Department of Internal Medicine, Division of Nephrology, University of California, Davis, Davis, California; Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy.
J Ren Nutr. 2013 Nov;23(6):406-10. doi: 10.1053/j.jrn.2013.02.007. Epub 2013 Apr 24.
Albumin and prealbumin are associated with nutritional status and inflammatory status. Each has a residual effect on mortality outcomes when included in regression models that include the other. Prealbumin is increased in the obese mouse model as a consequence of stabilization of prealbumin by retinol binding protein 4 (RBP4) secreted by adipocytes. We carried out this study to establish the contribution of adiposity to prealbumin levels in prevalent patients receiving dialysis and the relationship of prealbumin to RBP4.
We determined whether prealbumin was associated with adiposity in patients receiving hemodialysis (HD), controlling for the effects of inflammation and nutrition. We evaluated body composition in 48 prevalent patients receiving HD by magnetic resonance imaging (MRI), measuring total skeletal muscle mass (SM), visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and serum albumin, prealbumin, RBP4, and interleukin-6 (IL-6) levels. We used normalized protein catabolic rate (nPCR) to report nutrition and separately analyzed the determinants of albumin and then of prealbumin by multiple stepwise regression.
Thirty-two patients were women, 16 patients were diabetic, and median age and body mass index were 54.5 and 27.3 kg/m(2), respectively. Median total adipose tissue (TAT) was 24.3 kg and VAT was 3.25 kg. Prealbumin was positively associated with VAT, nPCR, and RBP4 and was negatively associated with IL-6; r(2) for the model was 0.64. By contrast, albumin was positively associated with nPCR and negatively associated with IL-6 but not with any measure of adiposity (r(2) for the model = 0.2).
Prealbumin, like albumin, is associated with markers of nutrition (nPCR) and inflammation, but unlike albumin, prealbumin levels are positively associated with visceral adiposity.
白蛋白和前白蛋白与营养状况和炎症状态有关。当它们包含在包含其他的回归模型中时，每种物质对死亡率结果都有残余影响。肥胖小鼠模型中前白蛋白增加，是由于脂肪细胞分泌的视黄醇结合蛋白 4（RBP4）稳定了前白蛋白。我们进行这项研究是为了确定肥胖对接受透析的患者前白蛋白水平的影响，并研究前白蛋白与 RBP4 的关系。
我们通过磁共振成像（MRI）确定了接受血液透析（HD）的患者前白蛋白是否与肥胖有关，同时控制了炎症和营养的影响。我们评估了 48 名接受 HD 的患者的身体成分，测量了总骨骼肌质量（SM）、内脏脂肪组织（VAT）、皮下脂肪组织（SAT）和血清白蛋白、前白蛋白、RBP4 和白细胞介素-6（IL-6）水平。我们使用归一化蛋白分解率（nPCR）报告营养状况，并分别通过多元逐步回归分析白蛋白和前白蛋白的决定因素。
32 名患者为女性，16 名患者为糖尿病患者，中位年龄和体重指数分别为 54.5 岁和 27.3kg/m2。中位总脂肪组织（TAT）为 24.3kg，VAT 为 3.25kg。前白蛋白与 VAT、nPCR 和 RBP4 呈正相关，与 IL-6 呈负相关；模型的 r2 为 0.64。相比之下，白蛋白与 nPCR 呈正相关，与 IL-6 呈负相关，但与任何脂肪量测量均无相关性（模型 r2=0.2）。
与白蛋白一样，前白蛋白与营养（nPCR）和炎症标志物有关，但与白蛋白不同的是，前白蛋白水平与内脏脂肪呈正相关。
