title: Unraveling the Link between Malnutrition and Adverse Clinical Outcomes: Association of Acute and Chronic Malnutrition Measures with Blood Biomarkers from Different Pathophysiological States.
abstract: OBJECTIVE
  Malnutrition is associated with poor clinical outcomes. Whether there is a causal relationship or it merely mirrors a severe patient condition remains unclear. We examined the association of malnutrition with biomarkers characteristic of different pathophysiological states to better understand the underlying etiological mechanisms.
  
  
  METHODS
  We prospectively followed consecutive adult medical inpatients. Multivariable regression models were used to investigate the associations between malnutrition - as assessed using the Nutritional Risk Screening (NRS 2002) - and biomarkers linked to inflammation, stress, renal dysfunction, nutritional status and hematologic function.
  
  
  RESULTS
  A total of 529 patients were included. In a fully adjusted model, malnutrition was significantly associated with the inflammatory markers procalcitonin (0.20, 95% CI 0.03-0.37), proadrenomedullin (0.28, 95% CI 0.12-0.43) and albumin (-0.39, 95% CI -0.57 to -0.21), the stress marker copeptin (0.34, 95% CI 0.17-0.51), the renal function marker urea (0.23, 95% CI 0.07-0.38), the nutritional markers vitamin D25 (-0.22, 95% CI -0.41 to -0.02) and corrected calcium (0.29, 95% CI 0.10-0.49) and the hematological markers hemoglobin (-0.27, 95% CI -0.43 to -0.10) and red blood cell distribution width (0.26, 95% CI 0.07-0.44). Subgroup analysis suggested that acute malnutrition rather than chronic malnutrition was associated with elevated biomarker levels.
  
  
  CONCLUSIONS
  Acute malnutrition was associated with a pronounced inflammatory response and an alteration in biomarkers associated with different pathophysiological states. Interventional trials are needed to prove causality.
authors: University Department of Internal Medicine, Kantonsspital Aarau, Aarau, Switzerland.
authors: Susan
authors: S
authors: Felder
authors: Nina
authors: N
authors: Braun
authors: Zeno
authors: Z
authors: Stanga
authors: Prasad
authors: P
authors: Kulkarni
authors: Lukas
authors: L
authors: Faessler
authors: Alexander
authors: A
authors: Kutz
authors: Deborah
authors: D
authors: Steiner
authors: Svenja
authors: S
authors: Laukemann
authors: Sebastian
authors: S
authors: Haubitz
authors: Andreas
authors: A
authors: Huber
authors: Beat
authors: B
authors: Mueller
authors: Philipp
authors: P
authors: Schuetz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D015897:Comorbidity; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D008875:Middle Aged; D015596:Nutrition Assessment; D063868:Patient Outcome Assessment; D011446:Prospective Studies; D012306:Risk; D000067011:Severe Acute Malnutrition / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D013557:Switzerland / Q000453:epidemiology; D062606:Tertiary Care Centers; D014218:Triage; D015854:Up-Regulation
chemical_list: D015415:Biomarkers