Changes in Prealbumin, Nutrient Intake, and Systemic Inflammation in Elderly Recuperative Care Patients

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1532-5415.2008.01789.x Byline: Richard A. Dennis (*[dagger]), Larry E. Johnson ([dagger][double dagger]), Paula K. Roberson (s.), Muhannad Heif ([dagger][double dagger]), Melinda M. Bopp ([dagger]), Judy Cook ([double dagger]), Dennis H. Sullivan (*[dagger]) Keywords: elderly; prealbumin; nutrition; calorie counts; C-reactive protein Abstract: OBJECTIVES: To determine the relationship between prealbumin, nutrient intake, and indicators of inflammation for recuperative and rehabilitative care patients. DESIGN: Prospective cohort. SETTING: Recuperative Care Unit within a Veterans Administration Nursing Home Care Unit. PARTICIPANTS: One hundred eleven men (100 white; mean age 80, range 64-93). MEASUREMENTS: Prealbumin and seven markers of inflammation (C-reactive protein (CRP), tumor necrosis factor, and interleukin-6 (IL-6) and their soluble receptors) were measured at admission and discharge (median length of stay 23 days, interquartile range 15-40 days). Detailed calorie counts were performed daily, and intake was expressed as a percentage of estimated requirements for protein (1.5 g/kg body weight per day) and energy (Harris-Benedict equation). The study objective was examined using least-squares regression analysis. RESULTS: Discharge prealbumin and the change in prealbumin were positively correlated with protein and energy intake and inversely correlated with markers of inflammation, particularly CRP and IL-6. When all covariates were included in a multivariable regression analysis, the markers of inflammation predominantly accounted for the variance in prealbumin change (56%), whereas discharge protein intake accounted for 6%. CONCLUSION: For older recuperative care patients, prealbumin and its change during hospitalization are positively associated with protein intake, but inflammation or changes in inflammation appear to exert a much more-powerful influence on prealbumin concentration. Given the potential confounding effects of inflammation, monitoring the change in prealbumin is not an adequate substitute for a more-detailed nutritional assessment in this population. Author Affiliation: (*)Geriatric Research Education and Clinical Center, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas ([dagger])Donald W. Reynolds Department of Geriatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas ([double dagger])Geriatrics and Extended Care Service, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas (s.)Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas. Article note: Address correspondence to Dennis H. Sullivan, MD, Geriatric Research Education and Clinical Center (Building 170, 3J/NLR), Central Arkansas Veterans Healthcare System, 4300 W 7th Street, Little Rock, AR 72205. E-mail: SullivanDennisH@uams.edu