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CIRCULATING GLP-1 PREDICTS MORTALITY AND NUTRITIONAL OUTCOMES IN HOSPITALIZED PATIENTS AT NUTRITIONAL RISK - A SECONDARY ANALYSIS OF THE RANDOMIZED CLINICAL TRIAL EFFORT
A. Lava1,2,*, C. Wunderle2, P. Tribolet2,3,4, Z. Stanga5, A. Baumgartner2, P. Schütz1,2
1Medical Faculty, University of Basel, Basel, 2Medical University Department, Division of General Internal and Emergency Medicine, Division of Endocrinology, Diabetes and Metabolism, Kantonsspital Aarau, Aarau, 3Department of Health Professions, Applied Sciences, University of Bern, Bern, Switzerland, 4Department of Nutritional Sciences, Faculty of Life Sciences, University of Vienna, Vienna, Austria, 5Division of Diabetes, Endocrinology, Nutritional Medicine, and Metabolism, University Hospital and University of Bern, Bern, Switzerland
Rationale: Glucagon-like peptide-1 (GLP-1) is a key anorexigenic hormone that suppresses appetite. While GLP-1 receptor agonists have revolutionized obesity management, the prognostic and therapeutic relevance of endogenous GLP-1 in disease-related malnutrition remains unclear.
Methods: In this secondary analysis of the Effect of early nutritional support on Frailty, Functional Outcomes, and Recovery of malnourished medical inpatients Trial (EFFORT), we examined associations of fasting GLP-1 concentrations at hospital admission and clinical and nutritional outcomes. The primary outcome was 30-day all-cause mortality.
Results: Among 997 patients with complete clinical and biochemistry data, higher GLP-1 levels were independently associated with increased 30-day mortality (adjusted HR 2.93, [95% CI 1.55–5.56], p<0.001) and sustained excess mortality up to five years, irrespective of randomization group, demographic factors, nutritional status, underlying diagnoses, comorbidities, and inflammation. Elevated GLP-1 was further linked to poorer nutritional intake, including lower achievement of energy and protein targets. Yet, patients with high GLP-1 appeared to derive greater benefit from individualized nutritional support than those with lower levels (HR 0.48 vs 1.27, interaction term p=0.151).
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Conclusion: Elevated fasting GLP-1 at admission identifies medical inpatients with high nutritional and clinical risk. These findings highlight endogenous GLP-1 as a potential prognostic biomarker for risk stratification and personalization of nutritional therapy in acute care.
Disclosure of Interest: A. Lava: None declared, C. Wunderle Grant / Research Support from: Nestlé Health Science, Nutricia Danone, BBraun, Baxter, Abbott Nutrition: lecture fee, P. Tribolet Grant / Research Support from: Nestlé Health Science and Abbott Nutrition: lecture fee, Z. Stanga Grant / Research Support from: Nestlé Health Science, Fresenius Kabi, B.Braun (funding grants), A. Baumgartner: None declared, P. Schütz Grant / Research Support from: Roche, Thermo Fisher, bioMérieux, Nestlé Health Science, Abbot Nutrition (funding grants)