title: The Interrelationships among albumin, nutrient intake, and inflammation in elderly recuperative care patients.
abstract: OBJECTIVE
  To examine the interrelationships among low serum albumin, nutritional depletion, and ongoing inflammation in older patients recovering from illness.
  
  
  METHODS
  A prospective cohort study.
  
  
  METHODS
  A transitional care unit (TCU) within a Department of Veterans Affairs hospital nursing home care unit.
  
  
  METHODS
  275 older veterans (mean age=78.9 ± 7.5y, 99% male) admitted for recuperative care and rehabilitation.
  
  
  METHODS
  At admission and discharge (median LOS 24d, IQR 16 to 44d), each subject completed a comprehensive standardized evaluation including a nutritional assessment and measurement of serum albumin, C-reactive protein (CRP), interleukin-6 (IL-6) and its soluble receptor, and tumor necrosis factor-alpha (TNF-α) and its soluble receptors (sTNF-RI and II). Complete nutrient intake assessments (calorie counts) were performed daily.
  
  
  RESULTS
  Both the discharge albumin and the change in albumin (discharge minus admission) were strongly and inversely correlated with various indicators of inflammation, particularly CRP and IL-6. Change in CRP was the strongest correlate of change in albumin (R2 = 0.21, P<.001) and discharge IL-6 the strongest correlate of discharge albumin (R2 = 0.21, P<.001). Nutrient intake also correlated with albumin and its change, but entered the multivariable models after inflammatory indicators and explained a smaller portion of the variance. Although there were significant interactions between time and both nutrient intake and inflammation, the relative importance of inflammation as a potential determinant of the serum albumin concentration appeared to remain unchanged with longer periods of observation.
  
  
  CONCLUSIONS
  Among elderly patients admitted to a TCU, inflammation appears to be a more powerful determinant of albumin and its change during the hospitalization than is nutrient intake. Further study is needed to prove causality and to determine whether the relative importance of inflammation on the albumin concentration diminishes with more prolonged periods of observation.
authors: Geriatric Research Education and Clinical Center, Central Arkansas Veterans Healthcare System, Little Rock, AR 72205, USA. SullivanDennisH@uams.edu
authors: D H
authors: DH
authors: Sullivan
authors: L E
authors: LE
authors: Johnson
authors: R A
authors: RA
authors: Dennis
authors: P K
authors: PK
authors: Roberson
authors: M
authors: M
authors: Heif
authors: K K
authors: KK
authors: Garner
authors: M M
authors: MM
authors: Bopp
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000378:metabolism; D015331:Cohort Studies; D005260:Female; D015577:Geriatric Assessment; D006787:Hospitals, Veterans; D006801:Humans; D007249:Inflammation / Q000097:blood* / Q000503:physiopathology; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D015596:Nutrition Assessment; D009752:Nutritional Status; D011446:Prospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis*; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D015850:Interleukin-6; D012709:Serum Albumin; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein