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Cited by 764Clinical Nutrition and GastroenterologyProtein Interaction Studies and Fluorescence AnalysisLiver Disease and Transplantation

The DOI matches its Crossref record; 158 of the 158 references it cites were found in a registry or an index.

Human serum albumin homeostasis: a new look at the roles of synthesis, catabolism, renal and gastrointestinal excretion, and the clinical value of serum albumin measurements

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Levitt, David, Levitt, Michael·2016·International Journal of General Medicine
DOI 10.2147/ijgm.s102819PMC PMC4956071
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Abstract

Serum albumin concentration (CP) is a remarkably strong prognostic indicator of morbidity and mortality in both sick and seemingly healthy subjects. Surprisingly, the specifics of the pathophysiology underlying the relationship between CP and ill-health are poorly understood. This review provides a summary that is not previously available in the literature, concerning how synthesis, catabolism, and renal and gastrointestinal clearance of albumin interact to bring about albumin homeostasis, with a focus on the clinical factors that influence this homeostasis. In normal humans, the albumin turnover time of about 25 days reflects a liver albumin synthesis rate of about 10.5 g/day balanced by renal (≈6%), gastrointestinal (≈10%), and catabolic (≈84%) clearances. The acute development of hypoalbuminemia with sepsis or trauma results from increased albumin capillary permeability leading to redistribution of albumin from the vascular to interstitial space. The best understood mechanism of chronic hypoalbuminemia is the decreased albumin synthesis observed in liver disease. Decreased albumin production also accounts for hypoalbuminemia observed with a low-protein and normal caloric diet. However, a calorie- and protein-deficient diet does not reduce albumin synthesis and is not associated with hypoalbuminemia, and CP is not a useful marker of malnutrition. In most disease states other than liver disease, albumin synthesis is normal or increased, and hypoalbuminemia reflects an enhanced rate of albumin turnover resulting either from an increased rate of catabolism (a poorly understood phenomenon) or enhanced loss of albumin into the urine (nephrosis) or intestine (protein-losing enteropathy). The latter may occur with subtle intestinal pathology and hence may be more prevalent than commonly appreciated. Clinically, reduced CP appears to be a result rather than a cause of ill-health, and therapy designed to increase CP has limited benefit. The ubiquitous occurrence of hypoalbuminemia in disease states limits the diagnostic utility of the CP measurement.

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  1. [16]Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients): A Report of the Panel on Macronutrients, and the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes Washington, DC National Academies Press 2005
  2. [92]Takeda Y Reeve EB Studies of the metabolism and distribution of albumin with autologous I131-albumin in healthy men J Lab Clin Med 1963 61 183 202 13984638
  3. [122]Ballmer PE McNurlan MA Milne E Measurement of albumin synthesis in humans: a new approach employing stable isotopes Am J Physiol 1990 259 6 Pt 1 E797 E803 2260648

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Metadata

Authors
Levitt, D., & Levitt, M.
Affiliations
  • University of Minnesota (US)
  • Veterans Health Administration (US)
Corresponding author
Levitt, Michael
ORCID
Venue
International Journal of General Medicine
Publisher
Informa UK Limited
Published
2016-07
Volume
Volume 9
Pages
229-255
ISSN
1178-7074 (ISSN-L)
DOI
10.2147/ijgm.s102819
PMC
PMC4956071
OpenAlex
W2488911476
Cited by
763
References
156
Citations by year
2026: 97 · 2025: 91 · 2024: 88 · 2023: 101 · 2022: 96 · 2021: 117 · 2020: 73 · 2019: 49 · 2018: 27 · 2017: 20 · 2016: 3
FWCI
34.47
Type
journal article
Language
en
Open access
Licence
Locations
  • International Journal of General Medicine (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Dove Medical Press (Taylor and Francis Group) (submittedVersion, cc-by-nc)
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Protein Interaction Studies and Fluorescence Analysis
  • Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
Keywords
human serum albumin, hypoalbuminemia, albumin synthesis, albumin catabolism, albumin turnover, protein-losing enteropathy, nephrotic syndrome, liver disease, malnutrition, prognostic factors

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