Image source: https://image.slidesharecdn.com/biochemicalassessment-160512195607/95/biochemical-assessment-powerpoint-9-638.jpg?cb=1463083014
We continue to obtain questions from practitioners regarding if which could be related to use serum albumin and/or prealbumin to seriously look into quite a lot of nutritional fame and/or nutritional repletion. To answer this question, I'll p.c a bunch of information from our guide, The Complete Guide to Nutrition Care for Pressure Ulcers: Prevention and Treatment, Copyright 2012:
Prealbumin (transthyretin and thyroxine-binding albumin) has a half of lifetime of only 2-3 days, so practitioners have historically assumed that which could be the next indicator of protein fame. However, prealbumin is topic to an similar elements that make albumin a terrible nutritional indicator. Inflammatory stress, metabolic stress and zinc deficiency shrink prealbumin levels. In addition, prealbumin levels may additionally be maintained all of how through malnutrition (5,6).
1. Covinsky KE, Covinsky MH, Palmer RM, Sehgal AR. Serum albumin concentration and clinical assessments of nutritional fame in hospitalized older persons: selection elements of selection coins? J Am Geriatr Soc. 2002;50:631-637.
CMS further clarifies in F314 Pressure Sores of the CMS State Operations Manual, Surveyor Guidance: Although a bunch of laboratory tests may source clinicians do not forget nutritional problems in a resident with stress ulcers, no laboratory test is similar or sensitive enough to warrant serial/repeated sorting out. Serum albumin, pre-albumin and cholesterol may be favourable to source comprehend overall prognosis; however it absolutely, they would almost absolutely no longer correlate well with clinical observation of nutritional fame (1,2). At his or her discretion, a practitioner may order test(s) that present favourable additional information or source with leadership of treatable prerequisites (7).
3. Myron Johnson A, Merlini G, Sheldon J, & Ichihara K. (2007). Clinical indications for plasma protein assays: transthyretin (prealbumin) in inflammation and malnutrition. Clinical Chemistry and Laboratory Medicine: CCLM / FESCC, 45(3), 419-426.
Albumin has a lengthy half of lifetime of roughly 20 days so the concentration within the blood transformations slowly. There is an outsized extravascular pool of albumin which could be per probability accessible to return to the circulation whilst needed, thus skewing the outcomes of lab tests. There are additionally many elements which will shrink albumin levels by reason of inflammatory cytokine creation or other comorbidity even whilst an individual's protein consumption is adequate: infection, acute stress, surgery or cortisone excess (4). Dehydration may falsely raise albumin levels.
7. Centers for Medicare & Medicaid Services. Department of Health and Human Services. State Operations Manual, Guidance to Surveyors for Long Term Care Facilities, Appendix PP. Rev. 70. 01-07-11. Accessed December 11, 2013.
Only 3% of the body's total protein is within the plasma and extravascular fluids. About 10% is visceral organ protein. Because plasma protein measurements are transient and honest, and since many plasma proteins are synthesized within the liver, plasma protein has historically been used to assess protein fame. Neither serum albumin or prealbumin are accurate markers of protein or nutritional fame.
6. Thomas DR. Prevention and Treatment of Pressure Ulcers. J Am Dir Assoc 2006;7:46-59.
4. Friedman FJ, Campbell AJ, Caradoc-Davies TH. Hypoalbuminemia within the elderly is by reason of disease no longer malnutrition. Clinical Experimental Gerontol. 1985;7:191-203.
References
5. Mahan K and Escott-Stump S, Krause's Food and Nutrition Therapy, 12thed, 2008. Saunders, Philadelphia, PA.
Laboratory Assessment: Biochemical files analysis may source clinicians to do not forget overall health problems however it absolutely, care must be taken within the interpretation of lab values for use as nutritional markers. Although markers of protein fame equal to albumin and prealbumin may support the clinician to comprehend progress, they would almost absolutely no longer correlate with clinical observations of nutritional fame (1-3). Since which could be very unlikely to separate nutrition from total health fame, these lab values are top in aiding to comprehend overall prognosis and severity of malady.
