The distributions and correlates of serum albumin levels in institutionalised individuals with intellectual and/or motor disabilities

Abstract

The serum albumin level is a widely accepted indicator of nutritional status in healthy adults and elderly individuals. However, there are few data regarding the distribution and correlates of serum albumin levels in individuals with intellectual and/or motor disabilities. We conducted a crosssectional study at a public facility for individuals with intellectual and/or motor disabilities in Ibaraki prefecture, Japan. Health check-up data obtained in 2001 from 477 individuals with intellectual disability (286 males, average age 40·6 (SD 12·3) years; 191 females, average age 45·1 (SD 11·6) years) were retrospectively reviewed. With the exception of men with cerebral palsy, the serum albumin level was nearly normally distributed. The mean was 44 (SD 3·6) g/l for males and 44 (SD 3·6) g/l for females with intellectual disability, 43 (SD 3·2) g/l in males and 44 (SD 2·6) g/l for females with cerebral palsy, 41 (SD 2·7) g/l for males and 42 (SD 3·7) g/l for females with Down's syndrome, and 42 (SD 4·5) g/l for males and 41 (SD 3·2) g/l for females with severe motor and intellectual disabilities. Only six of 474 individuals (1·3 %) had a serum albumin # 35 g/l. Low serum albumin was related to age, use of anticonvulsants and/or major tranquilisers, use of other medications, high C-reactive protein (CRP), high zinc sulfate turbidity test (ZTT), low serum Hb and low serum Fe among men; among women, high CRP and high ZTT were related to low serum albumin. The present study found an unexpectedly low incidence of low serum albumin among institutionalised individuals with intellectual and/or motor disabilities. Low serum albumin was associated with age, medications and inflammation in men, as well as inflammation in women.

Serum albumin levels and their correlates among individuals with motor disorders at five institutions in Japan

“…CRP is a sensitive marker of inflammation [ 42 ], and CRP levels were negatively associated with serum albumin in a number of studies [ 43 44 45 46 47 48 49 ]. In the present study, the negative correlation between CRP and serum albumin levels was significant in both the sex- and age-adjusted and multivariable analyses, similar to results from a previous study on individuals with ID [ 23 ]. A negative correlation with inflammation was also observed in individuals with MD.…”

“…Second, use of medications, particularly antiepileptic drugs, can decrease the capability to synthesize hepatic albumin, and use anticonvulsants and/or major tranquilizers and other medications has been associated with low serum albumin levels in men with ID [ 23 ]; 234 of 249 individuals (94%) in the present study were taking medications. Albumin is synthesized only in liver cells, and its production is quite constant in healthy individuals; therefore, just a small intracellular deposit of protein is needed [ 14 ].…”

“…We previously reported low prevalence (1.3%) of hypoalbuminemia (serum albumin level ≤ 3.5 g/dL) among individuals with intellectual disabilities (ID) as well as an association between low serum albumin and both inflammation and medication [ 23 ]. However, no studies have examined the distributions and correlates of serum albumin levels in institutionalized individuals with MD.…”

The Mini Nutritional Assessment (MNA) is useful for assessing the risk of malnutrition in adults with intellectual disabilities

“…However, in the present study, despite a relatively high proportion (22%) of the participants rated malnourished or at risk of malnutrition, only one of 104 participants was below the threshold of 3·5 g/dl. Poor correlation of serum albumin with nutritional status has also been observed by Ohwada and Nakayama (2008). Their study also observed a relatively low incidence (six of 474 persons, 1·3%) of low serum albumin in institutionalised persons with intellectual disabilities.…”

Assessment of growth and nutrition in children with cerebral palsy

“…Given the primarily caloric nutritional compromise this population experiences, albumin and pre-albumin are generally normal. 15,16 Their normality should not be interpreted as evidence of adequate nutritional status. Low values may be nutritional (chronic lowprotein intake) or non-nutritional (the fluid shifts of an acutely ill patient, protein losses in urine or stool or liver disease).…”