Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK.
Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK; The East-Midlands Bariatric and Metabolic Institute (EMBMI), Derby Teaching Hospitals NHS Foundation Trust, Royal Derby Hospital, Derby DE22 3NE, UK.
Clin Nutr. 2019 Feb;38(1):204-212. doi: 10.1016/j.clnu.2018.01.032. Epub 2018 Feb 15.
BACKGROUND & AIMS: The aims of this study were to identify whether differences in distribution of adipose tissue and skeletal muscle in obese and non-obese individuals contribute to the magnitude of the postoperative inflammatory response and insulin resistance, with and without preoperative treatment with carbohydrate drinks.
Thirty-two adults (16 obese/16 non-obese) undergoing elective major open abdominal surgery participated in this 2 × 2 factorial, randomised, double-blind, placebo-controlled study. Participants received Nutricia preOp or placebo (800 ml on the night before surgery/400 ml 2-3 h preoperatively) after stratifying for obesity. Insulin sensitivity was measured using the hyperinsulinaemic-euglycaemic clamp preoperatively and on the 1st postoperative day. Vastus lateralis, omental and subcutaneous fat biopsies were taken pre- and postoperatively and analysed after RNA extraction. The primary endpoint was within subject differences in insulin sensitivity.
Major abdominal surgery was associated with a 42% reduction in insulin sensitivity from mean(SD) M value of 37.3(11.8) μmol kg fat free mass (FFM) to 21.7(7.4) μmol kg FFM, but this was not influenced by obesity or preoperative carbohydrate treatment. Activation of the triggering receptor expressed on myeloid cells (TREM1) pathway was seen in response to surgery in omental fat samples. In postoperative muscle samples, gene expression differences indicated activation of the peroxisome proliferator-activated receptor (PPAR-α)/retinoid X-receptor (RXR-α) pathway in obese but not in non-obese participants. There were no significant changes in gene expression pathways associated with carbohydrate treatment.
The reduction in insulin sensitivity associated with major abdominal surgery was confirmed but there were no differences associated with preoperative carbohydrates or obesity.
本研究旨在确定肥胖和非肥胖个体中脂肪组织和骨骼肌分布的差异是否导致术后炎症反应和胰岛素抵抗的程度不同，以及是否存在术前给予碳水化合物饮料治疗的影响。
32 名成年人（16 名肥胖/16 名非肥胖）接受择期大型开放性腹部手术，参与了这项 2×2 析因、随机、双盲、安慰剂对照研究。参与者按肥胖分层，接受纽迪希亚术前口服营养（手术前夜 800ml/术前 2-3 小时 400ml）或安慰剂治疗。术前和术后第 1 天使用高胰岛素正葡萄糖钳夹法测量胰岛素敏感性。术前和术后取股外侧肌、网膜和皮下脂肪活检，并在提取 RNA 后进行分析。主要终点是受试者自身胰岛素敏感性的差异。
大型腹部手术后，胰岛素敏感性降低了 42%，从平均（SD）37.3（11.8）μmol kg 去脂体重（FFM）降至 21.7（7.4）μmol kg FFM，但肥胖或术前碳水化合物治疗对其没有影响。在网膜脂肪样本中，手术引起了髓样细胞表达的触发受体（TREM1）途径的激活。在术后肌肉样本中，基因表达差异表明，肥胖参与者的过氧化物酶体增殖物激活受体（PPAR-α）/视黄酸 X 受体（RXR-α）途径被激活，而非肥胖参与者则没有。与碳水化合物治疗相关的基因表达途径没有发生显著变化。
大型腹部手术后胰岛素敏感性降低得到了证实，但与术前碳水化合物或肥胖无关。
