The use of visceral proteins as nutrition markers: an ASPEN position paper

Date
2021-02
Authors
Evans, David C.
Corkins, Mark R.
Malone, Ainsley
Miller, Sarah
Mogensen, Kris M.
Guenter, Peggi
Jensen, Gordon L.
ASPEN Malnutrition Committee
Version
Published version
OA Version
Citation
© 2020 American Society for Parenteral and Enteral Nutrition. This work is licensed under a Creative Commons Attribution Non Commercial No Derivatives 4.0 license.
Abstract
Serum albumin and prealbumin, well-known visceral proteins, have traditionally been considered useful biochemical laboratory values in a nutrition assessment. However, recent literature disputes this contention. The aim of this document is to clarify that these proteins characterize inflammation rather than describe nutrition status or protein-energy malnutrition. Both critical illness and chronic illness are characterized by inflammation and, as such, hepatic reprioritization of protein synthesis occurs, resulting in lower serum concentrations of albumin and prealbumin. In addition, the redistribution of serum proteins occurs because of an increase in capillary permeability. There is an association between inflammation and malnutrition, however, not between malnutrition and visceral-protein levels. These proteins correlate well with patients' risk for adverse outcomes rather than with protein-energy malnutrition. Therefore, serum albumin and prealbumin should not serve as proxy measures of total body protein or total muscle mass and should not be used as nutrition markers. This paper has been approved by the American Society for Parenteral and Enteral Nutrition Board of Directors.
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