A joint research conducted by Sapienza University of Rome in collaboration with I.R.C.S. Neuromed of Pozzilli, Mediterranea Cardiocentro of Naples and LUM University of Casamassima, revealed a significant association between hypoalbuminemia (low levels of albumin in the blood) and an increased risk of mortality from vascular diseases and cancer in elderly individuals.

The research, based on data collected from the Moli-sani epidemiological study and published in the scientific journal eClinical Medicine-Lancet, analysed a large group of people (around 18,000 subjects, of whom 3,299 were aged 65 years and over) and showed that albumin levels below 35 g/L are linked to an increased risk of death in the elderly. This relationship was also observed after excluding factors such as kidney or liver disease and acute inflammatory states, which may influence albumin levels.

"The possibility of obtaining predictive indications on diseases with a high incidence and high risk of death - such as cardiovascular diseases or tumours - through a simple and widely available test, even at low cost, represents an important achievement for modern medicine", says Rector Antonella Polimeni. "This study, which confirms and consolidates the excellence of the scientific activities of Italian universities and research institutions in the medical field, also has an important social value attributable to the possible spin-offs in the field of prevention".

"Our analysis", says Francesco Violi, Professor Emeritus of Sapienza University of Rome and creator of the study, "is based on the fact that albumin is a protein in the blood that has antioxidant, anti-inflammatory and anticoagulant activities. Its reduction therefore aggravates the systemic inflammatory state and facilitates the hyperactivity of cells predisposed to carcinogenesis or thrombosis. In this context, it is important to stress that cancer and myocardial infarction share a common basis in the presence of a chronic inflammatory state and that patients at risk of cardiovascular disease, such as diabetics and obese people, are also at risk of cancer".

"The results of our study", adds Augusto Di Castelnuovo, an epidemiologist at Mediterranea Cardiocentro and I.R.C.S. Neuromed, "show that a low albumin level, in addition to providing information on nutritional status and liver health, also signals an increased susceptibility to other serious diseases. Hypoalbuminemia could reflect the chronic inflammatory process typical of ageing, known as 'inflammaging', which may have contributed to the high mortality risk we observed".

An interesting finding of the research is that hypoalbuminemia correlates with a lower socio-economic level. This raises an important social issue, as older people often choose a less healthy diet for economic reasons, opting for foods with less high-quality protein.

"In addition to providing us with a starting point for further research into the relationship between albumin in the blood and health," says Licia Iacoviello, Director of the Department of Epidemiology and Prevention at I.R.C.S. Neuromed and Professor of Hygiene at LUM University, "this study may have direct implications for clinical practice and prevention. Measuring albumin in the blood is a simple and inexpensive test. It can therefore be considered as a first-level analysis that would allow more clinical-diagnostic attention to be paid to elderly people who may be at risk. Our study also provides a reference value (35 g/L) that can guide the physician in the interpretation of the albumin measurement".

References:

The association between hypoalbuminemia and risk of death due to cancer and vascular disease in individuals aged 65 years and older: findings from the prospective Moli-sani cohort study - Augusto Di Castelnuovo, Marialaura Bonaccio, Simona Costanzo, Amalia De Curtis, Sara Magnacca, Mariarosaria Persichillo, Teresa Panzera, Francesca Bracone, Pasquale Pignatelli, Roberto Carnevale, Chiara Cerletti, Maria Benedetta Donati, Giovanni de Gaetano, Licia Iacoviello, Francesco Violi, for theMoli-sani Study Investigators - eClinical Medicine-Lancet doi: https://doi.org/10.1016/j.eclinm.2024.102627.

Further Information

Francesco Violi 
Department of Clinical Internal, Anaesthesiological and Cardiovascular Sciences
francesco.violi@uniroma1.it