IngentaConnect Randomized clinical trial of the effect of preoperative oral carb...

Authors: Svanfeldt, M.; Thorell, A.; Hausel, J.; Soop, M.; Rooyackers, O.; Nygren, J.; Ljungqvist, O.

Source: British Journal of Surgery, Volume 94, Number 11, November 2007 , pp. 1342-1350(9)

Abstract:

Background:

Preoperative oral carbohydrate (CHO) reduces postoperative insulin resistance. In this randomized trial, the effect of CHO on postoperative whole-body protein turnover was studied.

Methods:

Glucose and protein kinetics ([6,6²H₂]D-glucose, [²H₅]phenylalanine, [²H₂]tyrosine and [²H₄]tyrosine) and substrate oxidation (indirect calorimetry) were studied at baseline and during hyperinsulinaemic normoglycaemic clamping before and on the first day after colorectal resection. Fifteen patients were randomized to receive a preoperative beverage with high (125 mg/ml) or low (25 mg/ml) CHO content.

Results:

Three patients were excluded after the intervention, leaving six patients in each group. After surgery whole-body protein balance did not change in the high oral CHO group, whereas it was more negative in the low oral CHO group after surgery at baseline (P = 0·003) and during insulin stimulation (P = 0·005). Insulin-stimulated endogenous glucose release was similar before and after surgery in the high oral CHO group, but was higher after surgery in the low oral CHO group (P = 0·013) and compared with the high oral CHO group (P = 0·044).

Conclusion:

Whole-body protein balance and the suppressive effect of insulin on endogenous glucose release are better maintained when patients receive a CHO-rich beverage before surgery. Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Randomized clinical trial of the effect of preoperative oral carbohydrate treatment on postoperative whole-body protein and glucose kinetics