title: Effects of preoperative oral carbohydrate supplementation on postoperative metabolic stress response of patients undergoing elective abdominal surgery.
abstract: BACKGROUND
  The goal of the present study was to evaluate the effects of preoperative oral carbohydrate supplementation (OCH) on the postoperative metabolic stress response of patients undergoing elective abdominal surgery.
  
  
  METHODS
  The study was designed as a controlled, prospective, cohort study including 38 patients treated with OCH (800 mL the day before surgery and 400 mL within 3 h before the induction of anesthesia) and 38 controls matched for surgical procedure. Fasting glucose, insulin, insulin resistance (HOMA-IR index), cortisol, and interleukin 6 (IL-6) were assessed before and after surgery (postoperative day (POD) 1, 2, and 3).
  
  
  RESULTS
  The administration of OCH resulted in lower fasting glucose, HOMA-IR index, cortisol, and IL-6 on both POD 1 and POD 2. At multivariable regression analyses, the reduction of these parameters was independent of sex, age, body mass index, and major abdominal surgery. Particularly, models including OCH treatment explained 70, 63, and 66 % of the variance of the increase in IL-6 levels at POD 1, POD 2, and POD 3, respectively. The effect of OCH on changes in glucose, insulin resistance, and cortisol on POD 1 and POD 2 disappeared after the inclusion of IL-6 in the models.
  
  
  CONCLUSIONS
  Treatment with OCH was associated with attenuation of the postoperative metabolic stress response. We hypothesize that modulation of the inflammatory response is one of the mechanisms involved.
authors.affiliation: Department of Surgical Sciences and Institute of Hepatopancreatic Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
authors.forename: Jacopo
authors.initials: J
authors.lastname: Viganò
authors.forename: Emanuele
authors.initials: E
authors.lastname: Cereda
authors.forename: Riccardo
authors.initials: R
authors.lastname: Caccialanza
authors.forename: Roberta
authors.initials: R
authors.lastname: Carini
authors.forename: Barbara
authors.initials: B
authors.lastname: Cameletti
authors.forename: Marcello
authors.initials: M
authors.lastname: Spampinato
authors.forename: Paolo
authors.initials: P
authors.lastname: Dionigi
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000284:Administration, Oral; D015415:Biomarkers / Q000378:metabolism; D001786:Blood Glucose / Q000378:metabolism; D002241:Carbohydrates / Q000008:administration & dosage*; D016022:Case-Control Studies; D017558:Elective Surgical Procedures; D005215:Fasting / Q000378:metabolism; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D007249:Inflammation / Q000378:metabolism; D007328:Insulin / Q000378:metabolism; D007333:Insulin Resistance / Q000502:physiology*; D015850:Interleukin-6 / Q000378:metabolism; D010535:Laparoscopy; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000378:metabolism / Q000517:prevention & control; D011184:Postoperative Period; D011300:Preoperative Care; D011446:Prospective Studies; D018709:Statistics, Nonparametric
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D002241:Carbohydrates; D007328:Insulin; D015850:Interleukin-6; D006854:Hydrocortisone