Nutrition and Periodontal Disease.

The identification of inflammatory periodontal disease and education in local and systemic risk factors and their management forms the foundation of the treatment of this disease. Nutrition is potentially a modifiable risk factor that could drive or abrogate the underlying oxidative stress in periodontitis. As research in this area is still in its infancy, clinical guidance on the delivery of dietary advice for susceptible patients is scarce. This paper will explain the possible mechanisms linking nutrition and periodontal disease, as well as the guidelines currently available to the dental profession. CPD/CLINICAL RELEVANCE: With a growing evidence base, an appreciation of the links between nutrition and inflammatory periodontal disease can help guide clinicians in educating patients on this potentially important modifiable risk factor.

Exploring the influence of the gut microbiota and probiotics on health: a symposium report.

The present report describes the presentations delivered at the 7th International Yakult Symposium, 'The Intestinal Microbiota and Probiotics: Exploiting Their Influence on Health', in London on 22-23 April 2013. The following two themes associated with health risks were covered: (1) the impact of age and diet on the gut microbiota and (2) the gut microbiota's interaction with the host. The strong influence of the maternal gut microbiota on neonatal colonisation was reported, as well as rapid changes in the gut microbiome of older people who move from community living to residential care. The effects of dietary changes on gut metabolism were described and the potential influence of inter-individual microbiota differences was noted, in particular the presence/absence of keystone species involved in butyrate metabolism. Several speakers highlighted the association between certain metabolic disorders and imbalanced or less diverse microbiota. Data from metagenomic analyses and novel techniques (including an ex vivo human mucosa model) provided new insights into the microbiota's influence on coeliac, obesity-related and inflammatory diseases, as well as the potential of probiotics. Akkermansia muciniphila and Faecalibacterium prausnitzii were suggested as targets for intervention. Host-microbiota interactions were explored in the context of gut barrier function, pathogenic bacteria recognition, and the ability of the immune system to induce either tolerogenic or inflammatory responses. There was speculation that the gut microbiota should be considered a separate organ, and whether analysis of an individual's microbiota could be useful in identifying their disease risk and/or therapy; however, more research is needed into specific diseases, different population groups and microbial interventions including probiotics.

[Immunonutrition after trauma]. / Immunonutrition nach Trauma.

Immunonutrition may be superior to standard clinical nutrition in specific clinical situations. After severe trauma, an enteral immuno-enhancing diet, enriched with arginine, omega-3 fatty acids, and nucleotides, decreases infectious complications. During acute respiratory distress syndrome, a continuous enteral diet with high-dose omega-3 fatty acids, gamma-linolenic acid, and antioxidants improved clinical outcome. Glutamine should be administered enterally or parenterally whenever total parenteral nutrition is indicated.

Antibody formation in first and second generation offspring of nutritionally deprived rats.

Prolonged partial restriction of calorie intake in young rats results in reduced growth, involution of lymphoid organs, and lymphopenia. After immunization with sheep red blood cells, the number of antibody-forming cells in the spleen and serum hemolysin titers are markedly reduced. The effect is more pronounced on the primary response and on immunoglobulin G antibody-forming cells. Significant impairment of antibody formation is detectable in the first (F1) and second (F2) generation offspring of starved Fo mothers.

Neuroimmunomodulation by nutrition in stress situations.

Stress has long been suspected to play a role in the etiology of many diseases and may be detrimental to health. Nowadays, the communication between the neuroendocrine and the immune systems is well established and there is enough evidence that the magnitude of stress-associated immune dysregulation is large enough to have health implications. In stress conditions, modulation of the immune system by the central nervous system (CNS) is mediated by a complex network of signals, showing a relationship between stress and resistance to infection. On the other hand, an adequate balanced diet plays a crucial role in the management of stress, and nutrition seems to be a critical determinant in the interactions among CNS and the immune system under stress conditions. Thus, interactions among nutrition, CNS and the immune system could be a key to understand implications in physiological stress situations. The present article will briefly review nutrition approaches on stress-related immune response and CNS communication.

The health impact of polyparasitism in humans: are we under-estimating the burden of parasitic diseases?

Parasitic infections are widespread throughout the tropics and sub-tropics, and infection with multiple parasite species is the norm rather than the exception. Despite the ubiquity of polyparasitism, its public health significance has been inadequately studied. Here we review available studies investigating the nutritional and pathological consequences of multiple infections with Plasmodium and helminth infection and, in doing so, encourage a reassessment of the disease burden caused by polyparasitism. The available evidence is conspicuously sparse but is suggestive that multiple human parasite species may have an additive and/or multiplicative impact on nutrition and organ pathology. Existing studies suffer from a number of methodological limitations and adequately designed studies are clearly necessary. Current methods of estimating the potential global morbidity due to parasitic diseases underestimate the health impact of polyparasitism, and possible reasons for this are presented. As international strategies to control multiple parasite species are rolled-out, there is a number of options to investigate the complexity of polyparasitism, and it is hoped that that the parasitological research community will grasp the opportunity to understand better the health of polyparasitism in humans.

Extra-intestinal manifestations of non-celiac gluten sensitivity: An expanding paradigm.

Non celiac gluten sensitivity (NCGS) is a syndrome characterized by a cohort of symptoms related to the ingestion of gluten-containing food in subjects who are not affected by celiac disease (CD) or wheat allergy. The possibility of systemic manifestations in this condition has been suggested by some reports. In most cases they are characterized by vague symptoms such as 'foggy mind', headache, fatigue, joint and muscle pain, leg or arm numbness even if more specific complaints have been described. NCGS has an immune-related background. Indeed there is a strong evidence that a selective activation of innate immunity may be the trigger for NCGS inflammatory response. The most commonly autoimmune disorders associated to NCGS are Hashimoto thyroiditis, dermatitis herpetiformis, psoriasis and rheumatologic diseases. The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported; it could be a characteristic feature that could help the diagnosis and be simultaneously managed. A possible neurological involvement has been underlined by NCGS association with gluten ataxia, gluten neuropathy and gluten encephalopathy. NCGS patients may show even psychiatric diseases such as depression, anxiety and psychosis. Finally, a link with functional disorders (irritable bowel syndrome and fibromyalgia) is a topic under discussion. In conclusion, the novelty of this matter has generated an expansion of literature data with the unavoidable consequence that some reports are often based on low levels of evidence. Therefore, only studies performed on large samples with the inclusion of control groups will be able to clearly establish whether the large information from the literature regarding extra-intestinal NCGS manifestations could be supported by evidence-based agreements.

Nutrition and immune system disorders / Nutrición y trastornos del sistema inmune

INTRODUCTION: Energy and nutrients obtained through food play an important role in the development and preservation of the immune system therefore any nutritional imbalance affects its competence and integrity. OBJECTIVES: Knowing the nutritional approach on different disorders of the immune system. METHODS: A review has been carried out on the most prevalent immunological disorders in developed countries, the nutritional characteristics to which they are associated and their nutritional approach. RESULTS: Nutritional treatment for immune disorders has focused in recent years on the role of PUFA-ω3 and vitamin D. Maintaining body weight, preventing malnutrition and protein catabolism are key strategies for nutritional treatment. This should be adapted to each disease stage because it is a dynamic process. CONCLUSIONS: Nutritional treatment for immunological disorders, especially in autoimmune diseases, is not always clear because they present acute and remission states. Anorexia is one of the most characteristic symptoms derived mainly from pharmacological treatment and inflammatory processes. Diet should be dense in nutrients that prevent deterioration.Nutritional treatment of immunological disorders should aim to maintain an optimal state of nutrition during symptomatic periods, prevent their deterioration during acute episodes and improve during stable periods free of symptoms.

INTRODUCCIÓN: la energía y los nutrientes que obtenemos a través de la alimentación ejercen un papel importante en el desarrollo y preservación del sistema inmune, por lo que cualquier desequilibrio nutricional en el individuo afecta a su competencia e integridad. OBJETIVOS: conocer el abordaje nutricional sobre diferentes trastornos del sistema inmune. MÉTODOS: se ha realizado una revisión sobre los trastornos inmunológicos de mayor prevalencia en países desarrollados, las características nutricionales a los que se encuentran asociados y su abordaje nutricional. RESULTADOS: el abordaje nutricional de los trastornos inmunológicos se ha centrado en los últimos años en los AGP-ω3 y la vitamina D. Mantener el peso corporal, evitar estados de desnutrición y catabolismo proteico, son estrategias clave del tratamiento nutricional. Este debe adecuarse a cada fase de la enfermedad, por lo que se trata de un proceso dinámico. CONCLUSIONES: el abordaje nutricional de los trastornos inmunológicos, sobre todo en las enfermedades autoinmunes, no siempre es del todo claro, debido a los estados agudos y de remisión que presentan. La anorexia es uno de los síntomas más característicos, derivada del tratamiento farmacológico y el proceso inflamatorio. La dieta debe contener una elevada densidad en nutrientes que eviten el deterioro.El abordaje nutricional de los trastornos inmunológicos debe tener como objetivo mantener un estado óptimo de nutrición durante los periodos sintomáticos, prevenir su deterioro durante los episodios agudos y mejorarlo durante los periodos estables libres de sintomatología.

Possible role of nutrients in neoplasia.

The relationship between cancer and diet is supported by epidemiological evidence suggesting that diet is a factor in the development of cancer of various organs including the esophagus, stomach, liver, and large bowel. The role of depressed immunocompetency, especially during critical periods of growth and development, is stressed as a possible important consequence of nutritional insults leading to carcinoma. Study of the relationships among nutritional factors, host-defense mechanisms, and carcinogens to carcinogenesis is significant since, theoretically, manipulation of diet could suppress or prevent chemically induced cancers. The distinction should be emphasized, however, between "nutrients," those elements of one's intake that are essential because the body is unable to synthesize them de novo, and "diet," which refers to everything that is ingested. It is the components of diet, chemicals in particular, that are most convincingly implicated as carcinogens, while it is doubtful that nutrient deficiencies or excesses have a direct causal relationship with the onset or development of cancer. Rather, nutrition probably exerts its carcinogenic effects indirectly; nutrients possibly enhance chemical carcinogenesis multifactorially by mechanisms linked to their ability to: (a) act as carriers of carcinogens or their precursors; (b) alter intestinal flora so that carcinogenic reactions are facilitated; (c) enhance levels and reactivity of cocarcinogens; (d) influence absorptive properties or morphology of tissues so that carcinogenic activity is enhanced; and/or (e) modify host-defense mechanisms that normally protect the organism.

Nutrition and tumor immunity: divergent effects of antitumor antibody.

Nutritional deficiency reduces antibody synthetic capacity. Antibody directed against tumor antigens, however, may serve either to heighten tumor immunity, as in antibody-dependent cellular cytotoxicity, or to diminish host resistance to cancer growth by "blocking" cell-mediated tumor immunity. Diets made deficient in specific amino acids are inimical to tumor growth, apparently through reduction of synthesis of blocking antibody. Thus, where tumor immune function is involved, complex and possibly paradoxical effects of nutritional status on tumor growth can be predicted.

Alcohol and alcohol-related deficiencies as carcinogens.

From the available evidence, alsohol ingestion per se does not appear to be carcinogenic. While alcoholism constitutes a major and serious social problem, it is not clear to what extent it constitutes a major health problem. We suggest that excessive alcohol ingestion coupled with a nutritional deficiency or some other insult (e.g., smoking) may be carcinogenic. Alcohol and/or several nutritional deficiencies usually associated with alcoholism have been shown to be immunosuppressive. The relationship between immunoincompetency and neoplasia has long been appreciated, and the exact role that alcohol and/or nutritional insults have in this relationship requires further investigation.

Leptin levels are associated with immune response in malnourished infants.

Circulating leptin levels, proinflammatory and T helper cells type 1 (Th1), Th2 cytokine production, and lymphoproliferative response were measured in 15 infants with primary moderate protein calorie malnutrition on admission and after recovery of 10% of weight. Sixteen healthy, well nourished infants of comparable age served as controls. A significant deficit in the z-score of weight for age, weight for height, body mass index, and circulating leptin and growth factors were detected in malnourished infants on admission compared with controls (P < 0.05). These deficits were associated with a significant suppression of the lymphoproliferative response, Th1, and proinflammatory cytokine production (P < 0.05). After a 10% weight gain, a significant increase in circulating leptin levels was produced in parallel with a significant increase in Th1 activity, as revealed by an enhancement in interferon-gamma and a suppression in IL-4 production. Concomitantly, the lymphoproliferative response became similar to that detected in control infants. Furthermore, a significant increase in IL-1 and TNFalpha production compared with that at admission was shown. These findings suggest an association between the increase in leptin and the immunological recovery observed following refeeding of malnourished infants.

Impact of nutritional status and nutrient supplements on immune responses and incidence of infection in older individuals.

With advancing age there is a progressive decline in immune responses although this is not inevitable. The impairment in immunocompetence is noticeable as early as 35-40 years in many individuals. At the same time, some persons even in the 80s may show a vigorous immune system comparable with that of the young adult. Nutrient deficiencies are frequent in older populations. A variety of nutrients are affected: zinc, iron, beta-carotene, Vitamins B6, B12, C, D and E, ad folic acid. The causal interaction between nutritional deficiencies and impaired immunity has been known in children; a similar relationship has been postulated in the elderly. In the last 25 years, many studies employing different designs have examined the role of diet, nutritional status, and nutrient supplements in the immune responses of older individuals. Some nutrients, for example zinc and Vitamin E, have been shown to increase selected immune responses but have not been beneficial in terms of reduction in infectious morbidity. A growing consensus indicates that the use of a multinutrient containing optimum amounts of essential trace elements and vitamins is likely to result in enhanced immune responses and reduction in the occurrence of common infections. These findings have considerable fundamental, clinical and public health significance.

Immune responses to measles and smallpox vaccinations in malnourished children.

Children with different levels of nutritional status were studied to determine their immune response to, and complications from, immunization with live measles vaccine and lyophilized smallpox vaccine. Two hundred forty-one children between the ages of 5 months and 9 years were examined to assess their nutritional status at the time of immunization. Sero-conversion was defined as a hemagglutination-inhibition titer to measles virus, of greater than or equal to 1:20 6 to 8 weeks after vaccination in initially sero-negative children. Of 111 initially sero-negative children 94% had an adequate immune response, shown by sero-conversion. Of 193 children without a smallpox vaccinationscar 97% were successfully immunized against smallpox. These rates of immune response were independent of age, sex, and nutritional status of the children. The geometric mean titer rise to measles immunization of groups, whose nutritional status was normal (greater than 90% of median weight for age), mildly (75 to 90%), moderately (60 to 75%), or severely (less than 60%) malnourished were 7.5, 8.8, 7.9, and 7.9, respectively. Malnutrition did not affect the children's ability to develop adequate immune response to measles of smallpox vaccine, and there were no major complications during the 8-week period of follow-up. Since measles is a very severe disease, which in malnourished children can carry a case fatality rate as high as 50%, malnutrition should be a prime indication for measles immunization, and certainly not a contraindication.

Cellular immune competence and diarrheal morbidity in malnourished Bangladeshi children: a prospective field study.

A year-long prospective study of 152 Bangladeshi children with mild to moderate protein-calorie malnutrition related nutritional status and cellular immune defects to morbidity due to diarrheal, respiratory, and febrile diseases. In children older than 36 mo, wasting correlated with skin test anergy to three recall antigens and with inability to initiate hypersensitivity to dinitrochlorobenzene. In this older age group, anergy was associated with a 58% increased attack rate and an 83% increased duration of diarrheal diseases but not with febrile or respiratory infections. In stepwise regression analysis, this anergy effect was independent of the small negative impact of poorer nutritional status on morbidity. Ninety-three percent of diarrheal illnesses lasting at least 14 d were among anergic children. Cellular immune incompetence, indicated by anergy of unknown etiology, is associated with increased diarrheal morbidity and may promote the vicious cycle of repeated infections and deteriorating nutritional status.

PIP: A year long prospective study of 152 Bangladeshi children with mild to moderate protein-calorie malnutrition related nutritional status and cellular immune defects to morbidity due to diarrheal, respiratory, and febrile diseases. In children older than 36 months, wasting correlated with skin test anergy to 3 recall antigens and with inability to initiate hypersensitivity to dinitrochlorobenzene. In this older age group, anergy was associated with a 58% increased attack rate and an 83% increased duration of diarrheal diseases but not with febrile or respiratory infections. In stepwise regression analysis, this anergy effect was independent of small negative impact of poorer nutritional status on morbidity. 93% of diarrheal illnesses lasting at least 14 days were among anergic children. Cellular immune incompetence, indicated by anergy of unknown etiology, is associated with increased diarrheal morbidity and may promote the vicious cycle of repeated infections and deteriorating nutritional status.

Immunocompetency in anorexia nervosa.

Twenty-two consecutively admitted patients diagnosed for anorexia nervosa were evaluated for cellular immune functioning by means of an anergy panel to test delayed hypersensitivity. The panel included candida, streptokinase-streptodornase, and mumps antigen administered by a standard protocol. A standard nutritional profile including current weight, usual weight, total protein, albumin, total iron-binding capacity, white blood cell count, total lymphocyte count, triceps skinfold, and arm muscle circumference was concurrently compiled on these subjects. Six of 22 patients studied were anergic. Visceral protein measures were generally within normal limits even in the most depleted patients. Malnutrition as measured by severity of weight loss and triceps skinfolds was significantly related to anergy, whereas visceral protein indicators (serum albumin, total iron binding capacity, transferrin) were not correlated with anergy. Anergy appeared to be related more strongly to anthropometric indices of malnutrition than to visceral protein values. Cellular immunity was generally preserved until weight loss was far advanced.

Effect of maternal nutritional status on immunological substances in human colostrum and milk.

Substances in colostrum and breast milk confer significant disease resistance to the breast-fed infant. The influence of maternal nutritional status on both immunological and nonimmunological milk factors was studied in a group of 23 Colombian women during the first 2 months of lactation. Maternal malnutrition was characterized by significantly lower weight/height ratio, creatinine/height index, total serum proteins, serum albumin, and serum IgG and IgA. The colostrum of malnourished mothers contained only one-third the normal concentration of immunoglobulin G and less than half the normal level of albumin. Significant reductions in colostrum levels of IgA and the fourth component of complement (C4) were also observed in the malnourished group. No differences were observed in colostral concentrations of lysozyme, C3 complement, or IgM. Titers of antibody in milk directed against respiratory syncytial virus were not influenced by maternal nutritional status. The differences noted above tended to disappear in mature milk, concomitant with improvement in the nutritional status of malnourished mothers during the first several weeks postpartum. We conclude that the protective qualities of colostrum and milk may be significantly influenced by maternal nutritional status.

Weight fluctuations after immunization in a rural preschool child community.

After inoculations with diphtheria, pertussis, tetanus (DPT), smallpox Bacillus Calmette-Guèrin (BCG), polio, and DPT + polio vaccine preparations, weight-for-age fluctuations were monitored in over 470 rural preschool children and compared to those in nonvaccinated control children matched for age, weight-for-age, season and year of immunization, and village affiliation. It was found that children immunized with live agents (BCG, smallpox, polio, DPT + polio) who also were below 6 months of age suffered statistically significant reductions in their weight-for-age compared to matched nonimmunized controls. Children inoculated with polio or smallpox who also were below 80% of the Harvard weight-for-age median experienced a larger decrease in their nutritional levels than those above, with correction for age distribution. It is suggested that in the developing world immunizations with live agents to children below 6 months of age should be given only if the infectious illness in which immunization is provided poses a real threat to health, or if vaccination coverage of children above 6 months of age would subsequently be difficult to achieve.

Effect of moderate malnutrition on concentrations of immunoglobulins and enzymes in tears and saliva of young Colombian children.

The influence of moderate malnutrition on immunoglobulins and enzymes in the sera and secretions of 71 Colombian children was studied. Concentrations of immunoglobulin A, immunoglobulin G, lysozyme, albumin, and aminopeptidase were measured in the sera, tears, and saliva of 27 normal, 32 grade I, 9 grade II, and 3 grade III malnourished children. The most severely malnourished children, grades II and III, had markedly reduced immunoglobulin A concentrations and elevated immunoglobulin G concentrations in tears. Immunoglobulin A levels in whole saliva were also reduced in these malnourished children. In contrast, the concentration of immunoglobulin A in the sera of these children was significantly elevated. There was no influence of malnutrition on levels of lysozyme, albumin, total protein, and aminopeptidase in tears or saliva. These results indicate that secretory immunity may be impaired in moderately malnourished children due to decreased levels of immunoglobulin A in secretions.