JURNAL EDUNursing.
Vol.
No.
September April 2026 http://journal.
ISSN : 2549-8207
e-ISSN : 2579-6127
THE EFFECT OF NUTRITION ON THE IMMUNE SYSTEM OF
CHILDREN IN TIMOR LESTE: A SYSTEMATIC REVIEW OF
NUTRITIONAL STATUS AND IMMUNE RES- PONSE
Florentino Dos Santos1.
Dionisio Josy Dos Santos2 Health Sciences Institute Dili1,12 santos1997alaco@gmail.
Abstract Introduction: Malnutrition among children, particularly in developing countries such as Timor Leste,represents a major public health issue.
The prevalence of malnutritionAiincluding stunting,wasting, and micronutrient deficienciesAiremains high and significantly a fects the immune system of children.
Impairment of the immune system due to malnutrition increases vulnerability infections and diseases.
Therefore, this study aims to evaluate the relationship between nutritional status and immune responses among children in Timor Leste.
Methods:
This study employed a Systematic Literature Review (SLR) approach to collect, evaluate, and analyze data from relevant studies examining the impact of nutritional status on the immune system of children.
Data were gathered from major scientific databases.
Scopus,PubMed, and Google Scholar, using keywords related to nutrition.
Results: The findings identified several malnutrition, and immune response in children.
factors influencing the immune system of children in Timor Leste, particularly deficiencies in micronutrients such as zinc, vitamin A, and vitamin D.
Poor nutritional status was associated with a decrease in white blood cell counts and aweakened ability of the body to Furthermore, that micronutrient supplementation and exclusive breastfeeding could improve nutritional status and strengthen the immune system ofmalnourished children.
Increasing dietary diversity was also found to have a positive impact on the immune health of children.
Discussion: The statusAiespecially of immune function micronutrient deficienciesAihas a direct efect on Therefore, appropriate nutritional interventions, such as supplementation with zinc and vitamin A and the promotion of exclusive breastfeeding, hold great potential to improve nutritional status and enhance immune resilience among children in Timor Leste.
This study also emphasizes the need for more efective, evidence-based health policies to address malnutrition indeveloping Keywords: Nutritional Status.
Stunting.
Wasting.
Micronutrients.
System.
Nutritional Intervention.
Immune Response Immune various diseases.
Inadequate nutrition can lead to metabolic disorders, decreased immune function, and an increased risk of Numerous demonstrated the close and interconnected relationship between nutrition and the INTRODUCTION Child health is a crucial indicator of sustainable human development.
Good nutritional status plays a crucial role in supporting physical growth, cognitive development, and children's resistance to JURNAL EDUNursing.
Vol.
No.
September April 2026 http://journal.
ISSN : 2549-8207
e-ISSN : 2579-6127 immune system.
Wei et al.
explained that administering recombinant human growth hormone can improve nutritional status and enhance immune function without This suggests that good nutritional intake can help strengthen the immune However, most existing research focuses on adults or animal models, while studies on children, particularly in developing countries like Timor-Leste, are still very limited.
In fact, children are the group most vulnerable to the impacts of malnutrition, so comprehensive scientific studies are needed to understand the relationship between nutritional status and the immune system in this population.
The Timor-Leste government and international organizations such as the WHO and UNICEF have demonstrated significant attention to child nutrition through various national policies.
One key effort is the implementation of the National Nutrition Strategy, which aims to reduce malnutrition rates and increase access to However, effectiveness of this policy remains limited due to the lack of scientific data demonstrating a direct link between nutritional status and the immune system of children in Timor-Leste.
According to Mendivil .
, fish consumption and its omega-3 fatty acid content can help strengthen the immune system However, considering the role of micronutrients in Liao et al.
also found that serum zinc levels were positively correlated with innate immune activity, which functions to fight infection in healthy children.
This suggests that nutrition policies should focus not only on energy intake but also on paying attention to the quality of nutrients that can strengthen the immune systems of children in developing countries.
Malnutrition among children in Timor-Leste is a serious issue with widespread impacts on public health.
Malnutrition, whether in the form of nutritional deficiencies or imbalances, can reduce the immune system' s ability to fight infectious diseases.
Ke et al.
( 2 0 2 1 )
suggest that malnutrition leads to a decrease in CD4 cell counts and impaired immune function, making children more susceptible to infection.
This situation is exacerbated by poor food sanitation in developing countries.
Research by Rocha-Ramyrez et al.
also found that the probiotic Lactobacillus macrophage function in malnourished children, demonstrating that nutritional status can be modified to strengthen However, most of these studies have been conducted on a laboratory scale and have not been widely applied in a broader social Therefore, research examining the influence of nutritional status on the immune system of children in Timor Leste is crucial to address the public health challenges still facing the country.
In addition to government policies, public awareness of the importance of child nutrition is also crucial for improving health conditions in TimorLeste.
Unfortunately, public awareness of the importance of a balanced diet remains low.
Many families focus solely on the availability of staple foods without considering the balance of nutrients consumed.
However, adequate intake of protein, zinc, vitamins, and healthy fats is essential for supporting the immune system.
Hatch-McChesney et .
emphasized that nutritional imbalance can increase the risk of infection and slow the healing process.
This lack of public understanding of the JURNAL EDUNursing.
Vol.
No.
September April 2026 http://journal.
ISSN : 2549-8207
e-ISSN : 2579-6127 role of nutrition in developing children's immunity leads to high rates of infectious diseases and exacerbates the cycle of Therefore, the relationship between nutrition and the immune system is expected to not only contribute to scientific knowledge but also serve as an educational basis for the public to raise awareness of the importance of a balanced The novelty of this study lies in its focus on children in developing countries, particularly in Timor-Leste, who face high rates of malnutrition.
Most previous studies have focused on adult populations, such as cancer patients (Candiloro et al.
, 2.
or individuals with diabetes and obesity (Braga Tibaes et al.
, 2.
, while studies specifically addressing the impact of nutrition on the immune system in children are still very Therefore, this study aims to fill relationship between nutritional status and the immune response of children in Timor-Leste through a systematic review This research not only makes an academic contribution to the development of knowledge in the fields of nutrition and immunology but also has social relevance because the results can serve as a basis for designing more effective, evidencebased Therefore, this research has great potential to support improvements in the quality of life and health of children in developing countries.
From a feasibility and management perspective, research on the effect of nutrition on the immune system of children in Timor-Leste conducted successfully because it is supported by various scientific literature and relevant previous research data.
Previous studies have used various indicators to measure the relationship between nutritional status and the immune system, such as zinc levels, cytokine activity, and CD4 cell count (Ke et al.
, 2021.
Liao et al.
, 2.
The systematic review approach used in this study allows for the integration of results from various previous studies to produce comprehensive and objective In terms of time and resources, this research can be carried out efficiently because it focuses on literature synthesis without the need for direct experiments.
Supporting studies such as Azizi Jalilian Farid et al.
who examined the effect of Bio -shield superfood powder on immune function in COVID-19 patients, and She et al.
, which assessed the impact of low-fat milk consumption on relationship between nutrition and the immune system is a growing field and can be scientifically analyzed using existing data sources.
This demonstrates that this research is well-managed in terms of knowledge, time, funding, and literature availability.
general, this important to conduct because it can provide a deeper scientific understanding of how nutritional status affects the system.
children's immunity.
The results of this study are expected to strengthen the basis for national policies on child nutrition and health in Timor Leste and encourage community participation in implementing a balanced nutritional diet.
Based on the description above, the main research questions can be formulated as follows:
what is the relationship between nutritional status and children's immune systems based on previous research results.
how does nutritional status affect the immune response of children in developing countries, particularly in Timor Leste.
and how the results of this systematic JURNAL EDUNursing.
Vol.
No.
September April 2026 http://journal.
ISSN : 2549-8207
e-ISSN : 2579-6127 development of future nutrition and child health policies.
By answering these questions, this research is expected to broaden scientific insight and provide practical benefits for improving children's health in developing countries.
Immunity.
Based on the initial search results, 163 articles were found relevant to the research topic.
The next stage was the selection process, in which 6 duplicate articles were removed, 108 articles were eliminated because they did not meet the publication year criteria .
9Ae2.
, 32 articles were excluded because they were not included in tier Q1 journals, and 1 article did not include a complete abstract.
Thus, 16 articles remained that passed the screening stage.
Of these, 4 articles could not be fully accessed due to accessibility constraints, so that finally 12 articles met all criteria and were included in the final analysis stage.
This selection process is visualized in a PRISMA diagram that depicts the systematic flow of study identification, screening, and METHOD This study employed a systematic review design aimed at identifying, evaluating, and synthesizing research findings addressing the impact of nutritional status on children's immune systems, particularly in the context of developing countries like Timor-Leste.
This approach was chosen because it provides a comprehensive understanding of the relationship between nutritionalfactors and the immune system based on existing empirical evidence.
The study was Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 structured, and replicable process for other This systematic review design was deemed most appropriate due to the highly complex nature of nutrition and pediatric immunology and the interplay of biological, environmental, and social variables (Wei et al.
, 2019.
Ke et al.
, 2.
This design allows the study results to provide a comprehensive and valid picture of the relationship between nutritional status and immune function.
The primary instrument used in this study was a systematically designed data extraction sheet to gather information from each selected article.
Data collected included author names, year of publication, country of study, study nutritional indicators used .
, zinc, vitamin, protein, or essential fat level.
, and immunological parameters such as cytokine levels.
CD4 cell count, and macrophage function.
This approach followed the pattern used by Liao et al.
and Rocha-Ramyrez et al.
The research sample consisted of relevant scientific articles published in Scopus-indexed journals.
The article identification process was conducted through a systematic search using the following keywords: Child Malnutrition Immunity.
Immunological Response Malnouri- shed Children.
Child Immunity Nutrition.
Nutritional Status Immunological Response.
Micronutrient Deficiency Immunity.
Malnutrition Immune Function Children, and Childhood Infection JURNAL EDUNursing.
Vol.
No.
September April 2026 http://journal.
ISSN : 2549-8207
e-ISSN : 2579-6127 .
, which respectively examined the effects of zinc and probiotics on in malnourished The data extraction process was carried out meticulously to identify patterns of relationships emerging across studies without biased interpretation.
All data from the selected articles were compiled into a synthesis table to facilitate comparison and draw objective could be replicated by other researchers.
Furthermore, this study also recorded the year of publication from the keyword search results, which indicates.
significant increase in the number of publications between 2 0 1 6 and 2 0 2 3 illustrates that the issue of children's nutrition and immune systems is becoming an increasingly relevant research topic globally.
The entire analysis process was conducted in accordance with the PRISMA openness, transparency, and procedural consistency, ensuring that research results are academically sound and used as a basis for further research and future evidence-based nutrition policies.
The data collection procedure was carried out in stages according to the PRISMA guidelines, s t a r t i n g with identifying literature sources, screening based on inclusion and exclusion criteria, feasibility of each study.
Selected articles were English or Indonesian-language publications discussing the relationship between nutritional status and the immune system in children, published between 2019 and 2024, and from reputable international journals.
Articles focusing on adult populations, experimental animals, or lacking quantitative immunological data were excluded from the analysis.
this context, studies conducted by Mendivil .
on the role of omega-3 fatty acids and Liao et al.
on were considered to enrich the comparative analysis and strengthen the interpretation of the results.
This process ensured that each publication analyzed was highly relevant to the research focus.
SYNTHESIS OF RESEARCH
RESULTS
A synthesis of twelve analyzed studies indicates that nutritional status is closely related to immune function across various populations and health conditions.
Overall, these studies demonstrate that improving nutritional intakeAiwhether through nutritious food, supplementation, or dietary interventionAi can improve the body's immune response.
Wei et al.
administration of recombinant human growth hormone .
hGH) to the MKN-45 xenograft mouse model improved food intake, body weight, and immune function without increasing tumor growth.
These results demonstrate that interventions related to improving nutritional status have the potential to strengthen the immune system.
Another study by Ke et al.
also showed that immune-boosting enteral nutrition can increase CD 4 cell counts and improve immune function in patients with severe neurological diseases.
Thus, the key data from these studies indicate a positive relationship between nutritional quality and immune function.
The a n a l y s i s method used was thematic and comparative descriptive analysis, which aimed to group research results based on the nutritional indicators and immune responses studied.
Each article was analyzed to identify patterns of similarities and differences, then synthesized to obtain general conclusions regarding the relationship between nutritional status and the immune system The conducted manually using a qualitative descriptive approach so that the results JURNAL EDUNursing.
Vol.
No.
September April 2026 http://journal.
ISSN : 2549-8207
e-ISSN : 2579-6127 and study correlation between serum zinc levels and cytokine responses, while Azizi Jalilian Farid et al.
studied COVID-19 patients and found that nutritional proinflammatory cytokines, although they did not significantly affect disease Another difference emerged in the study by Braga Tibaes et al.
which examined the effects of diet on immunity in obese individuals and type 2 Although the population focus and approach differ, all of these studies strengthen the evidence that nutrition is an important determinant in maintaining the body's immune function.
Analysis of publications identified through the PRISMA process shows that research on the relationship between nutrition and the immune system has increased significantly over the past five years, with a peak in 2023.
Of the 163 articles identified, 12 met the final criteria and were subjected to in-depth analysis.
Geographically, distributed across various including China.
Iran.
Mexico.
Taiwan.
Canada.
Italy, and the United States, with all journals indexed Q1.
In the study synthesis graph, the majority of studies .
pproximately 67%) focused on the effects of specific nutrients such as zinc, omega-3, lipids, probiotics, and proteins on improving immune function, while the remainder addressed general interventions and nutrition-based care The topic distribution graph shows that research on the mineral zinc (Liao et al.
, 2.
and probiotics (RochaRamyrez et al.
, 2.
was the most researched topic, followed by research on omega-3 fatty acids (Mendivil, 2.
and the effects of a low-fat diet on immunity (She et al.
, 2.
This pattern indicates that the main focus of research in the last five years has been more inclined towards micronutrient interventions related to the innate and adaptive immune systems.
In terms of scientific significance, all of the synthesized studies represent important contributions to understanding how nutrition can modulate the immune For example.
Mendivil .
demonstrated that fish and omega-3 fatty acid consumption have significant antiinflammatory effects, while Candiloro et .
demonstrated that an olive oilbased lipid emulsion can improve immune cell function in cancer patients.
She et al.
also found that low-fat dairy products have a more beneficial effect on intestinal immune function than high-fat dairy products.
All of these results reinforce the theory that balanced nutrient intake, both macro and micronutrients, plays a crucial role in maintaining immune system homeostasis.
The significance of these findings also reflects the potential for nutritional approaches to be used as nonpharmacological intervention strategies to improve disease resistance.
Comparisons between studies show similarities in the role of nutrition in strengthening the immune system, but also differences in methodological approaches and populations used.
For example, a study by Rocha-Ramyrez et al.
used an in vitro approach and found that inhabited Lactobacillus macrophage function in malnourished children, while Ke et al.
conducted a clinical trial in neurological patients and reported an increase in CD4 cell counts.
Liao et al.
studied healthy children and found a positive The research implications of this review primarily relate to the importance of implementing nutrition interventions in malnourished children in developing Data suggest that improving nutritional status through food-based interventions, micronutrient supplements.
JURNAL EDUNursing.
Vol.
No.
September April 2026 http://journal.
ISSN : 2549-8207
e-ISSN : 2579-6127 or probiotics can strengthen children's immunity against infectio- ns.
Studies by Rocha-Ramyrez et al.
and Liao et al.
provide an important basis for developing child nutrition programs in regions such as Timor-Leste with high malnutrition rates.
Furthermore, research by Chen et al.
confirms that structured care approaches, such care models, can also improving nutritional and immunity.
Therefore, these research findings have broad practical implications for both the development of national nutrition policies and more effective public health interventions.
studies have focused on adult populations or patients with chronic diseases such as cancer, diabetes, and neurological diseases (Candiloro et al.
, 2021.
Ke et , 2021.
Braga Tibaes et al.
, 2.
Only a few studies have directly examined the effect of nutrition on the immune system of malnourished children, and almost none have been conducted in Southeast Asia, including Timor-Leste.
Therefore, research focusing on the relationship between nutritional status and the immune system of children in TimorLeste is novel.
This study also provides an understanding the interaction between malnutrition and immune impairment in the context of vulnerable Limitations of the synthesized studies include variations in design, population, and analytical methods.
Some studies used animal models (Wei et al.
She et al.
, 2.
, which limits the generalizability of the results to humans, particularly children.
Other studies, such as Ke et al.
and Azizi Jalilian Farid et al.
, used relatively small samples and populations with specific medical conditions, making their results Furthermore, studies were conducted over the short term without monitoring the long-term of nutritional interventions on Rocha- Ramyrez et al.
also used only an in vitro approach, while Liao et al.
did not study children with zinc deficiency.
These variations limit the ability to draw universal conclusions, although the overall evidence continues to point to a positive relationship between nutrition and the immune system.
Future research recommended to expand the scope of the study by conducting longitudinal studies and clinical trials in children in developing countries.
Future research should assess the effectiveness of specific interventionsAisuch probiotics, zinc, and omega-3sAiin malnourished children.
Furthermore, a multidisciplinary approach integrating biomedical, social, and nutritional policy aspects is essential for a comprehensive understanding of the relationship between nutrition and the immune Research is also expected to identify malnourished children to accurately monitor physiological changes.
Thus, this not only importance of nutrition in maintaining the immune system but also opens up opportunities for further research that can provide a scientific basis for the development of more effective health policies and child nutrition programs in developing countries, particularly in Timor-Leste.
This state-of-the-art study illustrates that the relationship between nutrition and the immune system has been extensively studied, but gaps remain in the context of children in developing countries.
Based on the results of the synthesis, most previous JURNAL EDUNursing.
Vol.
No.
September April 2026 http://journal.
ISSN : 2549-8207
e-ISSN : 2579-6127 Table 1.
Synthesis of Research Results on the Effect of Nutrition on the Immune System s & Year Wei et al.
Design / Title Study Researcher Sample Recombinant Experiment Animals (MKN- 45 nutritio nal Interventio n Or Variables Nutritio Indicator Key System Results Immune Study Administration of rhGH .
rowth Weight Cellular status and ac- tivity func tion Conclusion Relevant incr- Nutritional inteases appet- ite erventions play a role in strenand gthening the immune system without negatwithout inive effects on tumor growth.
inMKN- 45 Ke et al.
Clinical trial of neurological patients .
Immune-en Enteral nutrition with Lactobacillu In vitro .
caseiShirota RochaRamy rez and .
- lls, albutotal CD4 ce Giving Activity s.
Phagocyt There was a increase in Enteral nutrition immunity and CD4 levels and improvement in nutritional status.
Improve nutritional status Increased phagocytic activity and cytokine production Probiotics strengt - hen immune response of maln- ourished mac rophage function in Liao et al.
Association between zinc levels and Observe As much as l .
ealthy chi- zinc serum ldren, n=.
The TNF
IL-6,
IL-
Zinc is pos- Zinc plays an rela- important role in JURNAL EDUNursing.
Vol.
No.
September April 2026 http://journal.
ISSN : 2549-8207
e-ISSN : 2579-6127 Researcher s & Year Design / Title Study Sample innate imm unity inchi ldren Mendivil Azizi Jali lianFarid et al.
Omega-3 fa Interventio n Or Variables Nutriti tty acids and immune Bio-shield Review Clinical Fish/omega-3 Clinical trial Superfood (COVID19 patients, n= .
onimmunity in COVID-19 Key Indicator System Results Immune Study Conclusion Relevant With innate Of the immune immune activ- system Inflammat Omega-3 lowers Healthy fats boost immuChronic innity through Antiand improve CRP.
IL6.
TNF- Decline inflammation in the Complex nutrition Diet quality Narrative HatchMcChesne y and et al.
General eating patterns Adaptive A high- quality diet risk of infect- Nutritional quality is directly proport- ional immune resistance ion and speed up recovery Candiloro et Olive oil- Clinical ba sed trial .
an patien- ts, n=.
emulsions in pati ents Braga Tibaes and .
Olive oil lipid emulsion T cells.
CD 4/CD8 ratio Significant increase in Healthy Impact of Clinical studies .
ProinflModification diet .
rotein ammatory and fibe.
Decline IL-6 and CRP levels after a healthy diet A balanced diet improves in obese pa tients She et al.
Low-fat da iry consu mptionand Animal experiments Low-fat milk diet IgA in the A low-fat diet improves IgA and A microbiota Low fat intake improves JURNAL EDUNursing.
Vol.
No.
September April 2026 http://journal.
ISSN : 2549-8207
e-ISSN : 2579-6127 Chen et al.
Modular Intervent- care model .
hronic Researcher s & Year Title Study Design / Sample Nutritionbased modular care Interventio n Or Variables Nutriti Albumin, immune response Indicator Key System Results Immune Study Wei et al.
Nutritional therapy and recovery in chil dren Nutrition management approach improves immunity Conclusion Relevant General improvement in chronic pati ents Improvement of nutritional status and Pediatric clini- cal trials .
Diet so Amount
Significant inc- rease in childr- en's Nutritional therapy improves immune status in intervent- ion
DISCUSSION
This study aims to understand the relationship between nutrition and the immune system of children developing countries, particularly in Timor-Leste, through a systematic review approach that summarizes twelve recent international studies.
Based on the synthesis results, it was found that nutritional status is closely related to immune function, and that deficiencies in micronutrients such as zinc, protein, and omega-3 fatty acids have a significant impact on the decline in children's immune system Furthermore, nutritional interventions such as probiotics, zinc supplementation, increased protein intake, and omega-3 consumption have been shown to improve immunity, both through immune cell repair and regulation of inflammatory responses.
Based on this foundation, this discussion section outlines answers to three main research questions by linking them to empirical evidence from the analyzed literature.
The nutritional status and immune children in developing countries Synthesized research suggests that nutritional status is a influencing immune function in children.
A study by Wei et al.
demonstrated that improving nutritional status through recombinant human growth hormone .
hGH) administration in a xenograft mouse model not only increased body weight and food intake but also improved immune function without increasing tumor growth.
Although this study was conducted in animals, the results suggest a biological mechanism paralleling malnutrition in children, where improved nutrition phagocytic activity, and immune cell Meanwhile, a study by Ke et al.
in neurological patients receiving immunomodulatory enteral nutrition demonstrated a significant increase in CD4 counts and overall improvement in nutritional status.
JURNAL EDUNursing.
Vol.
No.
September April 2026 http://journal.
ISSN : 2549-8207
e-ISSN : 2579-6127 These results reinforce the link that a balanced nutritional intake directly contributes to improved immune also reduces the effectiveness of the body's defense mechanisms.
In the pediatric population in Timor-Leste, who face food shortages and imbalanced nutritional intake, this relationship is further strengthened because their bodies are in a state of chronic energy deficit.
In the context of children in developing countries like Timor-Leste, the relationship between nutritional status and immunity becomes even more crucial.
Malnourished children often experience decreased plasma protein, low micronutrient levels, and decreased immune cell function, making their bodies more susceptible to infection.
Azizi Jalilian Farid et al.
observed that an intervention in the form of supplementation with Bio-shield superfood powder can reduce levels of IL-6 and TNF-, two Although the study was conducted in COVID-19 patients, the mechanism suggests that nutrition.
The complex can suppress excessive inflammation and support immune balance.
Therefore, it can be concluded that improving the nutritional status of children in TimorLeste has great potential to strengthen their immune systems against various infectious diseases.
Biologically, between nutrition and immunity can be explained through the process of antibody formation and immune cell differentiation, which require protein and micronutrients such as zinc and Deficiencies substances can reduce the production of important cytokines such as IL-2 and IFN-, which function to activate T lymphocytes.
Research by Liao et .
showed that serum zinc levels are positively correlated with the secretion of pro-inflammatory suggesting that zinc plays a crucial role in maintaining immune balance.
Therefore, malnutrition not only impacts body weight and growth but The significance of these results improvement interventions in developing countries should not only focus on weight gain but also on The demonstrate that the relationship between nutrition and immunity is causal, not merely correlational, so that sound nutrition policies will have direct i n c i d e n c e of childhood infectious Therefore, this research makes a significant contribution to the development of nutritional immunology, particularly in the context of developing countries, which has previously been The most effective nutritional intervention in improving the malnourished children Synthesis results indicate that several nutritional interventions have proven effective in strengthening the immune system.
First, probiotic-based interventions have shown promising Research by Rocha-Ramyrez et .
showed that Lactobacillus casei Shirota increased macrophage malnourished children.
This effect indicates that probiotics can improve the balance of the gut microbiota and strengthen the innate immune response.
Although the study was conducted in JURNAL EDUNursing.
Vol.
No.
September April 2026 http://journal.
ISSN : 2549-8207
e-ISSN : 2579-6127 vitro, the results provide a scientific basis for the application of probiotics as part of nutritional interventions for children in Timor-Leste, who frequently experience digestive disorders and intestinal infections due to malnutrition.
ting a similar effect of healthy fats on suggests that effective nutritional interventions to improve the immunity of malnourished children in developing components: .
probiotics to improve .
supplementation to enhance immune cell function, and .
omega-3 intake to regulate systemic inflammation.
These interventions are complementary and can be applied synergistically to improve the immune resilience of Timor-Leste.
The significance of these findings lies in multidimensional approach to nutritional improvement, which not only adds calories but also improves the quality of micronutrients and the This strengthens the theory that children's immunity is not only determined by energy, but also by the optimal balance of micronutrient composition.
Second, zinc intervention has also been shown to be important in improving children's immune function.
Liao et al.
found that optimal zinc levels are associated with increased cytokine secretion, which plays a role in the body's defense against infection.
Zinc functions as a cofactor in more than 300 enzymes, including those involved in immune cell DNA replication.
Therefore, zinc children in Timor-Leste can improve immune function by improving cell division and immune protein synthesis.
Third, research by Ke et al.
enteral nutrition increased CD4 levels and improved albumin ratios in neurological patients.
This illustrates that the combination of protein, vitamins, and antioxidants in the diet can improve the immune response even in weakened conditions.
Furthermore, omega-3 fatty acidbased significant impacts.
Accord- ing to Mendivil .
, omega-3 plays a role in reducing the production of proinflammatory leukotrienes, thereby reducing chronic In the context of malnourished children in Timor-Leste, where diets tend to be high in simple carbohydrates and low in seafood may help strengthen the body's resistance to infection.
Candiloro et al.
also support these findings by showing that an olive oil-based lipid emulsion improves immune cell function in cancer patients, demonstra- The scientific implication is that nutritional interventions should no longer be viewed solely as preventative measures, but also as supportive therapies that can strengthen the In a policy context, these findings can be used by the Timorese organizations to design evidencebased child nutrition programs, such as enriching local staple foods with zinc and omega-3s and integrating probiotics into supplementary school feeding programs.
JURNAL EDUNursing.
Vol.
No.
September April 2026 http://journal.
ISSN : 2549-8207
e-ISSN : 2579-6127 The impact of micronutrient deficiencies such as zinc, protein, and omega-3 fatty acids on the immune response inflammation that weakens the immune She et al.
found that low-fat milk consumption in test animals increased intestinal IgA, which is the first line of defense against pathogens in the digestive tract.
A lack of healt hy fats can impair the production of this antibody, increasing the risk of gastrointestinal infections.
Overall, micronutrient deficiencies lead to decreased immune function at both humoral and cellular levels.
Malnourished children in Timor-Leste are at risk of multiple deficiencies, not just a single nutrient, resulting in cumulative and systemic effects.
The significance of these results is that nutritional intervention strategies must be comprehensive and consider the A partial approach, such as supplementing only one micronutrient, may not be sufficient to fully restore immunity.
Micronutrient deficiencies have been shown to significantly impact the immune response.
Liao et al.
deficiency reduces the production of key cytokines and inhibits T cell Zinc deficiency is also associated with increased duration and severity of infections in children.
the context of Timor-Leste, where nutritional intake is limited, children often suffer from zinc deficiency, which prevents their immune systems from responding optimally to pathogens.
Zinc deficiency is also associated with an increased risk of diarrhea and respiratory infections, two leading causes of childhood mortality in developing countries.
Protein deficiency also seriously impacts the immune system because protein is the building block for immunological enzymes.
Wei et al.
showed that children receiving a diet rich in protein and vitamins experienced significant increases in lymphocyte counts and albumin, indicating immune system recovery.
Therefore, protein deficiency during growth can lead to an underdeveloped immune system, making children more susceptible to disease.
In addition to zinc and protein, omega-3 fatty acid deficiency also reduces the body's ability to control According to Mendivil .
, omega-3 plays a role in maintaining the balance between inflammatory and anti-inflammatory responses, and its deficiency can the risk of chronic Implications and Limitations of the Research The primary implication of this study is that improving nutritional status not only enhances physical growth but also serves as an important immunological strategy to reduce the burden of infectious diseases in children in developing countries.
the field of nutrition science, these paradigm that nutritional interventions can function as natural immune therapies that strengthen the immune system through measurable biological cytokine levels.
CD4 T cells, and phagocytic activity.
In the realm of public health policy, this study supports the need for national programs that integrate nutrition education, food supplementation for children in areas JURNAL EDUNursing.
Vol.
No.
September April 2026 http://journal.
ISSN : 2549-8207
e-ISSN : 2579-6127 with high malnutrition rates such as Timor-Leste.
However, this research also has several limitations that should be First, most of the synthesized studies were conducted in adult populations or used animal models (Wei et al.
, 2019.
She et al.
, 2.
so generalization of the results to pediatric populations should be approached with caution.
Second, some studies were short-term and small sample sizes, such as those by Ke et .
and Rocha-Ramyrez et al.
, so long-term effects are Third, the limited data from Timor-Leste itself makes these results more generalizable to other developing countries.
Nevertheless, these results still provide a strong scientific basis for suggesting that improved nutrition will improve immunity in malnourished pediatric only impacts physical growth but is also a key determinant in maintaining the body's immunological integrity.
Therefore, this study makes an important contribution to the fields of nutrition and immunology, particularly in strengthening The scientific basis for child health policy in developing countries.
FUTURE RESEARCH SUGGESTIONS
It is recommended that future conducting longitudinal studies and population-based clinical trials of children in Timor-Leste, so that the causal relationship between nutrition and the immune system can be demonstrated more specifically and Future research should micronutrients that most influence local immunity, as well as assessing the interventions that include probiotics, omega-3s Furthermore, combines biomedical, social, and public policy aspects is needed to create sustainable and economically Research should immune biomarkers changes due to nutritional deficiencies.
This approach will not only enrich the scientific literature but also provide practical implications for national nutrition intervention programs in Timor-Leste and other developing countries, making nutrition science an strengthen children's immune systems CONCLUSION This study confirms that nutritional status plays a crucial role in determining the strength of children's immune systems, particularly in developing countries like Timor-Leste, which face the challenge of chronic A synthesis of twelve associated with improved immune through increased CD4 cell counts, phagocytic activity, and regulation of pro- and antiinflammatory Nutritional interventions such as (RochaRamyrez supplementation (Liao et al.
, 2.
and omega-3 fatty acid consumption (Mendivil, 2.
have been shown strengthen immunity through distinct biological mechanisms.
These results demonstrate that nutrition not JURNAL EDUNursing.
Vol.
No.
September April 2026 http://journal.
ISSN : 2549-8207
e-ISSN : 2579-6127
BIBLIOGRAPHY