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Nutritional modulation of exercise-induced immunodepression in athletes: a systematic review and meta-analysis

European Journal of Clinical Nutrition volume 61, pages 443–460 (2007)Cite this article

Abstract

Background:

Heavy exercise induces marked immunodepression that is multifactorial in origin. Nutrition can modulate normal immune function.

Objective:

To assess the efficacy of nutritional supplements in exercise-induced immunodepression in athletes.

Design:

Systematic review.

Review methods:

Randomised and/or controlled trials of athletes undertaking nutritional supplements to minimise the immunodepression after exercise were retrieved. The primary outcome measure was incidence of upper respiratory tract (URT) illness symptoms after exercise, and secondary outcomes included cortisol, cell counts, plasma cytokine concentration, cell proliferative response, oxidative burst, natural killer cell activity and immunoglobulins. When data were available for a pooled estimate of the effect of intervention, meta-analyses were conducted for direct comparisons.

Results:

Forty-five studies were included (1603 subjects). The studies were heterogeneous in terms of exercise interventions, selection of athletes, settings and outcomes. The overall methodological quality of most of the trials was poor. Twenty studies addressed carbohydrate supplementation, eight glutamine, 13 vitamin C and four others interventions. Three trials assessed the effect of intervention on prevention of URT infections. The pooled rate ratio for URT infections after vitamin C supplementation against placebo was 0.49 (0.34–0.71). Carbohydrate supplementation attenuated the increase in cortisol and neutrophils after exercise; vitamin C attenuated the decrease in lymphocytes after exercise. No other interventions had significant or consistent effect on any of the studied outcomes.

Conclusions:

Although the prevention of URT infections by vitamin C was supported by two trials, further studies are needed. The available evidence failed to support a role for other nutritional supplements in preventing exercise-induced immune suppression. Larger trials with clinically relevant and uniform end points are necessary to clarify the role of these nutritional interventions.

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Acknowledgements

We thank the authors of the trials included in this review who provided supplementary data in response to our correspondence (Castell et al., 1996; Bassit et al., 2000; Koch et al., 2001; Krzywkowski et al., 2001a; Chan et al., 2003). We thank the following Ga2len members and participants in the ‘Sports, Allergy and Asthma’ Work Package for reviewing the manuscript: Kai-Hakon Carlsen, Sergio Bonini, Todor Popov, Stefano Del Giacco. We thank Luís Azevedo for reviewing the statistical analysis. We thank the reviewers who contributed their valuable time and expertise toward development of this manuscript. André Moreira holds a Grant from the Finnish Centre for International Mobility and a Fellowship Award from the European Academy of Allergy and Clinical Immunology.

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Authors and Affiliations

  1. Laboratory of Immunology, Faculty of Medicine, University of Porto, Porto, Portugal

    A Moreira & L Delgado

  2. Immuno-allergology, Hospital of São João, Porto, Portugal

    A Moreira & J Fonseca

  3. Institute of Biomedicine, University of Helsinki, Helsinki, Finland

    R A Kekkonen & R Korpela

  4. Valio Ltd, R&D, Helsinki, Finland

    R A Kekkonen & R Korpela

  5. Biostatistics and Medical Informatics, Faculty of Medicine, University of Porto, Porto, Portugal

    J Fonseca

  6. Foundation for Nutrition Research, Helsinki, Finland

    R Korpela

  7. Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland

    T Haahtela

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Correspondence to A Moreira.

Additional information

Guarantor: A Moreira.

Contributors: TH, AM, LD contributed to the conception and design of the study. AM and JF were responsible for data acquisition. All the authors contributed to interpretation of results. AM drafted the article. All authors approved the final version for publication.

Appendices

Appendix A: Search strategy

Database: SPORTDiscus 1830 to May 2005; EBM Reviews – Cochrane Central Register of Controlled Trials 2nd Quarter 2005; EBM Reviews – Cochrane Database of Systematic Reviews 2nd Quarter 2005; Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) 1966 to Present

Search strategy:

randomi[z]ed controlled trial.pt. (392250)

controlled clinical trial.pt. (134553)

Randomi[z]ed Controlled Trials/ (41104)

Random Allocation/ (72830)

Double-Blind Method/ (147455)

Single-Blind Method/ (14248)

or/1-6 (593956)

Animals/ not Human/ (2863905)

7 not 8 (570442)

clinical trial.pt. (657885)

exp Clinical Trials/ (201366)

(clinic$ adj25 trial$).tw. (149833)

((singl$ or doubl$ or trebl$ or tripl$) adj (mask$ or blind$)).tw. (173831)

Placebos/ (39895)

placebo$.tw. (178494)

random$.tw. (513086)

Research Design/ (42074)

(latin adj square).tw. (3033)

or/10-18 (1072000)

19 not 8 (1015274)

20 not 9 (455654)

or/9-20 (1082822)

(immun$ adj5 (athl$ or nutrit$ or exercise)).mp. [mp=ti, ot, ab, nm, hw, sh, kw, tx, ct, da, fa, ce, fc, fd] (4336)

(nutrit$ adj5 (athl$ or immun$ or exercise)).mp. [mp=ti, ot, ab, nm, hw, sh, kw, tx, ct, da, fa, ce, fc, fd] (6651)

(exercise$ adj5 (athl$ or immun$ or nutrit$)).mp. [mp=ti, ot, ab, nm, hw, sh, kw, tx, ct, da, fa, ce, fc, fd] (8929)

(exercise$ adj5 (carbohydrat$ or glutamine or vitam$ or immun$ or nutrit$)).mp. [mp=ti, ot, ab, nm, hw, kw, sh, tx, ct, fc, da, fa, ce, fd] (7568)

or/23-26 (15829)

(athl$ and immun$).mp. [mp=ti, ot, ab, nm, hw, kw, sh, tx, ct, fc, da, fa, ce, fd] (1528)

and/27-28 (795)

and/22,29 (105)

Appendix B: Quality rating of included studies

Table A1

Table 6 Table a1
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Moreira, A., Kekkonen, R., Delgado, L. et al. Nutritional modulation of exercise-induced immunodepression in athletes: a systematic review and meta-analysis. Eur J Clin Nutr 61, 443–460 (2007). https://doi.org/10.1038/sj.ejcn.1602549

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