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.
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.
Aronsson
Anna
A
Department of Chemistry and Biomedical Sciences, University of Kalmar, Kalmar, Sweden.
Al-Ani
N Amer
NA
Brismar
Kerstin
K
Hedström
Margareta
M
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
D004040:Dietary Carbohydrates; D018970:Insulin-Like Growth Factor Binding Protein 1; D010919:Placebos; D007334:Insulin-Like Growth Factor I