Can total parenteral nutrition reverse hypoalbuminemia in oncology patients?

To determine if hypoalbuminemia is a consequence of protein-energy malnutrition rather than an associated feature of cancer, we reviewed results when vigorous nutritional support was given to 13 men and 9 women who had solid tumors (head and neck [10], gastrointestinal [8], other [4]) and an initial serum albumin less than 3.5 g/dl. Patients had received a minimum of 21 days of nutritional support with total parenteral nutrition (TPN) supplying an average daily energy intake of at least 1.5 x basal energy expenditure (BEE). The TPN was started at a dosage commensurate with the patient's estimated postoperative caloric requirements, and patients had received an average of 2358 kcal/day (1.97 x BEE) and 1.54 g of protein/kg of body weight. Patient body weights increased by an average of 2.75 kg during the 21 days of TPN, but there was no statistically significant change in serum albumin, suggesting that factors other than malnutrition were primarily responsible for the hypoalbuminemia. Although TPN is useful as an adjunct in patients with cancer, it may not reverse the hypoalbuminemia commonly seen in this population.