The influence of short-term pre-operative intravenous nutrition upon anthropometric variables, protein synthesis and immunological indices in patients with gastrointestinal cancer

Abstract

The influence of short-term pre-operative intravenous nutrition (IVN) upon protein synthesis in human liver and skeletal muscle was investigated in 30 patients with weight loss (>5 kg in preceding 3 months) who underwent resection of a neoplasm of the gastrointestinal tract. Patients were randomised to receive a normal hospital diet (HD group) or a hospital diet supplemented by intravenous nutrition (IVN groups; 0.18 gN/kg/24h as FreAmine III; 126kJ/24h as glucose) for either 3 (IVN(3)) or 7 days (IVN(7)) Nutritional assessment was undertaken by measurement of anthropometric, biochemical and immunological indices. In addition, the rates of protein synthesis in biopsies of liver and skeletal muscle, which were obtained at operation, were determined in vitro from the incorporation into protein of (14)C-leucine. Patients who received a hospital diet only (HD group) were in negative energy balance and continued to lose weight during the pre-operative period. The imbalance between caloric intake and expenditure was met from endogenous fuel stores with a reduction in fat-free mass and arm muscle area. Patients who received IVN maintained body weight and fat-free mass and had higher rates of protein synthesis in liver and skeletal muscle. In addition there was an increase in the plasma concentrations of prealbumin, haptoglobin and complement C3 together with a rise in the concentrations of the circulating immunoglobulins IgM and IgA. The majority of these changes occurred after only 3 days of IVN.