albuminémie est-elle un marqueur de l’état nutritionnel ?

• Published in: Nutrition clinique et métabolisme 2013, Vol.27 (1), p.28-33
• Main Authors: Aussel, Christian, Cynober, Luc
• Format: Article
• Language: fre
• Subjects: anorexia nervosa; biomarkers; body weight; hospitals; nutrition assessment; nutritional status; protein energy malnutrition; risk; serum albumin
• ISSN: 0985-0562; 1768-3092

Serum albumin level is the most widely used diagnostic and follow-up marker of malnutrition. However, there are numerous contradictions between in-practice use of serum albumin and results of scientific studies, exemplified in the fact that serum albumin is used to diagnose malnutrition even though it values are neither correlated to protein mass nor decreased in characterized malnutrition such as marasmus or anorexia nervosa. Furthermore, protein restriction does not systematically lead to hypoalbuminemia, and efficient nutritional management does not always increase serum albumin levels. Serum albumin level is also a marker or morbidity-mortality independently of nutritional status. The serum albumin values used as diagnosis cut-off levels for malnutrition status, as set by health authorities or learned societies, are taken from studies where serum albumin levels correlated to non-anthropometric parameters such as mean hospital stay, infections, bedsores or rehospitalization, making it a marker of morbidity-mortality rather than malnutrition. Nevertheless, serum albumin level should remain part of the nutritional status assessment, either alone or – ideally – as part of a composite body weight index such as the Nutritional Risk Index or the Geriatric Nutritional Risk Index in order to guide the implementation of a nutritional strategy integrating the risks of malnutrition-related complications defined by the index. It is time the French health authority (Haute Autorité de santé [HAS]) recommendations to be updated to take this burgeoning evidence into account.