The Use of Visceral Proteins as Nutrition Markers: An ASPEN Position Paper.
Publication Title
Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition
Document Type
Article
Publication Date
10-30-2020
Keywords
adverse outcomes; albumin; critical care; inflammation; nutrition assessment; prealbumin; risk; visceral proteins
Abstract
Serum albumin and prealbumin, well-known visceral proteins, have traditionally been considered useful biochemical laboratory values in a nutrition assessment. However, recent literature disputes this contention. The aim of this document is to clarify that these proteins characterize inflammation rather than describe nutrition status or protein-energy malnutrition. Both critical illness and chronic illness are characterized by inflammation and, as such, hepatic reprioritization of protein synthesis occurs, resulting in lower serum concentrations of albumin and prealbumin. In addition, the redistribution of serum proteins occurs because of an increase in capillary permeability. There is an association between inflammation and malnutrition, however, not between malnutrition and visceral-protein levels. These proteins correlate well with patients' risk for adverse outcomes rather than with protein-energy malnutrition. Therefore, serum albumin and prealbumin should not serve as proxy measures of total body protein or total muscle mass and should not be used as nutrition markers. This paper has been approved by the American Society for Parenteral and Enteral Nutrition Board of Directors.
Clinical Institute
Digestive Health
Specialty/Research Institute
Nutrition
Specialty/Research Institute
Pharmacy
Specialty/Research Institute
Critical Care Medicine
