Effects of preoperative feeding with a whey protein plus carbohydrate drink on the acute phase response and insulin resistance. A randomized trial

Abstract

BackgroundProlonged preoperative fasting increases insulin resistance and current evidence recommends carbohydrate (CHO) drinks 2 hours before surgery. Our hypothesis is that the addition of whey protein to a CHO-based drink not only reduces the inflammatory response but also diminish insulin resistance.MethodsSeventeen patients scheduled to cholecystectomy or inguinal herniorraphy were randomized and given 474 ml and 237 ml of water (CO group) or a drink containing CHO and milk whey protein (CHO-P group) respectively, 6 and 3 hours before operation. Blood samples were collected before surgery and 24 hours afterwards for biochemical assays. The endpoints of the study were the insulin resistance (IR), the prognostic inflammatory and nutritional index (PINI) and the C-reactive protein (CRP)/albumin ratio. A 5% level for significance was established.ResultsThere were no anesthetic or postoperative complications. The post-operative IR was lower in the CHO-P group when compared with the CO group (2.75 ± 0.72 vs 5.74 ± 1.16; p = 0.03). There was no difference between the two groups in relation to the PINI. The CHO-P group showed a decrease in the both CRP elevation and CRP/albumin ratio (p < 0.05). The proportion of patients who showed CRP/albumin ratio considered normal was significantly greater (p < 0.05) in the CHO-P group (87.5%) than in the CO group (33.3%).ConclusionsShortening the pre-operative fasting using CHO and whey protein is safe and reduces insulin resistance and postoperative acute phase response in elective moderate operations.Trial registrationClinicalTrail.gov NCT01354249

Metabolic Stress Response Attenuate by Oral Glucose Preoperatively in Patient Underwent Major Surgery with General Anesthesia

“…Comparison between first treatment group and control group shown increase of blood glucose level significant higher in control groups than in first treatment group (p=0.041). This is appropriate with the research by Perrone, et al conclude that increase of the blood glucose level lower in sample groups who got oral glucose solution on the night and morning before surgery than placebo groups [6]. This result shown that administration of oral glucose solution preoperatively, especially twice on the night and morning give significant effect on lowering the increase of blood glucose level postoperative.…”

“…Study from Mathur et al in New Zealand, conducted in two groups of patients undergoing elective major abdominal surgery, this study showed the decrease of cortisol level was significantly lower in the group given oral glucose preoperatively on the night and two hours in the morning before induction than the group of patients given placebo on the first postoperative day [6].…”

Carbohydrate loading in the preoperative setting

“…The physiological consequences of intake of carbohydraterich sip drinks up to 2 hours before surgery are an up to 50% reduction in insulin resistance, which in turn shortens hospital stay and reduces postoperative complications; [6,8] lower muscle catabolism; [911] improved intraoperative haemodynamic stability, particularly in children, as a result of more favourable fluid balance status; reduced days to discharge fitness; and superior handgrip strength, a sensitive marker of early muscle protein loss. Perrone et al, [12] in a small study in 2011, showed that the addition of whey protein to a carbohydrate drink further improved insulin sensitivity and reduced acutephase markers compared with carbohydrate alone. In addition, benefits on various aspects of patient comfort (such as thirst and anxiety), cooperation, compliance and overall subjective satisfaction have been reported.…”

Can pre-operative carbohydrate loading be used in diabetic patients undergoing colorectal surgery?

“…17 In contrast, in a randomized study from Brazil of gastrointestinal surgery, the addition of whey protein to the carbohydrate drink appeared to have some added value in terms of reduced inflammatory response and lesser insulin resistance. 18 The benefits of the ERAS approach to colorectal surgery have been confirmed in several reports. 19,20,21 It can extend for a significant period after surgery.…”