Abstract
Low plasma albumin levels have been historically associated with insufficient nutritional nitrogen support.Recently, linked to the poor response of actual therapies and available supplements to manage this alteration, the role of this alteration has been attributed to the vast ensemble of modifications referred generally as consequent to inflammation. On the contrary, as recently it has been reported that life based on introduction of mainly essential amino acids is possible, and life span is improved when compared to standard diets, it is possible to hypothesize that by normal foods or by actually most widely diffused supplements insufficient amounts of essential amino acids to match with real needs of hypoalbuminemic patients are not provided. Peculiarly, some non essential amino acids provided in excess by diets may mislead clinicians by suggesting achievement of sufficient nitrogen intake if urea syntheses is used as reference of sufficient nutrition, while syntheses of liver proteins is not sufficiently implemented. Studies suitable to understand if some innovative therapy would be efficient in implementing albumin syntheses and thus prognosis in hypoalbuminemic patients are necessary.
Highlights
Since in 1979 Seltzen et al [1] proposed albumin, in association to total lymphocytes count, as a marker of instant nutritional assessment and of malnutrition, since a widely used way to screen patient for intensive nutritional care
To our knowledge, all authors agree that in presence of pathologies associated to hypoalbuminemia either mortality correlates with the dimensions of albumin lowering and quite obviously, that the best solution to restore normal values is to eliminate most efficiently the underlying pathology, a definitely embraceable purpose, not often completely achievable
Stated “we hypothesize that low serum albumin and prealbumin levels, in contrast, identify a group of patients who will be unable to benefit from nutritional support”, suggesting serum albumin totally useless as a marker of nutritional status
Summary
Since in 1979 Seltzen et al [1] proposed albumin, in association to total lymphocytes count, as a marker of instant nutritional assessment and of malnutrition, since a widely used way to screen patient for intensive nutritional care. Many editorials and papers have been recently published questioning the interpretation of low levels of circulating albumin as primarily a marker of poor nitrogen intake. Some authors, suggesting that low levels of albumin should be considered just a marker indicating and correlating with inflammation in both no diseased [2] and diseased patients [3], support the proposal that albumin concentration below normal should be considered mainly ”a negative acute phase reactant”. To our knowledge, all authors agree that in presence of pathologies associated to hypoalbuminemia either mortality correlates with the dimensions of albumin lowering and quite obviously, that the best solution to restore normal values is to eliminate most efficiently the underlying pathology, a definitely embraceable purpose, not often completely achievable
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