title: Does perioperative nutrition and oral carbohydrate load sustainably preserve muscle mass after bariatric surgery? A randomized control trial.
abstract: BACKGROUND
  Perioperative nutrition and preoperative oral carbohydrate loading (CHL) have a beneficial impact on the outcomes of gastrointestinal oncological surgery. However no data exists on their effect on morbidly obese patients.
  
  
  OBJECTIVE
  Our aim was to establish the short-term and long-term impact of these modalities, notably on metabolically active lean body mass (LBM) - an important factor in maintaining long-term weight loss.
  
  
  METHODS
  Patients undergoing laparoscopic Roux-en-Y gastric bypass were randomized to standard management or intervention: CHL drinks consumed 12 and 2 hours presurgery, and immediate postoperative peripheral parenteral nutrition. The primary outcome measured was LBM, measured by Bioelectrical Impedance Analysis (BIA), one and 12 months postsurgery. Secondary outcomes included excess weight loss (EBWL), 30-day complication rate, and length of stay.
  
  
  RESULTS
  Of the 203 randomized patients, 198 were included in the analysis. All 101 patients in the control group completed the one-year follow up and 76 completed the BIA. In the intervention group, 93 of 97 patients completed the one-year follow-up and 71 completed the BIA. At one and 12 months follow-up, body composition, LBM, or EBWL were comparable. There was no difference in operative outcomes, complications rates, or length of stay. There was no adverse effect in the intervention group.
  
  
  CONCLUSIONS
  In a highly homogeneous group of morbidly obese patients with one-year follow-up, CHL and short-term parenteral nutrition did not lead to significant or sustained LBM preservation or modification in EBWL. There was no significant decrease in complications or length of stay. Our study confirms the safety of these interventions, even in previously unstudied Type 2 diabetic patients.
authors: Both authors have contributed equally to this work; Gastrointestinal & Transplant Surgery Service, Department of Surgery, Geneva University Hospital, Geneva, Switzerland; Stanford University School of Medicine, Department of Surgery, Stanford, California. Electronic address: dazagury@stanford.edu.
authors: D E
authors: DE
authors: Azagury
authors: Both authors have contributed equally to this work; Gastrointestinal & Transplant Surgery Service, Department of Surgery, Geneva University Hospital, Geneva, Switzerland.
authors: F
authors: F
authors: Ris
authors: Nutrition Unit, Department of Medical Specialties, Geneva University Hospital, Geneva, Switzerland.
authors: C
authors: C
authors: Pichard
authors: Gastrointestinal & Transplant Surgery Service, Department of Surgery, Geneva University Hospital, Geneva, Switzerland.
authors: F
authors: F
authors: Volonté
authors: Nutrition Unit, Department of Medical Specialties, Geneva University Hospital, Geneva, Switzerland.
authors: L
authors: L
authors: Karsegard
authors: Gastrointestinal & Transplant Surgery Service, Department of Surgery, Geneva University Hospital, Geneva, Switzerland.
authors: O
authors: O
authors: Huber
mesh_terms: D000284:Administration, Oral; D000328:Adult; D050110:Bariatric Surgery; D015992:Body Mass Index; D002241:Carbohydrates / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal / Q000378:metabolism*; D009752:Nutritional Status; D018529:Nutritional Support / Q000379:methods*; D009767:Obesity, Morbid / Q000178:diet therapy / Q000601:surgery*; D019990:Perioperative Care / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss / Q000502:physiology*
chemical_list: D002241:Carbohydrates
keywords: Bariatric surgery; Carbohydrate load; Muscle mass preservation; Perioperative nutrition; Randomized control trial; Roux-en-Y gastric bypass