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Lars Sieske, Gregor Janssen, Nina Babel, Timm Westhoff, Rainer Wirth, Maryam Pourhassan

• 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 \(\geq\)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 \(\pm\) 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 (\(\it p\) = 0.003) and ESAS-appetite (\(\it p\) = 0.013) scores and CRP levels were observed. In addition, significant differences were observed in CRP levels between intake \(\geq\)75% and <75% of meals served (\(\it p\) < 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 (\(\it p\) = 0.011). In a regression analysis, inflammation was the major independent risk factor for patients' appetite (\(\it p\) = 0.003) and food intake (\(\it p\) = 0.011) whereas other variables such as infection (\(\it p\) = 0.960), chronic inflammatory diseases (\(\it p\) = 0.371), age (\(\it p\) = 0.679) and gender (\(\it p\) = 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.