title: A randomized placebo controlled trial of preoperative carbohydrate drinks and early postoperative nutritional supplement drinks in colorectal surgery.
abstract: OBJECTIVE
  There is evidence that preoperative carbohydrate drinks and postoperative nutritional supplements improve the outcome of colorectal surgery. There is little information on their individual contribution.
  
  
  METHODS
  A prospective four-arm double-blind controlled trial was carried out in which patients were randomized to carbohydrate or placebo drinks preoperatively and a polymeric supplement or placebo drink postoperatively. The primary outcome was insulin resistance (using the short insulin tolerance test and HOMA-IR). Secondary outcomes included handgrip strength, pulmonary function, intestinal permeability and postoperative complications.
  
  
  RESULTS
  A total of 120 patients were randomized to four demographically well matched groups. Patients who received preoperative and postoperative supplements had better glucose homeostasis (P = 0.004), peak expiratory flow rate (P = 0.035), handgrip strength (P = 0.002) and less insulin resistance (P = 0.001) compared with those who only received placebo drinks.
  
  
  CONCLUSIONS
  Oral nutritional supplements given preoperatively and postoperatively improve postoperative handgrip strength, pulmonary function and insulin resistance. A weaker effect was seen in patients who received supplements either preoperatively or postoperatively. Oral nutritional supplements should be given both preoperatively and postoperatively.
authors: Department of Surgery, Derriford Hospital, Plymouth, UK.
authors: P
authors: P
authors: Lidder
authors: S
authors: S
authors: Thomas
authors: S
authors: S
authors: Fleming
authors: K
authors: K
authors: Hosie
authors: S
authors: S
authors: Shaw
authors: S
authors: S
authors: Lewis
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D001628:Beverages; D001786:Blood Glucose; D003082:Colectomy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000601:surgery*; D004040:Dietary Carbohydrates / Q000627:therapeutic use*; D019587:Dietary Supplements; D004311:Double-Blind Method; D005260:Female; D018737:Hand Strength; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D007421:Intestine, Small / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods*; D010539:Permeability; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods; D012129:Respiratory Function Tests; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D004040:Dietary Carbohydrates; D007328:Insulin