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THE PROTEIN SPARING EFFECT OF PERIOPERATIVE NUTRITION: How Important is the Patient's Catabolic State Before Surgery and do we Need Glucose?

18 Years
Not Enrolling
Postoperative Protein Catabolism

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Trial Information

THE PROTEIN SPARING EFFECT OF PERIOPERATIVE NUTRITION: How Important is the Patient's Catabolic State Before Surgery and do we Need Glucose?

1. Goals The overall goal of perioperative nutrition support is to abolish protein wasting
and to promote anabolic processes by directing amino acids into protein synthesis
rather than oxidation. Protein repletion and enhancement of anabolism appear to be
particularly important in cancer patients who enter major abdominal surgery in a
catabolic state.

2. Objectives The objectives of this research program are

- to examine whether the anabolic effects of hypocaloric nutrition depend on the
degree of catabolism before the operation and thus identify patients who benefit
the most from perioperative nutrition support (study I)

- to investigate whether excluding glucose from hypocaloric nutrition, i.e. infusing
an isonitrogenous amount of amino acids without glucose avoids hyperglycemia and,
thus, accentuates the patient's anabolic response to feeding (study II).

In order to confirm the validity of our assumptions we will perform two consecutive studies
in two distinct patient populations. For the assessment of the patients' catabolic state and
obtaining insight into the biochemical mechanisms, whereby the effects of nutrition are
mediated, stable isotope tracer kinetics will be applied. Using primed continuous infusions
of L-[1-13C]leucine and [6,6-2H2]glucose we will quantitate the whole body dynamics of
protein and glucose metabolism, i.e. protein breakdown, amino acid oxidation, protein
synthesis, glucose production and glucose uptake before and after surgery. A positive
protein balance (difference between protein synthesis and protein breakdown) will be used as
an indicator of anabolism. Anabolic processes at the organ level (liver, muscle), i.e.
fractional synthesis rates of the acute phase proteins albumin and fibrinogen and muscle
protein synthesis will be determined using L-[2H5]phenylalanine infusions. Skeletal muscle
protein catabolism will be characterized by measuring the mRNA expression of ubiquitin and
two of its key ligases in muscle (MAFbx/atrogen-1 and MuRF-1).

Inclusion Criteria:

- American Society of Anesthesiologists <3

- colorectal surgery for non-metastatic colorectal carcinoma including right and left
hemicolectomy, transverse, subtotal and total colectomy, sigmoid resection

- ability to give informed consent

Exclusion Criteria:

- signs of severe malnutrition or obesity: body mass index <18 or >25 >10% involuntary
body weight loss over the preceding 6 months serum albumin <21 g/L

- significant cardiorespiratory, hepatic, renal and neurological disease

- ingestion of drugs known to affect protein, glucose and lipid metabolism (for example

- musculoskeletal or neuromuscular disease

- severe anemia (hemoglobin <10 g/dL)

- pregnancy

- history of severe sciatica or back surgery or other conditions which

- contraindicate the use of epidural catheters

Type of Study:


Study Design:

Allocation: Non-Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Subject), Primary Purpose: Treatment

Outcome Measure:

protein balance

Outcome Time Frame:

two days after surgery

Safety Issue:


Principal Investigator

Thomas Schricker, MD PhD

Investigator Role:

Principal Investigator

Investigator Affiliation:

Department of Anaesthesia, McGill University Health Centre


Canada: Canadian Institutes of Health Research

Study ID:




Start Date:

November 2009

Completion Date:

July 2011

Related Keywords:

  • Postoperative Protein Catabolism