Impact of Nutritional Status on Dengue Virus Infection Outcomes: A Systematic Review and Meta-Analysis

CONTEXT: The incidence of dengue cases has increased over the past decades, becoming a global public health concern. Investigating factors such as nutritional status can help identify individuals who are more susceptible to severe dengue fever (SDF) and help develop an appropriate prevention strategy for them. OBJECTIVE: The association between nutritional status and clinical outcomes of dengue virus infection was investigated in this systematic review and meta-analysis. DATA SOURCES: PubMed, SciELO, LILACS, ScienceDirect, and Google Scholar databases were searched for eligible articles. DATA EXTRACTION: The clinical outcomes analyzed included dengue with warning signs, SDF, hospitalization (or stay in an intensive care unit), and death. The parameters for risk factors were undernutrition, overnutrition, and obesity. Study quality was assessed using the JBI Critical Appraisal Checklist. Statistical analyses were performed using STATA, version 13.0, software. Heterogeneity was assessed using the I2 measure, and results with P values < .05 were considered statistically significant. DATA ANALYSIS: A total of 158 articles were identified, of which 29 were included in the systematic review and 27 in the meta-analysis. Undernutrition was associated with a lower risk of SDF. Conversely, overnutrition was identified as a risk factor for SDF and hospitalization, findings that were confirmed when obesity was analyzed as an independent exposure variable in the meta-analysis. The main limitations of this study include variability of anthropometric indicators and potential misclassification bias arising from standardization, predominance of pediatric hospitalized populations, and possible publication bias due to small-study effects. CONCLUSIONS: These findings revealed significant associations between nutritional status and varying degrees of dengue severity, enabling the appropriate management of dengue fever prognosis and the evaluation of variables related to different immune response triggers in the dengue virus. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration No. CRD42024549257.