The relationship between serum prealbumin and survival was determined using The serum albumin was directly correlated with the serum prealbumin (r. On the other hand, there was no significant difference between the two groups in terms of Albumin and prealbumin are among such proteins. Historically, serum proteins such as albumin and prealbumin (PAB) have . reported that there was no correlation between fat-free mass and.
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Measurement of serum proteins can provide indirect information about the levels of visceral protein. Albumin and prealbumin are among such proteins. Prealbumin is synthesized in the liver and acts as a transport protein in the body. It has a shorter half-life of 2—3 days and its amount in the body is low. Therefore, measurement of prealbumin is a good marker of visceral protein status and prealbumin is affected earlier by acute variations in protein balance [ 45 ].
Serum albumin is commonly used as a surrogate marker of nutrition; however, its half-life of 21 days makes it only minimally valuable. With such a long half-life, a new steady state level can only be reached after days [ 4 ].
As in this study, in conditions in which malnutrition develops in a short time, albumin is not a clinically relevant nutritional marker.Prealbumin
Therefore, prealbumin is a more sensitive marker than albumin or transferrin to assess the nutritional status [ 45 ]. Similarly, in this study, prealbumin level was significantly lower in patients with malnutrition than in those without malnutrition and there was no significant difference between the two groups in terms of albumin levels. In addition, the percentage of weight loss that was used to define malnutrition negatively correlated with prealbumin, but not with albumin.
Difference Between Albumin and Prealbumin | Difference Between | Albumin vs Prealbumin
The degree of malnutrition is related to the patient's nutritional status before tumor development, to the characteristics of the tumor, and to the cancer treatment itself such as RT and chemotherapy [ 14 ]. Malnutrition is a serious problem in patients with head and neck cancer.
It relates closely to the degradation of the quality of life and patient performance, decrease in adherence to treatment and response to therapy, reduction in life expectancy, and longer duration of hospitalization. It also may increase the risk of infection, and treatment toxicity and treatment costs [ 1815 ].
Performance scores in the patients in this study were in agreement with these findings. ECOG score was significantly worse in patients with malnutrition than in those without malnutrition after RT while there was no significant difference between the two groups for it before RT.
Subjective global assessment as well as the percentage of weight loss and BMI is a parameter used to assess the nutritional status in both cancer patients and patients without cancer [ 9 ]. Therefore, in this study, it was an expected finding that patients with malnutrition had a worse SGA score. Radiotherapy has serious side effects in both the early and late period on swallowing functions and these side effects manifest as dysphagia.
In the early period, side effects including severe dry mouth, stomatitis, superficial mucosal ulceration, taste disorder, bleeding, pain, and mucositis may develop [ 16 ].
On the other hand, in the late period, side effects including osteoradionecrosis, trismus, oral flora changes, dental caries, taste changes, and strictures may occur [ 17 ]. As expected, toxicity also increases with increasing dose of RT. In our study, dysphagia, a serious toxicity of RT, was significantly more frequent in patients with malnutrition, so it is a contributing factor to malnutrition in patients with head and neck cancer. Similarly, the development of severe mucositis and severe nausea was more common in patients with malnutrition, but the difference was not statistically significant.
- Laboratory/Serum Markers
However, there was a trend towards elevation which might reach significance if the number of patients is increased. On the other hand, there was also found a significant correlation between the amount of weight loss during RT and the development of RT-related toxicity such as mucositis and dysphagia. Chemotherapeutic drugs may negatively affect nutrition. This is usually a result of the adverse effects on the oral cavity, oropharynx and esophagus mucosa and hence mucositis and odynophagia may develop.
Other side effects that contribute to malnutrition and cachexia include nausea and vomiting. Cisplatin is a commonly used agent in patients with head and neck cancer and has a very high potential for nausea. Combined chemoradiotherapy may increase dysphagia and malnutrition more due to the combined toxicities of the two treatment modalities [ 1 ].
Thirty-two patients received concomitant chemotherapy in this study. The chemotherapeutic agent used was cisplatin. These side effects of cisplatin possibly appear to contribute to malnutrition in our patients. In conclusion, malnutrition was a common complication in patients undergoing radiotherapy for head and neck cancer.
Difference Between Albumin and Prealbumin
In one study of 60 cardiac transplant recipients at least five years post transplant, serum albumin was found to be a better predictor of underlying malnutrition than body mass index BMI and subjective global assessment SGA [ 17 ]. Similarly, serum albumin has also been used during preoperative management to screen and treat at-risk patients undergoing elective orthopedic surgery to reduce postoperative complications [ 18 ].
The evidence is weak for using serum albumin as a marker of malnutrition in non-inflammatory states such as starvation. Hence, it was concluded that albumin cannot be reliably used as a marker for diagnosing protein-calorie malnutrition [ 19 ]. Similarly, a case-control study that compared 14 anorexia nervosa patients with 15 healthy subjects reported that serum albumin levels did not vary in individuals with anorexia nervosa compared with controls during a follow-up of one year [ 20 ].
There has been much debate regarding the role of albumin as a measure of nutritional status in the non-acutely ill geriatric population with low functional capacity.
Additionally, posture-related effects supine, sitting, standing and moderate exercise on serum albumin levels have also been reported [ 22 ]. This is related to the alterations in hydrostatic and oncotic pressures with changes in body positions [ 23 ]. This can lead to falsely elevated or diminished levels of albumin; due to the above-mentioned reasons, albumin level is not the most accurate measure for determining malnutrition in this patient population. Prealbumin, transferrin and retinol-binding protein Similar to albumin, prealbumin PAB is also a negative acute-phase protein produced by the liver.
Thus, it is affected by some of the same inflammatory states such as infections and liver disease. However, there are a few key differences between these two proteins. The half-life of PAB is much shorter 2—3 daysand its total body pool is considerably smaller than albumin. However, PAB is degraded by the kidneys, and consequently any renal dysfunction causes an increase in its serum levels.
Furthermore, one of the functions of PAB is to act as a transport protein for thyroxine.