Why should plasma transthyretin become a routine screening tool in elderly persons?

Ingenbleek, Yves

doi:10.1007/s12603-009-0175-x

Cited by 14 publications

(4 citation statements)

References 47 publications

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“…In order to improve its predictive potency for sarcopenia the reference values for prealbumin should be adapted to the corresponding age and sex [32]. Ingenbleek proposed that routine screening for protein malnutrition using prealbumin should be performed in elderly subjects [63].…”

Section: Biomarkers Of Nutritional Risk In Some Specific Clinical mentioning

confidence: 99%

Nutritional Laboratory Markers in Malnutrition

Keller¹

2019

JCM

500

353

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Serum visceral proteins such as albumin and prealbumin have traditionally been used as markers of the nutritional status of patients. Prealbumin is nowadays often preferred over albumin due to its shorter half live, reflecting more rapid changes of the nutritional state. However, recent focus has been on an appropriate nutrition-focused physical examination and on the patient’s history for diagnosing malnutrition, and the role of inflammation as a risk factor for malnutrition has been more and more recognized. Inflammatory signals are potent inhibitors of visceral protein synthesis, and the use of these proteins as biomarkers of the nutritional status has been debated since they are strongly influenced by inflammation and less so by protein energy stores. The current consensus is that laboratory markers could be used as a complement to a thorough physical examination. Other markers of the nutritional status such as urinary creatinine or 3-methylhistidine as indicators of muscle protein breakdown have not found widespread use. Serum IGF-1 is less influenced by inflammation and falls during malnutrition. However, its concentration changes are not sufficiently specific to be useful clinically as a marker of malnutrition, and serum IGF-1 has less been used in clinical trials. Nevertheless, biomarkers of malnutrition such as prealbumin may be of interest as easily measurable predictors of the prognosis for surgical outcomes and of mortality in severe illnesses.

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Section: Biomarkers Of Nutritional Risk In Some Specific Clinical mentioning

confidence: 99%

Nutritional Laboratory Markers in Malnutrition

Keller¹

2019

JCM

500

353

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“…The data imply that older people constitute a vulnerable group at higher risk of cardiovascular mortality. In this population group, the measurement of Hcy is endowed with a predictive power going beyond that provided by classical Framingham criteria [81], making the routine use of TTR mandatory to disentangle the PEM component associated with the ageing process [82]. Second, PEM states are characterized by the suppression of liver TTR synthesis [83] and the downregulation of all protein components found in Table 1 whereas the upstream sequestration of Hcy progressively increases in opposite direction as an effect of C S inhibition [38,48].…”

Section: The Sulfur-deficiency Concept: Histori-cal Backgroundmentioning

confidence: 99%

“…LBM thus integrates, as does TTR [10,82], both nutritional and inflammatory facets of any disease spectrum, inhibiting C S so as to provide univocal responses safeguarding Met homeostasis as a high metabolic priority. The level of C S inhibition and the intensity of RM processes appear causally related to enhanced metabolic requirements, hence directly depending on LBM downsizing, reaching top responses in severe tissue depletion but disclosing mild or moderate Hcy elevations in rampant disturbances.…”

Section: Concluding Perspectivesmentioning

confidence: 99%

Hyperhomocysteinemia is a Biomarker of Sulfur-Deficiency in Human Morbidities~!2009-10-03~!2009-11-18~!2009-12-22~!

Ingenbleek¹

2010

TOCCHEMJ

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Methionine (Met) is crucially involved in the synthesis of S-compounds endowed with molecular, structural and functional properties of survival value. Dietary Met may undergo transmethylation processes to release homocysteine (Hcy) which may either be regenerated to Met following remethylation (RM) pathways or catabolized along the transsulfuration (TS) cascade. The activity of enzymes governing RM and TS pathways is depending on pyridoxine, folate and cobalamin bioavailability. Dietary restriction in any of these watersoluble B-vitamins may lead to hyperhomocysteinemia (HHcy) causing a panoply of cardiovascular disorders. Taken together, the vitamin triad only affords partial account of Hcy variance, prompting the search for additional causal factor(s). Body composition studies demonstrate that nitrogen (N) and sulfur (S) maintain tightly correlated concentrations in tissues of both healthy subjects and diseased patients. Any morbid condition characterized by insufficient N intake or assimilation, as seen in protein malnutrition or intestinal malabsorption, reduces body S accretion rates. Excessive urinary N-losses, as reported in acute or chronic inflammatory disorders, entail proportionate obligatory S-losses. As a result, lean body mass (LBM) undergoes downsizing and concomitant depletion of N and S body stores which depresses the activity of cystathionine--synthase, thereby promoting upstream accumulation of Hcy and overstimulation of RM processes. HHcy thus appears as the dark side of efforts developed by S-deprived patients to safeguard Met homeostasis. Irrespective of vitamin-B status, Hcy values are negatively correlated with LBM shrinkage well identified by the serial measurement of plasma transthyretin (TTR). The Sdeprivation theory fulfills the gap and allows full causal coverage of the metabolic anomaly, hence providing together with vitamin-deficiencies an unifying overview of the main nutritional determinants implicated in HHcy epidemiology.

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“… 10 – 13 Additionally, the short biological half-life of PAB has a high degree of reactivity to the protein status. 14 Therefore, PAB has been considered a good indicator of nutritional status that involves uncomplicated measurements. 15 Malnutrition is common for critically ill patients 16 and is related to increased mortality and length of hospital stay.…”

Section: Introductionmentioning

confidence: 99%

Role of Prealbumin in Predicting the Prognosis of Severely and Critically Ill COVID-19 Patients

Cui

Tong

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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Most critically ill patients experience malnutrition, resulting in a poor prognosis. This study aimed to evaluate the association of prealbumin (PAB) with the prognosis for severely and critically ill coronavirus disease 2019 (COVID-19) patients and explore factors related to this association. Patients with laboratory-confirmed COVID-19 from West Campus of Union Hospital in Wuhan from January 29, 2020 to March 31, 2020 were enrolled in this study. Patients were classified into the PAB1 (150–400 mg/L; N = 183) and PAB2 (< 150 mg/L; N = 225) groups. Data collection was performed using the hospital’s electronic medical records system. The predictive value of PAB was evaluated by measuring the area under the receiver-operating characteristic (AUROC) curve. Patients were defined as severely or critically ill based on the Guidance for COVID-19 (7th edition) by the National Health Commission of China. During this analysis, 316 patients had severe cases and 65 had critical cases. A reduced PAB level was associated with a higher risk of mortality and a longer hospital stay. The AUROC curve for the prognosis based on the PAB level was 0.93, with sensitivity of 97.2% and specificity of 77.6%. For severe cases, a lower level of PAB was associated with a higher risk of malnutrition, higher NK cell counts, and lower B lymphocyte counts; these factors were not significant in critical cases. C-reactive protein and nutritional status mediated the association between PAB and prognosis. This retrospective analysis suggests that the PAB level on admission is an indicator of the prognosis for COVID-19.

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Why should plasma transthyretin become a routine screening tool in elderly persons?

Cited by 14 publications

References 47 publications

Nutritional Laboratory Markers in Malnutrition

Nutritional Laboratory Markers in Malnutrition

Hyperhomocysteinemia is a Biomarker of Sulfur-Deficiency in Human Morbidities~!2009-10-03~!2009-11-18~!2009-12-22~!

Role of Prealbumin in Predicting the Prognosis of Severely and Critically Ill COVID-19 Patients

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