title: A carbohydrate-rich drink shortly before surgery affected IGF-I bioavailability after a total hip replacement. A double-blind placebo controlled study on 29 patients.
abstract: OBJECTIVE
  In response to surgical stress, the body reacts with a change in metabolism to a catabolic state. This is further aggravated by the fasting state preoperatively. We aimed to determine the effects on catabolism i.e., body composition and IGF-I bioavailability as measured by the serum IGF-I/IGFBP-1 ratio, of a carbohydrate rich drink given shortly before surgery.
  
  
  METHODS
  Twenty-nine patients scheduled for a total hip replacement (THR) were randomized in a double-blind placebo-controlled pilot study to a carbohydrate-rich drink or to placebo pre-operatively. The nutritional supplementation consisted of an iso-osmolar carbohydrate-rich drink (12.5 g carbohydrates/100 ml, pH 5.0). Fasting blood samples were collected before surgery and repeated after 5 days and after 2 months. IGF-I and IGFBP-1 were determined in serum by RIA. Body composition was determined by dual energy X-ray absorptiometry (DXA).
  
  
  RESULTS
  Compared with placebo we found a relative increase in IGF-I bioavailability post-operatively after a carbohydrate-rich drink given shortly before surgery. There were no significant longterm differences in the changes in fat or lean body mass between groups, but, in a subgroup with late scheduled surgery, there was a tendency to a difference (p=0.08) of fat loss after 2 months, with less fat loss in those who received another carbohydrate drink close to surgery. The pre-operative intake of a 200-200 x 2 ml carbohydrate drink was well tolerated and safe. There were no adverse events such as pulmonary aspiration before, during or after operation.
  
  
  CONCLUSIONS
  A carbohydrate- rich drink given shortly before surgery increases IGF-I bioavailability post-operatively in patients undergoing a THR, but has no significant effects on body composition after 2 months in physically active people. We suggest that, if the operation is postponed for more than four hours on the same day, an additional carbohydrate drink should be given.
authors.affiliation: Department of Chemistry and Biomedical Sciences, University of Kalmar, Kalmar, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Aronsson
authors.forename: N Amer
authors.initials: NA
authors.lastname: Al-Ani
authors.forename: Kerstin
authors.initials: K
authors.lastname: Brismar
authors.forename: Margareta
authors.initials: M
authors.lastname: Hedström
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D001823:Body Composition; D004040:Dietary Carbohydrates / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D018970:Insulin-Like Growth Factor Binding Protein 1 / Q000097:blood; D007334:Insulin-Like Growth Factor I / Q000378:metabolism*; D008297:Male; D010919:Placebos; D011183:Postoperative Complications / Q000178:diet therapy* / Q000378:metabolism* / Q000517:prevention & control; D011300:Preoperative Care; D013312:Stress, Physiological / Q000502:physiology
chemical_list: D004040:Dietary Carbohydrates; D018970:Insulin-Like Growth Factor Binding Protein 1; D010919:Placebos; D007334:Insulin-Like Growth Factor I