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
Prealbumin
Inflammation, infection, acute stress,
Negative Acute
recent surgery, malignancy, protein
phase protein
wasting disease of intestine, liver
damage, burns, zinc deficiency,
salicylate poisoning
Albumin
Inflammation, infection, acute stress,
recent surgery, liver disease,
pregnancy, protein losing nephropathies
and enteropathies, third spacing,
increased capillary permeability
Transferrin
Inflammation, chronic illness,
Negative acute
malignancy, collagen ascular disease,
phase protein
liver disease
C-Reactive
Protein
Positive Acute
Phase Protein
CRP disappears when the inflammatory
process is suppressed by salicylates or
steroids
Increased
Chronic Kidney disease, nephritic
syndrome, pregnancy, Hodgkin’s
disease
Dehydration
Pregnancy
Estrogen therapy
Do not consistently rise with viral
infections. Acute inflammatory
response from bacteria, fungi and
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.