Discussion
ACUTE DISEASE, SECONDARY, DISEASE
In this secondary post-hoc analysis of a randomized clinical trial, we investigated first whether nutritional support affects short-term changes in serum albumin concentrations among medical inpatients at nutritional risk, and second, whether an increase in albumin concentrations has prognostic implications regarding clinical outcome and treatment response. We found that 42% of patients in our study population had an increase in albumin concentrations from baseline to day 7 and, compared with usual hospital food, nutritional support was not associated with a more pronounced increase in albumin concentrations. The changes in serum albumin concentrations, however, provided prognostic information, and mortality and length of hospital stay were significantly lower in patients with an increase in albumin concentration compared with those with decrease. Finally, patients with and without increase in albumin concentrations had a similar treatment response to the nutritional intervention and monitoring of albumin from baseline to day 7 was, thus, not helpful for predicting response to nutritional support.These findings are largely in line with a recent statement by the American Society for Parenteral and Enteral Nutrition (ASPEN) stating that “visceral proteins have not been shown to be sensitive markers of energy and protein intake adequacy and therefore should not be a guide for therapeutic changes.” [While nutritional intervention did not show differences in albumin concentrations in the overall population suggesting that nutritional support had little effect on the short-term changes in serum albumin concentrations over one week, there were some significant effects in the subgroup of patients in participants with a high Interestingly, most patients in our study showed an absolute decrease in serum albumin concentrations in the short-term follow-up over 7 days. We assume that this was due to the acute disease of our patients with an increase in catabolism and the fact that human serum albumin has a half-life of about 19 days [We are aware of several strengths and limitations. To our knowledge, this analysis is among the first and maybe the most comprehensive study to look at changes in serum albumin concentrations in a large population of medical patients from a previous randomized trial with detailed information about nutritional intake and the resolution of the disease. In the 1980s Winkler et al. [