Abstract
Inguinal hernia disease is associated with an imbalanced collagen metabolism. Surgical stress has a negative impact on nutrients important for collagen synthesis. We hypothesized that supplementation with a combination of nutrients would enhance collagen biosynthesis in inguinal hernia disease patients when undergoing hernia repair. In this exploratory randomized controlled trial, 21 men (age: 55.2±2.8 y; BMI: 25.0±0.7kg/m2) scheduled for Lichtenstein inguinal hernia repair were assigned to multinutrient supplementation (n=10; multinutrient group) or no multinutrient supplementation (n=11; control group). The multinutrient group received 14g l-arginine, 14g l-glutamine, 1250mg vitamin C, and 55mg zinc daily starting 14 d before surgery and ending 14 d after surgery. The multinutrient and control groups received high-quality protein to ensure a daily intake of 1.5g protein/kg. Collagen biosynthesis was measured by the biomarkers type I procollagen propeptide (CICP), type III procollagen propeptide (PRO-C3), and type V procollagen propeptide (PRO-C5) in the sera on days -14, 0, and 1, and in the wound fluids on postoperative days 1 and 2. Compliance was recorded after the 28-d intervention period. Serum PRO-C5 concentrations decreased (P <0.05) postoperatively in the control but not the multinutrient group. Neither CICP nor PRO-C3 serum concentrations differed significantly between the 2 groups. In wound fluid, the CICP concentrations increased (P <0.05) from days 1 to 2 in the multinutrient group and were 49% higher (P=0.10) than those in the control group on day 2. Wound fluid concentrations PRO-C3 and PRO-C5 showed no significant time or group differences. The 28-d compliance was similar (P=0.27) in the 2 groups. Oral supplementation with arginine, glutamine, vitamin C, and zinc augment collagen synthesis during the first 2 d after inguinal hernia repair. This trial was registered at clinicaltrials.gov as NCT03221686.
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