Impact of Personalized Nutritional Intervention on Inflammatory Markers in Hospitalized Patients with Multiple Comorbidities

Abstract

Introduction: Disease-related malnutrition is common in hospitalized patients with multimorbidity and is associated with increased morbidity, mortality, and hospital stay. Systemic inflammation, as assessed by C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α), modulates the response to nutritional therapy (Wunderle et al., 2025a). The ESPEN guidelines recommend individualized nutritional support in polymorbid patients (Wunderle et al., 2023).

Objective: To evaluate the impact of a personalized nutritional intervention on changes in CRP, IL-6, and TNF-α in hospitalized patients with multiple comorbidities, compared to standard nutritional care.

Methodology: Quasi-experimental study with random assignment by blocks (1:1) in a tertiary hospital. A total of 120 adult patients (≥ 18 years) with ≥ 2 chronic comorbidities and nutritional risk were included (NRS-2002 ≥ 3). The intervention group (IG) received personalized nutritional support guided by the Nutritional Care Process and the ESPEN guidelines; the control group (CG) received the usual nutritional care. CRP, IL-6 and TNF-α were measured at admission (day 0) and at day 7.

Results: The mean age was 72.3 ± 10.7 years; the median number of comorbidities was 4 (IQR 3–5). At day 7, the IG showed greater relative reductions in CRP (−36.8% vs. −17.9%; p = 0.006) and IL-6 (−23.9% vs. −9.8%; p = 0.022) compared to the CG. The reduction in TNF-α was greater in the IG (−11.5% vs. −4.9%; p = 0.09). 72% of the IG reached ≥75% of the energy and protein requirements compared to 45% of the CG (p = 0.003). Fewer infectious complications were observed in the IG (23.3% vs. 38.3%; p = 0.048).

Conclusions: Personalized nutritional intervention was associated with a greater reduction in CRP and IL-6 and with better coverage of nutritional requirements in hospitalized patients with multimorbidity. These findings support the systematic incorporation of personalized nutrition models guided by inflammatory biomarkers in the comprehensive management of disease-related malnutrition.