Letters

Serum albumin concentration is not a marker of nutritional status

BMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7051.230b (Published 27 July 1996) Cite this as: BMJ 1996;313:230
  1. Emma Chojnowska
  1. Registrar Department of Anaesthetics, Southampton General Hospital, Southampton SO16 6YD

    EDITOR,—In their paper on postoperative enteral feeding in patients undergoing bowel resection Cornelia S Carr and colleagues used serum albumin concentrations as one of six markers of nutritional status.1 Doweiko and Nompleggi and Klein show that although protein energy malnutrition causes a decrease in the rate of synthesis of albumin, this has little impact on albumin concentrations because of albumin's low rate of turnover and large pool size.2 3 Even during chronic malnutrition, serum albumin concentration is maintained because of a compensatory decrease in the degradation of albumin and transfer of extravascular albumin to the intravascular compartment. Hence the serum albumin concentration changes little in patients with anorexia nervosa.

    Although inadequate nutrition may contribute to low serum albumin concentrations in patients in hospital, the metabolic response to stress—for example, surgery and disease—is a far more important factor. In such “inflammatory stress” states, synthesis of albumin decreases and degradation and transcapillary losses of albumin increase. Disruption of the normal ratio between body compartments alone will change the serum albumin concentration. Hence, in Carr and colleagues' study I would not expect the serum albumin concentration to have differed between the groups fed enterally and conventionally unless their metabolic response to surgery differed.

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