Abstract
The present study aimed to investigate the effect of acute changes in serum C-reactive protein (CRP) on appetite and food intake among older hospitalised patients. A total of 200 patients (age range 65-94 years, 62·5 % women) participated in this prospective longitudinal observational study. Risk of malnutrition was measured according to the Mini Nutritional Assessment Short Form. The Simplified Nutritional Appetite Questionnaire (SNAQ) and Edmonton Symptom Assessment System (ESAS) were used to evaluate patients' appetite at the time of hospital admission (baseline) and after 7 d (follow-up). Food intake was measured according to the plate diagram and serum CRP was analysed at baseline and follow-up. At baseline, 30·5 % of the patients had moderate to severe inflammation, 31·0 % were malnourished and 48·0 % had food intake <75 % of the meals offered. Also, 32·5 and 23·5 % reported poor and very poor appetite or severe loss of appetite according to the SNAQ and ESAS, respectively. Of the patients, 40 % displayed a pronounced reduction in median CRP levels by -1·2 mg/dl and 19 % demonstrated an increase in median CRP levels by +1·2 mg/dl. Appetite significantly improved (P = 0·006) in patients with a decrease in CRP level and deteriorated in those with an increase in CRP level (P = 0·032). Changes in CRP levels did not show any significant impact on food intake. In a regression analysis, changes of inflammation were the major independent predictor for changes of patients' appetite. We conclude that inflammation has a significant impact on appetite and should therefore be considered in the diagnosis and treatment of malnutrition.
Highlights
Older individuals frequently experience negative healthrelated outcomes, such as decline in physical and cognitive functioning, psychological disorders and acute and chronic diseases[1]
Much of the evidence regarding the associations of inflammation with appetite and food intake were constricted to Abbreviations: CRP, C-reactive protein; ESAS, Edmonton Symptom Assessment System; ICU, intensive care unit; IQR, interquartile range; SNAQ, Simplified Nutritional Appetite Questionnaire
Mean CRP significantly decreased by −0·8 (SD 4·6) mg/dl (P = 0·012) and appetite significantly improved (P = 0·043) from baseline to follow-up, whereas total SNAQ score and food intake remained unchanged over time (Table 2)
Summary
Older individuals frequently experience negative healthrelated outcomes, such as decline in physical and cognitive functioning, psychological disorders and acute and chronic diseases[1]. Some of these factors may cause metabolic changes, suppress appetite and impair food consumption leading to the development of malnutrition[2,3]. Much of the evidence regarding the associations of inflammation with appetite and food intake were constricted to Abbreviations: CRP, C-reactive protein; ESAS, Edmonton Symptom Assessment System; ICU, intensive care unit; IQR, interquartile range; SNAQ, Simplified Nutritional Appetite Questionnaire
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