have different

effect either through physical barrier
(skin), gut microbiome, innate or adaptive
immune system.
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6.0 Nutritional Immunology

Ponton et al. (2011) 11

 6.1 Nutrition and Immune Function:
Current Knowledge (cont.)

• Most studies showed effect on common

flu/cold (runny nose, sore throat, headaches).

• Effect of dietary patterns and nutrients on

allergic reaction.

• Human studies lack of mechanisms.

• Most mechanistic studies were done in murine

models.

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 7.0 Specific Nutrients/Supplements to Boost
Immune System

• Some ‘promising’ nutrients and

supplements.

1) Non-starch polysaccharides (dietary

fibre)

2) Healthy ‘fats’ – polyunsaturated fatty

acids (PUFA) particularly omega-3 and
omega-6

3) Vitamin C

4) Zinc
This Photo by Unknown Author is licensed under CC BY

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 7.1 Single Nutrient:
Soluble fibre,
resistant starch
• Fibre particularly soluble fibre is an
important energy for gut microbiota.

• Production of short-chain fatty acids

(SCFA) – acetate (2C), propionate (3C)
and butyrate (4C).

• Acetate – used for lipogenesis, some

converted to butyrate.

• Propionate – precursor for

gluconeogenesis, play important role in
anorexigenic hormones (PYY and GLP-1).

• Butyrate – supply energy to epithelial cells

in the large intestine, ameliorating the pro- This Photo by Unknown Author is licensed under CC BY-SA
inflammatory response of immune cells to
antigen stimulus.

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 7.1 Single Nutrient:
Soluble fibre, resistant
starch) (cont.)

• SCFA (butyrate) – may modulate

immune-mediated diseases through G
protein coupled receptors (GPR)
particularly GPR41 and GPR 43 that
are highly expressed in immune cells.

• How much fibre is needed?

• 25 to 31 g/day or more!

• Or 14 g fibre per 1000 kcal energy. This Photo by Unknown Author is licensed under CC BY-SA

• Dietary fibre – 2 kcal/g

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 7.2 Single Nutrient: Polyunsaturated Fatty
Acids (PUFA)

• Omega 3, omega 6 as substrates for

the synthesis of signaling molecules,
including eicosanoids and docosanoids.

• Promoting sensitization of immune-

antigen interfacing à modify disease
risk.

• LCn3PUFA (EPA and DHA) - Effect on

autoimmune disease ie inflammatory
bowel disease and rheumatoid arthritis.

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 7.2
Polyunsaturated
Fatty Acids • 10 RCTs, 183 RA patients vs 187 placebo-controls.

(PUFA) (cont.) • LCn3PUFA reduced NSAID consumption.

• ‘Reduced’ other parameters (morning stiffness, swollen

joint count and physical function) but did not reach
statistical significance.

• Studies differs in dosage, duration and PUFA

composition.

• Conclusion: Dose of > 2.7 g/day for > 3 months

reduced NSAID consumption by RA patients. 17
 7.3 Vitamin C (Ascorbic Acid)
Supplements

• Has been a subject of controversy for

70 years.

• Ambiguous results - different doses,

health condition and age groups.

• Outcomes differ – incidence vs

duration vs severity.

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 • Meta-analysis, 29 RCTs (mostly double blinded),
11,306 participants.
7.3 Vitamin C
(Ascorbic Acid) • Vitamin C dose: 1 to 2 g/day.

• General community trials:

• Adults – duration of colds reduced by 8% (3 to 12%)

(mean days of cold episodes).

• Children – duration of cold reduced by 14% (7 to 21%).

• Therapeutic trials – no consistent effect of vitamin C

on duration and severity of colds.

• Incidence of colds – no change.

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 7.4 Zinc Supplements

• Zinc acetate, zinc fumarate (ionic zinc, iZn)

for common cold.

• Meta-analysis - ½ successful and ½ failed to

show any significant results.

• Mechanisms - inhibits intercellular

adhesion molecule-1 (ICAM-1) and inhibits
the release of vasoactive ingredients from
mast cell granules.
This Photo by Unknown Author is licensed under CC BY-NC

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 • Meta-analysis, 7 RCTs, 575 participants.

• Zinc dose: > 75 mg/day.

7.3 Zinc
Supplements • Zinc acetate (3 trials):

• Reduced duration of colds by 40% (mean days of

illness).

• Zinc gluconate (4 trials):

• Reduced duration of colds by 28% (mean days of

illness).

• No evidence of dose more than 100 mg/day is helpful

to treat common colds.
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 8.0 Take Home
Messages

• Effect of individual nutrients/supplements were

small and often masked by persons’ habitual
dietary intake.

• Two of the nutrients often studied (but not

exclusively studied) in their relation to the immune
system are LCn3PUFA and dietary fibre, but much
information is required before disease-specific
recommendations can be made with high
confidence.

• Enjoy variety of foods, get enough sleep and

exercise regularly for a healthy life.

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This Photo by Unknown Author is licensed under CC BY-SA
 • Exploring diet-microbiome-immune function.

• Understanding heterogeneity at different life

stages, between healthy individuals, those at
risks and with diseases.

• Explore and further characterize dietary

patterns or derivation of dietary patterns that
appear protective against the development of
immune-related diseases in a more rigorous
trials to identify novel immunomodulatory
dietary components.

• Single-nutrient studies controlling for other

dietary/environmental factors.

• Mechanistic studies focusing on how food

impacts on the immune system, microbiome,
This Photo by Unknown Author is licensed under CC BY-SA epigenome and interaction of these
components.

9.0 Future Directions

 References

1. How does the immune system work? https://www.ncbi.nlm.nih.gov/books/NBK279364/ (accessed on 31st

May 2020)
2. Effects of Stress on Immune Function: The Good, the Bad, and the Beautiful. Immunol Res (2014).
3. Zinc lozenges as cure for the common cold--a review and hypothesis. Med Hypotheses, 74(3):482-92
(2010)
4. Dietary fiber and prebiotics and the gastrointestinal microbiota, Gut Microbes, 8(2): 172–184 (2017)
5. Nutrition and the Immune System: A Complicated Tango. Nutrients, 12(3), 818 (2020)
6. Impact of Obesity and Metabolic Syndrome on Immunity. Adv Nutr, 7(1):66-75 (2016)
7. Immunomodulatory Potential of Gut Microbiome-Derived Short-Chain Fatty Acids (SCFAs). Acta Biochim
Pol, 4;66(1):1-12 (2019).
8. Nutritional Immunology: A Multi-Dimensional Approach. PLoS Pathog, 7(12): e1002223 (2011)
9. Role of Gut Microbiota-Generated Short-Chain Fatty Acids in Metabolic and Cardiovascular Health. Curr
Nutr Rep. 7(4): 198–206 (2018).

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Thank You

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