Dietary Patterns, Immune Response, and Their Role in the Prevention and Management of Hepatitis B in Adults
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Abstract
Introduction: Hepatitis B virus (HBV) infection remains a major global health challenge, with approximately 254 million people living with chronic infection and 1.1 million deaths annually. Despite effective vaccination and antivirals, treatment coverage is below 5%, and host factors — including nutritional status — strongly influence vaccine response, immune control, and progression to cirrhosis and hepatocellular carcinoma. Objective: To synthesize current evidence on the role of dietary patterns and individual nutrients in modulating immune response to HBV, supporting vaccine immunogenicity, and influencing disease progression and management in adults. Methods: A structured narrative review was conducted using PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library for studies published between January 2000 and December 2025. Search terms combined "hepatitis B," "HBV," "diet," "nutrition," "Mediterranean diet," "vitamin D," "zinc," "polyphenols," and "immune response." In vitro studies, randomized controlled trials, cohort studies, systematic reviews, and meta-analyses published in English were eligible. Results: The Mediterranean diet and other plant-rich, anti-inflammatory dietary patterns are associated with reduced chronic liver disease risk and improved metabolic profiles relevant to HBV outcomes. Vitamin D deficiency is highly prevalent in chronic HBV and correlates with disease severity and impaired antiviral response. Zinc, selenium, vitamin E, and lactoferrin support immune competence and modulate HBV replication. Polyphenols including epigallocatechin-3-gallate, curcumin, and resveratrol exhibit direct anti-HBV activity through inhibition of viral entry, transcription, and replication. Older age, male sex, obesity, smoking, and undernutrition reduce hepatitis B vaccine seroconversion. Conclusion: Dietary patterns and targeted nutritional interventions represent a clinically meaningful complement to vaccination and antiviral therapy in HBV. Integration of nutrological assessment into routine hepatology care is recommended, though large, well-designed randomized trials with HBV-specific endpoints remain needed.
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