PW23 - POOR APPETITE AND GDF-15 AS PREDICTORS OF INSUFFICIENT ENERGY AND PROTEIN INTAKE DURING AND AFTER HOSPITALIZATION IN ADULTS AGED ≥65 YEARS ACUTELY ADMITTED FOR MEDICAL ILLNESS: AN EXPLORATORY ANALYSIS OF A RANDOMIZED CONTROLLED TRIAL
PW23
POOR APPETITE AND GDF-15 AS PREDICTORS OF INSUFFICIENT ENERGY AND PROTEIN INTAKE DURING AND AFTER HOSPITALIZATION IN ADULTS AGED ≥65 YEARS ACUTELY ADMITTED FOR MEDICAL ILLNESS: AN EXPLORATORY ANALYSIS OF A RANDOMIZED CONTROLLED TRIAL
O. Bornæs1,2,*, R. L. Nielsen1,3, M. B. Houlind1,4,5, T. Kallemose1, B. Jawad1, A. M. Beck6, D. P. Sonne7, I. Poulsen1,8, A. L. Andersen1, M. M. Pedersen1,2
1Department of Clinical Research, University Hospital Amager and Hvidovre, Denmark, Hvidovre, 2Department of Clinical Medicine, Faculty og Health and Medical Sciences, University of Copenhagen, 3Department of Clinical Medicine, Faculty og Health and Medical Sciences, University of Copenfagen, Copenhagen, 4The Hospital Pharmacy, Region Hovedstaden, Herlev, 5Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, 6Dietetic and Nutritional Research Unit, Herlev-Gentofte University Hospital, Herlev, 7Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, 8Department of People and Technology, Roskilde University, Roskilde, Denmark
Rationale: Malnutrition is common in older adults during and after hospitalization and is linked to poor outcomes [1-2]. Anorexia of aging contributes to malnutrition, though the mechanisms are unclear [3]. Growth Differentiation Factor-15 (GDF-15) may be a biomarker for anorexia and malnutrition [1-2]. The Simplified Nutritional Appetite Questionnaire (SNAQ) assesses appetite, but its predictive value in acutely ill older patients is uncertain [4]. This study examined associations between GDF-15 and insufficient energy and protein intake and evaluated GDF-15 and SNAQ’s predictive ability in hospitalized older adults.
Methods: The study included 130 adults aged ≥65 at risk of or diagnosed with malnutrition, admitted for acute illness. Assessments were done at baseline and 8 and 16 weeks post-discharge. GDF-15, appetite (SNAQ), and intake (3-day food diaries) were measured. Intake was classified as insufficient at ≤75% and ≤100% of estimated energy and protein needs. Associations and predictive performance were analyzed using regression and ROC curves.
Results: A doubling in plasma GDF-15 was associated with a 6.7% decrease in baseline energy intake, though not statistically significant, with similar trends for protein intake. Adjusting for CRP attenuated these associations, suggesting inflammation’s role. SNAQ scores were modestly linked to energy intake, but neither SNAQ nor GDF-15 alone had adequate predictive accuracy (AUC < 0.70), and combining them did not improve performance.
Conclusion: Although GDF-15 and SNAQ are relevant for identifying older adults at nutritional risk, their limited predictive value restricts clinical use. Further research should explore combining GDF-15 with other markers to improve early detection of nutritional risk in hospitalized older patients.
References:
[1] Nielsen, R.L.; Bornæs, O.; Iversen, E.; Strejby Christensen, L.W.; Kallemose, T.; Jawad, B.; Rasmussen, H.H.; Munk, T.; Lund, T.M.; Andersen, O.; Houlind, M.B.; Leegaard Andersen, A.; Tavenier, J. Growth Differentiation Factor‑15 (GDF‑15) Levels Are Associated with Malnutrition, Poor Appetite, and Reduced Physical Function in Acutely Admitted Older Adults. Clinical Nutrition 2024, 43(8), 1685–1693, doi:10.1016/j.clnu.2024.06.005
[2] Rostami, N.; de van der Schueren, M.; Wijnhoven, H.A.H.; Maier, A.B. Growth Differentiation Factor 15 (GDF-15) and Malnutrition in Acutely Admitted Older Adults: A Prospective Observational Study. The Journal of Nutrition, Health and Aging 2024, 28(6), doi: 10.1007/s12603-024-2001-3.
[3] Landi, F.; Calvani, R.; Tosato, M.; Martone, A.; Ortolani, E.; Savera, G.; Sisto, A.; Marzetti, E. Anorexia of Aging: Risk Factors, Consequences, and Potential Treatments. Nutrients 2016, 8, 69, doi:10.3390/nu8020069.
[4] van Beek, A.; Koster, A.; den Uijl, I.W.; de Vet, H.C.W.; Rempe, I.; Visser, M. Predictive Validity of the SNAQ65+ for Undernutrition Risk in Community-Dwelling Older Adults. Clinical Nutrition ESPEN 2024, 58, 197–204, doi: 10.1016/j.clnesp.2024.02.015.
Disclosure of Interest: None declared