Abstract
BackgroundSurgery, commonly performed after an overnight fast, causes a postoperative decline in the anabolic and glucose lowering insulin-like growth factor-1 (IGF-1). Clinical fasting studies have exhibited a positive correlation between IGF-1 and nitrogen balance during different conditions. A perioperative amino acid infusion changes nitrogen balance and might thereby influence serum IGF-1. We hypothesized that amino acid infusion would enhance IGF-1 and thereby might influence glucose homeostasis after surgery. In this study we examined two different regimes of perioperative amino acids infusion.Methods24 females scheduled for abdominal hysterectomy were randomized into three groups; Ringer's solution infusion throughout anesthesia (Group B), amino acid infusion throughout anesthesia (Group C) and amino acid infusion 1 hour before anesthesia and during 1.5 hrs of surgery (Group D). Six female volunteers, who were not operated, but received the same amino acids infusion after fasting, served as controls (Group A). Fasting levels of IGF-1, Insulin-like growth factor binding protein-1 (IGFBP-1), insulin and P-glucose were studied prior to, and four days following, operation. Homeostasis model assessment (HOMA) was used as an index of insulin resistance. Non-parametric statistical methods were used.ResultsDuring the study the Ringer-group exhibited a decrease in IGF-1 and an increase in insulin and plasma glucose after surgery. Within the other groups there were no significant alterations over time after surgery, with the exception of a postoperative decrease in IGF-1 in group D. Group C had higher IGF-1 levels compared to group B on all days. Also, group D had higher IGF-1 levels than group B on day 2 – 4. From baseline to the first postoperative day there was a significant increase in HOMA and IGFBP-1 in groups B and C. These changes were not found in group D, in which insulin, glucose, HOMA and IGFBP-1 did not change. Amino acid infusion to the volunteers did not affect any of the variables studied.ConclusionAmino acid infusion during surgery attenuates the decrease in IGF-1 and diminishes the "diabetes of injury".
Highlights
Surgery, commonly performed after an overnight fast, causes a postoperative decline in the anabolic and glucose lowering insulin-like growth factor-1 (IGF-1)
Amino acid infusion during surgery attenuates the decrease in IGF-1 and diminishes the "diabetes of injury"
Group C had significantly higher IGF-1 levels compared to group B on all postoperative days (p < 0.05, Figure 6)
Summary
Commonly performed after an overnight fast, causes a postoperative decline in the anabolic and glucose lowering insulin-like growth factor-1 (IGF-1). A perioperative amino acid infusion changes nitrogen balance and might thereby influence serum IGF-1. We hypothesized that amino acid infusion would enhance IGF-1 and thereby might influence glucose homeostasis after surgery. The insulin-like growth factor-1 (IGF-1) is a common denominator for amino acid and carbohydrate metabolism [3]. Fasting and catabolic states cause an uncoupling between IGF-1 and GH with high serum levels of GH and low IGF1 [6] Both sufficient energy and protein intake are necessary for a normal IGF-1 response to GH. About 80–90% is bound to a stable ternary protein complex consisting of IGF-1, IGFBP-3 and Acid Labile Subunit (ALS) with a long half-life (≈15 h)[12,13]. Serum levels of the smaller binding proteins are often elevated during critical illness [20]
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