Nutrition before surgery-Effects on muscle transcriptome
Background:
Recommendations of strict pre-operative fasting have later on become replaced by provision of carbohydrate rich nutrition drinks prior to surgery. Carbohydrate (cho) drinks are shown to reduce postoperative insulin resistance and thus assumed to improve post-surgical muscle protein metabolism with expectations to reduce morbidity and complication rate, though meta-analyses indicate few clinical benefits. However, such studies investigating skeletal muscle metabolism are lacking. Therefore, our studies have evaluated skeletal muscle transcriptome alterations related to carbohydrate and protein metabolism by two different nutrition interventions.
Method:
Patients scheduled for major upper gastrointestinal cancer surgery were asked to participate. Provision of either oral carbohydrate -rich nutrition drinks (804 kcal cho/96 kcal protein) or provision of total parenteral nutrition (400 kcal cho/180 kcal protein/350 kcal fat) were administered in a 12-hours over-night period prior to surgery. The control group received clear fluids only. Blood samples and abdominal muscle biopsies were collected at operation start (n=38). Blood amino acids were quantified by LC-MS/MS and muscle mRNA transcripts were analyzed with Agilent SurePrint G3 Human GE v3 8x60K Microarrays. Data evaluation was done in Genespring software v.14.9.1.
Results:
Statistical analyses indicated ~1200 transcripts as altered among groups (Anova, p<0.05). Post-Hoc analyses indicated ~500 transcripts as altered by each nutrition protocol with most alterations specific to each treatment. The results indicate that both carbohydrate rich nutrition drinks and total parenteral nutrition influenced muscle glucose metabolism, while transcript alterations related to protein metabolism were induced by parenteral nutrition only (final manuscript in preparation).
Conclusions:
Whole genome transcript analyses on skeletal muscle biopsies indicate different “profiles” by the two nutrition interventions. Microarray analyses is thus a suitable method to further study underlaying mechanisms, such as activation of protein translation or glucose metabolism, in response to short time nutrition interventions.
Keywords:
pre-operative nutrition, transcriptomics, skeletal muscle, protein metabolism
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