scholarly journals Pre- and Post-Surgical Nutrition for Preservation of Muscle Mass, Strength, and Functionality Following Orthopedic Surgery

Nutrients ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1675
Author(s):  
Katie R. Hirsch ◽  
Robert R. Wolfe ◽  
Arny A. Ferrando
Keyword(s):  
Muscle Mass ◽  
Surgical Stress ◽  
Strong Predictor ◽  
Essential Amino Acids ◽  
Major Surgery ◽  
Oral Nutrition ◽  
Nutrient Timing ◽  
Nutritional Recommendations ◽  
Surgical Nutrition ◽  
Screening And Prevention

Nutritional status is a strong predictor of postoperative outcomes and is recognized as an important component of surgical recovery programs. Adequate nutritional consumption is essential for addressing the surgical stress response and mitigating the loss of muscle mass, strength, and functionality. Especially in older patients, inadequate protein can lead to significant muscle atrophy, leading to a loss of independence and increased mortality risk. Current nutritional recommendations for surgery primarily focus on screening and prevention of malnutrition, pre-surgical fasting protocols, and combating post-surgical insulin resistance, while recommendations regarding macronutrient composition and timing around surgery are less established. The goal of this review is to highlight oral nutrition strategies that can be implemented leading up to and following major surgery to minimize atrophy and the resultant loss of functionality. The role of carbohydrate and especially protein/essential amino acids in combating the surgical stress cascade and supporting recovery are discussed. Practical considerations for nutrient timing to maximize oral nutritional intake, especially during the immediate pre- and post- surgical periods, are also be discussed.

EFFECTS OF GENERAL ANAESTHESIA AND SEVERITY OF SURGICAL STRESS ON SERUM LH AND TESTOSTERONE IN MALES

1975 ◽  
Vol 78 (2) ◽  
pp. 258-269 ◽  
Author(s):  
A. Nakashima ◽  
K. Koshiyama ◽  
T. Uozumi ◽  
Y. Monden ◽  
Y. Hamanaka ◽  
...  
Keyword(s):  
General Anaesthesia ◽  
Surgical Stress ◽  
Fiberoptic Bronchoscopy ◽  
Serum Testosterone ◽  
Major Surgery ◽  
Succinylcholine Chloride ◽  
Serum Luteinizing Hormone ◽  
Serum Lh ◽  
Rate Of Increase ◽  
Male Patients

ABSTRACT Significantly decreased levels of serum testosterone from the pre-anaesthesia level were found during and up to 7 days following major surgery under general anaesthesia (nitrous oxide, oxygen and halothane following induction with thiopental and succinylcholine chloride) in 18 male patients. On the other hand, in the same patients, the serum luteinizing hormone (LH) increased significantly from the pre-anaesthesia level 30 min and 1 h after the beginning of anaesthesia. A slight increase in LH level was also noted on the 7th post-operative day. The determinations of serum testosterone and LH in fiberoptic bronchoscopy under the same general anaesthesia as that used in surgery or local anaesthesia in 26 male patients, revealed that the change in the serum LH during and following surgery seemed to be mainly induced by the general anaesthesia and that the rate of decrease in the serum testosterone may be related to the severity of surgical stress including the anaesthesia. The rate of increase in serum testosterone following the injection of gonadotrophin in 20 males on the 6th post-operative day was similar to that in 10 pre-operative males. The effects of pulmonary lobectomy on serum testosterone and urinary steroids were also studied in 6 males under adrenal suppression with dexamethasone. On the 6th post-operative day, the urinary aetiocholanolone plus androsterone and serum testosterone were found to be half the level of those on the pre-operative day, while the urinary 5β-pregnane-3α,17α,20α-triol remained unchanged. These observations in human are not inconsistent with the report of Tcholakian & Eik-Nes (1971) in dogs namely that a shift in androgen biosynthetic pathway is present in the testis under surgical stress.

scholarly journals Postoperative Albumin Drop Is a Marker for Surgical Stress and a Predictor for Clinical Outcome: A Pilot Study

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Martin Hübner ◽  
Styliani Mantziari ◽  
Nicolas Demartines ◽  
François Pralong ◽  
Pauline Coti-Bertrand ◽  
...  
Keyword(s):  
Stress Response ◽  
Pilot Study ◽  
Clinical Outcomes ◽  
Surgical Stress ◽  
Major Surgery ◽  
Surgical Trauma ◽  
Once Daily ◽  
Reactive Protein ◽  
Estimated Blood Loss ◽  
Postoperative Stress

Background. Surgical stress during major surgery may be related to adverse clinical outcomes and early quantification of stress response would be useful to allow prompt interventions. The aim of this study was to evaluate the acute phase protein albumin in the context of the postoperative stress response.Methods. This prospective pilot study included 70 patients undergoing frequent abdominal procedures of different magnitude. Albumin (Alb) and C-reactive protein (CRP) levels were measured once daily starting the day before surgery until postoperative day (POD) 5. Maximal Alb decrease (Alb Δ min) was correlated with clinical parameters of surgical stress, postoperative complications, and length of stay.Results. Albumin values dropped immediately after surgery by about 10 g/L (42.2±4.5 g/L preoperativelyversus33.8±5.3 g/L at day 1,P<0.001). Alb Δ min was correlated with operation length (Pearsonρ=0.470,P<0.001), estimated blood loss (ρ=0.605,P<0.001), and maximal CRP values (ρ=0.391,P=0.002). Alb Δ min levels were significantly higher in patients having complications (10.0±5.4versus6.1±5.2,P=0.005) and a longer hospital stay (ρ=0.285,P<0.020).Conclusion. Early postoperative albumin drop appeared to reflect the magnitude of surgical trauma and was correlated with adverse clinical outcomes. Its promising role as early marker for stress response deserves further prospective evaluation.

Altered Fibrinolysis during and after Surgery

2021 ◽  
Author(s):  
Maria J. Colomina ◽  
Esther Méndez ◽  
Antoni Sabate
Keyword(s):  
Surgical Stress ◽  
Point Of Care ◽  
Vena Cava ◽  
Coagulation Factors ◽  
Major Surgery ◽  
Fibrinogen Concentration ◽  
Tissue Destruction ◽  
Inflammatory Reactions ◽  
Hematological Disorders ◽  
Number Of Patients

AbstractMajor surgery induces hemostatic changes related to surgical stress, tissue destruction, and inflammatory reactions. These changes involve a shift of volume from extravascular space to intravascular and interstitial spaces, a “physiologic” hemodilution of coagulation proteins, and an increase of plasmatic fibrinogen concentration and platelets. Increases in fibrinogen and platelets together with a simultaneous dilution of pro- and anticoagulant factors and development of a hypofibrinolytic status result in a postoperative hypercoagulable state. This profile is accentuated in more extensive surgery, but the balance can shift toward hemorrhagic tendency in specific types of surgeries, for example, in prolonged cardiopulmonary bypass or in patients with comorbidities, especially liver diseases, sepsis, and hematological disorders. Also, acquired coagulopathy can develop in patients with trauma, during obstetric complications, and during major surgery as a result of excessive blood loss and subsequent consumption of coagulation factors as well as hemodilution. In addition, an increasing number of patients receive anticoagulants and antiplatelet drugs preoperatively that might influence the response to surgical hemostasis. This review focuses on those situations that may change normal hemostasis and coagulation during surgery, producing both hyperfibrinolysis and hypofibrinolysis, such as overcorrection with coagulation factors, bleeding and hyperfibrinolysis that may occur with extracorporeal circulation and high aortic-portal-vena cava clamps, and hyperfibrinolysis related to severe maintained hemodynamic disturbances. We also evaluate the role of tranexamic acid for prophylaxis and treatment in different surgical settings, and finally the value of point-of-care testing in the operating room is commented with regard to investigation of fibrinolysis.

scholarly journals Skeletal muscle mass at C3 may not be a strong predictor for skeletal muscle mass at L3 in sarcopenic patients with head and neck cancer

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254844
Author(s):  
Joon-Kee Yoon ◽  
Jeon Yeob Jang ◽  
Young-Sil An ◽  
Su Jin Lee
Keyword(s):  
Skeletal Muscle ◽  
Head And Neck Cancer ◽  
Diagnostic Accuracy ◽  
Prediction Model ◽  
Muscle Mass ◽  
Skeletal Muscle Mass ◽  
Strong Predictor ◽  
Healthy Adults ◽  
Muscle Area ◽  
The Relationship

Purpose To evaluate the feasibility of using skeletal muscle mass (SMM) at C3 (C3 SMM) as a diagnostic marker for sarcopenia in head and neck cancer (HNC) patients. Methods We evaluated 165 HNC patients and 42 healthy adults who underwent 18F-fluorodeoxyglucose positron emission tomography/computed tomography scans. The paravertebral muscle area at C3 and skeletal muscle area at L3 were measured by CT. Pearson’s correlation was used to assess the relationship between L3 and C3 SMMs. The prediction model for L3 SMM was developed by multiple linear regression. Then the correlation and the agreement between actual and predicted L3 SMMs were assessed. To evaluate the diagnostic value of C3 SMM for sarcopenia, the receiver operating characteristics (ROC) curves were analyzed. Results Of the 165 HNC patients, 61 (37.0%) were sarcopenic and 104 (63.0%) were non-sarcopenic. A very strong correlation was found between L3 SMM and C3 SMM in both healthy adults (r = 0.864) and non-sarcopenic patients (r = 0.876), while a fair association was found in sarcopenic patients (r = 0.381). Prediction model showed a very strong correlation between actual SMM and predicted L3 SMM in both non-sarcopenic patients and healthy adults (r > 0.9), whereas the relationship was moderate in sarcopenic patients (r = 0.7633). The agreement between two measurements was good for healthy subjects and non-sarcopenic patients, while it was poor for sarcopenic patients. On ROC analysis, predicted L3 SMM showed poor diagnostic accuracy for sarcopenia. Conclusions A correlation between L3 and C3 SMMs was weak in sarcopenic patients. A prediction model also showed a poor diagnostic accuracy. Therefore, C3 SMM may not be a strong predictor for L3 SMM in sarcopenic patients with HNC.

scholarly journals Surgical stress detection in human blood plasma by DSC

2020 ◽  
Vol 142 (2) ◽  
pp. 783-788 ◽  
Author(s):  
Andrea Ferencz ◽  
Dénes Lőrinczy
Keyword(s):  
Blood Loss ◽  
Blood Plasma ◽  
Surgical Intervention ◽  
Surgical Stress ◽  
Venous Blood ◽  
Operation Time ◽  
Major Surgery ◽  
Human Blood Plasma ◽  
Thermal Transitions ◽  
Surgical Interventions

Abstract It is a well-known fact that the extension of the surgical intervention influences both the success and time of the patient’s recovery, the degree of the blood loss, i.e., overall the patients’ surgical burden. Disease itself determines extent of surgical procedure (minor, intermediate or major surgery), which affects the risk and frequency of complications. Previous works have contributed to the validation of differential scanning calorimetry (DSC) as a potential non-invasive tool for diagnosing and monitoring several illnesses. Hence, the main goal of this study was to measure the effect of each surgical intervention on its own to blood plasma composition. Peripheral venous blood samples were collected from patients who underwent minor (n = 8), intermediate (n = 9) and major surgical interventions (n = 7). According our DSC data of blood plasma components, from the thermodynamic parameters, namely from the thermal transitions (Tm1–Tm8) to calorimetric enthalpy (ΔHcal) in proportion corresponded to the size of surgical interventions (duration of operation time, length of incision, surgical intraoperative stress, blood loss, etc.). This examination has shown that intraoperative stress during any surgical intervention affects the composition of plasma proteins, which should be always considered in the evaluation of DSC results in any surgical study.

scholarly journals Nutritional interventions in sarcopenia: a critical review

2015 ◽  
Vol 74 (4) ◽  
pp. 378-386 ◽  
Author(s):  
Mary Hickson
Keyword(s):  
Amino Acids ◽  
Amino Acid ◽  
Muscle Mass ◽  
Essential Amino Acid ◽  
Essential Amino Acids ◽  
Protein Supplementation ◽  
Nutrition Intervention ◽  
Nutritional Interventions ◽  
Intervention Trials ◽  
Nutritional Studies

The aim of the present paper is to critically review the details of the published nutrition intervention trials, with and without exercise, targeting sarcopenia. Sarcopenia is the loss of muscle mass, strength and/or performance with age. Since amino acids and energy are required for muscle synthesis it is possible that nutritional intake influences sarcopenia. Nutritional studies are challenging to carry out because of the complexity of modulating dietary intake. It is very difficult to change one nutrient without influencing many others, which means that many of the published studies are problematic to interpret. The studies included evaluate whole protein, essential amino acids and β-hydroxyl β-methylbutyrate (HMB). Whole-protein supplementation failed to show a consistent effect on muscle mass, strength or function. This can be explained by the variations in study design, composition of the protein supplement and the failure to monitor voluntary food intake, adherence and baseline nutritional status. Essential amino-acid supplements showed an inconsistent effect but there are only two trials that have significant differences in methodology and the supplement used. The HMB studies are suggestive of a beneficial effect on older adults, but larger well-controlled studies are required that measure outcomes relevant to sarcopenia, ideally in sarcopenic populations. The issues of timing and distribution of protein intake, and increased splanchnic amino-acid sequestration are discussed, and recommendations for future trials are made.

Blood Hypercoagulation Assessed with Thrombodynamics Test Predicts Postoperative Venous Thrombosis in Patients at High Risk

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 1132-1132
Author(s):  
Kirill Lobastov ◽  
Galina Dementieva ◽  
Natalia Soshitova ◽  
Victor Barinov ◽  
Leonid Laberko ◽  
...  
Keyword(s):  
High Risk ◽  
Venous Thrombosis ◽  
Research Funding ◽  
Strong Predictor ◽  
Vena Cava ◽  
Major Surgery ◽  
Normal Range ◽  
Time Points ◽  
The Third ◽  
Time Point

Abstract Aim. Weassessed the ability of the Thrombodynamics test to predict postoperative venous thromboembolism (VTE) in standard prophylaxis in high-risk patients. Methods. This prospective observational study involved 55 patients undergoing elective major surgery for colorectal cancer. The patients were 45-87 years old (mean: 72.9±8.1), and included 14 men and 26 women. According to the Caprini model, the patients had a mean score 9.9±2.1 (range: 5-14). Our standard prophylaxis for VTE consisted of above-knee graduated compression stockings with pressure 18-21 mm Hg and low-molecular weight heparin (LMWH) injections initiated 12 hours before surgery, continuing 6 hours after surgery, and then every morning after the first postoperative day (POD). Before LMWH administration, the Thrombodynamics test was performed at 8 time points: (1) one day before surgery (beforethe first LMWH injection); (2) the morning of the day of surgery (12 hours after the first injection); (3) 2-4 hours after surgery (before the second injection); (4) the morning of the first POD (12 hours after the second injection); (5,6) 2 and 4 hours after the third injection on the first POD; (7) 24 hours after the third injection in the morning of the second POD; (8) the morning of 5-7th PODs before the next injection. A duplex ultrasound was performed at baseline one day before surgery and then on the 5-7th PODs to assess the lower limb venous system up to the inferior vena cava. The endpoint of the study was ultrasound verification of deep vein thrombosis (DVT). Results. PostoperativeDVT was found in 15 of 55 patients (27.3%; 95% CI: 17.3-40.3%). Logistic regression showed that a blood hypercoagulation against the standard pharmacoprophylaxis revealed with the Thrombodynamics test was a strong predictor of DVT. The following Thrombodynamics parameters significantly predicted venous thrombosis (p<0.05): initial velocity of clot growth (Vin) at time points 4, 6, and 7; stationary velocity of clot growth (Vst) at time points 3 and 7. The maximal area under the ROC curve was 0.893 (95% CI: 0.742-1.000, p=0.019) for Vin at time point 4; 1.000 (p=0.003) for Vin at time point 7; 0.893 (95% CI: 0.742-1.000, p=0.019) for Vst at time point 3 and 0.848 (95% CI: 0.654-1.000, p=0.038) for Vst at time point 7. The cut-off point for Vin at time point 4 (with sensitivity 73.3% and specificity 73.5%) was 62.5 µm/min and at time point 7 (with sensitivity 75% and specificity 75%) was 63.5 µm/min (normal range: 36-56 µm/min). The cut-off point for Vst at time point 3 (with sensitivity 83.3% and specificity 75.0%) was 32.5 µm/min (normal range: 20-29 µm/min). There was found no high sensitivity-specificity cut-off point for Vst at time-point 7. When the defined Thrombodynamics parameters exceeded the cut-off points the rate of postoperative DVT was 42.9-52.4%, while when they did not exceed - the DVT rate was 6.3-12.9% (p<0.05). Conclusion. Despite the standard pharmacoprophylaxis, some high-risk surgical patients can experience blood hypercoagulation that is associated with postoperative DVT. Thrombodynamics test can reveal this hypercoagulation and predict DVT. Disclosures Lobastov: Bayer: Honoraria, Other: travel funding; HemaCore Company: Honoraria, Other: travel funding, Research Funding. Dementieva:HemaCore Company: Research Funding. Soshitova:HemaCore Company: Employment. Barinov:Bayer: Honoraria, Other: travel funding. Laberko:HemaCore Company: Research Funding.

scholarly journals Resistance training and timed essential amino acids protect against the loss of muscle mass and strength during 28 days of bed rest and energy deficit

2008 ◽  
Vol 105 (1) ◽  
pp. 241-248 ◽  
Author(s):  
Naomi Brooks ◽  
Gregory J. Cloutier ◽  
Samuel M. Cadena ◽  
Jennifer E. Layne ◽  
Carol A. Nelsen ◽  
...  
Keyword(s):  
Resistance Training ◽  
Muscle Mass ◽  
Muscle Wasting ◽  
Bed Rest ◽  
Essential Amino Acids ◽  
Energy Deficit ◽  
Active Recovery ◽  
Low Gravity ◽  
Muscle Area ◽  
Group 3

Spaceflight and bed rest (BR) result in losses of muscle mass and strength. Resistance training (RT) and amino acid (AA) supplementation are potential countermeasures to minimize these losses. However, it is unknown if timing of supplementation with exercise can optimize benefits, particularly with energy deficit. We examined the effect of these countermeasures on body composition, strength, and insulin levels in 31 men (ages 31–55 yr) during BR (28 days) followed by active recovery (14 days). Subjects were randomly assigned to essential AA supplementation (AA group, n = 7); RT with AA given 3 h after training (RT group, n = 12); or RT with AA given 5 min before training (AART group, n = 12). Energy intake was reduced by 8 ± 6%. Midthigh muscle area declined with BR for the AA > RT > AART groups: −11%, −3%, −4% ( P = 0.05). Similarly, greatest losses in lower body muscle strength were seen in the AA group (−22%). These were attenuated in the exercising groups [RT (−8%) and AART (−6%; P < 0.05)]. Fat mass and midthigh intramuscular fat increased after BR in the AA group (+3% and +14%, respectively), and decreased in the RT (−5% and −4%) and AART groups (−1 and −5%; P = 0.05). Muscle mass and strength returned toward baseline after recovery, but the AA group showed the lowest regains. Combined resistance training with AA supplementation pre- or postexercise attenuated the losses in muscle mass and strength by approximately two-thirds compared with AA supplement alone during BR and energy deficit. These data support the efficacy of combined AA and RT as a countermeasure against muscle wasting due to low gravity.

scholarly journals Impact of a ketogenic diet intervention during radiotherapy on body composition: III. An interim analysis of the KETOCOMP study

2018 ◽  
Author(s):  
Rainer J. Klement ◽  
Gabriele Schäfert ◽  
Reinhart A. Sweeney
Keyword(s):  
Breast Cancer ◽  
Skeletal Muscle ◽  
Amino Acids ◽  
Rectal Cancer ◽  
Body Composition ◽  
Cancer Patients ◽  
Muscle Mass ◽  
Skeletal Muscle Mass ◽  
Essential Amino Acids ◽  
Ketogenic Diets

AbstractBackgroundKetogenic therapy (KT) in the form of ketogenic diets (KDs) and/or supplements that induce nutritional ketosis have gained interest as a complementary treatment for cancer patients. Besides putative anti-tumor effects, preclinical and preliminary clinical data indicate that KT could induce favorable changes in body composition of the tumor bearing host. Here we present first results of our ongoing KETOCOMP study (NCT02516501) study concerning body composition changes among rectal, breast and head & neck cancer (HNC) patients who underwent concurrent KT during standard-of-care radiotherapy (RT).MethodsEligible patients were assigned to one of three groups: (i) a standard diet group; (ii) a ketogenic breakfast group taking 50-250 ml of a medium-chain triglyceride (MCT) drink plus 10 g essential amino acids in the morning of RT days; (iii) a complete KD group supplemented with 10 g essential amino acids on RT days. Body composition was to be measured prior to and weekly during RT using 8-electrode bioimpedance analysis. Longitudinal data were analyzed using mixed effects linear regression.ResultsA total of 17 patients underwent KT during RT thus far (rectal cancer: n=6; HNC: n=6; breast cancer: n=5). All patients consuming a KD (n=14) reached nutritional ketosis and finished the study protocol with only minor problems reported. Compared to control subjects, the ketogenic intervention in rectal and breast cancer patients was significantly associated with a decline in fat mass over time (−0.3 and −0.5 kg/week, respectively), with no significant changes in skeletal muscle mass. In HNC patients, concurrent chemotherapy was the strongest predictor of body weight, fat free and skeletal muscle mass decline during radiotherapy, while KT showed significant opposite associations. Rectal cancer patients who underwent KT during neoadjuvant RT had significantly better tumor response at the time of surgery as assessed by the Dworak regression grade (median 3 versus 2, p=0.04483).ConclusionsWhile sample sizes are still small our results already indicate some significant favorable effects of KT on body composition. These as well as a putative radiosensitizing effect on rectal tumor cells need to be confirmed once the final analysis of our study becomes possible.

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