Nutritional modulation of protein metabolism after gastrointestinal surgery

Abstract

Background: The metabolic response to surgery includes alterations in protein metabolism, resulting in a net loss of proteins. Protein hypercatabolism is considered an unavoidable consequence of injury, and an important source of morbidity and mortality. Our purpose was to determine the effect of nutrition on protein metabolism following gastrointestinal surgery, and to elucidate whether postoperative protein loss can be prevented with adequate nutritional support. Methods: Patients who had undergone gastrointestinal surgery were given four different parenteral nutritions with increasing glucose, lipid and amino acid content during the 7 days following surgery. Nitrogen balance, protein synthesis and protein breakdown were determined using in vivo stable isotope labelling. Other metabolites (3-methylhistidine, creatinine, urea, cortisol, glucose, insulin, amino acids and C-reactive protein) were measured. Results: A nutrition-dependent alteration of protein metabolism was found in response to surgical injury. Nutrition modified nitrogen balance, whole-body protein breakdown and, to a lesser extent, whole-body protein synthesis and muscle protein breakdown. The low-energy parenteral nutrition without amino acids produced a negative nitrogen balance (postoperative day 7 ¼ À0.381 g protein kg À1 day À1 ) and important alterations in postoperative protein metabolism that did not normalize during the study period (day 7 protein synthesis ¼ 239% and protein breakdown 217% vs preoperative). Patients receiving the two low energy parenteral nutritions containing amino acids had a less negative nitrogen balance (day 7 ¼ À0.011 and À0.133 g protein kg À1 day À1 ) and a transient increase in protein metabolism. The complete parenteral nutrition maintained, during all studied days, protein metabolism parameters within the preoperative reference range (synthesis day 2 ¼ 92%, day 4 ¼ 110% day 7 ¼ 79%; breakdown day 2 ¼ 85%, day 4 ¼ 80%, day 7 ¼ 76% vs preoperative) and a positive nitrogen balance (day 2 ¼ þ 0.0387, day 4 ¼ þ 0.578 and day 7 ¼ þ 0.227 g protein kg À1 day À1 ). Conclusion: Complete nutritional support can prevent protein loss after gastrointestinal surgery and maintain protein metabolism without alterations.

Estimation of Protein Requirements According to Nitrogen Balance for Older Hospitalized Adults with Pressure Ulcers According to Wound Severity in Japan

“…The concentration of 3MeH was measured using high‐performance liquid chromatography according to the laboratory's protocol (SRL Inc.) on the second day of a 3‐day urine collection. Urinary excretion of 3MeH were normalized according to creatinine excretion (3MeH/Cr) to standardize differences in muscle mass …”

Metabolic Effects of Intraoperative Amino Acid Infusion in Mongrel Dogs

“…Mikwra et al [34] found that excretion of urinary nitrogen and 3-methylhistidine was significantly reduced during glucose infusion, even at a relatively low rate. Lòpez Hellín et al [35] designed four different parenteral nutritions with increasing glucose, lipid, and amino acid contents during the 7 days following a gastrointestinal operation and found that the higher amino acid content is, the lower the urinary 3-methylhistidine output after the operation is.…”

Risk and predictive factors of hypoalbuminemia in cancer patients following extensive abdominal surgery despite total parenteral nutritional support

“…Furthermore, the extent of surgical intervention often required for radical tumour resection encompasses substantial trauma (Duda et al 2003;Hildebrandt et al 2003;Ló pez Hellín et al 2008), the magnitude of which is proximally correlated with the degree of total serum protein depletion (Tashiro et al 1996;Gibbs et al 1999;Pessaux et al 2003). In addition, intra-operative blood volume loss may compound SA level reduction (Sun et al 2009).…”