TTR and infection: Furthermore, it has been suggested that TTR changes precede the changes in growth parameters, thereby giving clinicians the opportunity to intervene before growth velocity changes occur.4,5 However, TTR may not be a sensitive marker for evaluating the adequacy of nutritional support in critically ill patients with infection or inflammation, because during inflammation the liver synthesizes acute-phase proteins such as C-reactive protein at the expense of TTR.2,6,7