Preoperative oral carbohydrate treatment attenuates endogenous glucose release 3 days after surgery

• Published in: Clinical nutrition (Edinburgh, Scotland) Scotland), 2004-08, Vol.23 (4), p.733-741
• Main Authors: Soop, Mattias, Nygren, Jonas, Thorell, Anders, Weidenhielm, Lars, Lundberg, Mari, Hammarqvist, Folke, Ljungqvist, Olle
• Format: Article
• Language: English
• Subjects: Administration; Administration, Oral; Aged; Analysis of Variance; Arthroplasty; Arthroplasty, Replacement, Hip; Biological and medical sciences; Blood Glucose - metabolism; Calorimetry; Calorimetry, Indirect; Carbohydrate; Carbohydrates - administration & dosage; Carbohydrates - therapeutic use; Carbohydrates/administration & dosage/therapeutic use; Double-Blind Method; Energy Metabolism - drug effects; Energy Metabolism - physiology; Energy Metabolism/drug effects/physiology; Female; Glucose Clamp Technique; Glucose metabolism; Hip; Humans; Indirect; Insulin Resistance; Kirurgi; Male; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Nitrogen - metabolism; Oral; Orthopedic surgery; Postoperative Period; Preoperative Care; Replacement; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Time Factors
• ISSN: 0261-5614; 1532-1983; 1532-1983
• DOI: 10.1016/j.clnu.2003.12.007

Background & aims: Postoperative metabolism is characterised by insulin resistance and a negative whole-body nitrogen balance. Preoperative carbohydrate treatment reduces insulin resistance in the first day after surgery. We hypothesised that preoperative oral carbohydrate treatment attenuates insulin resistance and improves whole-body nitrogen balance 3 days after surgery. Methods: Fourteen patients undergoing total hip replacement were double-blindly randomised to preoperative oral carbohydrate treatment (12.5%, 800+400 ml, n=8) or placebo ( n=6). Glucose kinetics (6,6-D 2-glucose), substrate utilisation (indirect calorimetry) and insulin sensitivity (hyperinsulinaemic-euglycaemic clamp) were measured preoperatively and on the third day after surgery. Nitrogen losses were monitored for 3 days after surgery. Values are mean (SEM). Analysis of variance (ANOVA) statistics were used. Results: Endogenous glucose release during insulin infusion increased after surgery in the placebo group. Preoperative carbohydrate treatment, as compared to placebo, significantly attenuated postoperative endogenous glucose release (0.69 (0.07) vs. 1.21 (0.13) mg kg −1·min −1, P