Study of Mechanism of Preoperative Oral Carbohydrate Involved in Attenuating Postoperative Insulin Resistance_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Zhiguo , YANG Zhe , QIN Huanlong

Department of General Surgery, The Affiliated Sixth People’s Hospital of Shanghai Jiaotong University, Shanghai 200233, China;

Corresponding author：

Keywords：

Colorectal surgery; Carbohydrate; Insulin resistance; Mechanism

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Objective To assess the tolerance of preoperative carbohydrate-rich beverage, to determine its effect on postoperative insulin resistance and analyze its potential mechanism. Methods Thirty-two patients undergoing elective colorectal cancer resection were recruited to this randomized controlled study and assigned to two groups at random. Patient in control group was fasted before operation, while patient in study group was given oral water. Homeostasis model assessment (HOMA) indexes, activity of PTK, and mRNA and (or) protein expressions of PKB, PI3K and GluT4 were measured before and (or) immediately after surgery. Furthermore preoperative well-beings of patients were studied. Results Among well-beings, feeling of thirst, hunger and anxiety tended to be better in patients receiving carbohydrate-rich beverages compared with fasted ones (P＜0.05). Whole body insulin sensitivity decreased by 33% in the study group while 38% in the control group (P=0.007 2), and the activity of PTK, expressions of PI3K and PKB in study group were higher than those in control group (P＜0.05， P＜0.01), but no significantly difference was observed about GluT4 in both groups (P gt;0.05）. Conclusion Preoperative consumption of carbohydrate-containing fluids is safe and effective. Provision of carbohydrate energy source prior to surgery may attenuate immediate postoperative insulin resistance. A carbohydrate-rich drink enhances insulin action at the time of onset of anaesthesia or surgery by activating three kinases named PTK, PI3K, PKB which are key enzymes in pathway of insulin signal transduction. It is likely to explain the effects on postoperative insulin resistance.

Citation： WANG Zhiguo,YANG Zhe,QIN Huanlong,.. Study of Mechanism of Preoperative Oral Carbohydrate Involved in Attenuating Postoperative Insulin Resistance. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2008, 15(11): 799-804. doi: Copy

1.	Thorell A, Efendic S, Gutniak M, et al. Insulin resistance after abdominal surgery [Ｊ]. Br J Surg, 1994; 81(1)∶59.
2.	Van den Berghe G, Wouters PJ, Bouillon R, et al. Outcome benefit of intensive insulin therapy in the critically ill: Insulin dose versus glycemic control [Ｊ]. Crit Care Med, 2003; 31(2)∶359.
3.	Nygren J, Thorell A, Jacobsson H, et al. Preoperative gastric emptying. Effects of anxiety and oral carbohydrate administration [Ｊ]. Ann Surg, 1995; 222(6)∶728.
4.	Brezinski D, Stone PH, Muller JE, et al. Prognostic significance of the Karnofsky Performance Status score in patients with acute myocardial infarction: comparison with the left ventricular ejection fraction and the exercise treadmill test performance. The MILIS Study Group [Ｊ]. Am Heart J, 1991; 121(5)∶1374.
5.	Haffner SM, Kennedy E, Gonzalez C, et al. A prospective analysis of the HOMA model. The Mexico City Diabetes Study [Ｊ]. Diabetes Care, 1996; 19(10)∶1138.
6.	Maltby JR, Lewis P, Martin A, et al. Gastric fluid volume and pH in elective patients following unrestricted oral fluid until three hours before surgery [Ｊ]. Can J Anaesth, 1991; 38(4 Pt 1)∶425.
7.	Thorell A, Nygren J, Ljungqvist O. Insulin resistance: a marker of surgical stress [Ｊ]. Curr Opin Clin Nutr Metab Care, 1999; 2(1)∶69.
8.	Krinsley JS. Effect of an intensive glucose management protocol on the mortality of critically ill adult patients [Ｊ]. Mayo Clin Proc, 2004; 79(8)∶992.
9.	Nygren J, Soop M, Thorell A, et al. Preoperative oral carbohydrates and postoperative insulin resistance [Ｊ]. Clin Nutr, 1999; 18(2)∶117.
10.	Nygren J, Thorell A, Ljungqvist O. Preoperative oral carbohydrate nutrition: an update [Ｊ]. Curr Opin Clin Nutr Metab Care, 2001; 4(4)∶255.
11.	Soop M, Nygren J, Myrenfors P， et al. Preoperative oral carbohydrate treatment attenuates immediate postoperative insulin resistance [Ｊ]. Am J Physiol Endocrinol Metab, 2001; 280(4)∶E576.
12.	Nygren JO, Thorell A, Soop M, et al. Perioperative insulin and glucose infusion maintains normal insulin sensitivity after surgery [Ｊ]. Am J Physiol, 1998; 275(1 Pt 1)∶E140.
13.	Nygren J, Soop M, Thorell A, et al. Preoperative oral carbohydrate administration reduces postoperative insulin resistance [Ｊ]. Clin Nutr, 1998; 17(2)∶65.
14.	Ljungqvist O, Thorell A, Gutniak M, et al. Glucose infusion instead of preoperative fasting reduces postoperative insulin resistance [Ｊ]. J Am Coll Surg, 1994; 178(4)∶329.
15.	Thorell A Eds. Insulin resistance after elective surgery and the eff-ect of preoperative glucose infusion [M]. Stockholm, Sweden: Karolinska Hospital and Institute, 1993.
16.	Crowe PJ, Dennison A, Royle GT. The effect of pre-operative glucose loading on postoperative nitrogen metabolism [Ｊ]. Br J Surg, 1984; 71(8)∶635.
17.	Svanfeldt M, Thorell A, Hausel J, et al. Effect of “preoperative” oral carbohydrate treatment on insulin action-a randomised cross-over unblinded study in healthy subjects [Ｊ]. Clin Nutr, 2005; 24(5)∶815.
18.	Hausel J, Nygren J, Lagerkranser M, et al. A carbohydrate-rich drink reduces preoperative discomfort in elective surgery patients [Ｊ]. Anesth Analg, 2001; 93(5)∶1344.
19.	Cheatham B, Kahn CR. Insulin action and the insulin signaling network [Ｊ]. Endocr Rev, 1995; 16(2)∶117.
20.	Shepherd PR, Withers DJ, Siddle K. Phosphoinositide 3-kinase: the key switch mechanism in insulin signalling [Ｊ]. Biochem J, 1998; 333 (Pt 3)∶471.
21.	Han DH, Hansen PA, Host HH, et al. Insulin resistance of muscle glucose transport in rats fed a high-fat diet: a reevaluation [Ｊ]. Diabetes, 1997; 46(11)∶1761.
22.	Zierath JR, He L, Gumà A, et al. Insulin action on glucose transport and plasma membrane GluT4 content in skeletal muscle from patients with NIDDM [Ｊ]. Diabetologia, 1996; 39(10)∶1180.
23.	Zorzano A, Fandos C, Palacín M. Role of plasma membrane transporters in muscle metabolism [Ｊ]. Biochem J, 2000; 349 Pt 3∶667.

1. Thorell A, Efendic S, Gutniak M, et al. Insulin resistance after abdominal surgery [Ｊ]. Br J Surg, 1994; 81(1)∶59.
2. Van den Berghe G, Wouters PJ, Bouillon R, et al. Outcome benefit of intensive insulin therapy in the critically ill: Insulin dose versus glycemic control [Ｊ]. Crit Care Med, 2003; 31(2)∶359.
3. Nygren J, Thorell A, Jacobsson H, et al. Preoperative gastric emptying. Effects of anxiety and oral carbohydrate administration [Ｊ]. Ann Surg, 1995; 222(6)∶728.
4. Brezinski D, Stone PH, Muller JE, et al. Prognostic significance of the Karnofsky Performance Status score in patients with acute myocardial infarction: comparison with the left ventricular ejection fraction and the exercise treadmill test performance. The MILIS Study Group [Ｊ]. Am Heart J, 1991; 121(5)∶1374.
5. Haffner SM, Kennedy E, Gonzalez C, et al. A prospective analysis of the HOMA model. The Mexico City Diabetes Study [Ｊ]. Diabetes Care, 1996; 19(10)∶1138.
6. Maltby JR, Lewis P, Martin A, et al. Gastric fluid volume and pH in elective patients following unrestricted oral fluid until three hours before surgery [Ｊ]. Can J Anaesth, 1991; 38(4 Pt 1)∶425.
7. Thorell A, Nygren J, Ljungqvist O. Insulin resistance: a marker of surgical stress [Ｊ]. Curr Opin Clin Nutr Metab Care, 1999; 2(1)∶69.
8. Krinsley JS. Effect of an intensive glucose management protocol on the mortality of critically ill adult patients [Ｊ]. Mayo Clin Proc, 2004; 79(8)∶992.
9. Nygren J, Soop M, Thorell A, et al. Preoperative oral carbohydrates and postoperative insulin resistance [Ｊ]. Clin Nutr, 1999; 18(2)∶117.
10. Nygren J, Thorell A, Ljungqvist O. Preoperative oral carbohydrate nutrition: an update [Ｊ]. Curr Opin Clin Nutr Metab Care, 2001; 4(4)∶255.
11. Soop M, Nygren J, Myrenfors P， et al. Preoperative oral carbohydrate treatment attenuates immediate postoperative insulin resistance [Ｊ]. Am J Physiol Endocrinol Metab, 2001; 280(4)∶E576.
12. Nygren JO, Thorell A, Soop M, et al. Perioperative insulin and glucose infusion maintains normal insulin sensitivity after surgery [Ｊ]. Am J Physiol, 1998; 275(1 Pt 1)∶E140.
13. Nygren J, Soop M, Thorell A, et al. Preoperative oral carbohydrate administration reduces postoperative insulin resistance [Ｊ]. Clin Nutr, 1998; 17(2)∶65.
14. Ljungqvist O, Thorell A, Gutniak M, et al. Glucose infusion instead of preoperative fasting reduces postoperative insulin resistance [Ｊ]. J Am Coll Surg, 1994; 178(4)∶329.
15. Thorell A Eds. Insulin resistance after elective surgery and the eff-ect of preoperative glucose infusion [M]. Stockholm, Sweden: Karolinska Hospital and Institute, 1993.
16. Crowe PJ, Dennison A, Royle GT. The effect of pre-operative glucose loading on postoperative nitrogen metabolism [Ｊ]. Br J Surg, 1984; 71(8)∶635.
17. Svanfeldt M, Thorell A, Hausel J, et al. Effect of “preoperative” oral carbohydrate treatment on insulin action-a randomised cross-over unblinded study in healthy subjects [Ｊ]. Clin Nutr, 2005; 24(5)∶815.
18. Hausel J, Nygren J, Lagerkranser M, et al. A carbohydrate-rich drink reduces preoperative discomfort in elective surgery patients [Ｊ]. Anesth Analg, 2001; 93(5)∶1344.
19. Cheatham B, Kahn CR. Insulin action and the insulin signaling network [Ｊ]. Endocr Rev, 1995; 16(2)∶117.
20. Shepherd PR, Withers DJ, Siddle K. Phosphoinositide 3-kinase: the key switch mechanism in insulin signalling [Ｊ]. Biochem J, 1998; 333 (Pt 3)∶471.
21. Han DH, Hansen PA, Host HH, et al. Insulin resistance of muscle glucose transport in rats fed a high-fat diet: a reevaluation [Ｊ]. Diabetes, 1997; 46(11)∶1761.
22. Zierath JR, He L, Gumà A, et al. Insulin action on glucose transport and plasma membrane GluT4 content in skeletal muscle from patients with NIDDM [Ｊ]. Diabetologia, 1996; 39(10)∶1180.
23. Zorzano A, Fandos C, Palacín M. Role of plasma membrane transporters in muscle metabolism [Ｊ]. Biochem J, 2000; 349 Pt 3∶667.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Study of Mechanism of Preoperative Oral Carbohydrate Involved in Attenuating Postoperative Insulin Resistance

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