An Inflammation-Adjusted Framework for Nutritional Assessment in Multimorbid Patients with Advanced Neurological...

Background and Objectives: Laboratory parameters associated with nutritional and metabolic status may be substantially influenced by inflammatory activity, complicating their interpretation in patients with advanced neurological diseases. This study aimed to characterize within-patient changes in inflammatory biomarkers and laboratory parameters related to nutritional and metabolic status in multimorbid patients receiving long-term enteral nutrition, with particular emphasis on differences between infectious and clinically non-infectious periods. A secondary objective was to propose a conceptual framework for interpreting these laboratory parameters in the context of inflammatory activity. Materials and Methods: A prospective longitudinal observational case series was conducted in an inpatient palliative care facility. Of 23 patients who entered prospective follow-up, five completed the predefined nine-month observation period and were included in the final longitudinal analysis. Twenty-three predefined assessment time points were evaluated for each participant. Inflammatory parameters, serum proteins, micronutrient-related measurements, and vitamin concentrations were analyzed descriptively in relation to the clinical course of each patient. Results: Patients with recurrent infectious episodes demonstrated pronounced increases in inflammatory biomarkers accompanied by decreases in serum proteins, particularly albumin, transferrin, and total protein, as well as changes in serum iron (Fe) and zinc (Zn). The greatest fluctuations were observed in patients with the highest inflammatory burden, whereas patients without recurrent infections showed comparatively stable laboratory profiles. Vitamin A, vitamin D, and folate concentrations showed relatively limited fluctuations. Importantly, all five patients received continued enteral nutritional support, with daily energy intake ranging from 1450 to 1800 kcal, and body weight increased by 1.0-3.0 kg during follow-up. Based on these case-based observations and current evidence, a conceptual framework for interpreting laboratory parameters in the context of inflammatory activity was proposed. Conclusions: In patients with advanced neurological diseases, laboratory parameters associated with nutritional and metabolic status should be interpreted in the context of inflammatory activity and should not be used independently to determine nutritional status. The proposed conceptual framework is intended as an interpretative aid for laboratory findings rather than as an alternative diagnostic system for malnutrition and requires validation in larger prospective studies.