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THIEME
Short Communication
1
The Risk Factors for Immune System Impairment and
the Need for Lifestyle Changes
Gunjan Y. Trivedi1, Banshi Saboo2
1Shri Jagdishprasad Jhabarmal Tibrewala University, Churela,
Rajasthan, India
2Society for Energy & Emotions, Wellness Space, Ahmedabad,
Gujarat, India
Address for correspondence Gunjan Y. Trivedi, Co-Founder, Society
for Energy & Emotions, Wellness Space, 119C Swastik Society,
Navrangpura, Ahmedabad, Gujarat, 380009, India
(e-mail: gunjan@wellness-space.net).
Healthy immune system helps in enhancing the quality of life and reduces the risk of
infectious disease. Chronic disease increases the risk of immune system impairment.
The article reviews the evidence on risk factors causing immune system imbalance
and articulates the complex nature of the relationships between immune system risk
factors, chronic disease, and infectious disease to highlight the importance of lifestyle
choices. Finally, some evidence is presented on mind–body interventions and lifestyle
choices for enhancing the immune system function.
Abstract
Keywords
►chronic disease
►immune system risk
factors
►infectious disease
►lifestyle choices
DOI https://doi.org/
10.1055/s-0040-1715778
ISSN 2321-0656.
©2020 Novo Nordisk Education
Foundation
Introduction
Recent developments of COVID-19 pandemic highlight the
importance of the immune system in quality of well-being
and preventive health management. The scientific evidence
indicates that individuals with immune system impair-
ment or those on medications that suppress the immune
system are considered to be at much greater risk of any
respiratory infections.1 It is also well-known that the num-
ber of individuals exposed to infection is much higher than
those presenting with the disease, confirming that most
individuals can destroy the microorganisms and prevent
the infection or slow down the progression. Unfortunately,
impaired immune system increases the susceptibility to
any infections, and a presence of any chronic disease (e.g.,
Type 2 diabetes) further increases the risk of impairment
in the immune system.2,3 Finally, the immunological studies
over several years have confirmed that in many infectious
diseases, the main pathological aspects are not related to
the direct action of an aggressor agent, but an abnormal
immune response.4 Together, the evidence points to under-
standing the risk factors for immune system impairment.
The article reviews these risk factors, the linkage with
chronic and infectious disease, the extent of choice the indi-
vidual or the society has to influence the risk factors, and
the implications for the individual and the clinician.
Key Immune System Risk Factors and
Linkage with Disease and Quality of Life
►Table1 (risk factors for immune system impairment) high-
lights the evidence of key risk factors impacting the immune
system often through the pathway that includes increased
(chronic) inflammation. Many of these factors are also the risk
factors for chronic disease and as discussed earlier, the impaired
immune system increases the risk of infectious disease.5,6
The evidence above confirms that the risk factors for
chronic disease also have an adverse impact on the immune
system, resulting in increased risk for the infectious disease.
Lack of Quantitative Evidence between
Specific Risk Factors and the Immune System
Impairment
Scientific studies have not yet been able to establish a quan-
titative relationship between altered immune response and
frequency or severity of disease in humans due to genetic dis-
similarity and heterogeneous form of environmental expo-
sure and finally lifestyle choices.25 This is further confounded
by the impact of life stage, gender, use of certain medications,
drug/alcohol usage, tobacco history, stress, lifestyle, occupa-
tion, and nutritional status.26 This indicates that despite the
evidence of the risk factors impairing the immune system, it
J Soc Health Diab
Published online: 2020-09-10
2
Journal of Social Health and Diabetes
Risk Factors for Immune System Impairment Trivedi, Saboo.
Table 1 Risk factors for immune system impairment
Lifestyle choice Impact on the immune system Discussions and implications
Poor diet
(includes macro- and micronutrient
imbalance) impacts both innate and
adaptive immune systems.7
Undernutrition due to
insucientmacronutrients and/or
deciencies in specic micronutrients
impairs the immune system, suppressing
immune functions that are fundamental to
host protection.8
Sucient scientic evidence conrms that
nutrient intake above recommended levels
may positively impact the immune function
and modulate chronic inammatory and
autoimmune condition while decreasing
infection risk.7
Improving the quality of diet must be
incorporated with the help of clinician.
There is a role of the individual, family, and
the society and the need for collabora-
tion between dietician, clinicians and the
individual.
Physical inactivity
Lack of physical activity impairs the
immune system and extreme physical
activity may temporarily aect the
immune system.
The evidence conrms physical activity
(moderate-to-vigorous intensity, less than
60 minutes) helps in enhancing the immune
system.
Regular exercise training has an overall
anti-inammatory inuence mediated
through multiple pathways.9
The evidence also highlights the negative
impact on the immune system of severe
exercise.10
Watchout: Extreme workload (exercise)
could adversely impact the immune system.
It is best to pursue WHO guidelines on
physical activity.11
Obesity
Obesity is a disease as well as the risk
factor for chronic disease and immune
system impairment.
Clinical and epidemiological data support
the evidence that the incidence and severity
of specic types of infectious illnesses are
higher in obese persons as compared with
lean individuals.12
Adipose tissuesand chronic inammation
are linked to suppression of the immune
system along with the presence of metabolic
syndrome parameters.13
Obesity and metabolic syndrome need both
lifestyle and clinical interventions.
Chronic Stress
“Stress-related disease emerges,
predominantly, out of the fact that
we so often activate a physiological
system that has evolved for responding
to acute physical emergencies, but we
turn it on for months on end, worrying
about mortgages, relationships, and
promotions”14.
There is direct linkage between chronic
stress and a broad spectrum of human
diseases.15
Stressors can increase the risk of developing
infectious disease, and they can also prolong
infectious illness episodes.16
Chronic stress also increases the risk of
immune system impairment through path-
ways that include chronic inammation.17
Psychological stress can deregulate the
human immune system. Stress can impact
immunity dierentially across individuals
and contexts.17
Lifestyle choices play a very important part
for addressing chronic stress. Being able to
identify the presence of chronic stress is the
rst step. Thus, it is important not only for
the clinician but also the family member to
identify and individual who is stressed and
seek appropriate help.
Sleep disruption
Sleep disruption has implications aecting
the nervous system, endocrine system,
energy balance, inammation (and
therefore immune system) and cognitive
functions.
Prolonged sleep disruption and increased
stress due to it results in increased
production of pro-inammatory cytokines
causing low-grade chronic inammation that
results in immune system impairment.18
The relationship between sleep and immune
function is bidirectional and increased sleep
disruption increases the risk of infectious
disease.19
Clinicians must screen for sleep disruption
through simple self-reported surveys,
especially for individuals at high risk of
immunosuppression or chronic disease.
Alcohol consumption Alcohol consumption decreases immune
system function, in general though there is
some evidence that moderate amount of
alcohol can enhance the immune system
(due to anti-inammatory impact).20
Given the serious health risks associated
with exceeding two drinks per day,
increased alcohol consumption cannot be
recommended.21
Tobacco consumption
(Includes smoking and chewing tobacco)
Ample evidence has shown that both
innate immunity and adaptive immunity
are susceptible to cigarette smoke, which
interrupts immunological homeosta-
sis, causes various diseases, and exerts
paradoxical eects on immune and tissue
cells.22,23 Chewing tobacco is also linked to
immune system impairment.24
Despite the anti-inammatory benets
of nicotine, smoking in general has an
overall negative impact and hence not
recommended. Any form of tobacco is likely
to impair the immune system.
3
Risk Factors for Immune System Impairment Trivedi, Saboo.
Journal of Social Health and Diabetes
is not possible to clearly link one or many risk factors with
likely occurrence of immune impairment or disease. In other
words, the intervention through lifestyle choice must address
all the risk factors.
The Importance of Lifestyle Choices and
Self-Regulation
The above evidence makes a strong case for lifestyle choices
and self-regulation. When the individual meets one or more
risk factors, there is an increased probability of immune sys-
tem impairment that may increase the risk for infectious and
chronic disease. Many of these risk factors are controllable and
could be managed if the individual or the society as a whole
understands and incorporates changes to reduce the risks.
Evidence indicates that adults who have poor self-regulation
are more likely to have health challenges (e.g., self-efficacy,
coping, adherence, and negative effects on health parameters)
that affects the quality of life due to chronic disease.27 From
health professionals’ perspective, it is important to find ways
to enhance the self-regulatory skills to slow down the disease
progression and also enhance the quality of life.28
Evidence on Mind–Body Interventions
Mind–body medicine focuses on the relationships between
the brain, mind, body, behavior, and their effect on health and
disease. According to the National Center for Complementary
and Alternative Medicine, it encompasses a large group of
therapies such as hypnosis, meditation, yoga, biofeedback,
tai chi, and visual imagery. Relaxation training had the stron-
gest scientific evidence of a mind–body medicine affecting
immune outcomes.29 Regular practice of yoga including slow
breathing or pranayama, tai chi, and meditation also have a
positive impact via reduction of inflammation (C-reactive
protein), thereby enhancing the immune function.30,31 To sum-
marize, practices that reduce stress, enhance relaxation, and
help in enhancing sleep can improve the immune system, pro-
vided they are incorporated into daily routine or lifestyle.
Conclusion
Many positive lifestyle choices such as quality diet, regu-
lar physical activity, maintaining ideal body-weight, good
stress management practices, quality sleep and no alcohol
or tobacco consumption can help in reducing the chronic
inflammation and thereby enhancing the immune system
function. This is more relevant for individuals with chronic
disease since the presence of chronic disease results in
impairment of the immune function.
The evidence also confirms that there is no quantitative
relationship to identify the linkage between a risk factor and
the impairment of the immune system. Hence, making a
healthy lifestyle choice is not a one-time intervention on one
risk factor but an overall lifestyle change across multiple risk
factors on a going basis.
Making the correct lifestyle intervention, when governed
by self-regulation, helps in enhancing the immune system
that can help in protection against infectious disease and
help in improving Quality of Life for individuals with chronic
disease.
Conict of Interest
None declared.
References
1 Australasian Society of Clinical Immunology and Allergy
Website. Available at: https://www.allergy.org.au/patients/
immunodeficiencies/covid-19-and-immunodeficiency.
Accessed March 15, 2020
2 Janeway CA Jr. How the immune system protects the host from
infection. Microbes Infect 2001;3(13):1167–1171
3 Geerlings SE, Hoepelman AI. Immune dysfunction in patients
with diabetes mellitus (DM) FEMS Immunol Med Microbiol
1999;26(3-4):259–265
4 Machado PRL, Araújo MIAS, Carvalho L, Carvalho EM. Immune
response mechanisms to infections. An Bras Dermatol
2004;79(6):647–662
5 Trivedi Gunjan Y, Hemalatha R, Ramani KV, Chronic Diseases
and Mind Body Management: An Introduction (Technical
Note), Reference No: CMHS0044TEC. Indian Institute of
Management; 2018
6 International Diabetes Federation. Available at: https://www.
idf.org/. Accessed March 15, 2020
7 Wu D, Lewis ED, Pae M, Meydani SN. Nutritional modulation
of immune function: analysis of evidence, mechanisms, and
clinical relevance. Front Immunol 2019;9:3160
8 Marcos A, Nova E, Montero A. Changes in the immune
system are conditioned by nutrition. Eur J Clin Nutr
2003;57(1, Suppl 1):S66–S69
9 Nieman DC, Wentz LM. The compelling link between physi-
cal activity and the body’s defense system. J Sport Health Sci
2019;8(3):201–217
10 Pedersen BK. Influence of physical activity on the cellular
immune system: mechanisms of action. Int J Sports Med
1991;12(Suppl 1):S23–S29
11 Physical Activity & Aduluts. World Health Organization web-
site. Available at: https://www.who.int/dietphysicalactivity/
factsheet_adults/en/. Accessed March 17, 2020
12 Martí A, Marcos A, Martínez JA. Obesity and immune function
relationships. Obes Rev 2001;2(2):131–140
13 Patel PS, Buras ED, Balasubramanyam A. The role of the
immune system in obesity and insulin resistance. J Obes
2013;2013:616193
14 Segerstrom SC, Miller GE. Psychological stress and the human
immune system: a meta-analytic study of 30 years of inquiry.
Psychol Bull 2004;130(4):601–630
15 Boscarino JA. Diseases among men 20 years after exposure to
severe stress: implications for clinical research and medical
care. Psychosom Med 1997;59(6):605–614
16 Glaser R, Kiecolt-Glaser JK. Stress-induced immune dys-
function: implications for health. Nat Rev Immunol
2005;5(3):243–251
17 Morey JN, Boggero IA, Scott AB, Segerstrom SC. Current direc-
tions in stress and human immune function. Curr Opin Psychol
2015;5:13–17
18 Besedovsky L, Lange T, Born J. Sleep and immune function.
Pflugers Arch 2012;463(1):121–137
19 Ibarra-Coronado EG, Pantaleón-Martínez AM,
Velazquéz-Moctezuma J, et al. The bidirectional relationship
between sleep and immunity against infections. J Immunol
Res 2015;2015:678164
20 Sarkar D, Jung MK, Wang HJ. Alcohol and the immune system.
Alcohol Res 2015;37(2):153–155
4
Journal of Social Health and Diabetes
Risk Factors for Immune System Impairment Trivedi, Saboo.
21 Romeo J, Wärnberg J, Nova E, Díaz LE, Gómez-Martinez S,
Marcos A. Moderate alcohol consumption and the immune
system: a review. Br J Nutr 2007;98(Suppl 1):S111–S115
22 Qiu F, Liang CL, Liu H, et al. Impacts of cigarette smoking on
immune responsiveness: up and down or upside down?
Oncotarget 2017;8(1):268–284
23 Sopori M. Effects of cigarette smoke on the immune system.
Nat Rev Immunol 2002;2(5):372–377
24 Willis D, Popovech M, Gany F, Zelikoff J. Toxicology of smoke-
less tobacco: implications for immune, reproductive, and
cardiovascular systems. J Toxicol Environ Health B Crit Rev
2012;15(5):317–331
25 House RV, Fundamentals of clinical immunotoxicology.
In:Immunotoxicity Testing. Humana Press; 2010 ; 363–384
26 DeWitt JC, Germolec DR, Luebke RW, Johnson VJ. Associating
changes in the immune system with clinical diseases for
interpretation in risk assessment. Curr Protoc Toxicol
2016;67(1):18.1.1–18.1.22
27 Lansing AH, Berg CA. Adolescent self-regulation as a founda-
tion for chronic illness self-management. J Pediatr Psychol
2014;39(10):1091–1096
28 Weidner G, Sieverding M, Chesney MA. The role of
self-regulation in health and illness. Psychol Health Med
2016;21(2):135–137
29 Wahbeh H, Haywood A, Kaufman K, Zwickey H. Mind-body
medicine and immune system outcomes: a systematic review.
Open Complement Med J 2009;1:25–34
30 Morgan N, Irwin MR, Chung M, Wang C. The effects of mind-
body therapies on the immune system: meta-analysis. PLoS
One 2014;9(7):e100903
31 Sengupta P. Health impacts of yoga and pranayama: a state-of-
the-art review. Int J Prev Med 2012;3(7):444–458