Abstract
We thank Plat and Mensink for their interest in our letter. They highlight that we focussed on the importance of ensuring nutritional adequacy in older people because of the immune impairments that occur with ageing, which are referred to as immunosenescence. These age-related changes are exaggerated by frailty, by insufficient intake of key micronutrients and, possibly, by gut dysbiosis, each of which occur in many older people. Immunosenescence can result in poorer responses to some vaccines in older people and to increased susceptibility to infection. The context of our letter was the possibility of poorer responses to “COVID-19 vaccines” in older people. Ageing is also associated with heightened low-grade inflammation, a state that is termed inflammaging. Of course, many factors other than ageing influence both the immune response and low-grade inflammation, and Plat and Mensink highlight one of those, obesity. People living with obesity can show immune impairments, have increased susceptibility to some infections, and have poorer outcomes following some vaccinations, perhaps including COVID-19 vaccines. Therefore, we fully agree with Plat and Mensink that a focus on weight management and on nutritional adequacy in those living with overweight and obesity is also important in the context of vaccination programmes.