On 2016 Aug 19, Mayer Brezis commented:

The study shows a correlation between low albumin and mortality - which makes sense and confirms previous literature. Is the relationship CAUSAL? The authors suggest causality: "Maintaining a normal serum albumin level may not only prolong patient survival but also may prevent medical complications...". Couldn't low albumin simply be A MARKER of more severe morbidity? If a baseline higher albumin BEFORE initiation of the tube feeding predicts lower mortality, how could this feeding mediate the improved survival? Are the authors suggesting that low albumin should a consideration AGAINST tube feeding because of predicted poorer prognosis?<br> Similarly, stable or increased albumin predicts long term survival not necessarily because of tube feeding, but simply as a marker of healthier people who survived the gastrostomy procedure. Causality cannot be implied in the absence of a control group and missed follow up in a third of the patients in the study.

On 2016 Aug 19, Mayer Brezis commented:

The study shows a correlation between low albumin and mortality - which makes sense and confirms previous literature. Is the relationship CAUSAL? The authors suggest causality: "Maintaining a normal serum albumin level may not only prolong patient survival but also may prevent medical complications...". Couldn't low albumin simply be A MARKER of more severe morbidity? If a baseline higher albumin BEFORE initiation of the tube feeding predicts lower mortality, how could this feeding mediate the improved survival? Are the authors suggesting that low albumin should a consideration AGAINST tube feeding because of predicted poorer prognosis?<br> Similarly, stable or increased albumin predicts long term survival not necessarily because of tube feeding, but simply as a marker of healthier people who survived the gastrostomy procedure. Causality cannot be implied in the absence of a control group and missed follow up in a third of the patients in the study.