title: Preservation of the gut by preoperative carbohydrate loading improves postoperative food intake.
abstract: OBJECTIVE
  A carbohydrate (CHO) drink given preoperatively changes the fasted state into a fed state. The ESPEN guidelines for perioperative care include preoperative CHO loading and re-establishment of oral feeding as early as possible after surgery. An intestinal ischaemia reperfusion (IR) animal model was used to investigate whether preoperative CHO loading increases spontaneous postoperative food intake, intestinal barrier function and the catabolic response.
  
  
  METHODS
  Male Wistar rats (n = 65) were subjected to 16 h fasting with ad libitum water and: A) sham laparotomy (Sham fasted, n = 24); B) intestinal ischaemia (IR fasted, n = 27); and C) intestinal ischaemia with preoperatively access to a CHO drink (IR CHO, n = 14). Spontaneous food intake, intestinal barrier function, insulin sensitivity, intestinal motility and plasma amino acids were measured after surgery.
  
  
  RESULTS
  The IR CHO animals started eating significantly earlier and also ate significantly more than the IR fasted animals. Furthermore, preoperative CHO loading improved the intestinal barrier function, functional enterocyte metabolic mass measured by citrulline and reduced muscle protein catabolism, as indicated by normalization of the biomarker 3-methylhistidine.
  
  
  CONCLUSIONS
  Preoperative CHO loading improves food intake, preserves the GI function and reduces the catabolic response in an IR animal model. These findings suggest that preoperative CHO loading preserves the intestinal function in order to accelerate recovery and food intake. If this effect is caused by overcoming the fasted state or CHO loading remains unclear.
authors.affiliation: Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands. j.luttikhold@vumc.nl
authors.forename: Joanna
authors.initials: J
authors.lastname: Luttikhold
authors.forename: Annemarie
authors.initials: A
authors.lastname: Oosting
authors.forename: Claudia C M
authors.initials: CC
authors.lastname: van den Braak
authors.forename: Klaske
authors.initials: K
authors.lastname: van Norren
authors.forename: Herman
authors.initials: H
authors.lastname: Rijna
authors.forename: Paul A M
authors.initials: PA
authors.lastname: van Leeuwen
authors.forename: Hetty
authors.initials: H
authors.lastname: Bouritius
mesh_terms: D000818:Animals; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose; D002956:Citrulline / Q000097:blood; D004040:Dietary Carbohydrates / Q000008:administration & dosage*; D004435:Eating / Q000502:physiology*; D041981:Gastrointestinal Tract / Q000378:metabolism*; D006706:Homeostasis; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D007413:Intestinal Mucosa / Q000378:metabolism; D007422:Intestines / Q000473:pathology; D008297:Male; D008762:Methylhistidines / Q000097:blood; D023421:Models, Animal; D011184:Postoperative Period; D011300:Preoperative Care / Q000379:methods; D051381:Rats; D017208:Rats, Wistar; D015427:Reperfusion Injury / Q000473:pathology / Q000517:prevention & control
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D004040:Dietary Carbohydrates; D007328:Insulin; D008762:Methylhistidines; D002956:Citrulline; C028118:3-methylhistidine