IS MALNUTRITION OVERDIAGNOSED IN OLDER HOSPITALIZED-PATIENTS - ASSOCIATION BETWEEN THE SOLUBLE INTERLEUKIN-2 RECEPTOR AND SERUM MARKERS OF MALNUTRITION

Background. Many researchers have speculated that markers of malnutrit ion such as albumin, prealbumin, cholesterol, and transferrin are infl uenced by inflammation. The mechanism of this interaction has not been well understood. Methods. This was a prospective cross-sectional stud y. We evaluated 72 male patients older than 60 years admitted to a ger iatric rehabilitation unit. Subjects with severe hepatic or renal dise ases were excluded. We measured body mass index, caloric intake, serum albumin, prealbumin, cholesterol, transferrin, hemoglobin, and total lymphocyte count. To detect inflammation, we measured C-reactive prote in, Westergren sedimentation rate, fibrinogen, and cytokines including tumor necrosis factor-alpha (TNF-alpha), interleukin-1 beta (IL-1 bet a), IL-6, IL-2, and the soluble IL-2 receptor. Results. Soluble IL-2 r eceptor was negatively associated with albumin (r = -.479, p < .0001), prealbumin (r = -.520, p =< .0001), cholesterol (r = -.487, p = .0001 ), transferrin (r = -.455, p = .0002), and hemoglobin (r = -.371, p = .002). TNF-alpha, IL-1 beta, IL-6, and IL-2 were not associated with t hese measures. Conclusions. inflammation increases the incidence of hy poalbuminemia and hypocholesterolemia, potentially leading to overdiag nosis of malnutrition. We suggest that albumin, cholesterol, prealbumi n, and transferrin be used with caution when assessing the nutritional status of older hospitalized patients. In the future, soluble IL-2 re ceptor levels might be used to correct for the impact of inflammation on these markers of malnutrition.