Value of prealbumin in assessment of nutrition for critically ill patients.

* Correspondence: [email protected] To the Editor, We read with great interest the article published in a recent issue of the Turkish Journal of Medical Sciences by Dumlu et al. entitled “A general consideration of the importance of nutrition for critically ill patients” (1). We thank Dr Dumlu and colleagues for their valuable investigation evaluating the nutritional status of intensive care unit patients retrospectively. They claimed that prealbumin levels of the patients had a tendency to increase after the provision of nutritional additives. We think that some important issues should be discussed while assessing serum prealbumin. Prealbumin is a serum carrier protein for thyroxine and retinol. Previous studies suggested that several disorders such as type 2 diabetes mellitus, anorexia nervosa, bulimia nervosa, pneumonia, tuberculosis, acute phase response (inflammation, infection, malignancy, trauma), ankylosing spondylitis, rheumatoid arthritis, protein losing enteropathy, Kawasaki disease, Helicobacter pylori infection, major depression, thyroid diseases, and liver diseases could affect serum prealbumin levels (2,3). In their paper, Dumlu et al. did not mention these contributing diseases. It is not obvious whether altered prealbumin levels were due nutrition or the course of the diseases. Secondly, several drugs such as nonsteroidal antiinflammatory drugs, anabolic steroids, corticosteroids, progestational agents, estrogens, and antithyroid drugs could alter serum prealbumin levels (2,4). Dietary food supplements such as omega-3 fatty acids, vitamin A, vitamin C, and zinc could also change these levels (5,6). In this respect, the authors should define whether the participants used these kinds of drugs and dietary supplements in their recent history. In addition, alcohol use is another confounder that should be described (7). Lastly, Bruguerolle et al. showed that a circadian rhythm was detected for serum prealbumin (8). We think that it is essential to express sampling time for measurement of serum prealbumin to provide reliable data. Therefore, interpretation of results in their current form seems problematic. In conclusion, we think that the study by Dumlu et al. contributes valuable data to the medical literature. However, clarifying these concerns would provide a clearer picture to readers. Received: 08.03.2015 Accepted/Published Online: 21.04.2015 Printed: 30.07.2015 Letter to the Editor