Clinical Advances in Immunonutrition and Atherosclerosis: A Review

Abstract

Atherosclerosis is a chronic low-grade inflammatory disease that affects large and medium-sized arteries and is considered to be a major underlying cause of cardiovascular disease (CVD). The high risk of mortality by atherosclerosis has led to the development of new strategies for disease prevention and management, including immunonutrition. Plant-based dietary patterns, functional foods, dietary supplements, and bioactive compounds such as the Mediterranean Diet, berries, polyunsaturated fatty acids, ω-3 and ω-6, vitamins E, A, C, and D, coenzyme Q10, as well as phytochemicals including isoflavones, stilbenes, and sterols have been associated with improvement in atheroma plaque at an inflammatory level. However, many of these correlations have been obtained in vitro and in experimental animals' models. On one hand, the present review focuses on the evidence obtained from epidemiological, dietary intervention and supplementation studies in humans supporting the role of immunonutrient supplementation and its effect on anti-inflammatory response in atherosclerotic disease. On the other hand, this review also analyzes the possible molecular mechanisms underlying the protective action of these supplements, which may lead a novel therapeutic approach to prevent or attenuate diet-related disease, such as atherosclerosis.

Keywords: Mediterranean diet; atherosclerosis; bioactive compounds; cardiovascular disease; dietary supplements; functional foods; immunonutrition; inflammation.

Figure 1

Potential protective effects of the different supplements on immune factors. CAT, catalase; CRP, C-reactive protein; d- ROMs, diacron-reactive oxygen metabolites; FGF21, Fibroblast growth factor 21; Foxp3, forkhead box protein-3; GPx, glutathione peroxidase; 8-OHDG, hydroxydeoxyguanosine; IFN-γ, Interferon gamma; IL-, interleukin; KTR, kynurenine-to-tryptophan ratio; LXA4, lipoxin A4; MDA, malondialdehyde; MCP-1, monocyte chemoattractant protein-1; MMP, metalloproteinases; NF-κβ, nuclear transcription factor signaling; NT-pro-BNP, N-terminal pro b-type natriuretic peptide; oxLDL, oxidized low-density lipoprotein; PAI-1, plasminogen activator inhibitor type 1; RORc, retinoid-related orphan receptor-c; sICAM-1, soluble intercellular adhesion molecule 1; SOD, superoxide dismutase; sVCAM-1, soluble vascular cell adhesion molecule-1; TAC, total antioxidant capacity; T-bet, T helper 1 cell lineage commitment; TGF-β, transforming growth factor-beta; TNF-α, tumor necrosis factor-alpha; WBC, white blood cell count.