Short Periods Of Fasting Research Articles

Knowledge and Practices of Nurses on Preoperative Fasting Guidelines Care for Adult Patients: A Review

Preoperative fasting is the term used to describe the time before a surgical procedure during which patients are not permitted to consume any liquids or solids by mouth. Pre-operative fasting guidelines for adult patients are critical for ensuring the well-being and safety of surgical patients. Pre-operative fasting is a standard practice designed to reduce the risk of complications during surgery, such as gastric aspiration. Fasting helps to prevent complications like pulmonary aspiration pneumonia, which can occur if patients do not empty their stomachs before surgery. Fasting durations for solids, liquids, and clear fluids are typically recommended in guidelines. Fasting before surgery or medical procedures that require anesthesia is a common practice. Fasting is done to reduce the risk of aspiration, which occurs when stomach contents enter the lungs during anesthesia and can lead to serious complications. The general guidelines for preoperative fasting typically include avoiding solid food for a specific period before the procedure, as well as limiting liquid intake. Fasting durations and recommendations, on the other hand, can vary. There has been some evolution in preoperative fasting guidelines in recent years. The traditional method involved fasting for extended periods, sometimes up to 12 hours or more for solid food and 2-6 hours for clear liquids. Recent research and updated guidelines in various countries suggest that shorter fasting periods may be just as effective in preventing aspiration while also improving hydration and reducing the stress associated with prolonged fasting. Many healthcare facilities are now more relaxed about preoperative fasting, allowing clear liquids up to 2 hours before surgery and light meals up to 6 hours before the procedure. It is important to note, however, that these guidelines are subject to change, specific fasting instructions are dependent on factors such as the type of surgery, the patient's health status, and .....

Gut physiology of rainbow trout (Oncorhynchus mykiss) is influenced more by short-term fasting followed by refeeding than by feeding fishmeal-free diets

Supplementing a fishmeal-free diet with yeast extract improves rainbow trout (Oncorhynchus mykiss) growth performance and modulates the hepatic and intestinal transcriptomic response. These effects are often observed in the long term but are not well documented after short periods of fasting. Fasting for a few days is a common practice in fish farming, especially before handling the fish, such as for short sorting, tank transfers, and vaccinations. In the present study, rainbow trout were subjected to a 4-day fast and then refed, for 8 days, a conventional diet containing fishmeal (control diet) or alternative diets composed of terrestrial animal by-products supplemented or not with a yeast extract. During the refeeding period alone, most of the parameters considered did not differ significantly in response to the different feeds. Only the expression of claudin-15 was upregulated in fish fed the yeast-supplemented diet compared to the control diet. Conversely, fasting followed by refeeding significantly influenced most of the parameters analyzed. In the proximal intestine, the surface area of villi significantly increased, and the density of goblet cell tended to decrease during refeeding. Although no distinct plasma immune response or major signs of gut inflammation were observed, some genes involved in the structure, complement pathway, antiviral functions, coagulation, and endoplasmic reticulum stress response of the liver and intestine were significantly regulated by refeeding after fasting. These results indicate that short-term fasting, as commonly practiced in fish farming, significantly alters the physiology of the liver and intestine regardless of the composition of the diet.

Fasting as a precursor to high-fat diet enhances mitochondrial resilience in Drosophila melanogaster.

Changes in diet type and nutrient availability can impose significant environmental stress on organisms, potentially compromising physiological functions and reproductive success. In nature, dramatic fluctuations in dietary resources are often observed and adjustments to restore cellular homeostasis are crucial to survive this type of stress. In this study, we exposed male Drosophila melanogaster to two modulated dietary treatments: one without a fasting period before exposure to a high-fat diet and the other with a 24-h fasting period. We then investigated mitochondrial metabolism and molecular responses to these treatments. Exposure to a high-fat diet without a preceding fasting period resulted in disrupted mitochondrial respiration, notably at the level of complex I. On the other hand, a short fasting period before the high-fat diet maintained mitochondrial respiration. Generally, transcript abundance of genes associated with mitophagy, heat-shock proteins, mitochondrial biogenesis, and nutrient sensing pathways increased either slightly or significantly following a fasting period and remained stable when flies were subsequently put on a high-fat diet, whereas a drastic decrease of almost all transcript abundances was observed for all these pathways when flies were exposed directly to a high-fat diet. Moreover, mitochondrial enzymatic activities showed less variation after the fasting period than the treatment without a fasting period. Overall, our study sheds light on the mechanistic protective effects of fasting prior to a high-fat diet and highlights the metabolic flexibility of Drosophila mitochondria in response to abrupt dietary changes and have implication for adaptation of species to their changing environment.

Using underwater currents as an occupational enrichment method to improve the stress status in rainbow trout.

This study investigated the effects of occupational enrichment, specifically underwater currents, on the stress status of rainbow trout (Oncorhynchus mykiss). A total of 540 fish were divided into three groups: control tanks without artificial currents (CO), tanks with randomly fired underwater currents (RFC), and tanks with continuous current throughout the day (CT). After 30days, half of the fish in each group underwent a 5-day pre-slaughter fasting (5D), while the others were fed until the day before slaughter (0D). Fish in the RFC group exhibited lower levels of plasma cortisol and acetylcholinesterase enzyme activity in hypothalamus and optic tract than other groups, suggesting an improved stress status. RFC group also showed higher levels of non-esterified fatty acids (NEFA) in 5D fish and higher liver glycogen stores, suggesting improved energy reserves. In comparison, the CT group had higher LDH levels, possibly due to their increased swimming activity. The CO group had significantly lower NEFA levels at 5D compared to the RFC group, suggesting lower energy reserves. The RFC fish had darker and yellow-reddish skin and liver color, suggesting an improved stress status and lower lipid reserves, respectively. Overall, although a significant stress response was not observed in fasted individuals, possibly due to the relatively short fasting period, the study suggests that providing occupational enrichment using randomly fired underwater currents for 1month helped to improve stress status in rainbow trout, indicating that occupational enrichment during the grow-out phase can positively impact the welfare of rainbow trout during routine handling procedures.

Food determines ephemerous and non-stable gut microbiome communities in juvenile wild and farmed Mediterranean fish

Novel insights were provided by contrasting the composition of wild and farmed fish gut microbiomes because the latter had essentially different environmental conditions from those in the wild. This was reflected in the gut microbiome of the wild Sparus aurata and Xyrichtys novacula studied here, which showed highly diverse microbial community structures, dominated by Proteobacteria, mostly related to an aerobic or microaerophilic metabolism, but with some common shared major species, such as Ralstonia sp. On the other hand, farmed non-fasted S. aurata individuals had a microbial structure that mirrored the microbial composition of their food source, which was most likely anaerobic, since several members of the genus Lactobacillus, probably revived from the feed and enriched in the gut, dominated the communities. The most striking observation was that after a short fasting period (86 h), farmed gilthead seabream almost lost their whole gut microbiome, and the resident community associated with the mucosa had a very much reduced diversity that was highly dominated by a single potentially aerobic species Micrococcus sp., closely related to M. flavus. The results pointed to the fact that, at least for the juvenile S. aurata studied, most of the microbes in the gut were transient and highly dependent on the feed source, and that only after fasting for at least 2 days could the resident microbiome in the intestinal mucosa be determined. Since an important role of this transient microbiome in relation to fish metabolism could not be discarded, the methodological approach needs to be well designed in order not to bias the results. The results have important implications for fish gut studies that could explain the diversity and occasional contradictory results published in relation to the stability of marine fish gut microbiomes, and might provide important information for feed formulation in the aquaculture industry.

Modulation of gut microbiota and intestinal immune response in gilthead seabream (Sparus aurata) by dietary bile salt supplementation.

Given their role in lipid digestion, feed supplementation with bile salts could be an economic and sustainable solution to alterations in adiposity and intestinal inflammation generated by some strategies currently used in aquaculture. An important part of the metabolism of bile salts takes place in the intestine, where the microbiota transforms them into more toxic forms. Consequently, we aimed to evaluate the gut immune response and microbial populations in gilthead seabream (Sparus aurata) fed a diet supplemented with a blend of bile salts with proven background as a regulator of lipid metabolism and fat content. After the 90-day feeding trial, a differential modulation of the microbiota between the anterior and posterior intestine was observed. While in the anterior intestine the relative abundance of Desulfobacterota doubled, in the posterior intestine, the levels of Firmicutes increased and Proteobacteria, Actinobacteriota, and Campylobacterota were reduced when supplementing the diet with bile salts. Even so, only in the anterior intestine, there was a decrease in estimated richness (Chao1 and ACE indices) in presence of dietary bile salts. No significant differences were displayed in alpha (Shannon and Simpson indices) nor beta-diversity, showing that bile sales did not have a great impact on the intestinal microbiota. Regarding the gene expression profile in 2 h postprandial-fish, several changes were observed in the analyzed biomarkers of epithelial integrity, nutrient transport, mucus production, interleukins, cell markers, immunoglobulin production and pathogen recognition receptors. These results may indicate the development of an intestinal immune-protective status to tackle future threats. This work also suggests that this immune response is not only regulated by the presence of the dietary bile salts in the intestine, but also by the microbial populations that are in turn modulated by bile salts. After a fasting period of 2 days, the overall gene expression profile was stabilized with respect to fish fed the unsupplemented diet, indicating that the effect of bile salts was transient after short periods of fasting. On the balance, bile salts can be used as a dietary supplement to enhance S. aurata farming and production without compromising their intestinal health.

PSUN240 A Case of Euglycemic DKA in Pregnancy

Abstract Background Euglycemic diabetic ketoacidosis (EKDA) is a rare diagnosis of exclusion occurring in a state of decreased hepatic production of glucose due to fasting state or enhanced urinary excretion of glucose. Pregnancy predisposes a woman to a state of accelerated starvation, where even short periods of fasting can lead to increased lipolysis and subsequent ketosis. DKA can develop quickly at lower serum glucose concentrations when triggers such as stress, pump malfunction, infection are present. EDKA is particularly important to recognize and treat in pregnant patients, as this increases risk of fetal demise. Diagnostic criteria of EKDA are elevated beta-hydroxybutyrate in serum or urine, decreased serum bicarbonate, glucose > 200 mg/dL, anion gap metabolic acidosis.Clinical case:26-year-old female G1P2 at 29-weeks’ gestation, with a medical history of type 1 diabetes mellitus on insulin pump, hypothyroidism, prior pregnancy complicated by pre-eclampsia presented as a transfer from an outside hospital after a low-impact motor vehicular accident. Patient was transferred with concern for DKA. At the time of presentation patient had been using her insulin pump per home settings, was NPO for at least 24 hours due to nausea and mild abdominal pain. BP was 140/77 mmHg, HR 114 beats/min, 97.6F, RR 16 with SpO2 99% on RA. Patient was alert and oriented, not in acute distress. Labs were notable for beta-hydroxybutyrate of 3.3 mmol/L, lactate 1.0 mmol/L, HbA1c 7.3%, TSH 3.16 mIU/L, Na 136 mmol/L, K 4 mmol/L, Cl 105 mmol/L, serum bicarbonate 18 mmol/L, glucose 97 mg/dL, creatinine 0.49 mg/dL, eGFR >90 mL/min/1.73m2, anion gap of 13 mmol/L. Patient was found to be in euglycemic DKA and was started on IV insulin with fluid resuscitation per protocol. Endocrinology was consulted as labs demonstrated worsening, with Na 135 mmol/L, serum bicarbonate 17 mmol/L, glucose 166 mg/dL. At this point patient had just started tolerating PO intake, no fetal distress was observed. We recommended continuation of treatment for a total of 24 hours, with subsequent normalization of labs and resolution of nausea. Patient was transitioned to home insulin pump with recommendation to snack frequently between meals and was discharged home with outpatient follow up. Upon follow up, patient did not experience recurrence of DKA but had been induced at 33 weeks due to pre-eclampsia, successfully giving birth to a live baby girl with Apgar scores of 5/6. Conclusions EDKA is a rare but easily missed diagnosis that is important to treat particularly in a pregnant patient, as risks of fetal demise are high. Serum or urine ketones should be checked in any hospitalized diabetic patient regardless of symptoms or other laboratory indicators. Triggers of EKDA in a state of pregnancy can include brief periods of fasting, infection, stress, and dehydration. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Exploring the impacts of different fasting and refeeding regimes on Nile tilapia (Oreochromis niloticus L.): growth performance, histopathological study, and expression levels of some muscle growth-related genes

The current study investigated how different fasting and refeeding regimes would impact Nile tilapia growth performance, histopathological examination, and gene expression of myostatin, myogenin, GH, IGF-1, and NPYa. Nile tilapia fish (n = 120) were randomly allocated into four groups, including the control group fed on a basal diet for 6 weeks (F6), group A starved for 1 week and then refed for 5 weeks (S1F5), group B starved for 2 weeks and then refed for 4 weeks (S2F4), while group C starved for 4 weeks and then refed for 2 weeks (S4F2). Fasting provoked a decrease in body weight coincided with more extended starvation periods. Also, it induced muscle and liver histological alterations; the severity was correlated with the length of fasting periods. Gene expression levels of GH, MSTN, MYOG, and NPYa were significantly increased, while IGF1 was markedly depressed in fasted fish compared to the control group. Interestingly, refeeding after well-planned short fasting period (S1F5) modulated the histopathological alterations. To some extent, these changes were restored after refeeding. Restored IGF-I and opposing fasting expression profiles of the genes mentioned above thus recovered weights almost like the control group and achieved satisfactory growth compensation. Conversely, refeeding following more extended fasting periods failed to restore body weight. In conclusion, refeeding after fasting can induce a compensatory response. Still, the restoration capacity is dependent on the length of fasting and refeeding periods through exhibiting differential morphological structure and expressions pattern for muscle and growth-related genes.Graphical abstract

Deletion of PTEN and VDR impair glucose and lipid metabolism

Background : PTEN, through PI3K/Akt suppression, inhibits insulin receptor signaling, and hence cellular glucose uptake. Vitamin D (VD), through its receptor VDR, regulates Ca+2 channel flux, which is essential for pancreatic insulin secretion, and also has a prosteatotic effect as a result of activating lipogenic routes and suppression of lipid β-oxidation in the liver. Therefore, we probed for potential molecular interactions of PI3K/Akt and VD-dependent pathways on glucose and lipid metabolism. Methods : We used inducible pan PTEN and VDR single gene KO and double KO (DKO) mouse models. After a single Tamoxifen injection (25mg/kg), 4 groups of mice were studied: DKO, PTEN-KO, VDR-KO and control (CNT)). In vivo glucose tests were performed (glucose tolerance test, pyruvate tolerance test, glucose behavior and blood glucose). We measured insulin secretion by isolating pancreatic islets and incubating them with 5mM glucose. Organs and blood were harvested for histological and molecular biology studies. Several strategies were used to increase survival of the animals (increased glucose delivery to the brain, sucrose in water, bicarbonate in water, and high fat diet). Results : DKO mice died prematurely (32% of survival after 2 months vs 74% in PTEN-KO mice and 100% in VDR-KO and CNT mice) and did not survive short fasting periods, showing rapid signs of lethargy and nonresponsiveness. PTEN deficiency induced severe hypoglycemia, both in a postprandial and starving state, and hypoinsulinemia was observed both in PTEN-KO and DKO mice. However, glucose supplementation did not enhance DKO survival. In addition, PTEN ablation promoted defects in insulin secretion that were enhanced by the absence of VDR. Furthermore, PTEN-KO mice had down-regulated renal glucose transporter expression that could explain the mild glycosuria, which was further exacerbated after deletion of VDR. In liver, PTEN deletion induced a pre-steatotic state, which was attenuated by co-ablation of VDR in DKO mice. Moreover, we detected delayed hepatic gluconeogenesis activation in PTEN-KO and DKO mice. With regard to lipid and ketone metabolism, we found that although PTEN-KO and DKO mice ate more, they used ketone bodies even when they were not food-restricted. Moreover, treating DKO mice with high fat diet increased their survival. Finally, we observed that PTEN deletion delayed β-oxidation and decreased lipogenesis, and this was aggravated by deletion of VDR. Conclusion : Absence of PTEN strongly impairs glucose and lipid metabolism and VDR deletion exacerbates the phenotype. If we extrapolate our DKO mice results to humans, we propose that VD levels should be clinically monitored in subjects with type 1 diabetes mellitus, particularly in those that have a lean phenotype and recurrent episodes of severe hypoglycemia. Dietary supplementation with VD may have therapeutic metabolic benefits in these individuals.

Late-evening food intake is highly prevalent among individuals with type 2 diabetes

Late-evening food intake is associated with cardiometabolic risk. We assessed the prevalence of late-evening and night-time eating in individuals with type 2 diabetes and its association with BMI and HbA1c. We hypothesized food intake during late evening and night-time to be prevalent among individuals with type 2 diabetes and to be associated with higher BMI and higher HbA1c. This cross-sectional analysis includes 348 adults with type 2 diabetes from an outpatient diabetes clinic in Denmark. Frequency of late-evening and night-time eating was assessed from a food frequency questionnaire and clinical data were obtained from electronic medical records. Participants were divided into those reporting to eat frequently (≥3 times/week) in the evening after dinner and/or during night-time (late-eaters) and those who did not (reference group) and BMI and HbA1c levels were compared between groups with and without adjustment for diabetes duration and antidiabetic medication. 42% of the study population reported to eat frequently (≥3 times/week) in the late evening and 8% reported to do so during the night. Most late-eaters reported to eat breakfast regularly, suggesting a long eating window and short fasting period in this group. BMI and HbA1c did not differ between late-eaters and the reference group. Eating late in the evening or during the night was prevalent among individuals with type 2 diabetes across BMI and HbA1c levels. Whether restriction of food intake during evening and night-time can induce weight loss and improve glycemic control in individuals with type 2 diabetes needs testing in randomized controlled trials.

Physiological Impairment as a Result of Bile Accumulation in an Apex Predator, the Tiger Shark (Galeocerdo cuvier Péron & Lesueur, 1822).

Physiological adaptations have evolved to help sharks face rapid periods of feast. Tiger sharks are generalist apex predators that rely on a high-lipid/protein diet. To achieve a satisfactory nutritional condition, proper lipid absorption and hepatic storage are needed. Bile secretion in sharks is low and sporadic but increases during short periods of fasting. The present study describes a physiological impairment caused by bile accumulation in juvenile tiger sharks, possibly due to prolonged fasting. These evidences suggest that, even though sharks have adaptations that prevent them from dying from starvation, alarming physiological alterations might occur. Future studies are needed to assess how such a condition can affect wild populations, as well as possible sublethal consequences that could impact their long-term survival.

Short-Term, Combined Fasting and Exercise Improves Body Composition in Healthy Males.

Fasting enhances the beneficial metabolic outcomes of exercise; however, it is unknown whether body composition is favorably modified on the short term. A baseline-follow-up study was carried out to assess the effect of an established protocol involving short-term combined exercise with fasting on body composition. One hundred seven recreationally exercising males underwent a 10-day intervention across 15 fitness centers in the Netherlands involving a 3-day gradual decrease of food intake, a 3-day period with extremely low caloric intake, and a gradual 4-day increase to initial caloric intake, with daily 30-min submaximal cycling. Using dual-energy X-ray absorptiometry analysis, all subjects substantially lost total body mass (-3.9 ± 1.9kg; p < .001) and fat mass (-3.3 ± 1.3kg; p < .001). Average lean mass was lost (-0.6 ± 1.5kg; p < .001), but lean mass as a percentage of total body mass was not reduced. The authors observed a loss of -3.9 ± 1.9% android fat over total fat mass (p < .001), a loss of -2.2 ± 1.9% gynoid over total fat mass (p < .001), and reduced android/gynoid ratios (-0.05 ± 0.1; p < .001). Analyzing 15 preselected single-nucleotide polymorphisms in 13 metabolism-related genes revealed trending associations for thyroid state-related single-nucleotide polymorphisms rs225014 (deiodinase 2) and rs35767 (insulin-like growth factor1), and rs1053049 (PPARD). In conclusion, a short period of combined fasting and exercise leads to a substantial loss of body and fat mass without a loss of lean mass as a percentage of total mass.

Failure of enhanced recovery programs after laparoscopic radical gastrectomy: a single-center retrospective study.

Enhanced recovery programs (ERPs), as a rapid rehabilitation method, have been widely used in gastric cancer patients. Although many related studies have confirmed their effectiveness, some patients may still experience poor clinical outcomes. This study analyzed risk factors associated with ERP failure after laparoscopic radical gastrectomy. We analyzed the outcomes of 212 patients who underwent ERP following laparoscopic radical gastrectomy between March 2017 and December 2019. The ERP included preoperative education, short periods of fasting, non-mechanical intestinal preparation, early ambulation and oral feeding. ERP failure was defined as more than 7days of hospitalization due to postoperative complications, unplanned readmission within 30days of surgery, or death. The mean patient age was 62 years (range 39-89 years). Surgical procedures included total gastrectomy (n = 161) and distal gastrectomy (n = 51). Overall, 38 (17.9%) patients failed to complete the program, with no mortality. Univariable analysis (P < 0.15) revealed that ERP failure was associated with age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) grade, tumor location, preoperative education, combined operation, long operation time, and significant blood loss. Multivariable analysis (P < 0.05) showed that age, ASA grade III, combined operation and preoperative education were independent risk factors for ERP failure. We showed that an advanced age, a high ASA grade, lack of a preoperative education and combined surgery were independent risk factors associated with ERP failure after laparoscopic gastrectomy. Therefore, a preoperative patient evaluations and education are important for the success of ERPs.

1538-P: Prevalence of Late-Evening and Nighttime Eating in Individuals with Type 2 Diabetes

Introduction: Late-evening food intake associates with metabolic risk. We assessed the prevalence of late-evening and night-time eating in individuals with type 2 diabetes and its association with BMI and HbA1c. Methods: This cross-sectional analysis includes 348 individuals with type 2 diabetes from an outpatient diabetes clinic in Denmark. Frequency of late-evening and night-time eating was assessed from a food frequency questionnaire and clinical data were obtained from electronic medical records. Participants were divided into those reporting to eat frequently (≥3 times/week) during the evening after dinner and/or night (late-eaters) and those who did not (reference) and BMI and HbA1c were compared between groups with and without adjustment for diabetes duration and antidiabetic medication. Results: Forty-two% reported to eat frequently (≥3 times/week) during late evening and 8% reported to do so during the night (Figure 1). Most late-eaters reported to eat breakfast regularly suggesting a long eating window and short fasting period. BMI and HbA1c did not differ between late-eaters and the reference group (Figure 1). Conclusion: Eating late was prevalent among individuals with type 2 diabetes across BMI and HbA1c levels. Whether restriction of eating during evening and night-time can induce weight loss and improve glycemic control in individuals with type 2 diabetes needs testing in randomized controlled trials. Disclosure J.S. Quist: None. M.B. Blond: None. K. Færch: None. B. Ewers: None. Funding Steno Diabetes Center

Assessment of Gastric Emptying of Maltodextrin, Coffee With Milk, and Orange Juice During Labour at Term Using Point of Care Ultrasound: A Noninferiority Randomized Clinical Trial

(Anaesthesia. 2019;74:856–861) Although patients have commonly been advised to fast for 8 hours before any surgery, some research has shown benefits associated with shorter fasting periods. Pregnant women have generally been considered to have a “full stomach” due to delayed gastric emptying and reduced lower esophageal sphincter tone. However, recent studies have shown normal gastric emptying in nonlaboring parturients after drinking water. Studies in nonpregnant volunteers have found that milk and other drinks with similar caloric content are cleared from the stomach at similar rates. This noninferiority, parallel group study was undertaken to compare gastric emptying rates in laboring women for maltodextrin, coffee with milk, and pulp-free orange juice.

Preoperative Fasting Practices Across Three Anesthesia Societies: Survey of Practitioners.

BackgroundPulmonary aspiration of gastric contents is recognized as a complication of anesthesia. To minimize that risk, anesthesiologists advised fasting for solid foods and liquids for an often prolonged period of time. However, 30 years ago, evidence was promulgated that fasting for clear liquids was unnecessary to ensure an empty stomach. Despite a strong evidence base and the knowledge that fasting may be physiologically harmful and unpleasant for patients, the adoption of society guidelines recommending short fasting periods for clear fluids into clinical practice is uncertain.ObjectiveThis study aimed to determine the current practices of anesthetists with respect to fasting guidelines.MethodsAn electronic internet survey was distributed to anesthetists in Canada (CAN), Australia and New Zealand (ANZ), and Europe (EUR) during April 2014 to February 2015. The anesthetists were asked about fasting guidelines, their recommendations to patients for the consumption of clear fluids and solid foods, and the reasons and consequences if these guidelines were not followed.ResultsA total of 971 anesthetists completed the survey (CAN, n=679; ANZ, n=185; and EUR, n=107). Although 85.0% (818/962) of these participants claimed that their advice to patients followed current society guidelines, approximately 50.4% (476/945) enforced strict fasting and did not allow clear fluids after midnight. The primary reasons given were with regard to problems with a variable operating room schedule (255/476, 53.6%) and safety issues surrounding the implementation of clear fluid drinking guidelines (182/476, 38.2%).ConclusionsMany anesthetists continue to follow outdated practices. The current interest in further liberalizing preoperative fluid intake will require more change in anesthesia culture.

Evaluation of pH and residual gastric volume after colon preparation with mannitol: prospective randomized study comparing procedure performed after 3 hours versus 6 hours

OBJECTIVES:Our goal was to compare the hydrogen potential (pH) and residual gastric volume (RGV) of patients undergoing colonoscopy after 3 and 6 hours of colon preparation with mannitol.METHODS:We described a prospective randomized trial with a 50:50 allocation rate of two distinct times of colonoscopy after colon preparation with 10% mannitol. We included outpatients aged over 18 years, with no history of gastric surgeries and an American Society of Anesthesiologists (ASA)-rated anesthetic risk below III. Colonoscopy was performed after upper digestive endoscopy at two different times: 3 versus 6-hour after mannitol ingestion. During upper gastrointestinal endoscopy, we measured RGV and evaluated pH with a digital pH meter. Clinical trials.gov: 71123317.9.3001.0065RESULTS:We randomized a total of 100 participants to the 3 and 6-hour groups, with the patients in the 6-hour group being younger and presenting a higher body mass index (BMI). The intervention did not result in any statistically significant differences between the two groups, neither for the RGV (p=0.98) or the pH (p=0.732). However, the subgroup of patients with diabetes mellitus showed statistically significant higher RGV values in the 3-hour group.CONCLUSION:There was no difference between RGV and pH values at 3 versus 6-hour after bowel preparation with mannitol, except for RGV in diabetic patients at 3 hours. As prolonged fasting protocols may result in adverse events such as dehydration and electrolyte imbalance, we can infer that colonic preparation with mannitol in shorter fasting periods, such as 3 hours, can be adopted safely and routinely.

Glucose-6 Phosphate, A Central Hub for Liver Carbohydrate Metabolism.

Cells efficiently adjust their metabolism according to the abundance of nutrients and energy. The ability to switch cellular metabolism between anabolic and catabolic processes is critical for cell growth. Glucose-6 phosphate is the first intermediate of glucose metabolism and plays a central role in the energy metabolism of the liver. It acts as a hub to metabolically connect glycolysis, the pentose phosphate pathway, glycogen synthesis, de novo lipogenesis, and the hexosamine pathway. In this review, we describe the metabolic fate of glucose-6 phosphate in a healthy liver and the metabolic reprogramming occurring in two pathologies characterized by a deregulation of glucose homeostasis, namely type 2 diabetes, which is characterized by fasting hyperglycemia; and glycogen storage disease type I, where patients develop severe hypoglycemia during short fasting periods. In these two conditions, dysfunction of glucose metabolism results in non-alcoholic fatty liver disease, which may possibly lead to the development of hepatic tumors. Moreover, we also emphasize the role of the transcription factor carbohydrate response element-binding protein (ChREBP), known to link glucose and lipid metabolisms. In this regard, comparing these two metabolic diseases is a fruitful approach to better understand the key role of glucose-6 phosphate in liver metabolism in health and disease.

Mice Microbiota Composition Changes by Inulin Feeding with a Long Fasting Period under a Two-Meals-Per-Day Schedule.

Water-soluble dietary fiber is known to modulate fecal microbiota. Although there are a few reports investigating the effects of fiber intake timing on metabolism, there are none on the effect of intake timing on microbiota. Therefore, in this study, we examined the timing effects of inulin-containing food on fecal microbiota. Mice were housed under conditions with a two-meals-per-day schedule, with a long fasting period in the morning and a short fasting period in the evening. Then, 10–14 days after inulin intake, cecal content and feces were collected, and cecal pH and short-chain fatty acids (SCFAs) were measured. The microbiome was determined using 16S rDNA sequencing. Inulin feeding in the morning rather than the evening decreased the cecal pH, increased SCFAs, and changed the microbiome composition. These data suggest that inulin is more easily digested by fecal microbiota during the active period than the inactive period. Furthermore, to confirm the effect of fasting length, mice were housed under a one-meal-per-day schedule. When the duration of fasting was equal, the difference between morning and evening nearly disappeared. Thus, our study demonstrates that consuming inulin at breakfast, which is generally after a longer fasting period, has a greater effect on the microbiota.

Dietary Behaviour Is Associated with Cardiometabolic and Psychological Risk Indicators in Female Hospital Nurses-A Post-Hoc, Cross-Sectional Study.

Unfavourable dietary behaviours of female nurses, especially among shift-working nurses, including high snacking frequency, short fasting period and large day-to-day energy intake variability may be linked with adverse health. In this study we: (1) examined the relationship between dietary behaviour and cardiometabolic and psychological health in female nurses; and, (2) compared dietary behaviour, cardiometabolic and psychological health between shift-working and non-shift-working female nurses. A total of 73 nurses had their cardiometabolic health indicators evaluated and completed psychological health questionnaires; 55 completed a 3-day dietary log. Associations between dietary behaviour and health measures were examined using Spearman’s partial correlation analysis. Analysis of covariance (ANCOVA) was used to compare dietary behaviour and health indicators between shift- and non-shift-working nurses. The majority of snacks consumed by nurses (70%) were unhealthy snacks (e.g., chocolate and chips), and higher snacking frequency was associated with greater percent body fat (r(50) = 0.287, p = 0.039), and worse mood-tension (r(48) = 0.327, p = 0.021) and anger-hostility (r(48) = 0.289, p = 0.042) scores. Day-to-day energy intake variability was positively associated with body mass index (BMI, r(50) = 0.356, p = 0.010) and waist circumference (r(50) = 0.283, p = 0.042). Shift-working nurses exhibited shorter fasting duration, larger day-to-day energy intake variability and higher total mood disturbance score when compared to their non-shift-working colleagues (all p < 0.05). The results of the present study suggested that addressing dietary behaviours may improve the cardiometabolic and psychological health of female nurses. Shift-working nurses may require a more specific dietary program to improve their psychological health.