Basic nutritional investigationPreoperative feeding preserves heart function and decreases oxidative injury in rats
Introduction
Malnutrition has been recognized as a contributing factor to postoperative complications [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13]. The potential protective effect of feeding has been investigated in a rat model of hemorrhage. In this model, the animals fed before hemorrhagic insult showed lower morbidity and mortality outcomes than did animals fasted longer than 24 h. Further, feeding has been reported to increase endogenous plasma refill [14], [15], peripheral blood flow [16], and cardiac output [17], [18] and to be associated with lower mortality rate [5], [14], [15], [19], and lower translocation of bacteria [19].
One of the most severe complications that can occur after an operation is single or multiple organ dysfunction. The incidence of single/multiple organ dysfunction partly depends on the functionality of the liver-gut axis [20], [21], [22], [23], [24], [25], [26]. For an optimal liver-gut axis, it has been suggested that maintenance of the intestinal barrier function is an important factor in the prevention of sepsis and organ failure [20], [21], [27], [28].
We hypothesized that the incidence and severity of organ failure induced by intestinal ischemia is related to the severity of energy catabolism and induction of oxidative stress and, hence, that changes in both parameters are dependent on the preoperative nutritional status. To test this hypothesis, a rat ischemia/reperfusion (IR) model was developed. This model is considered representative for operations in inducing a surgical stress similar to that seen in an aortic aneurysm repair. The superior mesenteric artery is clamped, resulting in an ischemic insult to the blood-deprived intestine. We examined the effect of feeding and fasting on organ function and organ vitality and the severity of oxidative stress in distinct organs. Further, energy status in the liver and intestine was measured.
Section snippets
Animals
Male Wistar rats (200 to 300 g) were obtained from Harlan (Horst, The Netherlands). A 2-wk acclimatization period to an inverse day-night rhythm (9 pm to 9 am) was implemented before the animals proceeded to the experimental protocol. Five days before the start of the operation, rats were randomly assigned to groups, with the average body weight for all groups being 287 ± 32 g and average food intake being 20 g/d.
Ethical committee
The animal ethical committee of the Free University Medical Center (Amsterdam, The
Results
To establish whether intestinal ischemia induced organ injury, several organ injury and organ function parameters were measured. Then the effects of preoperative feeding on these parameters were measured. Moreover, to examine the influence of energy status of the liver and intestine on organ injury and function, levels of adenosine triphosphate (ATP) and adenosine diphosphate (ADP) in these organs were measured.
Discussion
We investigated whether presurgical feeding compared with fasting could protect against organ injury and dysfunction in the rat by using an intestinal IR model. In this model, animals that fasted before IR insult showed a significant decrease in heart performance as documented by cardiac output and heart rate (Figure 1A,B) that indicated heart failure. Such a change in heart performance was not observed in the IR-fed animals, which showed a similar performance as the sham-fasted animals. A
Acknowledgments
The authors thank Henri Leuvenink and A. A. van Lambalgen for advice in the design and implementation of the animal model. The authors gratefully acknowledge method development and expert technical assistance by Martin Balvers, Erik Hogenkamp, Ron Leuvenink, and Marlies Sutmuller-Ooms.
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