Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-Universität Bochum, 44625, Herne, Germany.
Medical Department I, General Internal Medicine, Marien Hospital Herne, Ruhr-Universität Bochum, 44625, Herne, Germany.
Nutrients. 2019 Aug 22;11(9):1986. doi: 10.3390/nu11091986.
The effect of inflammation on appetite and food intake has been rarely studied in humans. In this study, we examined the association of C-reactive protein (CRP), as an inflammatory marker, with appetite and food intake among older hospitalized patients. A total of 200 older individuals, who were consecutively admitted to a geriatric acute care ward, participated in this prospective observational study. Appetite was evaluated using the Edmonton Symptom Assessment System (ESAS) and the Simplified Nutritional Appetite Questionnaire (SNAQ), respectively. Food intake was measured according to plate diagram method and participants were categorized as having food intake <75% and ≥75% of meals served. Nutritional status was evaluated using the Mini Nutritional Assessment Short Form (MNA-SF). In addition, serum CRP was analyzed and the levels >3.0 (mg/dL) were considered as moderate to severe inflammation. Of total population with mean age 81.4 ± 6.6 years (62.5% females), 51 (25.5%) had no inflammation and 88 (44.0%) and 61 (30.5%) had mild and moderate to severe inflammation, respectively. According to MNA-SF, 9.0% and 60.0% had normal nutritional status or a risk of malnutrition, respectively, whereas 31.0% were malnourished. Based on the SNAQ-appetite-question, 32.5% of the patients demonstrated poor and very poor appetite whereas 23.5% reported severe loss of appetite according to ESAS. Ninety-five (48.0%) of the participants had food intake <75% of the meals offered. Significant associations between SNAQ-appetite ( = 0.003) and ESAS-appetite ( = 0.013) scores and CRP levels were observed. In addition, significant differences were observed in CRP levels between intake ≥75% and <75% of meals served ( < 0.001). Furthermore, there were significant associations between appetite and nutritional status whereas malnourished older patients demonstrated a decreased appetite compared to those with normal nutritional status ( = 0.011). In a regression analysis, inflammation was the major independent risk factor for patients' appetite ( = 0.003) and food intake ( = 0.011) whereas other variables such as infection ( = 0.960), chronic inflammatory diseases ( = 0.371), age ( = 0.679) and gender ( = 0.447) do not show any impact on appetite. Our findings confirm that poor appetite and low food intake are associated with inflammation in older hospitalized patients, suggesting that inflammation may contribute an important aspect to the development of malnutrition in these patients.
炎症对食欲和食物摄入的影响在人类中很少被研究。在这项研究中，我们研究了 C 反应蛋白（CRP）作为炎症标志物与老年住院患者的食欲和食物摄入之间的关系。共有 200 名年龄较大的患者连续入住老年急性护理病房，参与了这项前瞻性观察研究。通过埃德蒙顿症状评估系统（ESAS）和简化营养食欲问卷（SNAQ）分别评估了食欲。根据餐盘图法测量食物摄入量，参与者被分为食物摄入量<75%和≥75%的餐数。通过微型营养评估简表（MNA-SF）评估营养状况。此外，分析了血清 CRP，将水平>3.0（mg/dL）视为中度至重度炎症。在总人群中，平均年龄为 81.4±6.6 岁（62.5%为女性），51 名（25.5%）无炎症，88 名（44.0%）和 61 名（30.5%）有轻度和中度至重度炎症。根据 MNA-SF，9.0%和 60.0%的人分别有正常的营养状况或营养不良的风险，而 31.0%的人则有营养不良。根据 SNAQ-食欲问题，32.5%的患者表现出较差和极差的食欲，而 23.5%的患者根据 ESAS 报告严重食欲不振。95 名（48.0%）参与者的食物摄入量<提供的餐数的 75%。观察到 SNAQ-食欲（ = 0.003）和 ESAS-食欲（ = 0.013）评分与 CRP 水平之间存在显著相关性。此外，在摄入量≥75%和<75%的餐食之间，CRP 水平存在显著差异（<0.001）。此外，食欲与营养状况之间存在显著相关性，而营养不良的老年患者表现出的食欲下降与营养状况正常的患者相比（ = 0.011）。在回归分析中，炎症是患者食欲（ = 0.003）和食物摄入（ = 0.011）的主要独立危险因素，而其他变量如感染（ = 0.960）、慢性炎症性疾病（ = 0.371）、年龄（ = 0.679）和性别（ = 0.447）对食欲没有影响。我们的研究结果证实，食欲差和食物摄入量低与老年住院患者的炎症有关，这表明炎症可能是这些患者营养不良发展的一个重要因素。
