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Nutrition is key to global pandemic resilience
  1. Bryndis Eva Birgisdottir
  1. Unit for Nutrition Research, Faculty of Food Science and Nutrition and Landspitali University Hospital, University of Iceland, Reykjavik, Iceland
  1. Correspondence to Dr Bryndis Eva Birgisdottir, Unit for Nutrition Research, Faculty of Food Science and Nutrition and Landspitali-University Hospital, Haskoli Islands, Reykjavik, Iceland; beb{at}

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Healthful food of good quality is our first line of defence against diseases,1 including immune defences against pathogenic organisms.2 3 In the current worldwide concern of coronavirus SARS-CoV-2, resulting in the COVID-19 disease, a strurdy immune system is considered central.4 This inevitably puts focus on the saga of the harmonious concert between nutrition and the immune system, unfolding over the last century.2

Big pandemics and resourceful pathogens have shaken the world before, with devastating death tolls of often young people, such as through the Spanish influenza and tuberculosis.5 6 Although biological processes or mechanisms were less understood at the time, it was simply considered common sense that those who had access to enough quality food had a better chance against diseases. Later, or mid-century, the extended and cyclical relations between malnutrition and infections were elegantly described,2 and diabetes was also early identified as a condition making people especially vulnerable to pathogens.7

An interwoven world

Today, however, the increasing diversity of reliable quality tools that are available to assess immune function have facilitated the remarkable increases in our comprehension of the design of both the innate and adaptive immune system.2 Scientific advances have also brought with them an emerging understanding of the web of genes, the immune system and nutritional status, including energy metabolism and the gut microbiota, although many puzzles still remain to be solved.3 8 The current challenge is to capture the complexity of this multidimensional relationship, interacting via multiple direct and indirect pathways,3 while at the same time tracing and understanding the effect of single nutrients of special importance.9 10

As the immune system develops and forms from conception to adulthood,3 a natural decline in immune function is usually inevitable with age.4 However, this decline may be slowed …

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