31695
document
Parenteral nutrition and protein sparing after surgery : do we need glucose ? Although capable of inducing an anabolic state after surgery , parenteral nutrition , including glucose , leads to hyperglycemia . Even moderate increases in blood glucose are associated with poor surgical outcome . We examined the hypothesis that amino acids , in the absence of glucose supply , spare protein while preventing hyperglycemia . In this prospective study , 14 patients with colonic cancer were randomly assigned to undergo a 6-hour stable isotope infusion study ( 3 hours of fasting followed by 3-hour infusions of amino acids , Travasol [ Baxter , Montreal , Canada ] 10 % at 0.02 mL.kg ( -1 ) .min ( -1 ) , with or without glucose at 4 mg.kg ( -1 ) .min ( -1 ) ) on the second day after colorectal surgery . Protein breakdown , protein oxidation , protein balance , and glucose production were assessed by stable isotope tracer kinetics using l- [ 1- ( 13 ) C ] leucine and [ 6,6- ( 2 ) H2 ] glucose . Circulating concentrations of glucose , cortisol , insulin , and glucagon were determined . The administration of amino acids increased protein balance from -16+/-4 micromol.kg ( -1 ) .h ( -1 ) in the fasted state to 16+/-3 micromol.kg ( -1 ) .h ( -1 ) . Combined infusion of amino acids and glucose increased protein balance from -17+/-7 to 7+/-5 micromol.kg ( -1 ) .h ( -1 ) . The increase in protein balance during nutrition was comparable in the 2 groups ( P=.07 ) . Combined administration of amino acids and glucose decreased endogenous glucose production ( P=.001 ) and stimulated insulin secretion ( P=.001 ) to a greater extent than the administration of amino acids alone . Hyperglycemia ( blood glucose , 10.1+/-1.9 micromol/L ) occurred only in the presence of glucose infusion . In summary , excluding glucose from a short-term feeding protocol does not diminish the protein-sparing effect of amino acids and avoids hyperglycemia .
31696
Intervention_Surgical
surgery
31697
Intervention_Pharmacological
glucose
31698
Intervention_Pharmacological
parenteral nutrition
31699
Intervention_Pharmacological
glucose
31700
Intervention_Pharmacological
amino acids
31701
Intervention_Pharmacological
glucose
31702
Intervention_Pharmacological
isotope infusion
31703
Intervention_Physical
fasting
31704
Intervention_Pharmacological
amino acids
31705
Intervention_Pharmacological
with or without glucose
31706
Intervention_Pharmacological
amino acids
31707
Intervention_Pharmacological
amino acids
31708
Intervention_Pharmacological
glucose
31709
Intervention_Pharmacological
amino acids
31710
Intervention_Pharmacological
glucose
31711
Intervention_Pharmacological
glucose
31712
Intervention_Pharmacological
amino acids
31713
Outcome_Physical
Protein breakdown
31714
Outcome_Physical
protein oxidation
31715
Outcome_Physical
protein balance
31716
Outcome_Physical
glucose production
31717
Outcome_Physical
Circulating concentrations of glucose
31718
Outcome_Physical
cortisol
31719
Outcome_Physical
insulin
31720
Outcome_Physical
glucagon
31721
Outcome_Physical
protein balance
31722
Outcome_Physical
protein balance
31723
Outcome_Physical
protein balance
31724
Outcome_Physical
endogenous glucose production
31725
Outcome_Physical
insulin secretion
31726
Outcome_Physical
Hyperglycemia
31727
Outcome_Physical
protein-sparing effect
31728
Outcome_Physical
hyperglycemia
31729
Participant_Sample-size
14
31730
Participant_Condition
colonic cancer