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Association of Baseline Inflammation With Effectiveness of Nutritional Support Among Patients With Disease-Related Malnutrition: A Secondary Analysis of a Randomized Clinical Trial
Open accessAbstract
Importance: Inflammation is a key driver of malnutrition during illness and is often accompanied by metabolic effects, including insulin resistance and reduction of appetite. However, it still remains unclear if inflammation influences the response to nutritional support among patients with disease-related malnutrition. Objective: To examine whether patients' baseline inflammatory status is associated with the effect of nutritional support on 30-day mortality. Design, Setting, and Participants: This is a secondary analysis of the Effect of Early Nutritional Support on Frailty, Functional Outcomes, and Recovery of Malnourished Medical Inpatients Trial (EFFORT), a randomized clinical trial conducted in 8 Swiss hospitals from April 2014 to February 2018. A total of 1950 participants who had C-reactive protein measurements at the time of admission were included in this secondary analysis. Data analysis was conducted between June and July 2019. Interventions: Hospitalized patients at risk for malnutrition were randomly assigned to receive protocol-guided individualized nutritional support to reach protein and energy goals (intervention group) or standard hospital food (control group). Main Outcomes and Measures: The primary end point was 30-day mortality. Based on C-reactive protein levels at admission, patients were stratified into groups with low, moderate, or high inflammation (<10 mg/L, 10-100 mg/L, and >100 mg/L, respectively). Results: A total of 1950 patients (median [interquartile range] age, 75 [65-83] years; 1025 [52.6%] men) were included; 533 (27.3%) had low levels of inflammation, 894 (45.9%) had moderate levels of inflammation, and 523 (26.8%) had high levels of inflammation. Compared with the control group, patients receiving nutritional support showed a significant reduction in 30-day mortality, regardless of C-reactive protein level (adjusted odds ratio, 0.61; 95% CI, 0.43-0.86; P = .005). In the subgroup of patients with high inflammation, there was no beneficial effect of nutritional support (adjusted odds ratio, 1.32; 95% CI, 0.70-2.50; P = .39), providing evidence that inflammation has a significant modifying association (P for interaction = .005). Conclusions and Relevance: Based on this secondary analysis of a multicenter randomized trial, a patient's admission inflammatory status was associated with their response to nutritional support. If validated in future clinical trials, nutritional support may need to be individualized based on a patient's initial presentation and markers of inflammation. These results may also help to explain some of the heterogeneity in treatment effects of nutrition seen in previous critical care trials. Trial Registration: ClinicalTrials.gov Identifier: NCT02517476.
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“An RCT in non-ICU patients suggests that nutritional intervention, including both macro- and micronutrients, may improve outcomes [85].”
From Gastrointestinal function and nutritional interventions in septic shock (2025) · cites this paper as [85]
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“A secondary analysis of the multicentre randomized-controlled EFFORT trial suggested that patients with CRP levels of !100 mg/l no longer responded to nutritional therapy, while patients with lower levels had a significant mortality benefit from nutritional support [147] (Level of evidence: 1þþ).”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [147]
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“Markers of inflammation (i.e.C-reactive protein [CRP]) have been shown to correlate with disease-related anorexia, reduced food intake and muscle catabolism, and at the same predict lack of response to nutritional treatment [147,190,191].”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [147]
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Cites
ESPEN guidelines on definitions and terminology of clinical nutrition
Cederholm, T., Barazzoni, R., Austin, P., Ballmer, P., Biolo, G., Bischoff, S. C., Compher, C., Correia, I., Higashiguchi, T., Holst, M., et al. (2017) · Clinical Nutrition · doi:10.1016/j.clnu.2016.09.004 · Cited by 2,560
Prognostic impact of disease-related malnutrition.
Norman, K., Pichard, C., Lochs, H., & Pirlich, M. (2008) · Clinical Nutrition · doi:10.1016/j.clnu.2007.10.007 · Cited by 1,460
The National Heart, L., Rice, T. W., Wheeler, A. P., Thompson, B. T., Steingrub, J., Hite, R. D., Moss, M., Morris, A., Dong, N., & Rock, P. (2012) · JAMA: The Journal of the American Medical Association · doi:10.1001/jama.2012.137 · Cited by 935
Schuetz, P., Fehr, R., Baechli, V., Geiser, M., Deiss, M., Gomes, F., Kutz, A., Tribolet, P., Bregenzer, T., Braun, N., et al. (2019) · The Lancet · doi:10.1016/s0140-6736(18)32776-4 · Cited by 910
Self-citationLim, S., Ong, K., Chan, Y., Wai, C.-L.-K., Ferguson, M., & Daniels, L. (2011) · Clinical Nutrition · doi:10.1016/j.clnu.2011.11.001 · Cited by 865
Cachexia: pathophysiology and clinical relevance1,2
Morley, J. E., Thomas, D. R., & Wilson, M.-M. G. (2006) · The American Journal of Clinical Nutrition · doi:10.1093/ajcn/83.4.735 · Cited by 786
Sorensen, J., Kondrup, J., Prokopowicz, J., Schiesser, M., Krähenbühl, L., Meier, R., & Liberda, M. (2008) · Clinical Nutrition · doi:10.1016/j.clnu.2008.03.012 · Cited by 607
Nutritional Risk Screening and Assessment
Reber, E., Gomes, F., Vasiloglou, M. F., Schuetz, P., & Stanga, Z. (2019) · Journal of Clinical Medicine · doi:10.3390/jcm8071065 · Cited by 485
Self-citationDeutz, N. E., Matheson, E. M., Matarese, L. E., Luo, M., Baggs, G. E., Nelson, J. L., Hegazi, R. A., Tappenden, K. A., & Ziegler, T. R. (2016) · Clinical Nutrition · doi:10.1016/j.clnu.2015.12.010 · Cited by 472
SERUM C‐REACTIVE PROTEIN LEVELS IN DISEASE *
Morley, J. J., & Kushner, I. (1982) · Annals of the New York Academy of Sciences · doi:10.1111/j.1749-6632.1982.tb22153.x · Cited by 467
Nutrition in the acute phase of critical illness
Casaer, M. P., & Van den Berghe, G. (2014) · New England Journal of Medicine · doi:10.1056/nejmra1304623 · Cited by 335
Felder, S., Lechtenboehmer, C. A., Bally, M. R., Fehr, R., Deiss, M., Faessler, L., Kutz, A., Steiner, D., Rast, A. C., Laukemann, S., et al. (2015) · Nutrition · doi:10.1016/j.nut.2015.06.007 · Cited by 293
Self-citationGomes, F., Baumgartner, A., Bounoure, L., Bally, M., Deutz, N. E., Greenwald, J. L., Stanga, Z., Mueller, B., & Schuetz, P. (2019) · JAMA Network Open · doi:10.1001/jamanetworkopen.2019.15138 · Cited by 268
Self-citationInsufficient Activation of Autophagy Allows Cellular Damage to Accumulate in Critically Ill Patients
Vanhorebeek, I., Gunst, J., Derde, S., Derese, I., Boussemaere, M., Güiza, F., Martinet, W., Timmermans, J.-P., D'Hoore, A., Wouters, P. J., et al. (2011) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2010-2563 · Cited by 241
Hersberger, L., Bargetzi, L., Bargetzi, A., Tribolet, P., Fehr, R., Baechli, V., Geiser, M., Deiss, M., Gomes, F., Kutz, A., et al. (2019) · Clinical Nutrition · doi:10.1016/j.clnu.2019.11.041 · Cited by 226
Self-citationGunst, J., Derese, I., Aertgeerts, A., Ververs, E.-J., Wauters, A., den Berghe, G. V., & Vanhorebeek, I. (2012) · Critical Care Medicine · doi:10.1097/ccm.0b013e3182676657 · Cited by 166
Felder, S., Braun, N., Stanga, Z., Kulkarni, P., Faessler, L., Kutz, A., Steiner, D., Laukemann, S., Haubitz, S., Huber, A., et al. (2016) · Annals of Nutrition and Metabolism · doi:10.1159/000444096 · Cited by 86
Self-citationLoss of appetite in acutely ill medical inpatients: physiological response or therapeutic target?
Schütz, P., Bally, M., Stanga, Z., & Keller, U. (2014) · Swiss Medical Weekly · doi:10.4414/smw.2014.13957 · Cited by 78
Self-citationEarly versus late parenteral nutrition in ICU patients: cost analysis of the EPaNIC trial
Vanderheyden, S., Casaer, M., Kesteloot, K., Simoens, S., Rijdt, T. D., Peers, G., Wouters, P., Coenegrachts, J., Grieten, T., Polders, K., et al. (2012) · Critical Care · doi:10.1186/cc11361 · Cited by 71
Feeding critically ill patients the right ‘whey’: thinking outside of the box. A personal view
Marik, P. E. (2015) · Annals of Intensive Care · doi:10.1186/s13613-015-0051-2 · Cited by 69
Schüetz, P., Fehr, R., Baechli, V., Geiser, M., Gomes, F., Kutz, A., Tribolet, P., Bregenzer, T., Hoess, C., Pavlicek, V., et al. (2018) · International Journal of Clinical Trials · doi:10.18203/2349-3259.ijct20182085 · Cited by 57
Self-citationObesity paradox in patients with community-acquired pneumonia: Is inflammation the missing link?
Braun, N., Hoess, C., Kutz, A., Christ-Crain, M., Thomann, R., Henzen, C., Zimmerli, W., Mueller, B., & Schuetz, P. (2017) · Nutrition · doi:10.1016/j.nut.2016.07.016 · Cited by 49
Self-citationSchuetz, P. (2015) · Swiss Medical Weekly · doi:10.4414/smw.2015.14132 · Cited by 42
Self-citationSoeters, P., Bozzetti, F., Cynober, L., Elia, M., Shenkin, A., & Sobotka, L. (2016) · Clinical Nutrition · doi:10.1016/j.clnu.2015.08.008 · Cited by 40
Potential interplay between nutrition and inflammation in dialysis patients.
Kuhlmann, M., & Levin, N. (2008) · Contributions to Nephrology · doi:10.1159/000129759 · Cited by 34
Schüetz, P. (2017) · BMC Medicine · doi:10.1186/s12916-017-0812-x · Cited by 28
Self-citationEvidence-based nutrition for the malnourished, hospitalised patient: one bite at a time
Merker, M., Gomes, F., Stanga, Z. G., & Schüetz, P. (2019) · Swiss Medical Weekly · doi:10.4414/smw.2019.20112 · Cited by 28
Self-citationControversies and Misconceptions in Intensive Care Unit Nutrition
Hooper, M. H., & Marik, P. E. (2015) · Clinics in Chest Medicine · doi:10.1016/j.ccm.2015.05.013 · Cited by 21
Nutritional Support Among Medical Inpatients—Feed the Cold (and Malnourished) and Starve the Febrile
Marik, P. E. (2019) · JAMA Network Open · doi:10.1001/jamanetworkopen.2019.15707 · Cited by 9
Flagged first, then by citations
2 of the 31 references couldn’t be matched to a known paper.
Research works printed but not linked: 1
- Ross, 1996, The CONSORT statement., JAMA, 276, 1877, 10.1001/jama.1996.03540230027024 · DOI
Cited by
Sorted by citations
The use of visceral proteins as nutrition markers: an ASPEN position paper
Evans, D. C., Corkins, M. R., Malone, A., Miller, S., Mogensen, K. M., Guenter, P., Jensen, G. L., & the ASPEN Malnutrition Committee (2021) · Nutrition in Clinical Practice · doi:10.1002/ncp.10588 · Cited by 589
Heyland, D. K., Patel, J., Compher, C., Rice, T. W., Bear, D. E., Lee, Z.-Y., González, V. C., O'Reilly, K., Regala, R., Wedemire, C., et al. (2023) · The Lancet · doi:10.1016/s0140-6736(22)02469-2 · Cited by 401
Morales, F., la Paz, S. M., León, M. J., & Rivero‐Pino, F. (2023) · Nutrients · doi:10.3390/nu16010001 · Cited by 452
“The effects of nutritional interventions on immune function and other parameters (especially body weight) in malnourished adults has also been evaluated in many studies [82,83].”
BackgroundManagement of disease-related malnutrition for patients being treated in hospital
Schuetz, P., Seres, D., Lobo, D. N., Gomes, F., Kaegi-Braun, N., & Stanga, Z. (2021) · The Lancet · doi:10.1016/s0140-6736(21)01451-3 · Cited by 355
Self-citationPrevalence and Prognostic Significance of Malnutrition in Patients With Acute Coronary Syndrome
Raposeiras‐Roubín, S., Assi, E. A., Fernández, M. C., Pardal, C. B., Castro, A. L., Barcía, J. A. P., Pérez, D. D., Prieto, S. B., Rosselló, X., Ibáñez, B., et al. (2020) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2020.06.058 · Cited by 281
Metadata
- Authors
- Merker, M., Felder, M., Gueissaz, L., Bolliger, R., Tribolet, P., Kägi-Braun, N., Gomes, F., Hoess, C., Pavlicek, V., Bilz, S., Sigrist, S., Brändle, M., Henzen, C., Thomann, R., Rutishauser, J., Aujesky, D., Rodondi, N., Donzé, J., Stanga, Z., Mueller, B., & Schuetz, P.
- Affiliations
- University of Basel (CH)
- Bern University of Applied Sciences (CH)
- Internal Medicine, Kantonsspital Muensterlingen, Muensterlingen, Switzerland
- New York Academy of Sciences (US)
- Kantonsspital Münsterlingen (CH)
- Kantonsspital St. Gallen (CH)
- Luzerner Kantonsspital (CH)
- Internal Medicine, Kantonsspital Solothurn, Solothurn, Switzerland
- Kantonsspital Baselland (CH)
- University of Bern (CH)
- Medical University Department, University of Basel, Kantonsspital Aarau, Aarau, Switzerland
- ORCID
- Venue
- JAMA Network Open
- Publisher
- American Medical Association (AMA)
- Published
- 2020-03-10
- Volume
- 3
- Issue
- 3
- Pages
- e200663
- ISSN
- 2574-3805 (ISSN-L)
- PMC
- PMC7064875
- OpenAlex
- W3011737478
- Cited by
- 262
- References
- 31
- Citations by year
- 2026: 26 · 2025: 71 · 2024: 56 · 2023: 46 · 2022: 35 · 2021: 21 · 2020: 5
- FWCI
- 16.91
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JAMA Network Open (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- ARBOR - Bern University of Applied Sciences Repository (submittedVersion, other-oa)
- Bern Open Repository and Information System (University of Bern) (submittedVersion, cc-by)
- BFH: ARBOR
- Open Access CRIS of the University of Bern
- Funders
- National Science Foundation
- Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (150531)
- Forschungsrat des Kantonsspitals Aarau (1410.000.044, 1410.000.058)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Physiology (medical) › Nutrition and Health in Aging
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Keywords
- disease-related malnutrition, inflammation, C-reactive protein, nutritional support, 30-day mortality, frailty, insulin resistance, appetite, older adults, hospital food service, functional outcome, length of hospital stay, hospital readmission
- MeSH terms
- Aged, Aged, 80 and over, C-Reactive Protein, Female, Hospitalization, Humans, Inflammation, Male, Middle Aged, Cohort Studies, Survival Rate, Treatment Outcome, Nutritional Support, Malnutrition
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