Department of Surgery and the Heart and Vascular Center, Brigham & Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
Department of Molecular Metabolism, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
Nutrients. 2021 Nov 11;13(11):4024. doi: 10.3390/nu13114024.
(1) Background: Vascular surgery operations are hampered by high failure rates and frequent occurrence of peri-operative cardiovascular complications. In pre-clinical studies, pre-operative restriction of proteins and/or calories (PCR) has been shown to limit ischemia-reperfusion damage, slow intimal hyperplasia, and improve metabolic fitness. However, whether these dietary regimens are feasible and safe in the vascular surgery patient population remains unknown. (2) Methods: We performed a randomized controlled trial in patients scheduled for any elective open vascular procedure. Participants were randomized in a 3:2 ratio to either four days of outpatient pre-operative PCR (30% calorie, 70% protein restriction) or their regular ad-libitum diet. Blood was drawn at baseline, pre-operative, and post-operative day 1 timepoints. A leukocyte subset flow cytometry panel was performed at these timepoints. Subcutaneous/perivascular adipose tissue was sampled and analyzed. Follow-up was one year post-op. (3) Results: 19 patients were enrolled, of whom 11 completed the study. No diet-related reasons for non-completion were reported, and there was no intervention group crossover. The PCR diet induced weight loss and BMI decrease without malnutrition. Insulin sensitivity was improved after four days of PCR ( = 0.05). Between diet groups, there were similar rates of re-intervention, wound infection, and cardiovascular complications. Leukocyte populations were maintained after four days of PCR. (4) Conclusions: Pre-operative PCR is safe and feasible in elective vascular surgery patients.
（1）背景：血管外科手术的失败率较高，且围手术期心血管并发症频发。在临床前研究中，术前限制蛋白质和/或热量（PCR）已被证明可限制缺血再灌注损伤、减缓内膜增生并改善代谢适应性。然而，这些饮食方案在血管外科患者群体中是否可行和安全仍不清楚。（2）方法：我们对计划进行任何择期开放血管手术的患者进行了一项随机对照试验。参与者按照 3:2 的比例随机分配至 4 天门诊术前 PCR 组（热量 30%，蛋白质 70%限制）或常规随意饮食组。在基线、术前和术后第 1 天采集血液。在这些时间点进行白细胞亚群流式细胞术检测。采集并分析皮下/血管周围脂肪组织。术后随访 1 年。（3）结果：共纳入 19 例患者，其中 11 例完成了研究。未报告与饮食相关的未完成原因，且无干预组交叉。PCR 饮食导致体重减轻和 BMI 下降，但无营养不良。经过 4 天的 PCR 后胰岛素敏感性得到改善（=0.05）。两组间再干预、伤口感染和心血管并发症的发生率相似。经过 4 天的 PCR 后白细胞群保持不变。（4）结论：术前 PCR 在择期血管外科患者中是安全且可行的。
