title: Short-Term Preoperative Calorie and Protein Restriction Is Feasible in Healthy Kidney Donors and Morbidly Obese Patients Scheduled for Surgery.
abstract: BACKGROUND
  Surgery-induced oxidative stress increases the risk of perioperative complications and delay in postoperative recovery. In mice, short-term preoperative dietary and protein restriction protect against oxidative stress. We investigated the feasibility of a calorie- and protein-restricted diet in two patient populations.
  
  
  METHODS
  In this pilot study, 30 live kidney donors and 38 morbidly obese patients awaiting surgery were randomized into three groups: a restricted diet group, who received a synthetic liquid diet with 30% fewer calories and 80% less protein for five consecutive days; a group who received a synthetic diet containing the daily energy requirements (DER); and a control group. Feasibility was assessed using self-reported discomfort, body weight changes, and metabolic parameters in blood samples.
  
  
  RESULTS
  Twenty patients (71%) complied with the restricted and 13 (65%) with the DER-diet. In total, 68% of the patients reported minor discomfort that resolved after normal eating resumed. The mean weight loss on the restricted diet was significantly greater (2.4 kg) than in the control group (0 kg, p = 0.002), but not in the DER-diet (1.5 kg). The restricted diet significantly reduced levels of serum urea and plasma prealbumin (PAB) and retinol binding protein (RBP).
  
  
  CONCLUSIONS
  A short-term preoperative calorie- and protein-restricted diet is feasible in kidney donors and morbidly obese patients. Compliance is high and can be objectively measured via changes in urea, PAB, and RBP levels. These results demonstrate that this diet can be used to study the effects of dietary restriction on surgery-induced oxidative stress in a clinical setting.
authors.affiliation: Laboratory of Experimental Transplantation and Intestinal Surgery (LETIS), Erasmus University Medical Center, Department of Surgery, Wytemaweg 80, 3015 CN Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. f.jongbloed@erasmusmc.nl.|Laboratory of Health Protection Research, National Institute of Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands. f.jongbloed@erasmusmc.nl.
authors.forename: Franny
authors.initials: F
authors.lastname: Jongbloed
authors.affiliation: Laboratory of Experimental Transplantation and Intestinal Surgery (LETIS), Erasmus University Medical Center, Department of Surgery, Wytemaweg 80, 3015 CN Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. r.w.f.debruin@erasmusmc.nl.
authors.forename: Ron W F
authors.initials: RW
authors.lastname: de Bruin
authors.affiliation: Department of Surgery, Maasstad Hospital, 3000 CA Rotterdam, The Netherlands. klaassenr@maasstadziekenhuis.nl.
authors.forename: René A
authors.initials: RA
authors.lastname: Klaassen
authors.affiliation: Laboratory of Health Protection Research, National Institute of Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands. piet.beekhof@rivm.nl.
authors.forename: Piet
authors.initials: P
authors.lastname: Beekhof
authors.affiliation: Laboratory of Health Protection Research, National Institute of Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands. harry.van.steeg@rivm.nl.|Department of Toxicogenetics, Leiden University Medical Center, Einthovenweg 20, 2333 ZC Leiden, The Netherlands. harry.van.steeg@rivm.nl.
authors.forename: Harry
authors.initials: H
authors.lastname: van Steeg
authors.affiliation: Laboratory of Experimental Transplantation and Intestinal Surgery (LETIS), Erasmus University Medical Center, Department of Surgery, Wytemaweg 80, 3015 CN Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. frank.dor@imperial.nhs.uk.
authors.forename: Frank J M F
authors.initials: FJ
authors.lastname: Dor
authors.affiliation: Department of Surgery, Maasstad Hospital, 3000 CA Rotterdam, The Netherlands. harste@maasstadziekenhuis.nl.
authors.forename: Erwin
authors.initials: E
authors.lastname: van der Harst
authors.affiliation: Laboratory of Health Protection Research, National Institute of Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands. martijn.dolle@rivm.nl.
authors.forename: Martijn E T
authors.initials: ME
authors.lastname: Dollé
authors.affiliation: Laboratory of Experimental Transplantation and Intestinal Surgery (LETIS), Erasmus University Medical Center, Department of Surgery, Wytemaweg 80, 3015 CN Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. j.ijzermans@erasmusmc.nl.
authors.forename: Jan N M
authors.initials: JN
authors.lastname: IJzermans
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects / Q000379:methods*; D015415:Biomarkers / Q000097:blood; D031204:Caloric Restriction / Q000009:adverse effects; D018753:Diet, Protein-Restricted / Q000009:adverse effects; D005240:Feasibility Studies; D005260:Female; D006304:Health Status; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods*; D010535:Laparoscopy / Q000009:adverse effects; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D009426:Netherlands; D009767:Obesity, Morbid / Q000175:diagnosis / Q000601:surgery*; D018384:Oxidative Stress; D010349:Patient Compliance; D010865:Pilot Projects; D011228:Prealbumin / Q000378:metabolism; D011300:Preoperative Care / Q000009:adverse effects / Q000379:methods*; D011446:Prospective Studies; D054839:Retinol-Binding Proteins, Plasma / Q000378:metabolism; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D011228:Prealbumin; D054839:Retinol-Binding Proteins, Plasma
keywords: compliance; dietary restriction; feasibility; preoperative diet; protein restriction