Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Jul 15;11(1):21.
doi: 10.1186/s40794-025-00258-z.

A scoping review: the impact of nutritional status on the efficacy, effectiveness, and immunogenicity of COVID-19 vaccines

Vicka Oktaria  1 , Bayu Satria Wiratama  2 , Slamet Riyanto  3   4 , Ratih Puspitaningtyas Purbaningrum  3   5 , Citra Widya Kusuma  1 , Lintang Dian Saraswati  6   7 , Vitri Widyaningsih  8 , Ratih Puspita Febrinasari  8 , Ari Probandari  8 , Riris Andono Ahmad  1   9
Affiliations
Review

A scoping review: the impact of nutritional status on the efficacy, effectiveness, and immunogenicity of COVID-19 vaccines

Vicka Oktaria et al. Trop Dis Travel Med Vaccines. .

Abstract

Background: Vaccination is one of the most effective strategies in mitigating the severity of SARS-CoV-2 infection. While a connection between poor nutritional status and diminished immune responses to vaccination has been noted, comprehensive reviews elucidating this association have been scarce. To address this gap, we conducted a scoping review to characterise the relationship between nutritional status (specifically, body mass index (BMI) or micronutrient deficiencies) and the responses to COVID-19 vaccination, encompassing efficacy, effectiveness, and immunogenicity.

Method: We searched PubMed, OVID-Medline, Scopus, Cochrane Covid Register, LitCovid, and WHO COVID-19 research databases for studies that reported the association between nutritional status and responses to the COVID-19 vaccines (published between December 20, 2019, and December 30, 2023). Two reviewers independently screened the articles, and disagreements were resolved through consensus or by a third reviewer.

Results: Seventy-three out of 1,853 identified articles were included in this review, predominantly featuring cohort designs (72%). Among these studies, 63% reported BMI, 30% focused on micronutrients (specifically vitamin D, selenium, iron, zinc), and 6% examined both. Most studies (84%) focused on vaccine immunogenicity. The most frequently studied vaccines were BNT162b2 (Pfizer, 74%), ChAdOx (AstraZeneca, 23%), and mRNA-1273 (Moderna, 14%). High BMI significantly reduced COVID-19 vaccine immunogenicity in 23 studies, while adequate vitamin D was associated with increased vaccine response in seven studies.

Conclusion: Overnutrition and micronutrient deficiencies (vitamin D, iron, selenium and zinc) have been observed to attenuate the potency of COVID-19 vaccines. Future strategies aimed at prioritizing vaccination in obese and overweight individuals, or enhancing their vaccine response, may involve identifying measures such as the provision of booster doses. Additionally, efforts should ensure micronutrient adequacy, including improving vitamin D status through strategies like increased sun exposure or supplementation, particularly for deficient individuals.

Keywords: BMI; COVID-19; Immune response; Obesity; Vaccines; Vitamin D.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not required. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flowchart
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Panneer S, Kantamaneni K, Palaniswamy U, Bhat L, Pushparaj RRB, Nayar KR, et al. Health, Economic and Social Development Challenges of the COVID-19 Pandemic: Strategies for Multiple and Interconnected Issues. Healthcare. 2022;10(5):770. - PMC - PubMed
    1. WHO. WHO Coronavirus (COVID-19) Dashboard. WHO Coronavirus (COVID-19) Dashboard. 2022.
    1. World Bank Group. Chapter 1. The economic impacts of the COVID-19 crisis. World Bank Group. 2022. Available from: https://www.worldbank.org/en/publication/wdr2022/brief/chapter-1-introdu.... Cited 2022 Dec 3.
    1. Lipsitch BM, Dean NE. Viral shedding are important for protection. Science. 2020;370(6518):763–6. - PubMed
    1. Zheng C, Shao W, Chen X, Zhang B, Wang G, Zhang W. Real-world effectiveness of COVID-19 vaccines: a literature review and meta-analysis. Int J Infect Dis. 2022;114:252–60. - PMC - PubMed

LinkOut - more resources