title: [Effect of intensive insulin therapy on resting energy expenditure in postoperative patients underwent radical distal gastrectomy].
abstract: OBJECTIVE
  To investigate the effect of intensive insulin therapy on resting energy expenditure in postoperative patients underwent radical distal gastrectomy.
  
  
  METHODS
  Sixty-four patients with gastric neoplasms in the middle or lower part of stomach from January to October 2010 were enrolled and underwent radical distal gastrectomy, then were randomized to intensive insulin therapy (IIT) group to keep glucose levels from 4.4 to 6.1 mmol/L or conventional insulin therapy (CIT) group to keep levels from 4.4 to 10.0 mmol/L. Resting energy expenditure (REE), respiratory quotient (RQ), resting energy expenditure per kilogram (REE/kg) and lipid oxidation ratio (LOR) were monitored by indirect energy metabolic system on preoperative and postoperative 1(st), 3(rd) and 7(th) day. Fasting blood glucose and insulin concentration were measured for HOMA-IR assessment.
  
  
  RESULTS
  Compared with preoperative baseline, postoperative REE, REE/kg, LOR, Ln-HOMA-IR increased dramatically (P < 0.05, respectively). RQ decreased markedly (P < 0.05). Compared with group CIT, IIT reduced the REE/kg level [(27.2 ± 1.3) kcal/kg vs. (30.0 ± 1.5) kcal/kg, P = 0.008; (24.7 ± 1.4) vs. (25.7 ± 1.6) kcal/kg, P = 0.013]; and decreased the Ln-HOMA-IR score (P = 0.019 and 0.028) on postoperative 1(st) and 3(rd) day; IIT could decrease obviously the level of C-reaction protein level on postoperative 1(st) and 3(rd) day (P = 0.017, 0.006). The total protein and albumin concentration in IIT group were more than its levels in group CIT (P = 0.023, 0.009).
  
  
  CONCLUSIONS
  There are some benefits of IIT in reducing mean energy expenditure and the consumption of proteins, decreasing postoperative insulin resistance level in this small population underwent radical distal gastrectomy.
authors.affiliation: Department of General Surgery, the Affiliated Hospital of Medical College Qingdao University, Qingdao 266003, China.
authors.forename: Han-cheng
authors.initials: HC
authors.lastname: Liu
authors.forename: Yan-bing
authors.initials: YB
authors.lastname: Zhou
authors.forename: Dong
authors.initials: D
authors.lastname: Chen
authors.forename: Zhao-jian
authors.initials: ZJ
authors.lastname: Niu
authors.forename: Yang
authors.initials: Y
authors.lastname: Yu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004734:Energy Metabolism; D005260:Female; D005743:Gastrectomy; D006801:Humans; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D013274:Stomach Neoplasms / Q000378:metabolism* / Q000601:surgery; D055815:Young Adult
chemical_list: D007328:Insulin