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Randomized Controlled Trial
. 2008 Dec 7;14(45):6960-9.
doi: 10.3748/wjg.14.6960.

Antioxidant enriched enteral nutrition and oxidative stress after major gastrointestinal tract surgery

Mireille F M van Stijn  1 , Gerdien C Ligthart-Melis, Petra G Boelens, Peter G Scheffer, Tom Teerlink, Jos W R Twisk, Alexander P J Houdijk, Paul A M van Leeuwen
Affiliations
Randomized Controlled Trial

Antioxidant enriched enteral nutrition and oxidative stress after major gastrointestinal tract surgery

Mireille F M van Stijn et al. World J Gastroenterol. .

Abstract

Aim: To investigate the effects of an enteral supplement containing antioxidants on circulating levels of antioxidants and indicators of oxidative stress after major gastrointestinal surgery.

Methods: Twenty-one patients undergoing major upper gastrointestinal tract surgery were randomised in a single centre, open label study on the effect of postoperative enteral nutrition supplemented with antioxidants. The effect on circulating levels of antioxidants and indicators of oxidative stress, such as F2-isoprostane, was studied.

Results: The antioxidant enteral supplement showed no adverse effects and was well tolerated. After surgery a decrease in the circulating levels of antioxidant parameters was observed. Only selenium and glutamine levels were restored to pre-operative values one week after surgery. F2-isoprostane increased in the first three postoperative days only in the antioxidant supplemented group. Lipopolysaccharide binding protein (LBP) levels decreased faster in the antioxidant group after surgery.

Conclusion: Despite lower antioxidant levels there was no increase in the circulating markers of oxidative stress on the first day after major abdominal surgery. The rise in F2-isoprostane in patients receiving the antioxidant supplement may be related to the conversion of antioxidants to oxidants which raises questions on antioxidant supplementation. Module AOX restored the postoperative decrease in selenium levels. The rapid decrease in LBP levels in the antioxidant group suggests a possible protective effect on gut wall integrity. Further studies are needed on the role of oxidative stress on outcome and the use of antioxidants in patients undergoing major abdominal surgery.

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Figures

Figure 1
Figure 1
Intake of Kcal after surgery (mean ± SD). Caloric intake on the day before and on 7 d after surgery in the control and treatment groups. No significant difference in intake was observed between the groups.
Figure 2
Figure 2
F2-Isoprostane after surgery (mean ± SD). Development of F2-isoprostane in urine (ng/mg creatinine) after surgery in the control and treatment groups. The difference between the two groups over time was observed to be significant between the first and the third day after surgery, bP < 0.01.
Figure 3
Figure 3
Development of LBP plasma concentration. Data represent means ± SD. 1Indicates statistically significant difference between the control and treatment groups with respect to day 1.
See this image and copyright information in PMC

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