Association of Serum Albumin with Markers of Nutritional Status among HIV-Infected and Uninfected Rwandan Women

Abstract

IntroductionThe objectives of this study are to address if and how albumin can be used as an indication of malnutrition in HIV infected and uninfected Africans.MethodsIn 2005, 710 HIV-infected and 226 HIV-uninfected women enrolled in a cohort study. Clinical/demographic parameters, CD4 count, albumin, liver transaminases; anthropometric measurements and Bioelectrical Impedance Analysis (BIA) were performed. Malnutrition outcomes were defined as body mass index (BMI), Fat-free mass index (FFMI) and Fat mass index (FMI). Separate linear predictive models including albumin were fit to these outcomes in HIV negative and HIV positive women by CD4 strata (CD4>350,200–350 and <200 cells/µl).ResultsIn unadjusted models for each outcome in HIV-negative and HIV positive women with CD4>350 cells/µl, serum albumin was not significantly associated with BMI, FFMI or FMI. Albumin was significantly associated with all three outcomes (p<0.05) in HIV+ women with CD4 200–350 cells/µl, and highly significant in HIV+ women with CD4<200 cells/µl (P<0.001). In multivariable linear regression, albumin remained associated with FFMI in women with CD4 count<200 cells/µl (p<0.01) but not in HIV+ women with CD4>200.DiscussionWhile serum albumin is widely used to indicate nutritional status it did not consistently predict malnutrition outcomes in HIV- women or HIV+ women with higher CD4. This result suggests that albumin may measure end stage disease as well as malnutrition and should not be used as a proxy for nutritional status without further study of its association with validated measures.

Effects of nutritional education and lifestyle modification on the nutritional status of HIV positive patients: results of a cluster randomized intervention over a period of six months

“…The difference between the groups was statistically significant. Although no correlation was observed between albumin after 6 months and baseline CD4 count in our study, other investigators have observed a positive correlation between albumin and CD4 in HIV patients initiating ARV [32,34,36,37]. The fact that these patients were initiating ARV, indirectly indicate that they were at an advanced stage of the infection (i.e., CD4 counts below 350 cells/µl).…”

“…Dusingize and co-workers observed a positive correlation between albumin and BMI with HIV positive women having CD4 cells/µl below 200 cells/µl [37]. These results suggest that, at an early stage of the HIV infection, albumin levels may be influenced by other clinical manifestations other than nutritional status.…”

“…These results suggest that, at an early stage of the HIV infection, albumin levels may be influenced by other clinical manifestations other than nutritional status. Thus, the ability for albumin to be used as a specific marker of malnutrition is limited [31,37].…”

Associations between serum albumin and serious non-AIDS events among people living with HIV

“…Although low sAlb is commonly regarded as a marker of nutritional status, it is poorly associated with other measures of nutritional status in the general population and in PLWH [8,9]. Other causes of low sAlb may include liver disease (decreased synthesis), enhanced turnover resulting from either increased catabolism or enhanced loss of albumin into the urine or intestine [10], or trans-capillary loss due to increased vascular permeability [11].…”

Nutrition and Physical Exercise in Older Patients with HIV

“…Nevertheless, in patients with HIV this biochemical parameter is not as useful as in non-infected older patients, since it does not consistently predict malnutrition outcomes. This suggests that albumin may measure end stage disease as well as malnutrition and should not be used as a proxy for nutritional status without further study of its association with validated measures [ 6 ].…”