Severity of Inflammation Is Associated with Food Intake in Hospitalized Geriatric Patients—A Merged Data Analysis

Abstract

The extent to which inflammation impacts food intake remains unclear, serving as a key risk factor for malnutrition as defined by the Global Leadership Initiative on Malnutrition (GLIM). To address this, we analyzed a large, merged dataset of geriatric hospitalized patients across Europe. The study included 1650 consecutive patients aged ≥65 year from Germany, Italy, Finland, Denmark, and Poland. Nutritional intake was assessed using the first item of the Mini Nutritional Assessment Short Form; C-reactive protein (CRP) levels were measured using standard procedures. In total (age 79.6 ± 7.4 year, 1047 females), 23% exhibited moderate to severe inflammation, and 12% showed severe inflammation; 35% showed moderate reductions in food intake, and 28% were considered malnourished. Median CRP levels differed significantly between patients with severe, moderate, and no decrease in food intake. Among patients with a CRP level of 3.0–4.99 mg/dL, 19% experienced a severe decrease in food intake, while 66% experienced moderate to severe decreases. Regression analysis revealed that inflammation was the most prominent risk factor for low food intake and malnutrition, surpassing other factors such as age, gender, infection, and comorbidity. A CRP level of ≥3.0 mg/dL is associated with reduced food intake during last 3 months in two thirds of hospitalized geriatric patients and therefore indicative for a high risk of malnutrition.

Guidance for assessment of the inflammation etiologic criterion for the GLIM diagnosis of malnutrition: A modified Delphi approach

“…These thresholds are provided to help support identification of individuals with inflammatory diseases and conditions, not to assess risk for development of disease. They are consistent with reports that moderate and severe inflammation may be associated with significant reductions in food intake in hospitalized older patients 33 …”

“…Many of these publications were disease‐ or setting‐specific—for example, end‐stage renal disease or critical care. However, a more general analysis of a merged data set of geriatric hospitalized patients from across Europe 33 found that food intake was more likely to be significantly compromised at CRP levels above 30 mg/L. Therefore, little guidance was available in the context of the more general application to malnutrition diagnosis sought by GLIM, such that extrapolation of established inflammation assessments from other specific medical conditions proved necessary.…”