Table 2.

Effects of macronutrients on the immune system.

Nutrient	Innate immunity	Adaptive immunity	Immunological outcome	Impact on health and disease	Refs.
Proteins	Regulation of NK cell activation, macrophage activation, and cytokine and cytotoxic factor production. ↑NK killing activity, macrophage phagocytosis, antioxidant activity. ↓Pro-inflammatory adipokines chemerin and progranulin.	Regulation of B and T cell activation, lymphocyte proliferation, and antibody and cytokine production.	Immunomodulation. Regulation of activation of innate and adaptive immunity.	Robust immune responses. Modulation of inflammatory immune responses in type 2 diabetes. ↓Pro-inflammatory monocytes in obese/overweight individuals.	(141–149)
Carbohydrates	Regulation of cell adhesion during leukocyte migration, recognition of carbohydrates in the membrane of pathogens → regulation of immunity to infection. Influencing the binding of antigen presentation proteins (MHC-I/II), modulation of NKT cell activation. ↓Phagocytic activity of monocytes and granulocytes, oxidation, limitation of pro- and anti-inflammatory cytokine response. Cell surface molecules → recognition by TLRs, activation of γδ and αβ T cells. ↓TLR-4 by monocytes.	Influencing the binding of antigen presentation proteins (MHC-I/II), modulation of T cell recognition, activation of Th, Tc and NKT cells and cytokine production.	Immune recognition. Balanced number of immune cells.	Robust immune responses. Anti-inflammatory activity in obese/overweight individuals and type 2 diabetes. Restoration of T cell subsets in HIV infection. Immunomodulation in multiple sclerosis.	(150–157)
Fatty acids	Regulation of APC activation signaling. Regulation of NLRP-3 inflammasome and production of pro-inflammatory IL-1β, IL-18 and activity of transcription factor NF-κB. Regulation of phagocytic activity of macrophages, leukocyte migration, infiltration of DCs into lymph nodes and activation of mast cells. Polyunsaturated fatty acids → ↓ expression of adhesion molecules by endothelial cells → leukocyte migration.	Influencing immune cell function → energy source, cell membrane components, signaling molecules/gene expression. Regulation of T and B cell activation, T cell proliferation, cytokine production, activation of apoptosis/cell death. ↑IgM production. Influence on immune cell crosstalk. Promotion of Th0 cell differentiation into Tregs, ↑Treg suppressive capacity.	Immune cell function. Immunomodulation	Immune regulation (Th0 → Tregs) in multiple sclerosis/healthy subjects. Polyunsaturated fatty acids → ↓risk of allergic diseases, ↓atherosclerosis. Maintenance of Th cells and hsCRP in breast cancer. Resolution of inflammation in chronic kidney disease.	(158–179)