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Cited by 196Nutrition and Health in AgingClinical Nutrition and GastroenterologyInflammatory Biomarkers in Disease Prognosis

Albumin Synthesis Rates Are Not Decreased in Hypoalbuminemic Cachectic Cancer Patients With an Ongoing Acute-Phase Protein Response

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Fearon, Kenneth C. H., Falconer, J. Stuart, Slater, Christine, McMillan, Donald C., Ross, James A., Preston, Tom·1998·Annals of Surgery
DOI 10.1097/00000658-199802000-00015PMC PMC1191243
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Abstract

OBJECTIVE: To determine whether suppression of albumin synthesis contributes to the hypoalbuminemia observed in weight-losing cancer patients with evidence of an ongoing acute-phase protein response (APPR). BACKGROUND DATA: Proinflammatory cytokines such as tumor necrosis factor (TNF) and interleukin 6 (IL-6) are known to downregulate albumin synthesis and increase acute-phase protein production in isolated hepatocytes. However, whether albumin synthesis is suppressed in hypoalbuminemic cancer patients with evidence of an ongoing acute-phase response is unknown. METHODS: Albumin synthesis rates were determined in six healthy controls and in six weight-losing pancreatic cancer patients with an ongoing APPR using a flooding dose technique with [2H5]-phenylalanine. The presence of an APPR was defined as a serum C-reactive protein concentration >10 mg/L. Serum cytokines (TNF, IL-6) and soluble TNF receptors (sTNF-R 55 and 75), along with serum cortisol and insulin, were also measured in both groups. RESULTS: Cancer patients had reduced serum albumin (median 32 [range, 23-36] vs. 42 g/L [40-45]; p < 0.01) and increased serum C-reactive protein concentrations (72 [23-126] vs. <5 mg/L; p < 0.01) when compared with controls. TNF was not detected in either group. sTNF-R 55 levels were significantly elevated in the cancer patients (3.8 [1.9-8.1] vs. 1.2 pg/mL [0.9-2.2]; p < 0.01). Circulating IL-6, insulin, and cortisol concentrations were not significantly different between the groups. The intravascular albumin mass was lower (88 [56-93] vs. 133 g [105-177]; p < 0.01), but the intravascular albumin fractional synthetic rate was higher (13.9 [13.5-18.5] vs. 10.3%/d [71-11.3]; p < 0.01) in the cancer patients compared with the controls. The total intravascular albumin synthetic rate was, however, similar between the two groups (12.7 [7.7-15.7] vs. 11.7 g/d [8.5-18.7]; p NS). CONCLUSIONS: In weight-losing pancreatic cancer patients with evidence of an ongoing APPR, hypoalbuminemia is not caused by a decreased rate of albumin synthesis.

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  • In most disease states in which synthesis rates have been measured, fractional synthesis rate in plasma is normal or mildly increased.

    “However, in most disease states in which synthesis rates have been measured, fractional synthesis rate (FSR) in plasma has been reported to be normal or mildly increased (Table 1).63, 64, 65, 66, 67, 68, 69, 70, 71”

    From Hypoalbuminemia: Pathogenesis and Clinical Significance (2019) · cites this paper as [66]

    The Abstract (article pp. 249–254; passage page unspecified) reports a higher intravascular albumin fractional synthetic rate in weight-losing pancreatic cancer patients than in healthy controls. This supports an increased rate in one disease group, but the paper does not establish that rates are normal or mildly increased in most disease states. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • All acutely ill or surgically traumatized patients have low serum albumin levels.

    “In clinical practice, all acutely ill or (surgically) traumatized patients have low serum albumin levels.66, 67, 68, 69, 98, 99, 100”

    From Hypoalbuminemia: Pathogenesis and Clinical Significance (2019) · cites this paper as [66]

    The Abstract (Results) reports reduced serum albumin in six weight-losing pancreatic cancer patients with an ongoing acute-phase response. It does not establish that all acutely ill patients, or all surgically traumatized patients, have low serum albumin. (LLM, conf=0.84)

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Authors
Fearon, K. C. H., Falconer, J. S., Slater, C., McMillan, D. C., Ross, J. A., & Preston, T.
Affiliations
  • Edinburgh Royal Infirmary (GB)
  • Scottish Universities Environmental Research Centre (GB)
  • Glasgow Royal Infirmary (GB)
Corresponding author
  • Fearon, Kenneth C. H.
  • Falconer, J. Stuart
  • Ross, James A.
ORCID
Venue
Annals of Surgery
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
1998-02
Volume
227
Issue
2
Pages
249-254
ISSN
0003-4932 (ISSN-L)
DOI
10.1097/00000658-199802000-00015
PMC
PMC1191243
OpenAlex
W2068129622
Cited by
196
References
31
Citations by year
2026: 3 · 2025: 3 · 2024: 5 · 2023: 6 · 2022: 9 · 2021: 12 · 2020: 5 · 2019: 9 · 2018: 5 · 2017: 4 · 2016: 13 · 2015: 10 · 2014: 5 · 2013: 10 · 2012: 2
FWCI
7.17
Type
journal article
Language
en
Open access
Locations
  • Annals of Surgery (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion)
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
hypoalbuminemia, cancer cachexia, pancreatic cancer, TNF-α, interleukin-6, C-reactive protein, inflammatory cytokines, weight loss, phenylalanine
MeSH terms
Acute-Phase Proteins, Acute-Phase Reaction, Aged, Albumins, Cachexia, Female, Humans, Male, Middle Aged, Pancreatic Neoplasms, Plasma Volume, Serum Albumin, Cytokines

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