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, Chronic Kidney disease, nephritic Negative Acute recent surgery, malignancy, protein syndrome, pregnancy, Hodgkin’s phase protein wasting disease of intestine, liver disease damage, burns, zinc deficiency, salicylate poisoning Albumin Inflammation, infection, acute stress, Dehydration recent surgery, liver disease, pregnancy, protein losing nephropathies and enteropathies, third spacing, increased capillary permeability Transferrin Inflammation, chronic illness, Pregnancy Negative acute malignancy, collagen ascular disease, Estrogen therapy phase protein liver disease

C-Reactive CRP disappears when the inflammatory Do not consistently rise with viral Protein process is suppressed by salicylates or infections. Acute inflammatory Positive Acute steroids response from bacteria, fungi and Phase Protein trauma. Post op 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.