Document Detail

Postoperative parenteral nutrition while proactively minimizing insulin resistance.
MedLine Citation:
PMID:  16473497     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: We compared the metabolic effects of postoperative total parenteral nutrition (TPN) and hypocaloric glucose after treatment with oral carbohydrates preoperatively and epidural anesthesia to proactively minimize postoperative insulin resistance. METHODS: Thirteen patients undergoing colorectal resections were given oral carbohydrates preoperatively and epidural anesthesia and randomized to TPN or hypocaloric glucose during and after surgery. Insulin sensitivity (hyperinsulinemic clamp [0.8 mU x kg(-1) x min(-1)], normoglycemic clamps [4.5 mM]), and glucose kinetics (6,6(2)H2-D-glucose), were studied before and on postoperative day 3. Indirect calorimetry was performed and nitrogen excretion in urine was measured. Values are presented as mean +/- standard deviation. Analysis of variance, planned comparison, and Bonferroni's correction were used for statistical analysis. RESULTS: Three days after surgery insulin-stimulated whole-body glucose disposal decreased by 24 +/- 11% versus 28 +/- 23% in patients receiving TPN and hypocaloric glucose, respectively (P < 0.05 for both, not significant between groups). Endogenous glucose production during insulin stimulation was increased only in the glucose group after surgery (P < 0.05 versus before). After surgery, insulin-stimulated glucose oxidation was higher after treatment with TPN, whereas fat oxidation was lower (P < 0.05 for both versus glucose treatment). Fat oxidation increased in the glucose group at basal after surgery (P < 0.05 versus before). Nitrogen balance was less negative after treatment with TPN (P < 0.01). CONCLUSIONS: Treatment with TPN does not seem to improve postoperative peripheral insulin sensitivity in patients with minor insulin resistance after pretreatment with preoperative carbohydrates and perioperative epidural anesthesia. Hypocaloric nutrition results in changes in substrate utilization and nitrogen balance resembling starvation, whereas TPN attenuates these changes.
Monika Svanfeldt; Anders Thorell; Jonas Nygren; Olle Ljungqvist
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2006-02-13
Journal Detail:
Title:  Nutrition (Burbank, Los Angeles County, Calif.)     Volume:  22     ISSN:  0899-9007     ISO Abbreviation:  Nutrition     Publication Date:  2006 May 
Date Detail:
Created Date:  2006-04-07     Completed Date:  2006-09-05     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8802712     Medline TA:  Nutrition     Country:  United States    
Other Details:
Languages:  eng     Pagination:  457-64     Citation Subset:  IM    
Division of Surgery, Department for Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
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MeSH Terms
Analysis of Variance
Anesthesia, Epidural
Blood Glucose / metabolism
Calorimetry, Indirect
Colorectal Neoplasms / surgery*,  therapy
Dietary Carbohydrates / administration & dosage*,  therapeutic use
Energy Metabolism / drug effects*,  physiology
Glucose / pharmacokinetics*
Glucose Clamp Technique
Insulin Resistance*
Middle Aged
Nitrogen / urine
Parenteral Nutrition, Total / methods*
Postoperative Care / methods
Postoperative Complications / prevention & control
Time Factors
Reg. No./Substance:
0/Blood Glucose; 0/Dietary Carbohydrates; 50-99-7/Glucose; 7727-37-9/Nitrogen

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