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Evaluation of the Effects of a Preoperative 2‐Hour Fast With Maltodextrine and Glutamine on Insulin Resistance, Acute‐Phase Response, Nitrogen Balance, and Serum Glutathione After Laparoscopic Cholecystectomy
Author(s) -
DockNascimento Diana Borges,
AguilarNascimento Jose Eduardo,
Magalhaes Faria Marcelo Sepulveda,
Caporossi Cervantes,
Slhessarenko Natasha,
Waitzberg Dan Linetzky
Publication year - 2012
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1177/0148607111422719
Subject(s) - placebo , glutamine , medicine , insulin resistance , insulin , nitrogen balance , glutathione , gastroenterology , preoperative fasting , endocrinology , anesthesia , surgery , chemistry , perioperative , biochemistry , amino acid , alternative medicine , organic chemistry , pathology , nitrogen , enzyme
Background : Prolonged preoperative fasting increases insulin resistance (IR). The authors investigated whether an abbreviated preoperative fast with glutamine (GLN) plus a carbohydrate (CHO)–based beverage would improve the organic response after surgery. Methods : Forty‐eight female patients (19‐62 years) were randomized to either standard fasting (control group) or to fasting with 1 of 3 different beverages before video‐cholecystectomy. Beverages were consumed 8 hours (400 mL; placebo group: water; GLN group: water with 50 g maltodextrine plus 40 g GLN; and CHO group: water with 50 g maltodextrine) and 2 hours (200 mL; placebo: water; GLN: water with 25 g maltodextrine plus 10 g GLN; and CHO: water with 25 g maltodextrine) before anesthesia. Blood samples were collected pre‐ and postoperatively. Results : The mean (SEM) postoperative homeostasis model assessment–insulin resistance was greater ( P < .05) in control patients (4.3 [1.3]) than in the other groups (placebo, 1.6 [0.3]; CHO, 2.3 [0.4]; and GLN, 1.5 [0.1]). Glutathione was significantly higher ( P < .01) in the GLN group than in both CHO and control groups. Interleukin‐6 increased in all groups except the GLN group. The C‐reactive protein/albumin ratio was higher ( P < .05) in controls than in CHO and GLN groups. The nitrogen balance was less negative in GLN (–2.5 [0.8] gN) than in both placebo (–9.0 [2] gN; P = .001) and control (–6.6 [0.4] gN; P = .04) groups. Conclusions : Preoperative intake of a GLN‐enriched CHO beverage appears to improve IR and antioxidant defenses and decreases the inflammatory response after video‐cholecystectomy.