Nutrition

A real public health issue, protein-energy malnutrition affects between 5 and 10% of people over 65 years of age at home and 20% to 70% of people in institutions, the population most directly concerned by malnutrition, which is sometimes life-threatening and requires specific treatment. Malnutrition is responsible for the increase in morbidity and mortality and the lengthening of hospital stays: Incidence of nosocomial infections x4

A real public health issue, protein-energy malnutrition affects between 5 and 10% of people over 65 years of age at home and 20% to 70% of people in institutions, the population most directly concerned by malnutrition, which is sometimes life-threatening and requires specific treatment. Malnutrition is responsible for the increase in morbidity and mortality and the lengthening of hospital stays: Incidence of nosocomial infections x4

The biological evaluation of the nutritional state is mainly based on the albumin level, which is the indicator of a protein deficiency affecting the body’s defense functions (immunity, etc.). However, the plasma albumin concentration must be interpreted according to the level of CRP (inflammation protein), and the possible presence of other causes of hypoalbuminemia (liver failure, nephrotic syndrome, digestive losses).

The role of pre-albumin

An infectious and/or inflammatory state can indeed lead to an average drop of 5g/l in albumin levels. Moreover, albuminemia is not a very reactive marker of the short-term evolution of the nutritional state, given its long half-life (about 3 weeks). To assess the effectiveness of nutritional support, it is therefore advisable to use the transthyretin (also known as pre-albumin) assay, whose hepatic synthesis also decreases in the presence of an inflammatory state but whose half-life is 48 hours. It should be noted that albumin levels are recognized as a marker of morbidity and mortality in many pathological situations.

Recommendations of the French High Authority for Health (HAS)

Since 2019, the French High Authority for Health (HAS) recommends an immunoassay for albumin because of its better specificity.

RBP, Retinol Binding Protein, is also a sensitive marker of acute undernutrition and allows to assess renutrition.

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