Response to “Low albumin levels should be interpreted, but not ignored”

Evans, David C.; Guenter, Peggi; Jensen, Gordon L.; Malone, Ainsley

doi:10.1002/ncp.10648

Cited by 3 publications

(7 citation statements)

References 6 publications

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“…Our study has revealed an association between ALB and carnitine. ALB is an important marker of nutrition status and a useful predictive marker of surgical risk 17 . Our study showed a significant correlation both between ALB and TC and between ALB and FC, suggesting that TC and FC are possible predictive markers of surgical risk.…”

Section: Discussionsupporting

confidence: 56%

“…ALB is an important marker of nutrition status and a useful predictive marker of surgical risk. 17 Our study showed a significant correlation both between ALB and TC and between ALB and FC, suggesting that TC and FC are possible predictive markers of surgical risk. Interestingly, when patients were divided into groups by low and high ALB level, while the correlations between ALB level and both TC and FC were no longer significant in either group, there was a tendency towards a negative relationship between ALB level and both TC and FC in the low ALB group.…”

Section: Discussionsupporting

confidence: 55%

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Serum carnitine as a biomarker of sarcopenia and nutritional status in preoperative gastrointestinal cancer patients

Takagi

Hawke

Tokuda

et al. 2021

J cachexia sarcopenia muscle

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Background Sarcopenia is an important factor in the postoperative outcome of gastrointestinal cancer patients. However, little research has been carried out on potential biomarkers of sarcopenia. Carnitine is an amino acid derivative that is stored in skeletal muscle and is essential for muscle energy metabolism. The primary purpose of this study was to investigate whether serum carnitine level is a biomarker of sarcopenia in preoperative patients with gastrointestinal cancer. The secondary purposes were (i) to examine the associations between carnitine, nutritional status, and albumin level, and (ii) to determine whether carnitine is a prognostic factor for postoperative complications. Methods One hundred fourteen patients scheduled to undergo gastroenterological surgery between August 2016 and January 2017 were enrolled. Their mean age was 68.4 ± 10.5, and 64.9% were male. Serum carnitine fractions [total carnitine (TC), free l‐carnitine (FC), and acylcarnitine (AC)] were measured prior to surgery. The correlation between carnitine level and a variety of clinical features was analysed, including skeletal muscle index (SMI), sarcopenia, prognostic nutritional index (PNI), and postoperative complications. Results Tumour locations included the oesophagus (n = 17), stomach (n = 16), pancreas (n = 20), bile duct (n = 9), liver [n = 33; primary liver cancer (n = 18), liver metastasis (n = 15)], and colorectal region (n = 19). TC and FC levels varied significantly by tumour location. TC and FC showed significant positive correlations with SMI [TC (r = 0.295, P = 0.0014), FC (r = 0.286, P = 0.0020)] and PNI [TC (P = 0.0178, r = 0.222), FC (P = 0.0067, r = 0.2526)]. These levels were significantly lower in the sarcopenia group (TC, P = 0.0124; FC, P = 0.0243). In addition, TC and FC showed significant positive correlations with ALB level [TC (P = 0.038 r = 0.19), FC (P = 0.016 r = 0.23)]. When patients were divided into high ALB (≥3.5 g/dL, 96 patients) and low ALB (<3.5 g/dL, 18 patients) groups, these correlations were no longer significant, but in the low ALB group there was a tendency towards a negative relationship between ALB level and both TC and FC. No significant relationship was found between postoperative complications and carnitine level. Conclusions This study suggests that carnitine level is a biomarker of sarcopenia and nutritional status. However, it did not find an association between carnitine level and postoperative complications.

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Section: Discussionsupporting

confidence: 56%

Section: Discussionsupporting

confidence: 55%

Serum carnitine as a biomarker of sarcopenia and nutritional status in preoperative gastrointestinal cancer patients

Takagi

Hawke

Tokuda

et al. 2021

J cachexia sarcopenia muscle

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“…The integration of blood-biochemical indicators within the nutritional assessment framework persists as a contentious subject, specifically concerning the veracity of hepatic proteins as nutritional diagnostic biomarkers. [72][73][74] During the inaugural phase of this investigation, a concerted methodology involving extensive literature exploration, collaborative discourse, and meticulous clinical probes was orchestrated to conceptualize a framework for the nutritional screening and assessment indicator system tailored to esophageal cancer patients. This approach served as the bedrock for the subsequent Delphi methodological application.…”

Section: Blood-biochemical Indicatorsmentioning

confidence: 99%

Development of a nutritional screening and assessment indicator system for patients with esophageal cancer in China: Findings from the Delphi method

Shang,

Dong,

Huang

et al. 2023

Cancer Medicine

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BackgroundIn China, individuals diagnosed with esophageal cancer are confronted with an elevated risk of nutritional inadequacy or malnutrition throughout the course of their disease, a condition that contributes to various adverse clinical outcomes. A vast corpus of data are burgeoning at an unprecedented rate, primarily due to the revolutionary growth of digitalization technologies and artificial intelligence, notably within the domains of health care and medicine. The purpose of this investigation is to initiate the development of a nutritional screening and assessment indicator framework for patients with esophageal cancer within the Chinese context. We seek to furnish an instrumental reference to facilitate preparations for the forthcoming era of advanced, “deep,” evidence‐based medicine.MethodsAn integrative methodology was employed to forge the preliminary draft of the nutritional screening and assessment indicator system for preoperative patients with esophageal cancer. This encompassed a rigorous literature survey, in‐depth clinical practice investigation, and the facilitation of expert panel discussions. Thereafter, two iterative consultation phases were conducted using the Delphi method in China. The analytic hierarchy process was deployed to ascertain the weighting of each index within the definitive evaluation indicator system.ResultsThe effective response rates for the dual rounds of expert consultation were 91.7% and 86.4%, with commensurate authority coefficients of 0.97 and 0.91. The Kendall harmony coefficients were ascertained to be 0.19 and 0.14 (p < 0.01), respectively. The culminating nutritional screening and assessment indicator system for patients with esophageal cancer comprised 5 primary‐level indicators and 38 secondary‐level indicators.ConclusionsThe nutritional screening and assessment indicator system contrived for patients with esophageal cancer is underpinned by cogent theoretical principles, leverages an astute research methodology, and manifests dependable outcomes. This system may be appositely utilized as a meaningful reference for the nutritional screening and assessment process in patients afflicted with esophageal cancer.

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“…3 Serious concerns over the use of albumin as a measure of nutrition status arose over the ensuing years with American Society for Parenteral and Enteral Nutrition taking an official position recently that albumin is not an adequate indicator of malnutrition. 4,5 Extensive details about the intricacies of albumin metabolism are well documented in a series of reviews of albumin metabolism, several written by two fellows with our nutrition support service [6][7][8] as well as more current ones. 4,9 Serum albumin levels are a negative acute phase reactant and an excellent measure of the presence and intensity of the systemic inflammatory response.…”

mentioning

confidence: 99%

“…This, I believe, was the first attempt to classify and standardize the assessment of protein energy malnutrition in hospitalized adult patients in well‐developed countries, and the work was published in the first issue of the Journal of Parenteral and Enteral Nutrition 3 . Serious concerns over the use of albumin as a measure of nutrition status arose over the ensuing years with American Society for Parenteral and Enteral Nutrition taking an official position recently that albumin is not an adequate indicator of malnutrition 4,5 . Extensive details about the intricacies of albumin metabolism are well documented in a series of reviews of albumin metabolism, several written by two fellows with our nutrition support service 6‐8 as well as more current ones 4,9 …”

mentioning

confidence: 99%

Hypoalbuminemic malnutrition

Bistrian

2023

J Parenter Enteral Nutr

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Fifty years ago, we originally used anthropometric measures of weight/height and upper arm anthropometry and serum albumin levels to define and document the high prevalence of protein energy malnutrition in adult surgical patients in a municipal hospital in Boston 1 based on my experience with similar practices in pediatric patients in Haiti during an elective rotation in a philanthropic hospital during my medical training. This was soon followed by a similar survey repeated at several weekly intervals in adult medical patients also demonstrating high prevalence of protein energy malnutrition and little change over time, but with less hypoalbuminemia and lower weight/height in the medical patients. 2 In both surgical and medical surveys, arm muscle circumference was significantly associated with serum albumin levels. 1,2 This seemed to conform with two types of pediatric protein energy malnutrition I had first seen in Haiti, marasmus, defined

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Response to “Low albumin levels should be interpreted, but not ignored”

Cited by 3 publications

References 6 publications

Serum carnitine as a biomarker of sarcopenia and nutritional status in preoperative gastrointestinal cancer patients

Serum carnitine as a biomarker of sarcopenia and nutritional status in preoperative gastrointestinal cancer patients

Development of a nutritional screening and assessment indicator system for patients with esophageal cancer in China: Findings from the Delphi method

Hypoalbuminemic malnutrition

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