Where the Pendulum of Knowledge Stands Now: Is Circulating Albumin a Marker of Inflammation or of Malnutrition? How to Manage Hypoalbuminemia by Nutrition?

Low plasma albumin levels have been historically associated with insufficient nutritional nitrogen support.Recently, linked to the poor response of actual therapies and available supplements to manage this alteration, the role of this alteration has been attributed to the vast ensemble of modifications referred generally as consequent to inflammation. On the contrary, as recently it has been reported that life based on introduction of mainly essential amino acids is possible, and life span is improved when compared to standard diets, it is possible to hypothesize that by normal foods or by actually most widely diffused supplements insufficient amounts of essential amino acids to match with real needs of hypoalbuminemic patients are not provided. Peculiarly, some non essential amino acids provided in excess by diets may mislead clinicians by suggesting achievement of sufficient nitrogen intake if urea syntheses is used as reference of sufficient nutrition, while syntheses of liver proteins is not sufficiently implemented. Studies suitable to understand if some innovative therapy would be efficient in implementing albumin syntheses and thus prognosis in hypoalbuminemic patients are necessary.