Hypocaloric Glucose Research Articles

Perioperative amino acid supplementation of hypocaloric glucose does not impair glucose metabolism after surgery

We tested the hypothesis that perioperative amino acid supplementation of hypocaloric dextrose would attenuate the inhibitory effect of glucose on endogenous glucose production after surgery. Sixteen patients undergoing colorectal cancer surgery were randomly assigned to receive intravenous glucose either with or without amino acids. Nutrition was administered over 48 hours from surgical skin incision until the second postoperative day. Glucose provided 50% and amino acids 20% of the patient's measured resting energy expenditure. Glucose rate of appearance was assessed by [6,6- 2H 2]glucose before and after surgery. Circulating concentrations of glucose, lactate, insulin, and glucagon were also determined. Hypocaloric glucose suppressed postoperative endogenous glucose production to a similar degree in both groups. The circulating concentrations of glucose increased to the same extent, whereas there was no significant change in plasma concentrations of lactate, glucagon, and cortisol. Postoperative plasma levels of insulin were significantly higher in patients receiving amino acids ( P = .009). Perioperative amino acid administration does not mitigate the inhibitory effect of glucose on glucose production or aggravate hyperglycemia after colorectal surgery.

Anticatabolic effect of epidural analgesia and hypocaloric glucose

Anticatabolic effect of epidural analgesia and hypocaloric glucose

A Randomized Controlled Trial of the Anticatabolic Effect of Epidural Analgesia and Hypocaloric Glucose

The goal of the present study was to investigate whether epidural analgesia exerts a protein-sparing effect after colorectal surgery in the presence of hypocaloric glucose supply initiated with surgical skin incision. We randomly allocated 10 patients to receive general anesthesia combined with epidural anesthesia with bupivacaine, followed by epidural analgesia using bupivacaine/fentanyl, and 10 patients to receive general anesthesia, followed by patient-controlled analgesia with intravenous morphine. All patients received a 48-hour infusion of glucose 10% from surgical skin incision until the second day after surgery. The glucose infusion rate provided 50% of the patient's resting energy expenditure. Kinetics of protein and glucose metabolism were assessed by a stable-isotope tracer technique (L-[1-(13)C]leucine and [6,6-(2)H(2)]glucose). The rate of appearance of leucine increased in the intravenous-analgesia group (112 +/- 29 to 130 +/- 25 micromol/kg/h) 2 days after surgery, and this increase was more pronounced than in the epidural analgesia group (preoperative 120 +/- 24, postoperative 123 +/- 22 micromol/kg/h, P < .05). Leucine oxidation rate increased in the intravenous analgesia group from 17 +/- 8 to 23 +/- 8 micromol/kg/h and in the epidural group from 17 +/- 6 to 19 +/- 7 micromol/kg/h without the difference between the groups reaching statistical significance (P = .067). Nonoxidative leucine disposal remained unaltered in both groups. No differences in glucose metabolism were seen between the groups. Epidural analgesia inhibits the increase in whole-body protein breakdown in patients receiving perioperative hypocaloric glucose infusion initiated with surgical skin incision. However, oxidative protein loss, protein synthesis, and glucose metabolism are not affected by epidural analgesia.

A Randomized Controlled Trial of the Anticatabolic Effect of Epidural Analgesia and Hypocaloric Glucose

A Randomized Controlled Trial of the Anticatabolic Effect of Epidural Analgesia and Hypocaloric Glucose

Postoperative parenteral nutrition while proactively minimizing insulin resistance

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 · kg −1 · min −1], normoglycemic clamps [4.5 mM]), and glucose kinetics (6,6 2H 2- 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.

Urinary excretion of polyamines in patients with surgical and accidental trauma: Effect of total parenteral nutrition

Excretion of polyamines first increases and then decreases in patients with multiple trauma receiving total parenteral nutrition (TPN). To separate the effects of trauma and TPN on polyamine excretion, we studied 12 patients with multiple trauma and 14 patients after surgery for colorectal malignancy. Patients were randomized to receive either TPN or hypocaloric glucose infusion. Urinary excretion of total and free polyamines, putrescine (PU), spermidine (SPD), and spermine (SP), and their metabolites, N 1-acetylspermidine (N 1-AcSPD) and N 8-acetylspermidine (N 8-AcSPD), and energy and nitrogen balance were measured. Polyamine excretion, excluding SP, markedly increased after trauma and surgery, exceeding the normal values by twofold to 10-fold. In patients receiving TPN, the excretion of total polyamines was 48% higher ( P < .01), PU was 34% higher ( P < .05), SPD was 35% higher ( P < .05), and SP was 350% higher ( P < .05) than in patients receiving hypocaloric glucose. Urinary excretion of SP was only 17% of the reference value during hypocaloric glucose ( P < .05), but was normal during TPN. The difference in polyamine excretion between nutrition groups was more pronounced when normalized for nitrogen or energy balance. Patients receiving TPN were more hypermetabolic than patients receiving hypocaloric glucose (resting energy expenditure, 1.36 ± 0.06 [SE] and 1.16 ± 0.04 times predicted values, respectively; P < .025). Statistically, energy expenditure could explain the difference in polyamine excretion between nutrition groups. Excretion of N 1-AcSPD was 116% higher ( P < .001), N 8-AcSPD was 72% higher ( P < .01), and total SPD was 123% higher ( P < .001) in patients with multiple trauma than in patients who had undergone elective surgery, and the difference in N 1-AcSPD and N 8-AcSPD could be explained by differences in nitrogen and energy balance between patient groups. In conclusion, TPN enhanced the already increased polyamine excretion in posttrauma and postsurgical patients. Excretion of N 1-AcSPD and N 8-AcSPD reflected the catabolic response to injury within each nutrition group. Our results suggest that urinary excretion of polyamines reflects metabolic activity in general rather than a solitary effect of a specific disease or therapy.

Effects of hypocaloric glucose vs glucosexylitol (1:1) and carbohydrate metabolism after coronary artery bypass grafting operation

Effects of hypocaloric glucose vs glucosexylitol (1:1) and carbohydrate metabolism after coronary artery bypass grafting operation

Nitrogen and energy balance in septic and injured intensive care patients: response to parenteral nutrition

We studied energy and nitrogen balance in 50 intensive care patients with sepsis (n = 18) or multiple trauma (n = 32). Most patients were mechanically ventilated during the study. Within 72h of admission the patients were randomised to receive one of 5 infusion regimens for 48h (group n = 9–11). The control group received hypocaloric glucose, two groups received 1.5g/kg/day of amino-acids, either with hypocaloric glucose on both days or with energy adjusted to pre-nutrition REE on the second day. The fourth group received 0.6g/kg/day of amino-acids and energy at REE, and the fifth group a high nitrogen (18g/day) regimen with a stepwise increase in energy intake from day 1 to day 2. Baseline REE was 118 ± 18.9% of predicted. No significant differences in REE were observed between the diagnostic groups, treatments or measurements performed during mechanical or spontaneous ventilation. Nitrogen balance in the control group was −250.3 ± 83.3 mg/kg on day 1 and 218.6 ± 95.3 mg/kg on day 2. Nitrogen balance remained negative in all groups throughout the study (range of group means—218.6 to −48.5 mg/kg/day). Increasing energy intake equal to prenutrition REE at an amino-acid dosage of 1.5g/kg/day decreased the negative nitrogen balance by 66%. Further increase in energy balance had only a marginal effect on nitrogen balance.

Growth hormone stimulates protein synthesis during hypocaloric parenteral nutrition. Role of hormonal-substrate environment.

The influence of growth hormone (GH) on protein metabolism and fuel utilization was investigated in eight paired studies of normal volunteers. GH (10 mg) was given daily during one period, and saline was injected during control studies. For 6 days, subjects received parenteral nutrition that provided adequate dietary nitrogen, vitamin, and minerals, but energy intake varied to provide 30-100% of requirements. On Day 7, the feedings were discontinued and an oral glucose load (100 g) was administered. The level of energy intake did not markedly influence the actions of GH. During nutrient infusions, GH caused positive nitrogen balance (1.0 +/- 0.3 g/m2/day vs. -1.2 +/- 0.3 in controls, p less than 0.001) and increased protein synthesis (16.8 +/- 0.7 g N/m2/day vs. 13.9 +/- 0.8, p less than 0.01). No change in the rate of protein breakdown or excretion of 3-methylhistidine occurred. GH was associated with an increase in insulin and insulin-like growth factor-I concentrations (IGF-I, 9.1 +/- 0.6 IU/ml vs. 3.3 +/- 0.5, p less than 0.001). After discontinuation of the parenteral nutrition and administration of the oral glucose load, glucose concentrations tended to be higher after GH; however, despite a two- to threefold increase in insulin response, muscle glucose uptake was attenuated (1.10 +/- 0.19 g/kg forearm vs. 1.64 +/- 0.30 in controls, p less than 0.05). Compared with control conditions, GH appeared to attenuate the increase in amino acid nitrogen efflux from muscle after the administration of oral glucose. These data demonstrate that the protein anabolic effect of GH, which occurs even during hypocaloric feedings, is related to multiple mechanisms that favor protein synthesis. These include the increase in plasma concentrations of GH, insulin IGF-I and fat utilization. GH administration results in a hormonal-substrate environment that favors nitrogen retention and protein synthesis. GH may be beneficial in promoting protein synthesis in surgical patients, particularly in association with hypocaloric glucose infusions that allow utilization of body fat as an energy source.

Muscle and plasma amino acids during semi-starvation in normal subjects: hypocaloric glucose vs. amino acid infusions

Normal subjects were fed hypocaloric amounts of amino acids or glucose for 3 days to separate the effects of these nutrients from those of trauma on muscle and plasma amino acids. Intracellular and plasma levels of Val, Leu and Ile were increased in both groups but were increased to a greater extent when amino acids were infused. Intracellular free glutamine concentration in muscle tissue was not significantly altered. Some of the trauma induced changes in amino acids can be replicated by maintaining normal subjects on hypocaloric amino acids; the decrease in glutamine concentration seen with trauma is not a function of hypocaloric nutrition.

Effect of Nutritional Status and 5-Fluorouracil on Protein Synthesis in Parenterally Alimented LEW/Mai Rats2

LEW/Mal rats bearing transplantable adenocarcinomas were maintained parenterally for 4 days on 1) a regimen adequate in amino acids and glucose and 2) severely hypocaloric glucose. Rats from both groups were given 17.5 mg 5-fluorouracil (FUra)/kg/day as a continuous infusion for 3 days. Cumulative nitrogen balance, fractional tissue protein synthesis rates, and liver and muscle distribution of FUra and its metabolites were determined. Results were compared to those found with a series of control rats that were not treated with FUra. No changes attributable to FUra were found in the starved rats (1.25 g glucose/day). In the fed rats (15 g glucose plus 2.5 g amino acids/day), FUra decreased the liver and diaphragm fractional protein synthesis rates and the nitrogen retention.

Changes in protein synthesis after trauma: importance of nutrition.

The effect of trauma (femur fracture) on protein synthesis in rats given four different parenterally administered nutrient formulations ("diets") was investigated. Diet I was a maintenance formulation. It contained sufficient amino acids and glucose to keep the rats in nitrogen balance but was inadequate to support growth. Diet II was amino acids only, diet III was severely hypocaloric glucose, and diet IV was diet I minus the amino acids. The rats received parenterally all nutrients for the duration of the 4-5 day study. Twenty-four hours posttrauma, the fractional synthesis rates of liver, lung, heart, kidney, and muscle were estimated by infusing [15N]glycine for 17.5-19 h. (T.P. Stein, J.C. Oram-Smith, M.J. Leskiw, H.W. Wallace, L.C. Long, and J.M. Leonard. The effects of protein and calorie restriction on protein synthesis in the rat. Am. J. Physiol. 230: 1321-1326, 1976.) Two trends were found: i) on the amino acid-containing diets (I and II), most protein synthesis rates were increased posttrauma. Lung was the exception: no change was found; ii) rats on the amino acid deficient diets (III and IV) showed a decrease in the fractional muscle and lung synthesis rates posttrauma. We concluded that in this rat trauma model the requirement is mostly for amino acid nitrogen posttrauma.

Plasma free fatty acid transport during prolonged glucose consumption and its relationship to plasma triglyceride fatty acids in man

Plasma free fatty acid (FFA) transport in human subjects has been studied during the course of prolonged ingestion of different amounts of glucose. Compared with the fasting state, hypocaloric glucose intake resulted in marked suppression of net transport of FFA with no change in (fractional) turnover rate. There was no further suppression of net transport of FFA when the intake was increased to isocaloric or hypercaloric levels, but there was a significant increase in the (fractional) turnover rate, indicating an enhancement of clearance mechanisms. During the 20-24-hr period of fasting after isocaloric glucose consumption, the (fractional) turnover rate quickly fell to that found in the fasting individual, whereas net transport remained suppressed for much longer. This suggested that ingestion of glucose maintains an influence on lipolysis longer than on esterification. During this period of fasting after glucose administration, the contribution of plasma FFA to circulating triglyceride fatty acids increased with time and was positively and significantly correlated with the changes in the net transport of plasma FFA.