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Lower serum albumin concentration and change in muscle mass: the Health, Aging and Body Composition Study^1,2,3

¹ From the Institute of Health Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, Netherlands (MV); the Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, Netherlands (MV); the Sticht Center on Aging, Wake Forest University School of Medicine, Winston-Salem, NC (SBK); the Department of Medicine, University of Pittsburgh, Pittsburgh, PA (ABN and BHG); the University of Tennessee Health Science Center, Memphis, TN (FAT); the Prevention Sciences Group, University of California, San Francisco, San Francisco, CA (MCN); the National Institute on Aging, Laboratory of Epidemiology, Demography and Biometry, Bethesda, MD (TBH)

Background: Low albumin concentrations in older persons increase the risk of poor health outcomes, including functional decline.

Objective: The aim of the study was to investigate the association between serum albumin concentration and skeletal muscle loss (sarcopenia) in old age.

Design: Serum albumin concentration was measured in 1882 black and white men and women aged 70–79 y participating in the Health, Aging and Body Composition Study. Five-year changes in appendicular skeletal muscle mass (ASMM), total-body fat-free mass (FFM), and trunk lean mass (TLM) were measured by using dual-energy X-ray absorptiometry. Confounders included health and lifestyle factors, which are markers of inflammation and protein intake.

Results: A low albumin concentration (<38 g/L) was observed in 21.2% of the study participants. After adjustment for confounders, the mean (±SE) change in ASMM was –82 ± 26 g per 3-g/L lower albumin concentration (P = 0.002). This association remained after persons with a low albumin concentration (<38 g/L) were excluded. The decline in ASMM in subjects with low albumin concentrations was almost 30% higher (–930 ± 56 g) than that in those with albumin concentrations 42 g/L (–718 ± 38 g; P < 0.01). The association between albumin and change in ASMM remained after additional adjustment for weight change. A weak association was observed for FFM, whereas no association was observed for TLM, which suggests a specific role of albumin in skeletal muscle change.

Conclusions: Lower albumin concentrations, even above the clinical cutoff of 38 g/L, are associated with future loss of ASMM in older persons. Low albumin concentration may be a risk factor for sarcopenia.

Key Words: Sarcopenia • dual-energy X-ray absorptiometry • body composition • aging • protein • inflammation

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