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Cited by 589Clinical Nutrition and GastroenterologyNutrition and Health in AgingBody Composition Measurement Techniques

The use of visceral proteins as nutrition markers: an ASPEN position paper

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Evans, David C., Corkins, Mark R., Malone, Ainsley, Miller, Sarah, Mogensen, Kris M., Guenter, Peggi, Jensen, Gordon L., the ASPEN Malnutrition Committee·2021·Nutrition in Clinical Practice
DOI 10.1002/ncp.10588
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Abstract

Serum albumin and prealbumin, well‐known visceral proteins, have traditionally been considered useful biochemical laboratory values in a nutrition assessment. However, recent literature disputes this contention. The aim of this document is to clarify that these proteins characterize inflammation rather than describe nutrition status or protein‐energy malnutrition. Both critical illness and chronic illness are characterized by inflammation and, as such, hepatic reprioritization of protein synthesis occurs, resulting in lower serum concentrations of albumin and prealbumin. In addition, the redistribution of serum proteins occurs because of an increase in capillary permeability. There is an association between inflammation and malnutrition, however, not between malnutrition and visceral‐protein levels. These proteins correlate well with patients’ risk for adverse outcomes rather than with protein‐energy malnutrition. Therefore, serum albumin and prealbumin should not serve as proxy measures of total body protein or total muscle mass and should not be used as nutrition markers. This paper has been approved by the American Society for Parenteral and Enteral Nutrition Board of Directors.

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  • 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 [17]

  • 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 [17]

  • 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 [17]

  • 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 [17]

  • Acute or chronic inflammation results in altered body composition and reduced biological function, contributing to malnutrition via reduced food intake, increased resting energy expenditure, and muscle catabolism.

    “It is commonly accepted that acute or chronic inflammation results in altered body composition and reduced biological function (7, 63), which contributes to malnutrition in several ways, including reduced food intake, increased resting energy expenditure, and muscle catabolism.”

    From Evolution of the diagnosis of malnutrition in adults: a primer for clinicians (2024) · cites this paper as [63]

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Authors
Evans, D. C., Corkins, M. R., Malone, A., Miller, S., Mogensen, K. M., Guenter, P., Jensen, G. L., & the ASPEN Malnutrition Committee
Affiliations
  • OhioHealth (US)
  • University of Tennessee Health Science Center (US)
  • Mount Carmel Health (US)
  • St. Patrick Hospital (US)
  • Brigham and Women's Hospital (US)
  • American Society for Parenteral and Enteral Nutrition (US)
  • University of Vermont (US)
Corresponding author
Malone, Ainsley
ORCID
Venue
Nutrition in Clinical Practice
Publisher
Wiley
Published
2020-10-30
Volume
36
Issue
1
Pages
22-28
ISSN
  • 0884-5336 (ISSN-L)
  • 1941-2452
DOI
10.1002/ncp.10588
OpenAlex
W3095418937
Cited by
589
References
55
Citations by year
2026: 141 · 2025: 105 · 2024: 118 · 2023: 108 · 2022: 77 · 2021: 38 · 2020: 2
FWCI
35.56
Type
journal article
Language
en
Update notices
correction (2021-06-24)
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Nutrition in Clinical Practice (publishedVersion)
  • PubMed (publishedVersion)
  • OpenBU (Boston University) (publishedVersion)
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
  • Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
  • Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
Keywords
serum albumin, prealbumin, visceral proteins, nutritional assessment, protein-energy malnutrition, inflammation, critical illness, chronic disease, hepatic protein synthesis, capillary permeability
MeSH terms
Humans, Nutritional Status, Protein-Energy Malnutrition, Biomarkers, Nutrition Assessment, Malnutrition

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