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Anticatabolic effects of avoiding preoperative fasting by intravenous hypocaloric nutrition: a randomized clinical trial.
Ann Surg. 2008 Dec; 248(6):1051-9.AnnS

Abstract

OBJECTIVE

We tested the hypothesis that the avoidance of preoperative fasting by hypocaloric nutrition attenuates protein catabolism after surgery.

SUMMARY BACKGROUND DATA

Prolonged fasting before major abdominal procedures has been demonstrated to accentuate the catabolic response to surgery.

METHODS

Twenty-two patients undergoing colorectal cancer surgery were randomly assigned to receive glucose and amino acids intravenously starting either 20 hours before the operation or with surgical skin incision. Nutrition was administered until the second postoperative day, with glucose providing 50% and amino acids 20% of each patient's measured resting energy expenditure. Whole body leucine and glucose kinetics were assessed by L-[1-(13)C]leucine and [6,6-(2)H(2)]glucose before and after surgery. Fractional synthesis rates of muscle protein, albumin, and fibrinogen were determined using primed continuous infusions of L-[(2)H(5)]phenylalanine postoperatively, whereas the expression of mRNA of proteolytic genes in muscle (Mafbx/atrogin-1, ubiquitin, Murf 1) was determined by quantitative RT-PCR. Circulating concentrations of glucose, lactate, amino acids, insulin, glucagon, and cortisol were also measured. This study has been registered at ClinicalTrials.gov (Identifier: NCT00614133).

RESULTS

Preoperative feeding inhibited endogenous protein breakdown (fasting group: 128 +/- 23 micromol . kg(-1) . h(-1); nutrition group: 96 +/- 22 micromol . kg(-1) . h(-1); P = 0.02) and blunted the increase in amino acid oxidation (fasting group: 27 +/- 5 micromol . kg(-1) . h(-1); nutrition group: 20 +/- 5 micromol . kg(-1) . h(-1); P = 0.03), resulting in positive whole-body protein balance after surgery (fasting group: -10 +/- 4 micromol . kg(-1) . h(-1); nutrition group: 1 +/- 3 micromol . kg(-1) . h(-1); P < 0.001). This anabolic response was associated with decreased muscle proteolytic gene expression and increased hepatic albumin synthesis. Total plasma protein, fibrinogen, and muscle protein synthesis were not affected.

CONCLUSIONS

Hypocaloric nutrition decreases protein catabolism, with a contribution from the ubiquitin pathway in muscle, and stimulates albumin synthesis after colorectal surgery if initiated 1 day before the operation.

Authors+Show Affiliations

Department of Anesthesia, McGill University, Royal Victoria Hospital, Montreal, Quebec, Canada. thomas.schricker@mcgill.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

19092350

Citation

Schricker, Thomas, et al. "Anticatabolic Effects of Avoiding Preoperative Fasting By Intravenous Hypocaloric Nutrition: a Randomized Clinical Trial." Annals of Surgery, vol. 248, no. 6, 2008, pp. 1051-9.
Schricker T, Meterissian S, Lattermann R, et al. Anticatabolic effects of avoiding preoperative fasting by intravenous hypocaloric nutrition: a randomized clinical trial. Ann Surg. 2008;248(6):1051-9.
Schricker, T., Meterissian, S., Lattermann, R., Adegoke, O. A., Marliss, E. B., Mazza, L., Eberhart, L., Carli, F., Nitschman, E., & Wykes, L. (2008). Anticatabolic effects of avoiding preoperative fasting by intravenous hypocaloric nutrition: a randomized clinical trial. Annals of Surgery, 248(6), 1051-9. https://doi.org/10.1097/SLA.0b013e31818842d8
Schricker T, et al. Anticatabolic Effects of Avoiding Preoperative Fasting By Intravenous Hypocaloric Nutrition: a Randomized Clinical Trial. Ann Surg. 2008;248(6):1051-9. PubMed PMID: 19092350.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Anticatabolic effects of avoiding preoperative fasting by intravenous hypocaloric nutrition: a randomized clinical trial. AU - Schricker,Thomas, AU - Meterissian,Sarkis, AU - Lattermann,Ralph, AU - Adegoke,Olasunkamni A J, AU - Marliss,Errol B, AU - Mazza,Louise, AU - Eberhart,Leopold, AU - Carli,Franco, AU - Nitschman,Evan, AU - Wykes,Linda, PY - 2008/12/19/entrez PY - 2008/12/19/pubmed PY - 2009/1/14/medline SP - 1051 EP - 9 JF - Annals of surgery JO - Ann Surg VL - 248 IS - 6 N2 - OBJECTIVE: We tested the hypothesis that the avoidance of preoperative fasting by hypocaloric nutrition attenuates protein catabolism after surgery. SUMMARY BACKGROUND DATA: Prolonged fasting before major abdominal procedures has been demonstrated to accentuate the catabolic response to surgery. METHODS: Twenty-two patients undergoing colorectal cancer surgery were randomly assigned to receive glucose and amino acids intravenously starting either 20 hours before the operation or with surgical skin incision. Nutrition was administered until the second postoperative day, with glucose providing 50% and amino acids 20% of each patient's measured resting energy expenditure. Whole body leucine and glucose kinetics were assessed by L-[1-(13)C]leucine and [6,6-(2)H(2)]glucose before and after surgery. Fractional synthesis rates of muscle protein, albumin, and fibrinogen were determined using primed continuous infusions of L-[(2)H(5)]phenylalanine postoperatively, whereas the expression of mRNA of proteolytic genes in muscle (Mafbx/atrogin-1, ubiquitin, Murf 1) was determined by quantitative RT-PCR. Circulating concentrations of glucose, lactate, amino acids, insulin, glucagon, and cortisol were also measured. This study has been registered at ClinicalTrials.gov (Identifier: NCT00614133). RESULTS: Preoperative feeding inhibited endogenous protein breakdown (fasting group: 128 +/- 23 micromol . kg(-1) . h(-1); nutrition group: 96 +/- 22 micromol . kg(-1) . h(-1); P = 0.02) and blunted the increase in amino acid oxidation (fasting group: 27 +/- 5 micromol . kg(-1) . h(-1); nutrition group: 20 +/- 5 micromol . kg(-1) . h(-1); P = 0.03), resulting in positive whole-body protein balance after surgery (fasting group: -10 +/- 4 micromol . kg(-1) . h(-1); nutrition group: 1 +/- 3 micromol . kg(-1) . h(-1); P < 0.001). This anabolic response was associated with decreased muscle proteolytic gene expression and increased hepatic albumin synthesis. Total plasma protein, fibrinogen, and muscle protein synthesis were not affected. CONCLUSIONS: Hypocaloric nutrition decreases protein catabolism, with a contribution from the ubiquitin pathway in muscle, and stimulates albumin synthesis after colorectal surgery if initiated 1 day before the operation. SN - 1528-1140 UR - https://www.unboundmedicine.com/medline/citation/19092350/Anticatabolic_effects_of_avoiding_preoperative_fasting_by_intravenous_hypocaloric_nutrition:_a_randomized_clinical_trial_ L2 - https://Insights.ovid.com/pubmed?pmid=19092350 DB - PRIME DP - Unbound Medicine ER -