Perspective: Role of micronutrients and omega-3 long-chain polyunsaturated fatty acids for immune outcomes of relevance to infections in older adults - a narrative review and call for action

Authors: EGGERSDORFER, MANFRED - University Medical Center Amsterdam; BERGER, METTE - Lausanne University Hospital; CALDER, PHILI - University Of Southampton; GOMBART, ADRIAN - Oregon State University; HO, EMILY - Oregon State University; LAVIANO, ALESSANDRO - University Of Rome Sapienza; MEYDANI, SIMIN - Jean Mayer Human Nutrition Research Center On Aging At Tufts University

Submitted to: Advances in Nutrition
Publication Type: Review Article
Publication Acceptance Date: 5/10/2022
Publication Date: 5/19/2022
Citation: Eggersdorfer, M., Berger, M.M., Calder, P.C., Gombart, A.F., Ho, E., Laviano, A., Meydani, S.N. 2022. Perspective: Role of micronutrients and omega-3 long-chain polyunsaturated fatty acids for immune outcomes of relevance to infections in older adults - a narrative review and call for action. Advances in Nutrition. https://doi.org/10.1093/advances/nmac058.
DOI: https://doi.org/10.1093/advances/nmac058

Interpretive Summary: Approximately 1 million Americans are currently living with human immunodeficiency virus (HIV), the virus that causes acquired immunodeficiency syndrome (AIDS). Due to the actions of antiretroviral drugs, HIV levels are now kept low and patents can go decades without developing AIDS. However, even in the absence of AIDS, HIV positive patients now appear in the clinic with conditions that collectively resemble premature aging. One driver of aging is cellular senescence, a stress or damage response in which cells undergo a permanent growth arrest coupled to the secretion of several factors that drive degenerative disease. Here we show that the antiretroviral drug atazanavir (ATV) induces senescence in cultured cells. Surprisingly, removal of the drug resulted in reversal of senescence in both cultured cells and in ATV-treated mice. Mice showed signs of premature aging in response to atazanavir treatment, which was similarly reversed when the drug was removed. These studies indicate that some aspects of both cellular senescence and aging may be reversible, and that diseases of aging driven by ATV may be reversed by performing intermittent treatment or switching to therapies that do not promote cellular senescence.

Technical Abstract: The immune system is weakened by advancing age, often referred to as immunosenescence, increasing the vulnerability to, and frequently the severity of, infectious diseases in older people. This has become very apparent in the current coronavirus disease 2019 (COVID-19) pandemic for which older people are at higher risk of severe outcomes, even those who are fully vaccinated. Aging affects both the innate and adaptive immune systems and is characterized by an imbalanced inflammatory response. Increasing evidence shows that optimal status of nutrients such as vitamins C, D and E, selenium and zinc as well as the omega-3 fatty acids docosahexaenoic (DHA) and eicosapentaenoic acid (EPA) can help compensate for these age-related changes. While inadequate intakes of these nutrients are widespread in the general population, this is often more pronounced in older people. Maintaining adequate intakes is a challenge for them due to a range of factors such as physical, physiological and cognitive changes, altered absorption and the presence of non-communicable diseases. While nutritional requirements are ideally covered by a balanced diet, this can be difficult to achieve, particularly for older people. Fortified foods and nutritional complements are effective in achieving adequate micronutrient intakes and should be considered as a safe and cost-effective means for older people to improve their nutritional status and hence support their defense against infections. Complementing the diet with a combination of micronutrients, particularly those playing a key role in the immune system such as vitamins C, D and E, selenium and zinc as well as DHA and EPA is recommended for older people. Optimal nutrition to support the immune system in older people will remain essential, particularly in the face of the current COVID-19 pandemic and, thus, developing strategies to ensure adequate nutrition for the growing number of older adults will be an important and cost-effective investment in the future.