The role of albumin and the extracellular matrix on the pathophysiology of oedema formation in severe malnutrition

Commentary: Mechanisms of kwashiorkor-associated immune suppression: Insights from human, mouse, and pig studies

“…In a recent study, we found that hypoalbuminemia is associated but alone was insufficient to explain edema in kwashiorkor ( 6 ). Other factors apart from hypoalbuminemia and low protein intake must develop kwashiorkor ( 7 ), such as extracellular matrix (ECM) degradation and lymphatic damage ( 6 ). Moreover, it was previously shown that edema in children with kwashiorkor resolved even when they were treated with a protein-deficient diet ( 8 ), and despite a small increase in serum albumin concentration among children whose oedema resolved or improved, serum albumin concentrations remained far below clinically recognized norms in children ( 6 , 9 ).…”

“…Firstly, the idea that reduced protein intake leads to hypoalbuminemia, which decreases oncotic pressur leading to edema in kwashiorkor, is widely believed, but this is an oversimplification which is not supported by strong evidence. In a recent study, we found that hypoalbuminemia is associated but alone was insufficient to explain edema in kwashiorkor (6). Other factors apart from hypoalbuminemia and low protein intake must develop kwashiorkor (7), such as extracellular matrix (ECM) degradation and lymphatic damage (6).…”

“…Other factors apart from hypoalbuminemia and low protein intake must develop kwashiorkor ( 7 ), such as extracellular matrix (ECM) degradation and lymphatic damage ( 6 ). Moreover, it was previously shown that edema in children with kwashiorkor resolved even when they were treated with a protein-deficient diet ( 8 ), and despite a small increase in serum albumin concentration among children whose oedema resolved or improved, serum albumin concentrations remained far below clinically recognized norms in children ( 6 , 9 ). It is important to emphasize that oversimplification of kwashiorkor etiology (presented in the review text and Figure 2 but unsupported by empirical evidence) can result in ineffective treatment strategies.…”

Albumin Level is Associated with Short-Term and Long-Term Outcomes in Sepsis Patients Admitted in the ICU: A Large Public Database Retrospective Research

“…However, we have comprehensively adjusted the potential confounders including different organ function variables. Third, hypoalbuminemia can be caused by various conditions, including hepatic cirrhosis, 32 heart failure, 33 malignant cancer, 34 and malnutrition, 35 which were considered as risk factors for the poor prognosis. Although we enrolled the variables including morbidities and lab findings as many as possible for analysis, not all the factors could be included due to the lack of some data in MIMIC-IV.…”

Kwashiorkor – New evidence in the puzzle of oedema formation

“…The paper by Gonzales et al in recent issue of eBioMedicine 8 gives important clues on oedema formation. First, by comparing children with and without oedema and children with similar albumin levels but different degrees of oedema, it confirms that low plasma albumin levels are necessary for oedema formation but that it is not the only explanation.…”