Serum Albumin Levels: A Simple Answer to a Complex Problem? Are We on the Right Track of Assessing Metabolic Syndrome?

Sohee Kim; Shinae Kang

doi:10.3803/EnM.2013.28.1.17

Articles

Page Path: HOME > Endocrinol Metab > Volume 28(1); 2013 > Article

Editorial Serum Albumin Levels: A Simple Answer to a Complex Problem? Are We on the Right Track of Assessing Metabolic Syndrome?: Sohee Kim, Shinae Kang; Endocrinology and Metabolism 2013;28(1):17-19.
DOI: https://doi.org/10.3803/EnM.2013.28.1.17
Published online: March 25, 2013

Division of Endocrinology and Metabolism, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

Corresponding author: Shinae Kang. Division of Endocrinology and Metabolism, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 135-720, Korea. Tel: +82-2-2019-3335, Fax: +82-2-3463-3882, shinae95@yuhs.ac

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

3,312 Views
35 Download
8 Crossref

Full Article

Download PDF

Article information
References

Serum albumin makes up a major portion of circulating proteins in our body. Serum albumin level is closely linked to the body's nutritional (malnutrition/overnutrition) and inflammatory status. Insulin resistance is the main pathogenetic mechanism underlying metabolic syndrome, a condition that is associated with obesity and chronic vascular inflammation [1]. Several studies have focused on the association between serum albumin level and factors/diseases related to metabolic syndrome (insulin resistance, diabetes, and cardiovascular disease).

In this issue, Bae et al. [2] reported that a high serum albumin level is associated with insulin resistance, but they failed to show a significant correlation between serum albumin level and the development of diabetes in a longitudinal follow-up. The authors analyzed data for a large cohort from a health promotion center located in an urban area, Seoul, South Korea. Cho et al. [3] also reported a positive relationship between serum albumin level and metabolic syndrome, although they studied a healthy adult population located in a rural area.

Bae et al. [2] explained that the positive association between serum albumin level and insulin resistance might be a consequence of increased albumin production in the liver under insulin-resistant conditions. Insulin resistance goes hand-in-hand with increased insulin levels and insulin is known to stimulate albumin production in hepatocytes [4]. On the other hand, some reports have shown that albumin has a cardioprotective effect [5,6] that may be due to albumin acting as an antioxidant and a protective protein against chronic inflammation [1,7]. Albumin is a main constituent of serum proteins and, owing to its presence in vast amounts, it accounts for approximately 80% of thiol's antioxidant effect in the body [8]. The free ³⁴cysteine (³⁴Cys) residue of albumin reacts with reactive oxygen species, generating two reversible intermediate derivatives, and finally sulfonic-albumin, which is susceptible to enzymatic digestion compared with the nonoxidized counter molecule [9]. Therefore, serum albumin seems to have complicated effects on metabolic syndrome and related factors/diseases.

Several reports have shown a negative correlation between serum albumin level and cardiovascular risk factors, as well as cardiovascular disease [10,11]. However, there have also been conflicting reports that serum albumin level is not associated with atherosclerosis as evaluated by carotid imtima media thickness [12]. To make matters even more difficult to interpret, there are also papers demonstrating positive relationships between serum albumin level and vascular dysfunction as measured by pulse wave velocity [6], as well as early carotid atherosclerosis [5]. These differences in findings between papers demonstrate a possible complex mechanism that underlies the interaction between albumin's antioxidant capacities. More specifically, the antioxidant effect of albumin is not solely dependent on the amount of serum albumin per se, but also on the oxidative status of albumin. Previous papers have demonstrated that the antioxidant capacity of albumin is decreased in various disease conditions, such as diabetes [13], and in patients on hemodialysis [14]. Furthermore, insulin signaling is altered under insulin-resistant conditions and insulin levels decrease in the later stages of diabetes. Therefore, the answer may lie in the total antioxidant capacity of serum albumin and not the total amount of albumin itself. In this context, a plausible explanation of the findings by Bae et al. [2] in this issue of the journal would be that the increase in serum albumin level may be because of a compensatory increase in albumin production that is due to a decrease in the antioxidant effects of albumin in an insulin-resistant state.

What, then, is the main message of the study by Bae et al. [2]? Serum albumin is relatively simple to measure and is included in every admission panel throughout Korea. Testing is inexpensive and does not need fasting for proper measurement, which certainly makes it more comfortable for patients visiting the hospital. Therefore, Bae et al. [2] are to be congratulated for re-emphasizing the clinical utility of a simple biomarker in evaluating a patient's complex metabolic status under stable metabolic conditions. Although the study fails to show a positive correlation between the development of diabetes and serum albumin level, a larger population or a longer follow-up period may be all that is needed. The medical society certainly awaits the results of such investigations.

And what remains to be investigated? First, the findings urge a large-scale population analysis on whether albumin level in a healthy population may serve as a good surrogate marker for future cardiovascular events. Because there are data in Western countries demonstrating that serum albumin level is associated with cardiovascular outcomes [10,15], a separate study in Asia, and particularly Korea, is definitely needed. This is important, especially considering that the pathogenetic mechanism leading to diabetes may be influenced by several factors, including genetic factors. Second, the total amount of albumin may not accurately reflect the total antioxidant capability, as discussed earlier. The data of Bae et al. [2] should also be supported by a thorough, mechanistic, in vitro analysis. Third, is the antioxidant property of albumin reversed with the improvement of a patient's metabolic status? This remains a crucial step to providing a definite answer as to whether albumin is really a good marker.

In conclusion, Bae et al. [2] have reinforced an important positive association between serum albumin level and parameters of insulin resistance in healthy Korean adults. In addition, even though they did not show a significant association between albumin level and diabetes development, the report is one of the first longitudinal studies to evaluate this issue. Further investigations are needed to demonstrate whether albumin is indeed 'the' important antioxidant in the body and whether it is linked to clinical outcomes. The medical society awaits the answers to these questions.

Article information

No potential conflict of interest relevant to this article was reported.

References

1. Wellen KE, Hotamisligil GS. Inflammation, stress, and diabetes. J Clin Invest 2005;115:1111–1119. Article PubMed PMC
2. Bae JC, Seo SH, Hur KY, Kim JH, Lee MS, Lee MK, Lee WY, Rhee EJ, Oh KW. Association between serum albumin, insulin resistance, and incident diabetes in nondiabetic subjects. Endocrinol Metab 2013;28:26–32.Article
3. Cho HM, Kim HC, Lee JM, Oh SM, Choi DP, Suh I. The association between serum albumin levels and metabolic syndrome in a rural population of Korea. J Prev Med Public Health 2012;45:98–104. Article PubMed PMC PDF
4. Peavy DE, Taylor JM, Jefferson LS. Time course of changes in albumin synthesis and mRNA in diabetic and insulin-treated diabetic rats. Am J Physiol 1985;248(6 Pt 1):E656–E663. Article PubMed
5. Ishizaka N, Ishizaka Y, Nagai R, Toda E, Hashimoto H, Yamakado M. Association between serum albumin, carotid atherosclerosis, and metabolic syndrome in Japanese individuals. Atherosclerosis 2007;193:373–379. Article PubMed
6. Kadono M, Hasegawa G, Shigeta M, Nakazawa A, Ueda M, Yamazaki M, Fukui M, Nakamura N. Serum albumin levels predict vascular dysfunction with paradoxical pathogenesis in healthy individuals. Atherosclerosis 2010;209:266–270. Article PubMed
7. Ceriello A, Motz E. Is oxidative stress the pathogenic mechanism underlying insulin resistance, diabetes, and cardiovascular disease? The common soil hypothesis revisited. Arterioscler Thromb Vasc Biol 2004;24:816–823. Article PubMed
8. Turell L, Carballal S, Botti H, Radi R, Alvarez B. Oxidation of the albumin thiol to sulfenic acid and its implications in the intravascular compartment. Braz J Med Biol Res 2009;42:305–311. Article PubMed PDF
9. Candiano G, Petretto A, Bruschi M, Santucci L, Dimuccio V, Prunotto M, Gusmano R, Urbani A, Ghiggeri GM. The oxido-redox potential of albumin methodological approach and relevance to human diseases. J Proteomics 2009;73:188–195. Article PubMed
10. Djousse L, Rothman KJ, Cupples LA, Levy D, Ellison RC. Serum albumin and risk of myocardial infarction and all-cause mortality in the Framingham Offspring Study. Circulation 2002;106:2919–2924. Article PubMed
11. Hostmark AT, Tomten SE, Berg JE. Serum albumin and blood pressure: a population-based, cross-sectional study. J Hypertens 2005;23:725–730. Article PubMed
12. Djousse L, Rothman KJ, Cupples LA, Arnett DK, Ellison RC. NHLBI Family Heart Study. Relation between serum albumin and carotid atherosclerosis: the NHLBI Family Heart Study. Stroke 2003;34:53–57. Article PubMed
13. Van Campenhout A, Van Campenhout C, Lagrou AR, Moorkens G, De Block C, Manuel-y-Keenoy B. Iron-binding antioxidant capacity is impaired in diabetes mellitus. Free Radic Biol Med 2006;40:1749–1755. Article PubMed
14. Lim PS, Cheng YM, Yang SM. Impairments of the biological properties of serum albumin in patients on haemodialysis. Nephrology (Carlton) 2007;12:18–24. Article PubMed
15. Phillips A, Shaper AG, Whincup PH. Association between serum albumin and mortality from cardiovascular disease, cancer, and other causes. Lancet 1989;2:1434–1436. Article PubMed

Figure & Data

References

Citations

Citations to this article as recorded by

Measures of Oxidative Status Markers in Relation to Age, Sex, and Season in Sick and Healthy Captive Asian Elephants in Thailand
Worapong Kosaruk, Janine L. Brown, Patcharapa Towiboon, Veerasak Punyapornwithaya, Kidsadagon Pringproa, Chatchote Thitaram
Animals.2023; 13(9): 1548. CrossRef
Copper(II) Affects the Biochemical Behavior of Proinsulin C-peptide by Forming Ternary Complexes with Serum Albumin
Jessica A. San Juan, Khetpakorn Chakarawet, Zhecheng He, Rebeca L. Fernandez, Michael J. Stevenson, Nathaniel H. O. Harder, Samuel E. Janisse, Lee-Ping Wang, R. David Britt, Marie C. Heffern
Journal of the American Chemical Society.2023; 145(30): 16726. CrossRef
Anti-Müllerian hormone: a novel biomarker for aggressive prostate cancer? Emerging evidence from a prospective study of radical prostatectomies
Stavros Kontogiannis, Georgios Markantes, Maria Stamou, Michail Tsagkarakis, Irini Mamali, Konstantinos Giannitsas, Petros Perimenis, Neoklis Georgopoulos, Anastasios Athanasopoulos
Hormones.2023;[Epub] CrossRef
The Association of Malnutrition With Chronic Kidney Disease in the Older Chinese Population With Hypertension: Evidence From the China H-type Hypertension Registry Study
Yumeng Shi, Chao Yu, Wei Zhou, Tao Wang, Lingjuan Zhu, Xiaoshu Cheng, Huihui Bao
Journal of Renal Nutrition.2023;[Epub] CrossRef
Association of the serum albumin level with prognosis in chronic kidney disease patients
Haiying Song, Cuimei Wei, Haofei Hu, Qijun Wan
International Urology and Nephrology.2022; 54(9): 2421. CrossRef
Association between serum albumin and mortality in Japan older people with dysphagia
Gaigai Li, Xun Zhou, Xunrui Hou, Yuheng Luo, Danmao Li, Tongtao Fan
Scientific Reports.2022;[Epub] CrossRef
U-shaped association between serum albumin and development of chronic kidney disease in general hypertensive patients
Chongfei Jiang, Binyan Wang, Youbao Li, Liling Xie, Xianglin Zhang, Jiancheng Wang, Yaren Yu, Yun Song, Min Liang, Guobao Wang, Jianping Li, Yan Zhang, Lishun Liu, Chengzhang Liu, Genfu Tang, Yong Huo, Xiping Xu, Xianhui Qin
Clinical Nutrition.2020; 39(1): 258. CrossRef
Association of Insulin Based Insulin Resistance with Liver Biomarkers in Type 2 Diabetes mellitus
Usha Adiga, Kathyayani P, Nandith P.B
Journal of Pure and Applied Microbiology.2019; 13(2): 1199. CrossRef

PubReader
Cite

CITE

export Copy Format

Close

XML Download