Elsevier

Nutrition

Volume 21, Issues 7–8, July–August 2005, Pages 859-866
Nutrition

Basic nutritional investigation
Preoperative feeding preserves heart function and decreases oxidative injury in rats

https://doi.org/10.1016/j.nut.2004.12.005Get rights and content

Abstract

Objective

The nutritional status of a patient has been implicated as an important factor in the development of postoperative complications. Fasting before an operation may have detrimental effects on the metabolic state. We hypothesized that there was a positive correlation between preoperative nutritional status and postoperative organ function.

Methods

Preoperative feeding was compared with fasting with respect to effects on organ function and biochemical parameters in an animal model of extensive large abdominal surgery. Male Wistar rats were fed ad libitum or fasted for 16 h, after which the arteria mesenterica superior was clamped for 60 min followed by 180 min of reperfusion.

Results

After the ischemic period, heart function was significantly better in animals that were fed ad libitum than in fasted animals. Moreover, after intestinal ischemia and reperfusion, fed rats showed significantly higher levels of intestinal adenosine triphosphate and a significantly higher malondialdehyde concentration in the intestine and lung than did fasted rats. The ratio of adenosine triphosphate to adenosine diphosphate in the liver, an indicator of energy status, in fed rats was similar to that in a sham group, whereas fasted animals showed a significantly lower value.

Conclusions

Preoperative nutrition in contrast to fasting may attenuate ischemia/reperfusion-induced injury and preserve organ function in the rat.

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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