Discussion
appetite impairment, hypercortisolism, Cushing’s disease
LOSS OF APPETITE, MALNOURISHED, SECONDARY, HYPERCORTISOLISM, ACUTE CORONARY SYNDROME, MALNUTRITION, APPETITE LOSS
We can draw three main conclusions from this secondary analysis of a randomized nutritional trial. First, patients with higher risk of malnutrition, reduced food intake, and appetite loss show significantly increased cortisol levels. Second, cortisol levels at time of admission to hospital have strong prognostic implications in terms of short- and long-term mortality and other clinically relevant outcomes. And third, the effect of nutritional treatment on mortality tends to be more pronounced in patients with high cortisol levels compared to patients with lower cortisol levels; especially in the severely malnourished population.Pathophysiologically, the association of cortisol levels and nutritional parameters is of high interest. In our cohort, patients experiencing loss of appetite and reduction of food intake had higher cortisol levels compared to patients without appetite impairment. Conversely, the appetite-increasing effect of cortisone treatment or hypercortisolism induced by Cushing’s disease per se is well known [High cortisol levels had a strong prognostic value regarding mortality and adverse outcomes in our cohort of patients at nutritional risk. This result is in line with findings of previous studies which have described associations between cortisol levels and poor prognosis in other cohorts, including acute coronary syndrome [Evidence of the positive effects of nutritional therapy on clinical outcomes in the medical inpatient population has been growing in recent years [