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Review Article

The Relationship between Nutrition and Infectious Diseases:

A Review
Sedigheh Farhadi1, Roman S. Ovchinnikov2
1
Department of English, Marvdasht Branch, Islamic Azad University, Marvdasht, Iran, 2Department of Bioactive Nanostructures, Microbiology Group, Federal Research
Centre for Microbiology and Epidemiology, N.A. N.F. Gamaleya, Moscow, Russia

Abstract
Nutrition and infectious diseases are related to each other in some aspects. First, nutrition affects the development of human body immune
system. Moreover, nutrition can influence emerge of infectious diseases (e.g., gastrointestinal infections), food poisoning, intestinal diseases,
and systemic infectious diseases. In this review, the mentioned aspects of the relationship between nutrition and infections are discussed.
Furthermore, the relationship between malnutrition and infectious diseases, nutrition in patients with severe combined immunodeficiency and
relationship between overeating and infection are reviewed. Overall, some factors can weaken the body’s ability to fight infection and cause
malnutrition. The factors include anorexia, traditional behaviors, reduction of intestinal absorption, metabolic damage, disorder metabolism
of lipids and carbohydrates, reduction of vitamins, iron, zinc, and copper. In the case of the relationship between malnutrition and infection, a
large number of studies have illustrated a bidirectional interaction of malnutrition and infection. In this aspect, to treat serious acute malnutrition
and limit the rate of death, some preventive studies applied antibiotics, probiotic bacteria, and prebiotic foods. In the future, studies may be
conducted on intestinal or systematic immunomodulation.

Keywords: Human body immunity, infection, malnutrition, nutrition

Introduction it will have normal weight and size. The normal weight of
the fetus is an important criterion for his/her health.[2] Fetal
The relationship between nutrition and infectious diseases
malnutrition has unfavorable effects on the development of
can be divided into five groups as follows [1]: (1) the
immune system. If the immune system does not efficiently
effect of nutrition on the development of human immune
develop in this period, it cannot defense against pathogens
system; (2) the effect of nutrition on emerge of infectious
in the future.
diseases (e.g., gastrointestinal infections), food poisoning
(e.g., botulism), intestinal diseases (e.g., microbial diarrhea), After birth, breast milk provides sufficient vitamins and
and systemic infectious diseases (e.g., brucellosis and minerals to a baby that can guarantee the baby’s growth and
typhoid); (3) relationship between malnutrition and infectious health.[2] Breastfeeding is the second‑most important step to
diseases; (4) nutrition in patients with severe combined develop a vigorous immune system.[2] A malnourished baby
immunodeficiency; and (5) relationship between overeating who does not receive enough protein and vitamins is prone to
and infection [Figure 1]. These five groups of balance between infectious diseases and does not respond well to vaccines.[3]
nutrition and infection are discussed below. Therefore, nutrition is critical to provide high immunity in
humans against environmental pathogens.
The effect of nutrition on the development of human body
immune system Address for correspondence: Dr. Roman S. Ovchinnikov,
The effect of diet on the development of human immune Federal Research Center for Microbiology and Epidemiology,
system begins from the embryonic stage. If during pregnancy, N.a. N.F. Gamaleya, 123098, Gamaleya St., 18, Moscow, Russia.
especially in the first trimester of pregnancy, the mother E‑mail: [email protected]
receives enough protein, vitamins, and minerals, the embryonic
tissues will develop very well. If a fetus develops sufficiently, This is an open access journal, and articles are distributed under the terms of the
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DOI: How to cite this article: Farhadi S, Ovchinnikov RS. The relationship
10.4103/bbrj.bbrj_69_18 between nutrition and infectious diseases: A review. Biomed Biotechnol
Res J 2018;2:168-72.

168 © 2018 Biomedical and Biotechnology Research Journal (BBRJ) | Published by Wolters Kluwer ‑ Medknow
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Farhadi and Ovchinnikov: The relationship between nutrition and infection

The role of nutrition to provide vigorous immunity against of raw or undercooked meat. As the parasitic cyst enters the
infectious diseases has been vastly investigated. For example, it human stomach, it is released by the action of gastric acid
has been shown that if a group of children receives enough food and absorbs into the liver through the intestinal mucosa and
and another group of children receives tuberculosis vaccine, then enters the lymph nodes.[11] Pinworm infection is another
those who have a good diet are less affected with tuberculosis parasitic disease transmitted through food. The infection is
than those who vaccinate. The risk of developing tuberculosis prevalent in all countries with more prevalence in children
is significantly reduced in people who have healthy nutrition compared to adults. Parasitic worm infections such as teniasis
and are vaccinated.[4‑6] and hookworm infection are also caused by inappropriate
nutrition.[12]
Nutrition effects on emergence of infections
If food, as a source of energy for human body, has microbial Malnutrition and infectious diseases
contamination, it can cause various diseases including digestive Effects of malnutrition on emergence the infectious
diseases and food poisoning. People are exposed to various diseases
food poisonings in different seasons. In hot weather, intestinal The effect of protein‑energy malnutrition on the increase of
diseases are highly observed, which the most dangerous one is infectious diseases has been studied extensively. In regions that
cholera.[7] Food poisoning is also caused by the consumption there is malnutrition of proteins, microbial contamination is a
of contaminated foods. In many cases, eating the spoiled health problem and affects the entire community of children. In
canned foods can be very dangerous. Typhoid fever, caused by such poor societies, the Vitamin A deficiency, which is one of
Salmonella species, is also one of the most dangerous diseases the important immune system boosters, should be added to diet.
transmitted through contaminated water and food.[8] It causes The lack of the mentioned nutrients, protein, and Vitamin A
many problems for patients since the pathogen is antibiotic has caused prevalent infections in the world’s poorest areas.[13]
resistance.[8]
Effects of infections on malnutrition
Besides, microbial contaminations transmitted through water In 1968, the World Health Organization reported that the
and food can cause severe diarrhea and infectious diseases infection could worsen malnutrition in humans.[14] This kind
in children.[9] Brucellosis is an infectious disease caused by of enhancement relationship is called synergy. It is believed
the ingestion of contaminated food and water. Brucellosis is that the infection can negatively influence the subjects’
a common disease between humans and animals. Bacterium nutritional status that results in reduction the body’s ability to
Brucella can cause illness in sheep, goats, cows, pigs, and fight infection. Consequently, infection can cause malnutrition
dogs. Humans become infected with Brucella by consuming and malnutrition may increase the infection.[14]
unpasteurized milk or undercooked meat from infected
animals.[10] Close contact with secretions of infected animals Some factors can weaken the body’s ability to fight infection
can also transmit the infection to human.[10] Amoebiasis is a and cause malnutrition [Figure 2]. First, anorexia can cause
major disease caused by consumption of contaminated water malnutrition and weaken the body’s immune system against
and food. Likewise, toxoplasmosis is caused through ingestion infection.[15] The traditional behaviors can also exacerbate
malnutrition and infection. For example, in some societies,
people who have fever or diarrhea are banned from eating.[15]
Reduced intestinal absorption due to intestinal infections

Figure 2: The factors that weaken the body’s ability to fight infection and
Figure 1: The relationship between nutrition and infectious diseases cause malnutrition

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Farhadi and Ovchinnikov: The relationship between nutrition and infection

can reduce protein, carbohydrate, and fat absorption by discussed. A large number of studies have illustrated
43%, 42%, and 72%, respectively. Of course, these values a bidirectional interaction of malnutrition and
depend on the type of infection.[16] Metabolic damage such infection [Figure 3].[16] The figure is adapted from Brown.
as losing proteins during the infection can increase the need
As one example, a study was conducted to show relationship
for dietary protein.[17] Disorder metabolism of lipids and
between infections and malnutrition in children. Results
carbohydrates (e.g., disorder in fatty acid self‑assembled
showed that malnourished children often suffered from
structure, ketone bodies, and triglycerides) may be observed diarrhea.[22] In these children, the rate and severity of diarrhea
in various infections. In addition, the infection can transmit was high.[22] The results indicate a direct relationship between
amino acids to carbohydrates via gluconeogenesis pathway malnutrition degree and risk of diarrhea. In another study,
that makes new glucose from noncarbohydrate precursors.[14] the influence of diarrhea was evaluated in infants from birth
The concentration of Vitamin A may be reduced in blood until 24 months of age. Results showed that impaired growth
during respiratory infections. Diseases such as hepatitis, acute was increased (about 16%) for every 5% increase in diarrhea
tonsillitis, and rheumatoid arthritis can also reduce serum incidence.[23] It has been also found that frequency of diarrhea
Vitamin A concentration.[13] The concentration of Vitamin C has a variable relationship with linear growth.[24] In a study
is reduced in patients’ blood with infections. As a result, the conducted in Western Kenya (2005–2007), 1146 children
concentration of Vitamin C increases in the urine. This situation hospitalized with moderate‑to‑severe diarrhea were examined.
is even seen in people who have received measles and smallpox It was found that children with severe malnutrition died from
vaccine. Obviously, people who have received the vaccine have diarrhea four times more than healthy children.[25]
an imitation infection.[18] Amount of Vitamin B2 (riboflavin) in
the body decreases following infection. Reduction of Vitamin The global enteric multicenter study conducted a study in
B2 due to infection is statistically significant.[2] Iron is another seven countries in Africa and Asia. In the study, 9439 children
nutrient that is reduced in the body due to infection. Iron with moderate‑to‑severe diarrhea and control children without
efficiency can help to reduce the activity of pathogens and diarrhea were enrolled.[26] Results showed that there was a
aid to treat infections.[2] Zinc and copper are other elements direct relationship among diarrhea, impaired growth and rate
whose concentration decreases when infections occur. Studies of postdiarrhea death during 90 days.[26]
have shown that the balance of copper and zinc in infections is A direct association has been found among malnutrition,
negative. In the blood, the concentration of copper increases, increase risk of pneumonia episodes and fatality. For example,
however, levels of copper may significantly decrease in the results of a study on 16,475 Malawian children demonstrated
infected body.[19] that severe malnutrition has a predictive value for hypoxemia
In order to treat malnutrition caused by infection, it is necessary and coma in children with pneumonia.[27] In Kenya, 25%
to compensate for energy and weight loss. Overall, nutrition is of 4187 hospitalized children with severe pneumonia were
critical in the treatment of malnutrition caused by infection.[13] reported to be severely malnourished. Thirty‑seven percent
of children were died after discharge from hospital. Effective
Nutrition in patients with severe immune deficiency factors on postdischarge mortality included malnutrition,
In severe immune deficiency, the susceptibility to infection can HIV status, young age, and prolonged length of stay.
occur. A healthy person may eat some poisoned canned food Malnourishment was found as a strong risk factor for inpatients
and do not get infection. However, patients with severe immune mortality and severity signs of the disease.[28]
deficiency may develop disease if they eat the same. Physicians
There is variable relationship between malnutrition and
emphasize that patients with severe immune deficiency,
bacteremia risk and malnourished children are more likely to
especially those with white blood cells below 1000 or less,
should not use raw foods and fruits. Such foods may transmit
pathogens. It is also recommended that the patients avoid
eating dried fruit when the white blood cells are under 1000.[20]
Overeating and infection
The relationship between overeating and infection is not
vastly investigated. However, in some studies, it is shown
that overweight persons are at more risk for respiratory tract
infections.[21] In addition, obese people have potential for get
diabetes and all diabetic people are sensitive to infections.[21]

Relationship between Malnutrition and Infection

Globally; Some Examples
In this section, some recent studies that focused Figure 3: Interaction of nutrition and infection. Adapted from Brown
on relationship between malnutrition and infection are 2003[16]

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Farhadi and Ovchinnikov: The relationship between nutrition and infection

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