The impact of acute changes of inflammation on appetite and food intake among older hospitalised patients

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 center dot 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 center dot 5 % of the patients had moderate to severe inflammation, 31 center dot 0 % were malnourished and 48 center dot 0 % had food intake <75 % of the meals offered. Also, 32 center dot 5 and 23 center dot 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 center dot 2 mg/dl and 19 % demonstrated an increase in median CRP levels by +1 center dot 2 mg/dl. Appetite significantly improved (P= 0 center dot 006) in patients with a decrease in CRP level and deteriorated in those with an increase in CRP level (P= 0 center dot 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.