Can liquid egg white increase albumin levels in patients with low albumin due to conditions such as liver disease or malnutrition?

Can Liquid Egg White Increase Albumin?

No, liquid egg white or any dietary protein supplementation alone will not meaningfully increase serum albumin levels in patients with hypoalbuminemia due to liver disease or malnutrition, because the primary drivers of low albumin are inflammation, liver dysfunction, and fluid overload—not simply inadequate protein intake. 1, 2

Why Dietary Protein Alone Is Insufficient

The fundamental misconception is that hypoalbuminemia primarily reflects protein deficiency that can be corrected by eating more protein. In reality:

• Inflammatory cytokines directly downregulate hepatic albumin synthesis, even when protein and caloric intake are adequate 1, 2, 3
• Inflammation causes the same changes in serum protein levels as protein-energy malnutrition, regardless of dietary intake 2
• The liver reprioritizes protein synthesis away from albumin production during inflammatory states 1
• In liver disease specifically, impaired synthetic capacity prevents albumin production regardless of substrate availability 2, 4

The Evidence Against Dietary Interventions

The highest quality evidence shows minimal benefit from nutritional interventions alone:

• In dialysis patients, a targeted nutrition intervention addressing specific barriers (including poor nutritional knowledge, inadequate intake, and gastrointestinal symptoms) resulted in only a modest 0.21 g/dL increase in albumin over 12 months compared to 0.06 g/dL in controls 5
• Importantly, this intervention showed no relationship between changes in albumin levels and inflammatory markers—meaning inflammation trumps nutrition 5
• Guidelines explicitly state there is little evidence that increasing dietary protein or small-molecule clearance improves serum albumin levels 6

What Actually Works: Treat the Underlying Cause

The American College of Physicians and multiple specialty societies recommend focusing on treating the underlying cause rather than the albumin level itself: 1

For Liver Disease:

• Albumin infusion (8g per liter of ascites removed) is indicated for large-volume paracentesis >5L to prevent circulatory dysfunction 1, 4
• Albumin infusion (1.5 g/kg day 1.0 g/kg day 3) reduces mortality in spontaneous bacterial peritonitis 1, 4
• Dietary protein does not address the impaired hepatic synthetic capacity 2, 4

For Malnutrition with Inflammation:

• Address the inflammation first—treating active inflammation is more powerful than nutritional support 1, 2
• Measure C-reactive protein to distinguish inflammation-driven hypoalbuminemia from pure malnutrition 1, 2
• Correct fluid overload, as hemodilution decreases serum albumin concentration 1, 2

For Dialysis Patients:

• Ensure adequate protein intake of 1.2-1.3 g/kg/day combined with 30-35 kcal/kg/day 1
• Maintain adequate dialysis clearance (Kt/Vurea) 1
• Minimize external protein losses (dialysate losses in peritoneal dialysis) 1, 2
• Even with optimal nutrition, inflammation remains the dominant factor 5, 3

The Albumin Infusion Controversy

Albumin infusion itself is NOT recommended for most cases of hypoalbuminemia: 1

• The American Thoracic Society recommends against IV albumin for first-line volume replacement or to increase serum albumin in critically ill patients (excluding specific liver disease scenarios) 1
• Simply administering albumin to critically ill patients with hypoalbuminemia has not been shown to improve survival or reduce morbidity 3
• The cause of hypoalbuminemia, rather than low albumin levels specifically, is responsible for morbidity and mortality 3

Critical Pitfalls to Avoid

• Assuming hypoalbuminemia is solely due to malnutrition when inflammation is often the primary driver 1, 2, 3
• Failing to recognize that albumin is a negative acute-phase reactant that decreases during inflammation, not a direct measure of nutritional status 2
• Believing that correction of a single parameter (albumin) for a short time would lead to major clinical benefits 7
• In liver disease, the development of hypoalbuminemia reflects reduced hepatocyte mass and synthetic dysfunction that cannot be overcome by dietary protein 4

The Bottom Line on Egg Whites

While liquid egg whites provide high-quality protein (approximately 3.6g protein per large egg white), this dietary intervention:

• Will not overcome inflammatory suppression of albumin synthesis 2, 3
• Will not restore hepatic synthetic capacity in liver disease 2, 4
• May provide modest benefit only in pure protein-energy malnutrition without inflammation, which is rare in clinical practice 5, 7
• Should be part of overall nutritional support (targeting 1.2-1.3 g/kg/day protein) but cannot be expected to meaningfully raise albumin levels on its own 1, 5

The target should be treating the underlying disease process—inflammation, liver dysfunction, or fluid overload—not simply increasing dietary protein intake. 1, 2, 3