Postoperative inflammation and insulin resistance in relation to body composition, adiposity and carbohydrate treatment: A randomised controlled study

Abstract

The reduction in insulin sensitivity associated with major abdominal surgery was confirmed but there were no differences associated with preoperative carbohydrates or obesity.

Prolonged preoperative fasting induces postoperative insulin resistance by ER-stress mediated Glut4 down-regulation in skeletal muscles

“…In the fasting group, the blood glucose level was significantly elevated at 24 h post cecectomy. The postoperative hyperglycemia was associated with significantly higher serum concentrations of insulin and C-peptide, which is consistent with the development of postoperative insulin-resistance in patients receiving major abdominal surgery 18 , 19 . We also analyzed the serum markers of muscle enzymes, histological changes and aldolase activity in the soleus muscle to characterize skeletal muscle injury or muscle wasting after cecectomy, as postoperative muscle loss significantly impacts morbidity and mortality in patients undertaking major open abdominal surgery 20 .…”

“…Clinical observational studies have demonstrated that prolonged fasting during the perioperative period leads to the development of insulin-resistant hyperglycemia and systemic skeletal muscle wasting after major operations 18 . However, the underlying mechanism of this surgery-related catabolic reaction remains undetermined.…”

Pre‐operative fasting in adults and children: clinical practice and guidelines

“…Overall, the clinical significance of carbohydrate loading on length of stay has been questioned. Moreover, these reductions in length of stay may not necessarily be attributable to carbohydrate loading alone, as other improvements in patient care, such as strategies to reduce fasting times and the surgical stress response , may also contribute to reduced length of stay.…”

Nutritional science: Diet, lifestyle and health

“…, ) and the demonstration of a 50% reduction in insulin sensitivity alongside an increase in inflammatory cytokine (predominantly CRP) 24 hours after major, open gastrointestinal surgery (Tewari et al . ).…”

“…, identification of the impact of increased myosteatosis and sarcopenia on outcomes for patients with inoperable pancreatic cancer, development of validated protocols for the use of computed tomography to document sarcopenia in surgical patients (Rollins et al 2015(Rollins et al , 2017 and the demonstration of a 50% reduction in insulin sensitivity alongside an increase in inflammatory cytokine (predominantly CRP) 24 hours after major, open gastrointestinal surgery (Tewari et al 2019).…”