The journal of nutrition, health & aging

, Volume 22, Issue 5, pp 589–593 | Cite as

The Association of Inflammation with Food Intake in Older Hospitalized Patients

  • Maryam Pourhassan
  • S. Böttger
  • G. Janssen
  • L. Sieske
  • R. Wirth



An acute inflammatory process may play a role in inhibiting appetite and food intake particularly in acutely ill older individuals. However, there is a lack of knowledge on the effect of inflammation on food intake in humans. In this study, we sought to investigate the association of C-reactive protein (CRP), as an inflammatory marker, with food intake in acutely ill older hospitalized patients.

Design and setting

This cross-sectional study investigated older participants who were consecutively admitted to a geriatric acute care ward. Food intake during previous week was measured according to the Nutritional Risk Screening (NRS-2002) and patients were grouped into two categories as intake ≥75% and <75% of requirements. Disease severity and mobility were measured based on the NRS-2002 and Mini Nutritional Assessment Short Form (MNA-SF), respectively. Serum CRP was analyzed according to standard procedures.


Of 177 older participants (mean age 83.1 ± 6.5 y, BMI range of 14.7–43.6 kg/m2; 116 females), 67 (38.0%) had moderate to severe inflammation (CRP>3.0 mg/dl). In addition, 109 (62.0%) patients had intake <75% of requirements during previous week, in which 34 (31.0%) and 54 (50.0%) demonstrated mild and moderate to severe inflammation, respectively. Furthermore, there were significant differences in CRP levels between intake ≥75% and <75% of requirements (P<0.001). In a logistic regression analysis, CRP level (odds ratio; OR, 1.14; P=0.006), disease severity (OR, 2.94; P=0.022), mobility (OR, 0.44; P=0.005) and BMI (OR, 0.89; P=0.003) were the major independent predictors of low food intake.


Our findings confirm a close association between food intake and inflammation in older hospitalized patients. In addition, CRP level and disease severity together were the most important independent predictors associated with food intake in these patients.

Key words

Inflammation C-reactive protein food intake older persons 


  1. 1.
    Ahmed, T. and N. Haboubi, Assessment and management of nutrition in older people and its importance to health. Clinical Interventions in Aging, 2010. 5: p. 207–216.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Brownie, S., Why are elderly individuals at risk of nutritional deficiency? International Journal of Nursing Practice, 2006. 12(2): p. 110–118.CrossRefPubMedGoogle Scholar
  3. 3.
    Gallagher, D., et al., Weight stability masks sarcopenia in elderly men and women. American Journal of Physiology-Endocrinology and Metabolism, 2000. 279(2): p. E366–E375.CrossRefPubMedGoogle Scholar
  4. 4.
    Pirlich, M., et al., The German hospital malnutrition study. Clinical Nutrition, 2006. 25(4): p. 563–572.CrossRefPubMedGoogle Scholar
  5. 5.
    Morley, J.E., Anorexia of aging: physiologic and pathologic. Am J Clin Nutr, 1997. 66(4): p. 760–73.CrossRefPubMedGoogle Scholar
  6. 6.
    Hickson, M., Malnutrition and ageing. Postgrad Med J, 2006. 82(963): p. 2–8.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Klipstein-Grobusch, K., et al., Energy intake and expenditure in elderly patients admitted to hospital with acute illness. Br J Nutr, 1995. 73(2): p. 323–34.CrossRefPubMedGoogle Scholar
  8. 8.
    Bossola, M., et al., Anorexia and serum leptin levels in hemodialysis patients. Nephron Clin Pract, 2004. 97(3): p. c76–82.CrossRefPubMedGoogle Scholar
  9. 9.
    Wong, S. and J. Pinkney, Role of cytokines in regulating feeding behaviour. Current Drug Targets, 2004. 5(3): p. 251–263.CrossRefPubMedGoogle Scholar
  10. 10.
    Zhang, G., et al., Hypothalamic programming of systemic ageing involving IKK-[bgr], NF-[kgr]B and GnRH. Nature, 2013. 497(7448): p. 211–216.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Leng, S.X., et al., Inflammation and frailty in older women. J Am Geriatr Soc, 2007. 55(6): p. 864–71.CrossRefPubMedGoogle Scholar
  12. 12.
    Roubenoff, R., Catabolism of aging: is it an inflammatory process? Curr Opin Clin Nutr Metab Care, 2003. 6(3): p. 295–9.PubMedGoogle Scholar
  13. 13.
    Banh, L., Serum proteins as markers of nutrition: What are we treating? Practical gastroenterology 30(10):46–64 · October 2006, 2006.Google Scholar
  14. 14.
    Wirth, M.D., et al., Construct validation of the Dietary Inflammatory Index among African Americans. Journal of Nutrition Health & Aging, 2017. 21(5): p. 487–491.CrossRefGoogle Scholar
  15. 15.
    Kushner, I., D. Rzewnicki, and D. Samols, What does minor elevation of C-reactive protein signify? Am J Med, 2006. 119(2): p. 166.e17–28.CrossRefGoogle Scholar
  16. 16.
    Vannini, F.D., et al., Associations between nutritional markers and inflammation in hemodialysis patients. International Urology and Nephrology, 2009. 41(4): p. 1003–1009.CrossRefPubMedGoogle Scholar
  17. 17.
    Zabel, R., et al., The relationship between subjective appetite sensations, markers of inflammation and appetite in dialysis patients. Journal of Human Nutrition and Dietetics, 2009. 22(4): p. 343–350.CrossRefPubMedGoogle Scholar
  18. 18.
    Wood, L.J. and K. Weymann, Inflammation and neural signaling: etiologic mechanisms of the cancer treatment-related symptom cluster. Current Opinion in Supportive and Palliative Care, 2013. 7(1): p. 54–59.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Kondrup, J., et al., Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr, 2003. 22(3): p. 321–36.CrossRefPubMedGoogle Scholar
  20. 20.
    Rubenstein, L.Z., et al., Screening for undernutrition in geriatric practice: Developing the Short-Form Mini-Nutritional Assessment (MNA-SF). Journals of Gerontology Series a-Biological Sciences and Medical Sciences, 2001. 56(6): p. M366–M372.CrossRefGoogle Scholar
  21. 21.
    Carrero, J.J., et al., Comparison of nutritional and inflammatory markers in dialysis patients with reduced appetite. Am J Clin Nutr, 2007. 85(3): p. 695–701.CrossRefPubMedGoogle Scholar
  22. 22.
    Kalantar-Zadeh, K., et al., Appetite and inflammation, nutrition, anemia, and clinical outcome in hemodialysis patients. Am J Clin Nutr, 2004. 80(2): p. 299–307.CrossRefPubMedGoogle Scholar
  23. 23.
    Gariballa, S. and S. Forster, Effects of acute-phase response on nutritional status and clinical outcome of hospitalized patients. Nutrition, 2006. 22(7-8): p. 750–757.CrossRefPubMedGoogle Scholar
  24. 24.
    Burrowes, J.D., et al., Self-reported appetite, hospitalization and death in haemodialysis patients: findings from the Hemodialysis (HEMO) Study. Nephrol Dial Transplant, 2005. 20(12): p. 2765–74.CrossRefPubMedGoogle Scholar
  25. 25.
    Kaizu, Y., et al., Association between inflammatory mediators and muscle mass in long-term hemodialysis patients. Am J Kidney Dis, 2003. 42(2): p. 295–302.CrossRefPubMedGoogle Scholar
  26. 26.
    Kuhlmann, M.K. and N.W. Levin, Potential interplay between nutrition and inflammation in dialysis patients. Contrib Nephrol, 2008. 161: p. 76–82.CrossRefPubMedGoogle Scholar
  27. 27.
    Plata-Salaman, C.R., Cytokines and anorexia: a brief overview. Semin Oncol, 1998. 25(1 Suppl 1): p. 64–72.PubMedGoogle Scholar
  28. 28.
    Gautron, L. and S. Laye, Neurobiology of inflammation-associated anorexia. Front Neurosci, 2009. 3: p. 59.PubMedGoogle Scholar
  29. 29.
    Mitchell, E.L., et al., Reduced intestinal motility, mucosal barrier function, and inflammation in aged monkeys. Journal of Nutrition Health & Aging, 2017. 21(4): p. 354–361.CrossRefGoogle Scholar
  30. 30.
    Murad, K. and D.W. Kitzman, Frailty and multiple comorbidities in the elderly patient with heart failure: implications for management. Heart Fail Rev, 2012. 17(4-5): p. 581–8.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Serdi and Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  • Maryam Pourhassan
    • 1
    • 2
  • S. Böttger
    • 1
  • G. Janssen
    • 1
  • L. Sieske
    • 1
  • R. Wirth
    • 1
  1. 1.Department of Geriatric Medicine, Marien Hospital HerneRuhr-UniversityBochumGermany
  2. 2.Department of Geriatric MedicineUniversity Hospital Ruhr-University Bochum, GermanyHerneGermany

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