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

Authors

  • Richard A. Dennis PhD,

    1. From the *Geriatric Research Education and Clinical Center, Central Arkansas Veterans Healthcare System, Little Rock, ArkansasDonald W. Reynolds Department of Geriatrics, University of Arkansas for Medical Sciences, Little Rock, ArkansasGeriatrics and Extended Care Service, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas§Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
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  • Larry E. Johnson MD, PhD,

    1. From the *Geriatric Research Education and Clinical Center, Central Arkansas Veterans Healthcare System, Little Rock, ArkansasDonald W. Reynolds Department of Geriatrics, University of Arkansas for Medical Sciences, Little Rock, ArkansasGeriatrics and Extended Care Service, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas§Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
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  • Paula K. Roberson PhD,

    1. From the *Geriatric Research Education and Clinical Center, Central Arkansas Veterans Healthcare System, Little Rock, ArkansasDonald W. Reynolds Department of Geriatrics, University of Arkansas for Medical Sciences, Little Rock, ArkansasGeriatrics and Extended Care Service, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas§Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
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  • Muhannad Heif MD,

    1. From the *Geriatric Research Education and Clinical Center, Central Arkansas Veterans Healthcare System, Little Rock, ArkansasDonald W. Reynolds Department of Geriatrics, University of Arkansas for Medical Sciences, Little Rock, ArkansasGeriatrics and Extended Care Service, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas§Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
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  • Melinda M. Bopp BS,

    1. From the *Geriatric Research Education and Clinical Center, Central Arkansas Veterans Healthcare System, Little Rock, ArkansasDonald W. Reynolds Department of Geriatrics, University of Arkansas for Medical Sciences, Little Rock, ArkansasGeriatrics and Extended Care Service, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas§Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
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  • Judy Cook MNSc,

    1. From the *Geriatric Research Education and Clinical Center, Central Arkansas Veterans Healthcare System, Little Rock, ArkansasDonald W. Reynolds Department of Geriatrics, University of Arkansas for Medical Sciences, Little Rock, ArkansasGeriatrics and Extended Care Service, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas§Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
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  • Dennis H. Sullivan MD

    1. From the *Geriatric Research Education and Clinical Center, Central Arkansas Veterans Healthcare System, Little Rock, ArkansasDonald W. Reynolds Department of Geriatrics, University of Arkansas for Medical Sciences, Little Rock, ArkansasGeriatrics and Extended Care Service, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas§Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
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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

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.

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