From the Guidelines
The most accurate measure of adequacy of nutritional support is (d) serum prealbumin level. According to the espen guidelines on definitions and terminology of clinical nutrition 1, plasma albumin and transthyretin/pre-albumin concentrations may be used mainly to indicate and monitor catabolic activity, but their validity as nutrition indicators is low due to perturbation by inflammation. However, prealbumin is preferred because it has a shorter half-life compared to albumin, making it more responsive to recent changes in nutritional status.
Key Points to Consider
- Prealbumin levels are more responsive to recent changes in nutritional status due to its shorter half-life of 2-3 days compared to albumin's 20 days 1.
- Body weight and triceps skinfold measurements provide information about overall nutritional status but don't reflect acute changes as rapidly or specifically as prealbumin.
- Serum albumin is affected by many non-nutritional factors, including inflammation, liver disease, and hydration status, making it less reliable for assessing short-term nutritional adequacy 1.
- Monitoring of nutrition therapy requires an individual plan where nutrition goals are defined, and prealbumin levels should be monitored regularly during nutritional support to ensure interventions are effective 1. Some important factors to consider when monitoring nutritional support include:
- Nutrition provision and intake: Are calculated requirements of fluid, energy, and protein met?
- Weight, anthropometry, body composition: Does e.g. weight, fat-free mass (FFM) or fat mass (FM) change as expected?
- Function: e.g. hand grip strength (HGS), chair rise tests, and gait speed, either alone or combined in the Short Physical Performance Battery (SPPB) could be used 1.
From the Research
Measures of Nutritional Support
The most accurate measure of adequacy of nutritional support can be evaluated based on various studies.
- Serum albumin level is often used as a marker of nutritional status, but studies have shown that it may not be a reliable indicator in certain cases 2.
- Body weight is a general indicator of nutritional status, but it does not provide specific information about the adequacy of nutritional support.
- Triceps skinfold measurement is a method used to assess body fat, but its accuracy as a measure of nutritional support is limited.
- Serum prealbumin level has been studied as a potential marker of nutritional status, with some studies suggesting it may be a useful tool in assessing malnutrition 3, while others have found it to be not sensitive enough to indicate nutrition and prognosis in critically ill patients 4.
Serum Prealbumin as a Marker of Nutritional Status
Studies have shown that serum prealbumin level can be affected by various factors, including inflammation and illness 2, 4.
- A study published in 2005 found that prealbumin level did not respond sensitively to nutritional support in critically ill patients 4.
- However, a more recent study published in 2024 found that dynamic changes in prealbumin level can be a reliable tool to estimate the effectiveness of nutrition support in the ICU, especially among high-risk patients 5.
- Another study published in 2022 discussed the clinical utility and analytical methodologies of prealbumin, highlighting its potential as a useful biomarker in routine clinical practice 6.
Comparison of Measures
Comparing the different measures of nutritional support, serum prealbumin level has been found to have a good sensitivity and specificity profile in assessing malnutrition 3.
- A study published in 2006 found that prealbumin showed the best concordance with the standard Detailed Nutritional Assessment (DNA) method and a good sensitivity/specificity profile compared to other methods 3.
- However, the use of prealbumin as a marker of nutritional status is still debatable, and its clinical applications require further consensus 6.