Clinical Nutrition and Immunology: Diet, Immunity, and Disease

This report on Clinical Nutrition and Immunology delves into the intricate relationships between diet, immunity, and various health conditions. It critically reviews the role of diet in cancer development and prevention, including the research on n-3 fatty acids in colon cancer prevention. The report further examines the potential health problems caused by obesity, and discusses the role of diet and other strategies in managing type II non-insulin dependent diabetes. A dedicated section discusses the challenges of preventing zinc deficiency worldwide. The role of ketogenic diets in managing young epilepsy patients is also reviewed. Furthermore, the report covers the risk factors and nutritional management strategies for colon cancer, and how to detect and provide nutritional support for patients with malnutrition. The immunology section explains how antibodies are generated during an immune response, how this process is harnessed for immunoassays, and the applications of flow cytometry. The report concludes with a comparison of different modes of immunotherapy for various diseases.

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Section A:
1)
There is a direct link between cancer and diet. Numerous aspects of diet influence the
development and progression of malignancies and neoplasms in humans. Several carcinogenic
substances are found naturally in food ingredients, while others are due to pesticide residues
from environmental pollution. For instance, fibres, natural components in most carbohydrates,
contributes to the development of colon cancer. More also, fungal contamination produces
carcinogenic toxins such as aflatoxin. According to Patel et al. (2018), contamination of grains
with aflatoxin present higher liver cancer incidence rates in some countries in Africa. Besides,
most food preservatives and dairy products contain nitrosamines, a product from the interaction
of nitrites and amines, which are potent carcinogens. Patel et al. assert that the
production of nitrosamines in dairy and stored food is responsible for the higher esophageal
cancer rates in the Middle East. High-protein diets have a prospective association with the
development of breast and colon cancers. Similarly, populations that consume diets rich in fats
show high breast cancer mortality.
Nonetheless, the biological properties in most diets play a crucial role in cancer
prevention. Most epidemiologic cancer studies affirm the relevance of dietary factors in cancer
prevention. Natural occurring compounds such as coumarins and flavones arrest the growth of
cancerous cells. A higher intake of Vitamin A and its derivatives such as retinoic acid prevents
the expression of neoplastic phenotypes; hence, inhibiting the progression of cancers (Yasueda et
al. 2016). Also, Vitamin A is responsible for proper growth and differentiation of cells, and
diminished levels pose a risk for cancer development in various organs. Most vegetables and
fruits contain antioxidants, which prevent the destruction of cells by free oxygen radicals.

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According to Yasueda et al. (2016), most cohort and observational studies show that antioxidants
prevent free radicals that contribute to the development of cancers. Besides, high intakes of
ascorbic acid help prevent some the development of some cancers. Yasueda et al. (2016) hold
that ascorbic acid represses the advancement of the stomach and esophageal cancers as it inhibits
the formation of nitrosamines, potent carcinogens. Indeed, diet can help reduce cell cycling,
hence, cancer prevention.
Colon cancer is among the chief causes of death globally. Inflammation is a hallmark for
colon cancer, and new concepts in research studies describe the role of n-3 fatty acids its
prevention. Inflammation is a hallmark for colon cancer, and fatty acids are determinants in
inflammatory responses. A plethora of research studies conducted illustrate that n- 3 fatty acids
are anti-inflammatory and anticancer. According to Miccadei et al. (2016), patients who receive
n- 3 fatty acids supplements show markedly low levels of cytokines hence reduced progression
of the disease. Similarly, in vitro studies demonstrate that docosahexaenoic acid, one of the n- 3
fatty acids, activates apoptosis, and inhibits the initiation and progression of cancer (Miccadei et
al. 2016).
Additionally, n-3 fatty acids have antineoplastic activity. These fatty acids control the
expression of genes, which regulate cellular mechanisms through DNA methylation or
acetylation (Weylandt et al. 2015). Polarizing of phagocytes towards pro-resolving M2
phenotype is a unique mechanism that demonstrates the antineoplastic activity of n-3 fatty acids.
More also, n-3 fatty acids not only boost the efficacy of chemo- and radiotherapies, but also
prevents the recurrence of colon cancer. Studies show that the immunomodulation capacities of
docosahexaenoic and eicosapentaenoic acids help reduce the inflammation due to chemo-and
radiotherapies (Weylandt et al. 2015).

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2)
Obesity is a condition in which a person carries excess body fat that might negatively
affect their health. Several measures that can be used to tell whether one is obese include body
mass index (BMI) and waist size among others. Obesity is linked to a higher risk for type II
diabetes, a condition characterized by higher insulin levels in the blood. According to Abdelaal
et al. (2017), about 87% of persons who develop diabetes are obese. Obesity alters a person’s
cells making them resistant to insulin, which carries glucose to various organs for metabolism.
Such alterations cause markedly elevated blood sugar levels that also cause secondary diseases
such as chronic kidney disease and stroke (Abdelaal et al. 2017).
Furthermore, obesity correlates with high blood pressure. Standard blood pressure
reference is 120/80 mmHg, but obese individuals record higher diastolic and systolic values. For
obese persons, their hearts have to pump blood at a higher pressure to reach every organ.
Besides, too much body fat damage the renal system that regulates blood pressure. More also,
obesity increases the risks of heart diseases. Increased blood pressure, elevated cholesterol, and
diabetes are likely to cause heart attacks, heart failure, and ultimately, death (Williams et al.
2015). Also, obesity risks the development of sleep apnea. Excessive fats around the neck of
obese persons make the air passages narrower, which makes breathing difficult (Abdelaal et al.
2017). More also, the unnecessary neck fats trigger an inflammatory response, a condition that
commonly occurs in the obese.
Dietary measures are essential in the management of type II non-insulin dependent
diabetes. The quality of fats and carbohydrates is of the essence when compared to quantity.
According to Ley et al. 2014, cereal fibres have an inverse association with diabetes type II.
Glycemic load and index are used to analyse carbohydrate quality: diets with lower glycemic

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indexes and load are essential in the management of type II diabetes. The foods rich in fruits,
vegetables, nuts, and whole grains; low refined food products; and moderate alcohol intake
reduces the risks or exacerbation of diabetes by regulating blood lipid and glycemic levels (Ley
et al. 2014). The ingestion of nuts neutralizes insulin and blood glucose by increasing satiety; it
is beneficial to liquid body profiles.
In addition to diet, it is crucial to incorporate other strategies in the management of
diabetes type II. Education promotes a healthy lifestyle for diabetic patients. Diabetic patients
ought to be educated on several content areas such as disease pathogenesis; treatment plans;
monitoring of blood glucose; nutritional plans; and secondary complications. Regular exercises
for diabetic and prediabetic individuals improves muscles’ sensitivity to glucose; boosts insulin
sensitivity; and, resultantly improving obesity (Dempsey et al. 2016). The adoption of gastric
reduction procedures will help improve glycemic control as well as weight control in diabetic
patients. According to Ley et al. 2014, 78% of the135,000 subjects that underwent the gastric
reduction surgery maintained controlled glycemic levels for more than two years as they also
shed excess weight.
3)
Zinc deficiency is a universal concern in human health and agriculture, but mostly in
developing countries. According to Kumssa et al. (2015), about 17% of the world population
suffers from zinc deficiency; 30% South Asians are a higher risk of zinc deficiency; and about
500,000 children die to such insufficiency. As a vital nutrient, zinc regulates gene transcription
and the metabolism of the biomolecules: proteins, lipids, and also nucleic acids. It is found in
every cell in the human body, and its roles include reproduction, immunity, wound healing, cell

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division/differentiation, and breaking down carbohydrates among others. On the other hand, zinc
deficiency triggers depression, loss of sense for taste, low fertility, poor wound healing, and low
immunity. There are several interventions adopted globally to curb this situation, but challenges
continue to arise.
Most countries have zinc-deficient soils. Such states correlate with the high incidences of
human zinc deficiency. In particular, the human body cannot synthesize the nutrient: it must be
obtained from the various food sources, such as legumes, vegetables, and cereals. Cultivation of
crops in regions with low zinc soils results in low yields that lack sufficient levels of zinc.
(Esfandiari et al. 2016). Low yields dictate low income; therefore, farmers will not be able to
purchase zinc fertilizers for their crops. Since food crops constitute the primary source of food
for humans, then, zinc deficiency is inevitable. Large populations in developing countries depend
on cereals as the source of calories. However, in countries such as Turkey, the growth of wheat
in zinc-deficient soils correlate to the human zinc deficiency in the country (Esfandiari et al.
2016).
Sociocultural and household factors hinder the provision of meat as the primary source of
zinc in several instances. Lack of knowledge by mothers on the significance of animal food
sources in diets for children hampers most global interventions (Ackland & Michalczyk 2016).
More also, a large population in most countries shun animal products for religious reasons.
Besides, the special allocation of food products, such as meat for adult males limits the quantity
offered to children and females in most developing nations (Ackland & Michalczyk 2016).
Limited availability of fresh fish and animal foods is universal in most regions globally due to
adverse weather conditions.

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The prevalence of HIV/AIDS is still high in most developing countries. Typically, zinc is
essential in sustaining the immune system. Persons infected by HIV/AIDS are susceptible to
lower zinc levels (Martinez et al. 2017). Due to stigma and lack knowledge of antiretroviral
therapy, the HIV epidemic continues to hinder the global interventions that aim at preventing
zinc deficiency. Notably, low serum zinc levels exacerbate the disease to an end-stage hence an
increased mortality rate. Besides, the higher incidence of diabetes type II in most developed and
developing countries has been a limiting factor in the prevention of zinc deficiency. Polyuria
leads to the loss of zinc; hence, the higher incidence of zinc deficiency in most nations.
Zinc is an essential nutrient found in both animals and plants. The human body requires
zinc for most cellular processes, and deficiency results in various medical conditions that often
cause death. Differential zinc in agricultural soils, sociocultural factors, human factors, and
diseases such as HIV/AIDS and diabetes type II challenge the prevention of zinc deficiency
globally.
4)
Over the years, fasting has been shown to suppress epileptic seizures, and it is believed
that ketogenic diets serve the same purpose. Physicians have been using ketogenic diets in
treating drug-resistant epilepsy amongst children for over a century. A ketogenic diet is rich in
fats and protein: it has low carbohydrate levels (Martin et al. 2016). The foods make the bodies
release ketone bodies from the liver into the blood. Under normal circumstances, the human
body uses carbohydrates for energy production, but under scarcity conditions, the liver releases
ketones from the breakdown of fatty acids, which are then used for energy production (Martin et
al. 2016). Since a ketogenic diet has minimal or lacks carbohydrates, an individual’s body is
forced to undergo ketosis to maintain the metabolic processes. A typical ketogenic diet includes

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butter, oils, fibrous vegetables, dairy products, nuts, and seafood. The classical ketogenic diet,
medium-chain triglyceride diet, modified Atkins diet, and low glycemic index diet is the various
types of keto therapies (Elia et al. 2017). The ratio range of fats to carbohydrates and proteins is
2:1 – 4:1. The medium-chain triglyceride sources it fats from medium-chain fat stores that are
quite efficient in inducing ketosis. These diets are effective in managing epilepsy in children;
however, the choices for the food are contingent on parental preferences, familial circumstances,
and the severity of the seizures.
About 25% of young epileptic patients are unresponsive to antiepileptic drugs. Pediatric
therapists recommend ketogenic diets when the young patient, usually children, fail three
anticonvulsant therapies (McArtney et al. 2017). More also, doctors refer young patients to
tertiary pediatric doctors following unresponsiveness to the antiepileptic drugs are put on
ketogenic diets. A ketogenic diet, through several mechanisms, helps to stabilize the neuron
synaptic functions. Ketones reduce neuronal excitability, decreases the production of oxidative
free radicals, inhibits the production of inflammatory agents, and produces antiepileptic effects
directly or indirectly (McArtney et al. 2017). Through mitochondrial phosphorylation, ketone
bodies enhance the production of ATP. The oxidation of the ketone bodies avails Acetyl-CoA
into the tricarboxylic acid (TCA) cycle through anaplerosis, increasing the turnover for the cycle;
hence, the production of protons and neutrons channeled through the electron transport chain
boosting the production of ATP.
Ketones, from the ketogenic diets, inhibit neuronal excitability. Ketone bodies activate
ATP-dependent potassium gates, thus inhibiting the rate in which neurons fire. Besides,
ketogenic diets hamper the role of the excitatory neurotransmitter glutamate, which lowers the
release rate of glutamate into the synapses, while at the same time inhibiting the production of

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GABA (Rogawski et al. 2016). Glutamate to GABA ratio alterations lessens neuronal
excitability. Additionally, ketogenic diets impact seizure control by depressing oxidative stress
and inflammation in cells. Through the inhibition of histone deacetylases, ketones, from the
foods, upregulates antioxidant genes. Furthermore, ketogenic diets change the levels adenosine, a
neurotransmitter (Rogawski et al. 2016). Alteration of adenosine signaling triggers epileptic
seizures; ketogenic diets reverse this alteration.
Lastly, a ketogenic diet exerts antiepileptic effects directly by elevating the amounts of
medium-chain fatty acids and lowering the metabolism of glucose (Rogawski et al. 2016).
Medium- chain fatty acids block epileptic-like activities in young adults. Also, since ketogenic
diets reduce glucose metabolism (glycolysis), the suppressed expression of neurotrophic factor (a
pro-convulsant) is thought to control seizures.
5)
Colon cancer is the 3rd and 2nd most commonly diagnosed cancers in males and females
respectively. Numerous risk factors that are linked with the initiation and development of colon
cancer include heredity, lifestyle, and environmental factors; however, diet accounts for the
occurrence of colon cancer. Most case-control and cohort studies provide substantial evidence
regarding the excess energy intake, in the form of food, and an increased risk of colon cancer.
According to Reddy (2018), the consumption of red meat increases the chances for cancer, but
other protein-rich sources do not elevate risk: it reduces its occurrence. More also, alcohol
consumption may augment the risk of malignancies of the distal colon. The effect of alcohol
becomes active in the instances when an individual consumes diets with low methionine and
folate; it suggests that the risk is due to the antagonism of methyl-group metabolism (Reddy
2018). Frequent habitual eating triggers the growth of tumors in the colon. Reddy (2018) holds

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that high eating frequencies correlate with the periodic release of bile into the gut. Too much
secretion of bile triggers gastrointestinal bacteria to produce tumorigenic secondary bile acid.
The resorption of these acids in the colon following subsequent metabolism induces the growth
and proliferation of tumors. Furthermore, the various cooking methods that involve extremely
high temperatures, such as grilling and frying, release chemicals that increase the risks of
acquiring cancer.
Nutritional management strategies aim to prevent colon cancer. Dietary folate from
supplements necessitates the synthesis, repair, and methylation of DNA (Burr et al. 2017) Active
cell proliferation occurs under different situations, such as in pregnancies and infancy. Folate
arrests DNA alterations that often causes cancer, hence its novel role in colon cancer treatment.
Colon cancer patients need to obtain folate from the diet since the human body cannot synthesize
it. According to Burr et al. (2017), the consumption of food with high dietary folate results in a
40% reduced risk of colon adenomas.
Garlic consumption plays a crucial role in colon cancer management. It contains organo-
sulfur, flavonoids, and selenium that are antioxidant and anticarcinogenic (Waly & Rahman
2018) Besides, an inverse link exists between garlic intake and colon cancer risk. According to
Waly and Rahman (2018), the sulfur component in garlic destroys the carcinogen-induced
tumors in the colon. More also, it suppresses the size and number of adenomas in parts of the
colon.
Diets or supplements rich in Vitamin B6 are essential in managing colon cancer. Most
enzymatic reactions involve the use of Vitamin B6, and importantly, the transfer of carbon
groups in DNA synthesis and methylation (Song et al. 2015). Thus, a deficiency in the vitamin
increases the risks for colon cancer due to aberrations in DNA synthesis, repair or methylation.

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The vitamin suppresses the carcinogenesis of cancer by reducing cell proliferation and oxidative
stress. Additionally, it prevents inflammation and further production of nitric oxide. High dietary
intake of calcium and Vitamin D reduces the risks of colon cancer development. Dairy products
such as cheese and milk are rich in calcium and vitamin D. The intracellular action of calcium
reduces the exposure of mucosal cells to toxins. Calcium prevents the proliferation of epithelial
cells. Vitamin D exhibit protective effects against adenomas in the colon: it reduces proliferation
of the linings in the colon (Song et al. 2015).
6)
Malnutrition is a detrimental condition which occurs when an individual’s diet lacks
particular nutrients. It affects morbidity and recovery processes (Brito et al. 2016). Assessing
patients’ nutritional statuses plays a crucial role in creating a nutritional plan. Various measures
assess malnutrition, for instance, body mass index (BMI) assesses a patient’s weight with regards
to their height (Brito et al. 2016). BMI measures are commonly used due to its simplicity. It
gives an insight about a patient’s nutritional status as low levels, below 18.5, indicates
malnutrition. It dictates that the patient lacks vital nutrients. For one to obtain a BMI
measurement, divide the height measurement, in kilograms, by height (meters squared).
However, this measurement tool is insufficient since a person may be normal or obese but still
lack some nutrients.
The percentage of a patient’s weight loss serves as an indicator of weight loss (Cederholm et
al. 2015). An unintentional weight loss of about 10% of total body weight within six months
indicates the extent of malnutrition. 5% and 7.5% weight loss within 30 and 90 days respectively
gives more insight regarding malnutrition (Cederholm et al. 2015). Medically, this percentage

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measure dictates a patient’s body compromise; it shows the nutritional status of a patient
population. Additionally, measuring the mid-upper arm circumference (MUAC) of children
helps detect the degree of malnutrition (Van Tonder et al. 2018). It assesses muscles and
subcutaneous fat, which are determinants in surviving starvation.
A malnourished patient needs support to restore their normal health. A multidisciplinary
team and family play a crucial role in the provision of assistance to these patients. The level of
malnutrition ought to correlate with its management. Safe and effective nutritional treatment or
care plans are essential for long-term outcomes. Oral nutrition is a crucial support strategy for
malnutrition. It involves the administration of liquid, solid or powder nutrients orally (Bounoure
et al. 2016). It is widely used for patients that cannot meet their nutritional needs through diet.
More also, enteral nutrition, feeding through tubes, can be used by malnourished patients.
Enteral nutrition is crucial in situations when the patient has gut problems or other chronic
diseases (Bounoure et al. 2016). In such circumstances, the doctors insert a tube through the nose
into the stomach, then liquid food or supplements pumped through the tube. This procedure lasts
for hours or days until when the malnourished patient recovers; however, if there are lower
chances of recovery, gastrostomy may be used. Equally important, parenteral nutrition supplies
all nutritional nutrients through an intravenous route (Bounoure et al. 2016). Doctors use this
when the nutritional needs cannot be met through enteral and oral means. It is crucial for
critically ill and malnourished patients. Most patients in intensive care units are malnourished
and need parenteral nutrition to boost their immunity. It is imperative that nurses assist in
implementing an effective nutritional care plan, which will optimize the malnourished patient’s
oral, enteral, and parenteral intakes. More also, monitoring these routes of nutrient administration
and duration of therapy are essential in alleviating malnutrition.