Prealbumin is Associated With Visceral Fat Mass in Patients Receiving Hemodialysis

Molfino, Alessio; Heymsfield, Steven B.; Zhu, Fansan; Kotanko, Peter; Levin, Nathan W.; Dwyer, Tjien; Kaysen, George A.

doi:10.1053/j.jrn.2013.02.007

Cited by 22 publications

(18 citation statements)

References 31 publications

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“…Possibly, the malabsorption of vitamin K is more prominent in our patients who purely restrict than in those who may binge on fatty and protein‐containing foods (even if they purge soon after), and thus AN‐R, high INR, and low prealbumin co‐occur. Despite the fact that prealbumin has been correlated with visceral fat mass in a hemodialysis population, there was no significant difference in the percent body fat as measured by lipodystrophy analysis between the low prealbumin and normal prealbumin groups in our study …”

Section: Discussioncontrasting

confidence: 74%

Low prealbumin is a significant predictor of medical complications in severe anorexia nervosa

Gaudiani

Sabel

Mehler

2013

Intl J Eating Disorders

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Objective: Prealbumin levels have been proven to correlate with hospital length of stay, wound healing, infection rates, and mortality in adults hospitalized for medical or surgical purposes, or those who have chronic illnesses. Little is known about the utility of prealbumin evaluation in adults with severe anorexia nervosa (AN).Method: We retrospectively evaluated prealbumin levels, along with numerous other clinical parameters relevant to illness acuity and early refeeding outcomes, in 132 adults with AN admitted for definitive inpatient medical stabilization from October 1, 2008 to December 31, 2012. Per clinical protocol, prealbumin was checked on admission and approximately weekly thereafter until discharge.Results: Patients had a median age of 28 years old, a mean admission body mass index (BMI) of 12.9 kg/m 2 (S.D. 6.1), and 89% of patients were women. A total of 47% of patients had a low prealbumin at the time of admission. By discharge, 77% of patients had normalized their prealbumin levels. Patients with low admission prealbumin levels had a threefold increased risk of refeeding hypophosphatemia and a twofold increase in hypoglycemia compared with patients who had a normal admission prealbumin, independent of admission BMI.Discussion: A low serum prealbumin level appeared concurrent with other markers of serious medical compromise, and was associated with two potentially life threatening complications of early refeeding: hypophosphatemia and hypoglycemia. The cause of low prealbumin remains elusive. Prealbumin should be checked in patients with severe AN prior to initiating weight restoration, as low levels may be an important harbinger of early refeeding complications. V C 2013 Wiley Periodicals, Inc.

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Section: Discussioncontrasting

confidence: 74%

Low prealbumin is a significant predictor of medical complications in severe anorexia nervosa

Gaudiani

Sabel

Mehler

2013

Intl J Eating Disorders

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“…We also used normalized protein catabolic rate (nPCR) (grams per kilogram per day) calculated from dialysis kinetic modeling during the month that body composition was measured as an estimate of dietary protein intake (13). In the course of evaluation, we also asked patients whether they had experienced any changes in body weight during the previous six months.…”

Section: Methodsmentioning

confidence: 99%

Validating Appetite Assessment Tools Among Patients Receiving Hemodialysis

Molfino

Kaysen

Chertow

et al. 2016

Journal of Renal Nutrition

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Objective To test the performance of appetite assessment tools among patients receiving hemodialysis. Design Cross-sectional. Setting Seven dialysis facilities in Northern California. Subjects 221 patients receiving hemodialysis. Intervention We assessed five appetite assessment tools [self-assessment of appetite, subjective assessment of appetite, visual analogue scale (VAS), Functional Assessment of Anorexia/Cachexia Therapy (FAACT) score and the Anorexia Questionnaire (AQ)]. Main outcome measures Reported food intake, normalized protein catabolic rate (nPCR), and change in body weight were used as criterion measures, and we assessed associations among the appetite tools and biomarkers associated with nutrition and inflammation. Patients were asked to report their appetite and the percentage of food eaten (from 0% to 100%) during the last meal compared to usual intake. Results Fifty-eight (26%) patients reported food intake ≤50% (defined as poor appetite). The prevalence of anorexia was 12% by self-assessment of appetite, 6% by subjective assessment of appetite, 24% by VAS, 17% by FAACT score, and 12% by AQ. All tools were significantly associated with food intake ≤50% (p<0.001), except self-assessment of appetite. The FAACT score and the VAS had the strongest association with food intake ≤50% (c-statistic 0.80 and 0.76). Patients with food intake ≤50% reported weight loss more frequently than patients without low intake (36% vs 22%) and weight gain less frequently (19% vs 35%; p=0.03). nPCR was lower among anorexic patients based on the VAS (1.1 ± 0.3 vs 1.2 ± 0.3, p=0.03). Ln IL-6 correlated inversely with food intake (p=0.03), but neither IL-6 nor CRP correlated with any of the appetite tools. Furthermore, only the self-assessment of appetite was significantly associated with serum albumin (p=0.02), prealbumin (p=0.02) and adiponectin concentrations (p=0.03). Conclusions Alternative appetite assessment tools yielded widely different estimates of the prevalence of anorexia in hemodialysis. When considering self-reported food intake as the criterion standard for anorexia, the FAACT score and VAS discriminated patients reasonably well.

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“…We have previously shown that both serum albumin and creatinine concentrations are associated with measures of protein intake (normalized Protein Catabolic Rate (nPCR) and inflammation (CRP) cross-sectionally and longitudinally 27,28 . Similarly, prealbumin concentration was associated also with nPCR and inflammatory biomarkers 29 .…”

Section: Discussionmentioning

confidence: 89%

Associations of Trimethylamine N-Oxide With Nutritional and Inflammatory Biomarkers and Cardiovascular Outcomes in Patients New to Dialysis

Kaysen

Johansen

Chertow

et al. 2015

Journal of Renal Nutrition

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142

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Background Trimethylamine-N-oxide (TMAO) is a product of metabolism of phosphatidylcholine (lecithin) and carnitine by the intestinal microbiome. Elevated serum concentrations of TMAO have been linked to adverse cardiovascular outcomes in the general population. We examined correlates of serum TMAO and the relations among serum TMAO concentrations, all-cause mortality and cardiovascular mortality and hospitalizations in a nationally derived cohort of patients new to hemodialysis (HD). Methods We quantified serum TMAO by liquid chromatography and online tandem mass spectrometry and assessed nutritional and cardiovascular risk factors in 235 patients receiving hemodialysis and measured TMAO in pooled serum from healthy controls. We analyzed time to death and time to cardiovascular death or hospitalization using Cox proportional hazards regression. Results Serum TMAO concentrations (median 43, (25th – 75th percentile 28–67 µM/L) were elevated compared to persons with normal or near normal kidney function (1.41 ± 0.49 µM/L). TMAO was directly correlated with serum albumin (Spearman rank correlation 0.24, 95% CI 0.12, 0.35; P < 0.001), prealbumin (0.19, 95% CI 0.07, 0.31; P =0.003), and creatinine (0.21, 95% CI 0.08, 0.33; P =0.002), and inversely correlated with log CRP (−0.18, 95% CI −0.30, – 0.06; P =0.005). Higher serum concentrations of TMAO were not significantly associated with time to death (0.84, CI 0.65, 1.09 P=0.19) or time to cardiovascular hospitalization or cardiovascular death (0.88, CI 0.57, 1.35 P =0.55). Conclusions Serum TMAO concentrations were markedly elevated and correlated directly with biochemical markers of nutritional status and inversely with markers of inflammation in patients receiving hemodialysis. There was no significant association between serum TMAO concentrations and all-cause mortality or cardiovascular death or hospitalizations. In patients receiving dialysis – in contrast to the general population – adverse vascular effects of TMAO may be counterbalanced by associations with nutritional or inflammatory status.

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Prealbumin is Associated With Visceral Fat Mass in Patients Receiving Hemodialysis

Cited by 22 publications

References 31 publications

Low prealbumin is a significant predictor of medical complications in severe anorexia nervosa

Low prealbumin is a significant predictor of medical complications in severe anorexia nervosa

Validating Appetite Assessment Tools Among Patients Receiving Hemodialysis

Associations of Trimethylamine N-Oxide With Nutritional and Inflammatory Biomarkers and Cardiovascular Outcomes in Patients New to Dialysis

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