Randomized clinical trial of the effect of preoperative oral carbohydrate treatment on postoperative whole-body protein and glucose kinetics.
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 ([6,6(2)H(2)]D-glucose, [(2)H(5)]phenylalanine, [(2)H(2)]tyrosine and [(2)H(4)]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).


CONCLUSIONS
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.
Svanfeldt
M
M
Division of Surgery, Karolinska Institute, Karolinska University Hospital Huddinge, Sweden. monika.svanfeldt@karolinska.se
Thorell
A
A
Hausel
J
J
Soop
M
M
Rooyackers
O
O
Nygren
J
J
Ljungqvist
O
O
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002151:Calorimetry; D002241:Carbohydrates / Q000008:administration & dosage / Q000494:pharmacology*; D003108:Colonic Diseases / Q000601:surgery; D005260:Female; D005947:Glucose / Q000008:administration & dosage / Q000493:pharmacokinetics*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010649:Phenylalanine / Q000008:administration & dosage / Q000493:pharmacokinetics*; D011184:Postoperative Period; D011300:Preoperative Care; D012002:Rectal Diseases / Q000601:surgery; D014443:Tyrosine / Q000008:administration & dosage / Q000493:pharmacokinetics*
D002241:Carbohydrates; D014443:Tyrosine; D010649:Phenylalanine; D005947:Glucose