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dc.contributor.authorDavidson, Isobel
dc.contributor.authorRichardson, Rosemary A.
dc.contributor.authorYuill, K. A.
dc.contributor.authorGarde, O. J.
dc.contributor.authorParks, R. W.
dc.date.accessioned2018-06-29T21:34:18Z
dc.date.available2018-06-29T21:34:18Z
dc.date.issued2005-02
dc.identifierER106
dc.identifier.citationDavidson, I., Richardson, R., Yuill, K., Garde, O. & Parks, R. (2005) The administration of an oral carbohydrate-containing fluid prior to major elective upper-gastrointestinal surgery preserves skeletal muscle mass postoperatively : a randomised clinical trial, Clinical Nutrition, vol. 24, , pp. 32-37,
dc.identifier.issn0261-5614
dc.identifier.urihttp://dx.doi.org/10.1016/j.clnu.2004.06.009
dc.identifier.urihttp://www.elsevier.com/wps/find/homepage.cws_home
dc.identifier.urihttps://eresearch.qmu.ac.uk/handle/20.500.12289/106
dc.description.abstractAim: Recent evidence suggests that the provision of energy-containing fluids is safe and may impact positively on markers of recovery. The aims of this study were to assess the tolerance of preoperative carbohydrate fluid administration and to determine its effect on postoperative metabolic and clinical responses. Methods: Patients admitted to the Royal Infirmary of Edinburgh for major, elective abdominal surgery were recruited to this double-blind, randomised study and received either a placebo drink or carbohydrate (12.6 g/100 ml) drink (CHOD). Patients consumed 800 ml of their drink on the evening before surgery and 400 ml on the day of surgery 2-3 h before the induction of anaesthesia. Nutritional status was determined using body mass index (BMI) and upper arm anthropometry; all measurements were taken preoperatively, postoperatively and at discharge. Blood glucose and insulin concentrations were also measured preoperatively and on the first post operative day. Length of hospital stay (LOS) and postoperative complications were recorded. Results: Seventy-two patients were recruited and 65 (34 male:31 female) completed this study. Thirty-four patients were randomised to receive the placebo drink (control group) and 31 patients to receive the carbohydrate drink (CHOD group). Groups were well-matched in terms of gender and age. There were no differences between the two groups at baseline for BMI (control: -25.11.7 kg/m2; CHOD -25.21.2 kg/m2), upper arm anthropometry or surgical procedure. At discharge loss of muscle mass (arm muscle circumference) was significantly greater in the control group when compared with the CHOD group (control: -1.10.15 cm; CHOD: -0.50.16 cm; P<0.05). Baseline insulin (control: 20.74.9mU/l; CHOD: 24.66.2mU/l) and glucose (control: 6.01.4 mmol/l; CHOD 5.71.4 mmol/l) were comparable in the two groups and did not differ postoperatively. No complications were recorded as a result of preoperative fluid consumption. Postoperative morbidity occurred in six patients from each group. Median LOS in the control group was 10 days (IQR=6), and 8 days (IQR=4) in the CHOD group. Conclusion: Preoperative consumption of carbohydrate-containing fluids is safe. Provision of a carbohydrate energy source prior to surgery may attenuate depletion of muscle mass after surgery. Further studies are required to determine if this preservation of muscle mass is reflected in improved function and reduced rehabilitation time.
dc.format.extent32-37
dc.publisherElsevier
dc.relation.ispartofClinical Nutrition
dc.subjectPreoperative feeding
dc.subjectPostoperative recovery
dc.subjectBody composition
dc.titleThe administration of an oral carbohydrate-containing fluid prior to major elective upper-gastrointestinal surgery preserves skeletal muscle mass postoperatively : a randomised clinical trial
dc.typearticle
dcterms.accessRightsrestricted
dc.description.facultysch_die
dc.description.referencetext1. Ljungqvist O, Nygren J. Thorell A. Insulin resistance and elective surgery. Surgery 2000;128:757-60. 2. Ljungqvist O, Nygren J, Hausel J. Thorell A. Preoperative nutrition therapyFnovel developments. Scand J Nutrition 2000;44:3-7. 3. Mendelson CL. The aspiration of stomach contents into the lungs during obstetric anaesthesia. Am J Obstet Gynaecol 1946;52:191-205. 4. Soop M, Nygren J, Myrenfors P, Thorell A, Ljungqvist O. Preoperative oral carbohydrate treatment attenuates immediate postoperative insulin resistance. Am J Physiol Endocrinol Metab 2000;280(4):E576-83. 5. Splinter WM, Schaeffer JD. Unlimited clear fluid ingestion two hours before surgery in children does not affect volume or pH of stomach contents. Anaesth Intensive Care 1990;18: 522-6. 6. Eriksson LI, Sandin R. Fasting guidelines in different countries. Acta Anaesthesiology Scandinavia 1996;40:971-4. 7. Maltby JR, Sutherland AD, Sale JP, Shaffer EA. Preoperative oral fluids: is a five-hour fast justified prior to elective surgery? Anaesth Analg 1986;65:1112-6. 8. Ljungqvist O, Thorell A, Guntiak M, H.aggmark T, Efendic S. Glucose infusion instead of preoperative fasting reduces postoperative insulin resistance. J Am Coll Surg 1994;178: 329-36. 9. Nygren J, et al. Perioperative insulin and glucose infusion maintains normal insulin sensitivity after surgery. Am J Physiol 1998;275:E140-8. 10. Nygren J, Thorell A, Jacobsson H, Schnell PO, Ljungqvist O. Preoperative gastric emptying; the effects of anxiety and carbohydrate administration. Ann Surg 1995;222:728-34. 11. Nygren J, Soop M, Thorell A, Efendic S, Nair KS, Ljungqvist O. Preoperative oral carbohydrate administration reduces postoperative insulin resistance. Clin Nutr 1998;17:65-71. 12. Bishop CW, Bowen PE, Ritchley SI. Norms for nutritional assessment of American adults by upper arm anthropometry. Am J Clin Nutr 1981;34:2530-9. 13. Fiore P, Merli M, Andreoli A, et al. A comparison of skinfold anthropometry and dual-energy X-ray absorptiometry for the evaluation of body fat in cirrhotic patients. Clin Nutr 1999;18(6):349-51. 14. Nygren J, Soop M, Thorell A, Sree Nair K, Ljungqvist O. Preoperative oral carbohydrates and postoperative insulin resistance. Clin Nutr 1999;18(2):117-20. 15. Ljungqvist O, Nygren A, Thorell A, Brodin U, Efendic S. Preoperative nutritionFelective surgery in the fed or the overnight fasted state. Clin Nutr 2001;20(Suppl 1):167-71. 16. Thorell A, H.aggmark T, Efendic S, Gutniak M, Ljungqvist O. Insulin resistance after abdominal surgery. Br J Surg 1994; 81:59-63. 17. Thorell A, Nygren J, Ljungqvist O. Insulin resistanceFa marker of surgical stress. Curr Op Clin Met Care 1999;2:69-79. 18. Bang P, Nygren J, Carlsson-Skwirut C, et al. Postoperative induction of insulin-like growth factor binding protein-3 proteolytic activity: relation to insulin and insulin sensitivity. J Clin Endocrinol Metab 1998;83:2509-15. 19. Nygren J, Carlsson-Skwirut C, Brismar K, et al. Insulin infusion increases levels of free IGF-1 and IGFBP-3 proteolytic activity in patients after surgery. Am J Physiol 2001. 20. Brandi L, Santoro D, Natali A, et al. Insulin resistance of stress: sites and mechanisms. Clin Sci 1993;85:525-35. 21. Frayn KN. Hormonal control of metabolism in trauma and sepsis. Clin Endocrinol 1986;24:577-99. 22. Nygren J, Thorell A, Ljungqvist O. Preoperative oral carbohydrate nutrition: an update. Curr Opin Clin Nutr Metab Care 2001;4(4):255-9. 23. Hausel J, Nygren J, Lagerkranser M, et al. A carbohydrate- rich drink reduces preoperative discomfort in elective surgical patients. Anaesth Analg 2001;93(5): 1344-50. 24. Ljungqvist O, Nygren J, Thorell A. Preoperative carbohydrates instead of overnight fasting reduces hospital stay following elective surgery (abstract). Clinical Nutrition 1998;17:10. 25. Henriksen M, Hansen H, Dela F, et al. Preoperative feeding might improve postoperative voluntary muscle function. Clinical Nutrition 1999;18(Suppl.1):82.
dc.description.volume24
dc.identifier.doihttp://10.1016/j.clnu.2004.06.009
dc.description.ispublishedpub
dc.description.eprintid106
rioxxterms.typearticle
qmu.authorDavidson, Isobel
dc.description.statuspub
dc.description.number1


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