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Our objective was to assess whether the serum albumin level rises in patients given total parenteral nutrition (TPN). All randomized controlled studies of TPN for at least 7 days versus oral therapy were reviewed. Data on serum albumin had to be available to be acceptable for analysis. Only trials of patients with cancer fulfilled these selection criteria for our analysis. None of the reported studies showed a significant rise in serum albumin with TPN when compared to controls. The mean change in serum albumin levels for all of the studies was -0.3 g/dl in the TPN group and —0.3 g/dl in the control group. In published randomized controlled studies of TPN versus oral diet, there is no significant increase in serum albumin levels in those receiving TPN or decrease in serum albumin in controls. Our study does not support the serum albumin level as a nutritional marker in patients with cancer.