Changes In Serum Albumin Concentrations Research Articles

Association between serum albumin concentration change trajectory and risk of hypertension: a cohort study in China.

We sought to assess the risk of hypertension based on the trajectory of changes in serum albumin concentrations. A total of 11,946 nonhypertension adults aged 30-60 years who underwent at least 3 medical examinations between 2009 and 2016 were included in this study. Group-based trajectory models were obtained for 4 category groups, and logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for each category group of serum albumin concentration and the risk of hypertension. During a mean follow-up period of 4.30 years, 1,537 hypertension events occurred in 11,946 subjects without hypertension. A high stable trajectory of serum albumin concentrations (OR, 0.70, 95% CI, 0.51-0.96) was associated with a significantly lower risk of developing hypertension. The results of the sensitivity analysis of the high stable trajectory (OR, 0.64, 95% CI, 0.43-0.96) remained statistically significant. Subjects with normal weight and those ≥45 years of age had a significantly lower risk of hypertension at moderate increase (P = 0.053 or 0.026) and high stable trajectories (P = 0.011 or 0.016). In males and overweight subjects, the risk of hypertension was significantly lower in the high stable trajectory (P = 0.038 or 0.044). In this study, we found that moderate increase in serum albumin concentrations and a high stable trajectory were significantly associated with a reduced risk of hypertension in subjects aged ≥45 years and those with normal weight and that high stable serum albumin concentrations were significantly associated with a reduced risk of hypertension in males and overweight subjects.

Synthesis of fluorescent 9-(4-aminoaniline)-acridine for highly specific and rapid detection of human serum albumin by fluorescence-capillary gel electrophoresis

In clinical practice, many diseases can lead to changes in serum albumin concentration (HSA) in patients. Accurate detection of HSA concentration is of great significance for disease diagnosis. Based on this, this study designed and synthesized 9-(4-amino-aniline)-acridine (AAA) as a fluorescent probe. By laser induction and capillary gel electrophoresis (CGE), a new rapid and highly specific HSA detection method based on fluorescence-CGE was established. Various experimental control factors were investigated, and the optimal experimental conditions were determined as follows: the running buffer was H3PO4–KH2PO4 (pH = 2.45, 15.0 mmol L−1), the separation voltage was 30 kV, and the experimental temperature was 25 °C. The sample solution injected 10 s with hydrodynamic mode (3.43×103 Pa), HSA could be directly determined by fluorescence-CGE method. The linear range was 0.10–1.0 μg L−1, the detection limit was 0.012 μg L−1, the relative standard deviation (RSD) was less than 0.30%. This method can be used for the determination of real HSA samples. In addition, in the presence of various biological macromolecules, small molecules, ions and ethanol, the accurate detection of HSA by fluorescence-CGE method will not be affected, suggesting that this method has a high specificity for HSA. The rapid and highly specific fluorescence-CGE method of HSA constructed in this study provides a new way to detect HSA, which is of great significance for the diagnosis of clinical diseases.

Changes in serum albumin concentrations over 7 days in medical inpatients with and without nutritional support. A secondary post-hoc analysis of a randomized clinical trial.

Serum albumin concentrations are frequently used to monitor nutritional therapy in the hospital setting but supporting studies are largely lacking. Within this secondary analysis of a randomized nutritional trial (EFFORT), we assessed whether nutritional support affects short-term changes in serum albumin concentrations and whether an increase in albumin concentration has prognostic implications regarding clinical outcome and response to treatment. We analyzed patients with available serum albumin concentrations at baseline and day 7 included in EFFORT, a Swiss-wide multicenter randomized clinical trial that compared individualized nutritional therapy with usual hospital food (control group). Albumin concentrations increased in 320 of 763 (41.9%) included patients (mean age 73.3 years (SD ± 12.9), 53.6% males) with no difference between patients receiving nutritional support and controls. Compared with patients that showed a decrease in albumin concentrations over 7 days, those with an increase had a lower 180-day mortality [74/320 (23.1%) vs. 158/443 (35.7%); adjusted odds ratio 0.63, 95% CI 0.44 to 0.90; p = 0.012] and a shorter length of hospital stay [11.2 ± 7.3 vs. 8.8 ± 5.6 days, adjusted difference -2.2 days (95%CI -3.1 to -1.2)]. Patients with and without a decrease over 7 days had a similar response to nutritional support. Results from this secondary analysis indicate that nutritional support did not increase short-term concentrations of albumin over 7 days, and changes in albumin did not correlate with response to nutritional interventions. However, an increase in albumin concentrations possibly mirroring resolution of inflammation was associated with better clinical outcomes. Repeated in-hospital albumin measurements in the short-term is, thus, not indicated for monitoring of patients receiving nutritional support but provides prognostic information. ClinicalTrials.gov Identifier: NCT02517476.

Evaluation of serum 25-hydroxyvitamin D, C-reactive protein, and haptoglobin as biomarkers in dogs newly diagnosed with histoplasmosis.

Serum 25-hydroxyvitamin (OH)D, C-reactive protein (CRP), and haptoglobin are useful biomarkers in various infectious diseases and inflammatory disorders in dogs, but their utility in histoplasmosis is unknown. Determine if serum 25(OH)D, CRP, and haptoglobin concentrations are different in dogs with histoplasmosis compared to healthy controls and whether serum globulin, albumin, CRP, or haptoglobin are associated with 25(OH)D concentration. Twenty-two client-owned dogs (histoplasmosis, n=12; controls, n=10). Prospective case-control study. Dogs with histoplasmosis were categorized as pulmonary, disseminated, or gastrointestinal (GI) tract. Serum 25(OH)D was measured using modified high-performance liquid chromatography(HPLC). Serum CRP and haptoglobin were measured with ELISA assays. Dogs with histoplasmosis were grouped as disseminated (n=8) and GI tract (n=4). No dogs had pulmonary tract involvement alone. Dogs with histoplasmosis (median, interquartile range [IQR]; 11.6ng/mL, 16.8) had lower serum 25(OH)D concentrations than controls (35.7ng/mL, 17.6; P < .001). Serum CRP and haptoglobin concentrations were higher in dogs with histoplasmosis (CRP: median, IQR; 63.5mg/L, 37.1 and haptoglobin: 459.7mg/dL, 419.6) than controls (CRP: 1.9mg/L, 2; P < .001 and haptoglobin: 85.5mg/dL, 106.7; P=.003). Serum 25(OH)D concentration was positively associated with fold change in serum albumin concentration (ρ=0.77; P < .001), and negatively associated with fold change in serum globulin (ρ=-0.61; P=.003) and CRP concentrations (ρ=-0.56; P=.01). Assay of serum 25(OH)D, CRP, and haptoglobin could have clinical value in dogs with histoplasmosis.

Investigating the Role of Altered Systemic Albumin Concentration on the Disposition of Theophylline in Adult and Pediatric Patients with Asthma by Using the Physiologically Based Pharmacokinetic Approach.

Theophylline is commonly used for the treatment of asthma and has a low hepatic clearance. The changes in plasma albumin concentration occurring in asthma may affect the exposure of theophylline. The aim of the presented work was to predict theophylline pharmacokinetics (PK) after incorporating the changes in plasma albumin concentration occurring in patients with asthma into a physiologically based pharmacokinetic (PBPK) model to see whether these changes can affect the systemic theophylline concentrations in asthma. The PBPK model was developed following a systematic model building approach using Simcyp. The predictions were performed initially in healthy adults after intravenous and oral drug administration. Only when the developed adult PBPK model had adequately predicted theophylline PK in healthy adults, the changes in plasma albumin concentrations were incorporated into the model for predicting drug exposure in patients with asthma. After evaluation of the developed model in the adult population, it was scaled to children on physiologic basis. The model evaluation was performed by using visual predictive checks and comparison of ratio of observed and predicted (Robs/Pre) PK parameters along with their 2-fold error range. The developed PBPK model has effectively described theophylline PK in both healthy and diseased populations, as Robs/Pre for all the PK parameters were within the 2-fold error limit. The predictions in patients with asthma showed that there were no significant changes in PK parameters after incorporating the changes in serum albumin concentration. The mechanistic nature of the developed asthma-PBPK model can facilitate its extension to other drugs. SIGNIFICANCE STATEMENT: Exposure of a low hepatic clearance drug like theophylline may be susceptible to plasma albumin concentration changes that occur in asthma. These changes in systemic albumin concentrations can be incorporated into a physiologically based pharmacokinetic model to predict theophylline pharmacokinetics in adult and pediatric asthma populations. The presented work is focused on predicting theophylline absorption, distribution, metabolism, and elimination in adult and pediatric asthma populations after incorporating reported changes in serum albumin concentrations to see their impact on the systemic theophylline concentrations.

Changes in serum albumin concentrations during transition to dialysis and subsequent risk of peritonitis after peritoneal dialysis initiation: a retrospective cohort study.

Evidence shows that lower serum albumin concentrations are associated with the risk of peritoneal dialysis (PD)-related peritonitis. However, little is known regarding its relationship and magnitude of change before PD initiation and peritonitis risk. We performed a multicenter retrospective cohort study on 1169 adult cases of PD in Thailand. The associations of serum albumin at concentration (< 2.5, 2.5-3.5, > 3.5 [reference] g/dL) and changes (unchanged + 0.1 to - 0.1 [reference], decrease or increase > 0.1g/dL) over 3- and 6-month before PD initiation with PD-related peritonitis were examined. Time-to-first and longitudinal rates of peritonitis were examined using the multivariable Cox proportional hazards model and Poisson regression analyses, respectively. At baseline PD initiation, patients with serum albumin concentration < 2.5 and 2.5-3.5g/dL had an adjusted hazard ratio (HR) of 1.69 and 2.0 times higher peritonitis (vs. > 3.5g/dL), respectively. Compared to the unchanged group, patients with a decrease and increase in serum albumin concentrations during transitioning to dialysis were significantly associated with higher and lower risk of peritonitis, adjusted HR of 2.25 (95% confidence interval [CI] 1.85-2.75) and 0.53 (95% CI 0.42-0.68) over three-month, and 1.43 (95% CI 1.15-1.79) and 0.64 (95% CI 0.52-0.79) over six-month, respectively. Similar trends of longitudinal rates of serum albumin concentrations and peritonitis risk were observed. Serum albumin concentrations at PD initiation and its magnitude of change during the transition to dialysis are strongly associated with subsequent risk of peritonitis. Further studies are required on strategies modifying serum albumin concentration during the transition to PD.

Baseline level and change in serum albumin concentration and the risk of incident type 2 diabetes

AimsWe aimed to determine whether baseline level and change in serum albumin concentration are predictive of future development of type 2 diabetes (T2D). MethodsA total of 15,428 subjects (8764 men and 6664 women) without diabetes at baseline, aged 21–88years (mean age of 51.0years), were enrolled from a health screening program. ResultsDuring the 5-year follow-up period, a total of 599 incident cases (3.9%) of T2D developed. Higher baseline serum albumin concentration was associated with increased T2D risk, independent of age, sex, or body mass index; however, this association was confounded and was not significant after further adjustment for other T2D risk factors. Compared with subjects in the lowest tertile of change in serum albumin concentration, subjects in the highest tertile showed a lower risk for T2D development, independent of risk factors for T2D and baseline serum albumin concentration [OR (95% CI), 0.30 (0.21–0.43), p for trend <0.001]. ConclusionHigher baseline serum albumin concentration was not an independent risk factor of future T2D, whereas an increase in serum albumin concentration was independently associated with a lower diabetes risk.

Increase in serum albumin concentration is associated with prediabetes development and progression to overt diabetes independently of metabolic syndrome

AimSerum albumin concentration is associated with both type 2 diabetes and metabolic syndrome (MetS). We sought to investigate whether baseline serum albumin and change in serum albumin could be independent risk factors for prediabetes in subjects without MetS. We further examined the effect of serum albumin on progression to overt diabetes in subjects who developed prediabetes.MethodsAmong 10,792 participants without diabetes and MetS who consecutively underwent yearly health check-ups over six years, 9,807 subjects without incident MetS were enrolled in this longitudinal retrospective study. The risk of developing prediabetes (impared fasting glucose or hemoglobin A1c) was analyzed according to baseline and percent change in serum albumin concentration using Cox regression analysis. Serial changes in serum albumin concentration were measured from baseline to one year before prediabetes diagnosis, and then from the time of prediabetes diagnosis to progression to overt diabetes or final follow-up.ResultsA total of 4,398 incident cases of prediabetes developed during 35,807 person-years (median 3.8 years). The hazard ratio for incident prediabetes decreased as percent change in serum albumin concentration (quartiles and per 1%) increased in a crude and fully adjusted model. However, baseline serum albumin concentration itself was not associated with prediabetic risk. Serum albumin levels kept increasing until the end of follow-up in prediabetic subjects who returned to normal glycemic status, whereas these measures did not change in prediabetic subjects who developed type 2 diabetes. Serum albumin concentration measured at the end of follow-up was the highest in the regression group, compared to the stationary (p = 0.014) or progression groups (p = 0.009).ConclusionsIncrease in serum albumin concentration might protect against early glycemic deterioration and progression to type 2 diabetes even in subjects without MetS.

Treatment tolerance and patient-reported outcomes favor online hemodiafiltration compared to high-flux hemodialysis in the elderly

Large cohort studies suggest that high convective volumes associated with online hemodiafiltration may reduce the risk of mortality/morbidity compared to optimal high-flux hemodialysis. By contrast, intradialytic tolerance is not well studied. The aim of the FRENCHIE (French Convective versus Hemodialysis in Elderly) study was to compare high-flux hemodialysis and online hemodiafiltration in terms of intradialytic tolerance. In this prospective, open-label randomized controlled trial, 381 elderly chronic hemodialysis patients (over age 65) were randomly assigned in a one-to-one ratio to either high-flux hemodialysis or online hemodiafiltration. The primary outcome was intradialytic tolerance (day 30-day 120). Secondary outcomes included health-related quality of life, cardiovascular risk biomarkers, morbidity, and mortality. During the observational period for intradialytic tolerance, 85% and 84% of patients in high-flux hemodialysis and online hemodiafiltration arms, respectively, experienced at least one adverse event without significant difference between groups. As exploratory analysis, intradialytic tolerance was also studied, considering the sessions as a statistical unit according to treatment actually received. Over a total of 11,981 sessions, 2,935 were complicated by the occurrence of at least one adverse event, with a significantly lower occurrence in online hemodiafiltration with fewer episodes of intradialytic symptomatic hypotension and muscle cramps. By contrast, health-related quality of life, morbidity, and mortality were not different in both groups. An improvement in the control of metabolic bone disease biomarkers and β2-microglobulin level without change in serum albumin concentration was observed with online hemodiafiltration. Thus, overall outcomes favor online hemodiafiltration over high-flux hemodialysis in the elderly.

Change in serum albumin concentration is inversely and independently associated with risk of incident metabolic syndrome

BackgroundLow serum albumin concentration is associated with a high risk of morbidity and mortality from cardiovascular diseases. However, high serum albumin level appears to be linked to metabolic syndrome (MetS). This study aimed to dissect the relative contributions of baseline and change in serum albumin concentration to the risk of incident metabolic syndrome. MethodsThis was a 5-year (63,060 person-years) retrospective longitudinal study of 12,567 participants without metabolic syndrome, diabetes, or cardiovascular disease who were enrolled in a health screening program. The risk of developing MetS was analyzed according to baseline and change in serum albumin concentration. ResultsA total of 2582 incident cases of metabolic syndrome developed. The hazard ratio (HR) for incident MetS increased with increasing quartile of baseline serum albumin level compared with those in the lowest quartile, in a fully adjusted model (p for trend = 0.013). The HRs [95% confidence intervals (CIs)] of incident MetS comparing the second, third, and fourth quartiles to the first quartile of change in serum albumin level were 0.478 (0.421–0.544), 0.353 (0.307–0.405), and 0.262 (0.224–0.305) in the fully adjusted model, respectively (p for trend <0.001). Percent change in serum albumin concentration inversely correlated with percent change in serum level of high-sensitivity C-reactive protein (r=−3.5444, p<0.001). ConclusionsAlthough a higher baseline level of serum albumin was linked to increased risk of incident metabolic syndrome, increase in serum albumin concentration might be a protective factor against the risk of MetS.

Ischemia-modified albumin must be evaluated as an oxidative stress marker together with albumin and bilirubin in individuals with acute appendicitis

Ischemia-modified albumin must be evaluated as an oxidative stress marker together with albumin and bilirubin in individuals with acute appendicitis

The effect of some medical plants extracts on some physiological and biochemical parameters aspects in broiler.

The study carried out to investigate the effect of some medical plants extract on some blood physiological and biochemical parameters in broiler. One week age broiler chicken were divided into 6 groups (30 birds each),all groups was orally treated with( 1 ml/ Kg), the control group were orally treated with 1 ml of distal water. The 1 st group was orally treated of Peganum harmala extract with concentration 25 mg /ml‚ the 2nd group were orally treated of Datura innoxia extract with concentration 25mg /ml. the 3rd group were orally treated of Salicornia europaea with concentration 25mg /ml , the 4th group were orally treated of Cyperus rotundus extract with concentration 25mg /ml, the 5th group were orally treated of Matricaria chamomilia extract with concentration 25mg /ml The treatment continues for fourteen nine days period. The results showed a significant increase in serum total protein, globulin concentration in 1 st , 2nd, and 3rd groups compared with control, while all groups not a significant changes in serum albumin concentration . This was accompanied by a significant decrease in serum glucose , total cholesterol concentration in1 st, 2nd and 3rd groups and significant decrease in serum Triglycerides , VLDL-C concentration in1 st , 3rd , 4th , and 5th groups compared with control, while the treatments 2nd , 3rd , 4th , and 5th groups caused a significant increase in serum HDL-C concentration compared with control. While treatments in1 st, 2nd , and 5th groups showed a significant decrease in the serum LDL-C concentration The study concluded that‚ the extracts of this medical plants enhanced some physiological and biochemical parameters

The use of canine‐specific albumin in dogs with septic peritonitis

To assess changes in serum albumin concentration (ALB), colloid osmotic pressure (COP), and Doppler blood pressure (DBP) following transfusion of 5% lyophilized canine-specific albumin (CSA) in hypoalbuminemic dogs following surgical source control for septic peritonitis. Prospective randomized clinical trial November 2009 - November 2010. University teaching hospital. Fourteen client-owned dogs with hypoalbuminemia (<27 g/L [2.7 g/dL]) following surgical source control for septic peritonitis. Dogs were randomized to clinician-directed therapy (CDT) and CSA groups. Dogs enrolled in the CSA group received 800 mg/kg of CSA within 24 hours following surgical intervention. At enrollment, ALB, COP, and DBP were not different between groups. ALB, COP, and DBP were significantly increased in the CSA group 2 hours following completion of the transfusion compared with the CDT group (P = 0.0234, 0.0078, 0.0156, respectively). In comparison to the CDT group, there was a significant change in ALB in the CSA group 24 hours after transfusion (P = 0.0039), but no difference in COP (P = 0.3914) or DBP (P = 0.5145). ALB was significantly higher in the CSA group at 24 hours compared with the CDT group (P = 0.0367) At the time of death or discharge, there was no difference between groups regarding ALB, COP, or DBP, but an association between ALB and survival was identified (P = 0.0273). One dog experienced tachypnea during transfusion of CSA; this dog died of unknown respiratory causes 120 hours after transfusion. The administration of CSA in dogs with septic peritonitis results in an increase in ALB, COP, and DBP 2 hours after administration. An increase in ALB persisted at 24 hours compared with a CDT group. Administration of this product was not associated with owner-reported delayed adverse events in this population of dogs.

The effect of frequent hemodialysis on nutrition and body composition: Frequent Hemodialysis Network Trial

We investigated the effects of frequency of hemodialysis on nutritional status by analyzing the data in the Frequent Hemodialysis Network Trial. We compared changes in albumin, body weight and composition among 245 patients randomized to 6- or 3-times per week in-center hemodialysis (Daily Trial) and 87 patients randomized to 6-times per week nocturnal or 3-times per week conventional hemodialysis, performed largely at home (Nocturnal Trial). In the Daily Trial, there were no significant differences between groups in changes in serum albumin or the equilibrated protein catabolic rate by 12 months. There was a significant relative decrease in pre-dialysis body weight of 1.5 ± 0.2 kg in the 6 times per week group at one month, but this significantly rebounded by 1.3 ± 0.5 kg over the remaining 11 months. Extracellular water decreased in the 6 times per week compared to the 3 per week hemodialysis group. There were no significant between-group differences in phase angle, intracellular water or body cell mass. In the Nocturnal Trial, there were no significant between-group differences in any study parameter. Any gain in “dry” body weight corresponded to increased adiposity rather than muscle mass but was not statistically significant. Thus, frequent in-center hemodialysis reduced extracellular water but did not increase serum albumin or body cell mass while frequent nocturnal hemodialysis yielded no net effect on parameters of nutritional status or body composition.

Decreased Serum Albumin as a Biomarker for Severe Acute Graft-versus-Host Disease after Reduced-Intensity Allogeneic Hematopoietic Cell Transplantation

Biomarkers capable of predicting the onset and severity of acute graft-versus-host disease (aGVHD) after allogeneic hematopoietic cell transplantation (HCT) would enable preemptive and risk-stratified therapy. Severe aGVHD leads to gastrointestinal protein loss, resulting in hypoalbuminemia. We hypothesized that decreases in serum albumin at onset of aGVHD would predict the risk of progression to severe aGVHD. We identified 401 patients who developed aGVHD grades II-IV after reduced-intensity allogeneic HCT and reviewed all available serum albumin values from 30 days before HCT to 45 days after initiation of treatment for aGVHD. A ≥0.5 g/dL decrease in serum albumin concentration from pretransplantation baseline to the onset of treatment for aGVHD predicted the subsequent development of grade III/IV aGVHD (versus grade II aGVHD) with a sensitivity of 69% and a specificity of 73%. Overall mortality at 6 months after initiation of aGVHD treatment was 36% versus 17% for patients with and without ≥0.5 g/dL decreases in serum albumin, respectively (P = .0009). We conclude that change in serum albumin concentration from baseline to initiationof aGVHD treatment is an inexpensive, readily available, and predictive biomarker of GVHD severity and mortality after reduced-intensity allogeneic HCT.

Long-Term Evolution and Changing Associations of Left Ventricular Hypertrophy after Starting Hemodialysis

Background/Aims:Left ventricular hypertrophy (LVH) is prevalent in dialysis patients and is recognized as a potent risk factor for cardiovascular diseases. We examined the evolution of LVH after starting dialysis and the determinants of changes in LV mass. Methods: A cohort of 107 patients who had two or more echocardiograms at yearly intervals after starting hemodialysis was studied. Results: At baseline, the mean LV mass index (LVMI) was 145.8 g/m² and 73 (68%) patients had LVH. During the mean follow-up period of 34.5 months, LVMI decreased by 3.9 g/m². At last follow-up, the mean LVMI was 141.5 g/m² and 68 (64%) patients had LVH. For changes in LVMI, a significant correlation was found in changes in systolic blood pressure, LVMI at baseline, changes in serum albumin concentration, and age. The relationship between changes in LVMI and systolic blood pressure was close during the 1st and 2nd intervals, but became weak gradually during the 3rd and 4th intervals. Conclusion: Many patients had LVH at starting hemodialysis and continued to have LVH thereafter. The most important determinants of LV mass changes were baseline LV mass and systolic blood pressure control, but the grade of reduction decreased gradually with time. These results suggest that active antihypertensive treatment should be started early to regress LVH and prevent cardiovascular diseases.

Longitudinal Relationship between Root Caries and Serum Albumin

Serum albumin levels are a practical marker of general health status in the elderly and have been used to determine the severity of an underlying disease and the risk for death. This longitudinal study evaluated the relationship between serum albumin levels and root caries. A total of 266 persons with at least 1 tooth at baseline underwent a baseline examination and then annual investigations for 6 years. Multiple linear regression analysis was used to assess the relationship between changes in serum albumin levels and the number of root caries lesions over 6 years, after adjustment for confounding factors. Change in the number of root caries lesions was significantly associated with change in serum albumin concentrations. The standardized coefficient was -0.148 (p = 0.024). We can confirm that serum albumin concentration correlates with root caries events. From these data, we conclude that persons with hypoalbuminemia are at high risk for root caries.

The Usefulness of Day-Service in Maintaining General Nutritional Status in Elderly Japanese: A Longitudinal Study

Day-service, commuting service for elderly people requiring care at home, is one healthcare option in Japan. To date, however, there exist no studies that have examined the effects of day-service use on health outcomes in Japan. The objective of the present longitudinal study was to determine whether there is an association between day-service use and various physical and mental health outcomes in elderly people requiring care. The subjects were 61 elderly persons who required between 25 and 49 min of assistance per day and used long-term care insurance. Measurements included demographic characteristics, activities of daily living, frequency of day-service use, body weight, height, grip strength, thigh muscle volume, degree of depression (Geriatric Depression Scale), the mini-mental state examination, and serum albumin and blood hemoglobin levels in the baseline and follow-up surveys two years later. In the day-service user group, the mean changes in serum albumin concentrations using day-service once, twice and three < or = times/week were -0.2, -0.3, and 0 g/dl, respectively, and the mean changes in blood hemoglobin were -0.7, -0.5, and 0.2 g/dl, respectively. The two-year change in serum albumin concentrations was less (p = 0.024) in subjects using day-service "three < or = times" (0 g/dl) than "twice" (-0.3 g/dl). The two-year change in blood hemoglobin was also less (p = 0.043) in subjects using day-service "three < or = times" (0.2 g/dl) than "twice" (-0.5 g/dl). The present study has shown that frequent use of day-service is useful in maintaining general nutritional status in elderly people.

Change of Serum Albumin and Risk of Cardiovascular Disease and All-Cause Mortality

The aim of this longitudinal study was to investigate 3-year change in serum albumin concentration as a determinant of incident cardiovascular disease (CVD) and all-cause mortality. Data were from 713 respondents of the Longitudinal Aging Study Amsterdam initially aged 55-85 years. Serum albumin was measured at baseline (1992/1993) and after 3 years. At the 6-year follow-up, incident CVD (among 456 respondents with no prevalent CVD at the 3-year follow-up) and all-cause mortality were ascertained. Overall, 18.9% developed CVD and 10.9% died. After adjustment for potential confounders, a higher level of serum albumin at the 3-year follow-up was associated with a lower risk for incident CVD (relative risk = 0.88, 95% confidence interval (CI): 0.79, 0.98). The risk of incident CVD was 0.88 (95% CI: 0.78, 0.99) per unit (g/liter) increase in change in albumin between 3-year follow-up and baseline. Chronic low serum albumin (<or=43 g/liter at baseline and 3-year follow-up) was not associated with incident CVD (p = 0.22). A clinically relevant decrease in serum albumin (>or=1 standard deviation (2.5 g/liter) between baseline and 3-year follow-up) tended to be associated with a twofold risk (relative risk = 2.00, 95% CI: 0.91, 4.39). For all-cause mortality, no associations were observed. These findings suggest that older persons with a decrease in serum albumin concentration, even within the normal range, might be at increased risk of incident CVD. Change in serum albumin may be used as an early marker for CVD risk.

Change in serum albumin and subsequent decline in functional status in older persons

This study examines whether a three-year change in serum albumin concentration is associated with subsequent decline in functional status in older persons. A total of 588 participants from the Longitudinal Aging Study Amsterdam aged 65-85 years were followed for six years. The three-year change in serum albumin was classified in four groups: chronic low (< or =43 g/L at both time points), decrease (decrease of 2.4% or more) from normal to low, decrease but still normal, and stable normal albumin (reference group). During the subsequent three years, absolute change and a decline of one standard deviation or more (termed substantial decline) in functional status was assessed. Functional status was measured in two ways: using performance tests and self-reported functional ability. Substantial decline in functional performance and functional ability was observed in 243 persons (41.3%) and 133 persons (22.6%), respectively. After adjustment for baseline functional status and potential confounders, chronic low albumin and a decrease from normal to low albumin were associated with a greater absolute decline in functional performance and in self-reported functional ability. Using the outcome substantial decline in functional status, only decrease to low serum albumin was associated with decline in functional ability [odds ratio (OR)=1.97; one-sided 95% Confidence Limit (CL)=1.09]. This study indicates that chronic low serum albumin is a determinant of decline in functional status. However, a decrease in serum albumin from normal to low levels but within the normal range was a stronger determinant of future decline in functional status. Change in serum albumin level within the normal range measured between two points in time may be used as a general marker of future functional decline.