title: Effects of preoperative feeding with a whey protein plus carbohydrate drink on the acute phase response and insulin resistance. A randomized trial.
abstract: BACKGROUND
  Prolonged preoperative fasting increases insulin resistance and current evidence recommends carbohydrate (CHO) drinks 2 hours before surgery. Our hypothesis is that the addition of whey protein to a CHO-based drink not only reduces the inflammatory response but also diminish insulin resistance.
  
  
  METHODS
  Seventeen patients scheduled to cholecystectomy or inguinal herniorraphy were randomized and given 474 ml and 237 ml of water (CO group) or a drink containing CHO and milk whey protein (CHO-P group) respectively, 6 and 3 hours before operation. Blood samples were collected before surgery and 24 hours afterwards for biochemical assays. The endpoints of the study were the insulin resistance (IR), the prognostic inflammatory and nutritional index (PINI) and the C-reactive protein (CRP)/albumin ratio. A 5% level for significance was established.
  
  
  RESULTS
  There were no anesthetic or postoperative complications. The post-operative IR was lower in the CHO-P group when compared with the CO group (2.75 ± 0.72 vs 5.74 ± 1.16; p = 0.03). There was no difference between the two groups in relation to the PINI. The CHO-P group showed a decrease in the both CRP elevation and CRP/albumin ratio (p < 0.05). The proportion of patients who showed CRP/albumin ratio considered normal was significantly greater (p < 0.05) in the CHO-P group (87.5%) than in the CO group (33.3%).
  
  
  CONCLUSIONS
  Shortening the pre-operative fasting using CHO and whey protein is safe and reduces insulin resistance and postoperative acute phase response in elective moderate operations.
  
  
  BACKGROUND
  ClinicalTrial.gov NCT01354249.
authors.affiliation: Department of Surgery, Julio Muller University Hospital, Federal University of Mato Grosso, Brazil.
authors.forename: Francine
authors.initials: F
authors.lastname: Perrone
authors.forename: Antônio C
authors.initials: AC
authors.lastname: da-Silva-Filho
authors.forename: Isa F
authors.initials: IF
authors.lastname: Adôrno
authors.forename: Nadia T
authors.initials: NT
authors.lastname: Anabuki
authors.forename: Fernando S
authors.initials: FS
authors.lastname: Leal
authors.forename: Tariane
authors.initials: T
authors.lastname: Colombo
authors.forename: Benedito D
authors.initials: BD
authors.lastname: da Silva
authors.forename: Diana B
authors.initials: DB
authors.lastname: Dock-Nascimento
authors.forename: Aderson
authors.initials: A
authors.lastname: Damião
authors.forename: José E
authors.initials: JE
authors.lastname: de Aguilar-Nascimento
mesh_terms: D000210:Acute-Phase Reaction / Q000188:drug therapy* / Q000473:pathology*; D000328:Adult; D000418:Albumins / Q000008:administration & dosage / Q000032:analysis; D002097:C-Reactive Protein / Q000378:metabolism; D002241:Carbohydrates / Q000008:administration & dosage*; D004311:Double-Blind Method; D005215:Fasting; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D008894:Milk Proteins / Q000008:administration & dosage* / Q000032:analysis; D019990:Perioperative Care; D000067816:Whey Proteins
chemical_list: D000418:Albumins; D002241:Carbohydrates; D008894:Milk Proteins; D000067816:Whey Proteins; D002097:C-Reactive Protein