Serum levels of prealbumin and albumin for preoperative risk stratification
Abstract
Preoperative risk stratification has long been developed as a strategy to predict postoperative outcomes and potentially alter or optimize comorbidities and modifiable risk. Malnutrition is among the most common potentially modifiable risk factors and the strongest predictor of poor postsurgical outcomes. Historically, malnutrition has been difficult to address for healthcare providers because of the lack of a cohesive definition. Adding to the confusion has been the use of serum levels of albumin and prealbumin as biomarkers for malnutrition; many fail to understand that these visceral proteins are only valid as markers of nutrition status while at homeostasis. Surgical need is often driven by both sterile and non‐sterile inflammation, but during this pathologic mechanism, hepatic reprioritization shunts visceral protein synthesis, rendering albumin and prealbumin invalid as biomarkers for malnutrition. Ultimately, understanding these limitations and embracing better indicators of malnutrition will improve preoperative risk stratification.
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In a nutrient-deficient state such as starvation, serum albumin decreases only slightly as the body compensates to maintain visceral protein status.
“Serum albumin has a 3-wk half-life, and in a nutrient-deficient state such as starvation the serum albumin will decrease only slightly as the body compensates to maintain visceral protein status.”
From The Value of Integrating the Nutritional Ecology into the Nutrition Care Continuum—A Conceptual and Systems Approach (2025) · cites this paper as [15]
Interpreting nutrition-related biomarkers in a context-specific manner is more important for individuals with conditions that can compromise nutrition-sensitive systems, such as compromised immune systems or disease-related inflammation and the acute phase response.
“Clearly, the nuances of interpreting nutrition-related biomarkers in a context-specific manner assumes greater importance for individuals with conditions that can potentially compromise nutrition-sensitive systems, e.g. those with compromised immune systems or disease-related inflammation and the concomitant acute phase response [[13], [14], [15], [16], [17]].”
From The Value of Integrating the Nutritional Ecology into the Nutrition Care Continuum—A Conceptual and Systems Approach (2025) · cites this paper as [15]
Serum albumin has a 3-week half-life.
“Serum albumin has a 3-wk half-life, and in a nutrient-deficient state such as starvation the serum albumin will decrease only slightly as the body compensates to maintain visceral protein status.”
From The Value of Integrating the Nutritional Ecology into the Nutrition Care Continuum—A Conceptual and Systems Approach (2025) · cites this paper as [15]
In catabolic states due to trauma, infection, or burns, serum albumin concentration decreases rapidly even when nutritional status may be preserved.
“However, if an individual enters a state of catabolism because of trauma, infection, or burns, the serum albumin concentration decreases rapidly, even when their nutritional status may be preserved.”
From The Value of Integrating the Nutritional Ecology into the Nutrition Care Continuum—A Conceptual and Systems Approach (2025) · cites this paper as [15]
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The use of visceral proteins as nutrition markers: an ASPEN position paper
Evans, D. C., Corkins, M. R., Malone, A., Miller, S., Mogensen, K. M., Guenter, P., Jensen, G. L., & the ASPEN Malnutrition Committee (2021) · Nutrition in Clinical Practice · doi:10.1002/ncp.10588 · Cited by 589 · see citing works
Malnutrition Screening and Assessment
Serón-Arbeloa, C., Labarta-Monzón, L., Puzo-Foncillas, J., Mallor-Bonet, T., Lafita-López, A., Bueno-Vidales, N., & Montoro-Huguet, M. (2022) · doi:10.20944/preprints202205.0071.v1 · Cited by 312
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- Authors
- Loftus, T. J., Brown, M. P., Slish, J. H., & Rosenthal, M. D.
- Affiliations
- University of Florida Health (US)
- Food and Nutrition Services Gainesville Florida USA
- Corresponding author
- Rosenthal, Martin D.
- Venue
- Nutrition in Clinical Practice
- Publisher
- Wiley
- Published
- 2019-03-25
- Volume
- 34
- Issue
- 3
- Pages
- 340-348
- ISSN
- 0884-5336 (ISSN-L)
- 1941-2452
- OpenAlex
- W2946370981
- Cited by
- 112
- References
- 5
- Citations by year
- 2026: 8 · 2025: 16 · 2024: 15 · 2023: 22 · 2022: 20 · 2021: 18 · 2020: 12
- FWCI
- 1.47
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Nutrition in Clinical Practice (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Oncology › Inflammatory Biomarkers in Disease Prognosis
- Keywords
- prealbumin, serum albumin, preoperative risk stratification, malnutrition, dietary biomarkers, postoperative outcomes, hepatic protein synthesis, inflammation, nutritional assessment
- MeSH terms
- Humans, Inflammation, Postoperative Complications, Prealbumin, Risk Factors, Sensitivity and Specificity, Serum Albumin, Biomarkers, Nutrition Assessment, Malnutrition, Preoperative Period
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