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Nutritional Epidemiology

Micronutrient Deficiencies Are Associated with Impaired Immune Response and Higher Burden of Respiratory Infections in Elderly Ecuadorians^1,2

³ Jean Mayer USDA Human Nutrition Research Center on the Aging, ⁴ Friedman School of Nutrition Science and Policy, ⁵ Department of Public Health and Family Medicine, School of Medicine, and ⁶ Department of Pathology, Sackler School of Graduate Sciences, Tufts University, Boston, MA; ⁷ Center for International Health and Development, School of Public Health and ⁸ Section of Infectious Diseases, Department of Medicine, School of Medicine, Boston University, Boston, MA; ⁹ Corporación Ecuatoriana de Biotecnología, Quito, Ecuador; and ¹⁰ Department of Microbiology, Pontifical Catholic University of Ecuador, Quito, Ecuador

The proportion of the Latin American population above age 65 y is expected to rise substantially. To better define the prevalence of infectious diseases and micronutrient deficiencies, assess immunological status, and evaluate associations between nutritional status and infection, we performed a cross-sectional study of elderly Ecuadorians in a low-income peri-urban community in Quito, Ecuador. Culturally adapted questionnaires, delayed type hypersensitivity (DTH) skin response, micronutrient, and immunological assays were performed in randomly selected Ecuadorians aged 65 y. Multiple linear and logistic regression models were developed to assess relationships between micronutrient concentrations and history of infection, DTH, and immune function. Participants (n = 352; mean age ± SD, 74.4 ± 6.4 y) recalled recent episodes of colds/influenza-like syndromes (62.8%), cough (61.0%), urinary tract infection (37.9%), diarrhea (32.2%), fever (24.1%), and pneumonia (3.5%). A prospective substudy of respiratory infections (RI) in 203 elderly revealed similar findings. Colds and pneumonia occurred in 42.8 and 7.9% of participants, respectively, during 737 person-weeks of observation (3.6 ± 1.1 wk per person). Anemia and micronutrient deficiencies, especially for vitamins C, D, B-6, and B-12 and folic acid and zinc, were common. Plasma vitamin C was associated with interferon- (IFN) (P < 0.01) and zinc with IFN and interleukin-2 (each P < 0.0001). RI history was associated with any micronutrient deficiency (P < 0.001). The burden of infectious diseases, micronutrient deficiencies, and anemia was substantial in this elderly Ecuadorian population. Deficiencies of essential vitamins and minerals place these elderly adults at risk for infections through their negative impact on immune function.

^* To whom correspondence should be addressed. E-mail: simin.meydani{at}tufts.edu.

Manuscript received 24 June 2008. Initial review completed 15 August 2008. Revision accepted 17 October 2008.

Published online 3 December 2008.