Hepatic Proteins and Nutrition Assessment



Hepatic Proteins and Nutrition Assessment

KEY POINTS TO REMEMBER:

• Albumin, Prealbumin and Trasnferrin are NOT recommended as markers for nutritional status.

• Decreased albumin, prealbumin and transferrin = the severity of illness NOT nutritional status or degree of malnutrition

• Decreased albumin, prealbumin and transferrin help identify patients likely to DEVELOP malnutrition.

• Exogenous substrate will not restore hepatic proteins to normal in the face of inflammation, infection and illness (when CRP is elevated)

• Resolution of inflammation, not exogenous substrate from nutrition support, restores normal hepatic protein metabolism and eventually serum levels of negative acute phase proteins

• Improved albumin, prealbumin and transferrin levels do NOT measure nutrition repletion, but rather measure decreased morbidity. Average increase in albumin due to nutrient/protein intake is only 0.4 mg/dL

• Hepatic proteins of patients with Anorexia Nervosa (very poor nutritional intake) will not differ from normally nourished patients with adequate intake

• N2 Balance reflects recovery from inflammation and a decrease in net protein catabolism

WHAT ELSE CAN AFFECT HEPATIC PROTEINS?

| |Decreased |Increased |

|Prealbumin |Inflammation, infection, acute stress, recent surgery, malignancy,|Chronic Kidney disease, nephritic syndrome, pregnancy, |

|Negative Acute phase |protein wasting disease of intestine, liver damage, burns, zinc |Hodgkin’s disease |

|protein |deficiency, salicylate poisoning | |

|Albumin |Inflammation, infection, acute stress, recent surgery, liver |Dehydration |

| |disease, pregnancy, protein losing nephropathies and | |

| |enteropathies, third spacing, increased capillary permeability | |

|Transferrin |Inflammation, chronic illness, malignancy, collagen ascular |Pregnancy |

|Negative acute phase |disease, liver disease |Estrogen therapy |

|protein | | |

|C-Reactive Protein |CRP disappears when the inflammatory process is suppressed by |Do not consistently rise with viral infections. Acute |

|Positive Acute Phase |salicylates or steroids |inflammatory response from bacteria, fungi and trauma. Post op|

|Protein | |wound infections (usually rise 4-6 hours postop and decrease by|

| | |3rd postop day-if they do not, then indicator of infection or |

| | |pulmonary infarct). Bacterial meningitis (normal indicates |

| | |viral meningitis). |

References:

- Furhman, MP, et al. Hepatic Proteins and Nutrition Assessment. J Am Diet Assoc.2004;104:1258-1264.

- NPUAP The Role of Nutrition in Pressure Ulcer Prevention and Treatment: NPUAP White Paper Adv Skin Wound Care. 2009:22:212-221.

- ASPEN Nutrition Support Core Curriculum: A Case-Based Approach – the Adult Patient. Silver Springs, MO. ASPEN 2007.

- Pagana, Kathleen. Mosby’s Diagnostic and Laboratory Test Reference. 9th ed. St Louis, MO. Mosby, Inc. 2009.

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