title: Association of serum albumin with markers of nutritional status among HIV-infected and uninfected Rwandan women.
abstract: BACKGROUND
  The objectives of this study are to address if and how albumin can be used as an indication of malnutrition in HIV infected and uninfected Africans.
  
  
  METHODS
  In 2005, 710 HIV-infected and 226 HIV-uninfected women enrolled in a cohort study. Clinical/demographic parameters, CD4 count, albumin, liver transaminases; anthropometric measurements and Bioelectrical Impedance Analysis (BIA) were performed. Malnutrition outcomes were defined as body mass index (BMI), Fat-free mass index (FFMI) and Fat mass index (FMI). Separate linear predictive models including albumin were fit to these outcomes in HIV negative and HIV positive women by CD4 strata (CD4>350,200-350 and <200 cells/µl).
  
  
  RESULTS
  In unadjusted models for each outcome in HIV-negative and HIV positive women with CD4>350 cells/µl, serum albumin was not significantly associated with BMI, FFMI or FMI. Albumin was significantly associated with all three outcomes (p<0.05) in HIV+ women with CD4 200-350 cells/µl, and highly significant in HIV+ women with CD4<200 cells/µl (P<0.001). In multivariable linear regression, albumin remained associated with FFMI in women with CD4 count<200 cells/µl (p<0.01) but not in HIV+ women with CD4>200.
  
  
  CONCLUSIONS
  While serum albumin is widely used to indicate nutritional status it did not consistently predict malnutrition outcomes in HIV- women or HIV+ women with higher CD4. This result suggests that albumin may measure end stage disease as well as malnutrition and should not be used as a proxy for nutritional status without further study of its association with validated measures.
authors.affiliation: Albert Einstein College of Medicine, Bronx, New York, United States of America. dusingize@gmail.com
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Dusingize
authors.forename: Donald R
authors.initials: DR
authors.lastname: Hoover
authors.forename: Qiuhu
authors.initials: Q
authors.lastname: Shi
authors.forename: Eugene
authors.initials: E
authors.lastname: Mutimura
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Kiefer
authors.forename: Mardge
authors.initials: M
authors.lastname: Cohen
authors.forename: Kathryn
authors.initials: K
authors.lastname: Anastos
mesh_terms: D000328:Adult; D001823:Body Composition; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000378:metabolism*; D006679:HIV Seropositivity / Q000150:complications / Q000378:metabolism*; D006801:Humans; D044342:Malnutrition / Q000150:complications / Q000378:metabolism*; D009752:Nutritional Status; D012307:Risk Factors; D012432:Rwanda; D012709:Serum Albumin / Q000032:analysis / Q000378:metabolism*; D014930:Women; D016387:Women's Health
chemical_list: D012709:Serum Albumin