Intermittent Fasting before Laparotomy: Effects on Glucose Control and Histopathologic Findings in Diabetic Rats

Abstract

(1) Background: Intermittent fasting is a nutrition practice in which individuals fast for several hours in a day, mainly with feeding time during the daylight hours. They seek to improve metabolic performance and cellular resistance to stress. In this study, we tested the fasting protocol to investigate the glycemic effect in a laparotomy perioperative period in diabetic rats and histopathologic findings. (2) Methods: The animals were diabetic-induced with alloxan. Two groups were set according to the feeding protocol: free food and intermittent fasting, whose rats could only eat 8 h in the daylight. Both groups were anesthetized, and a laparotomy was performed. We evaluated the glucose levels during the perioperative period, and we accessed organ histology seeking damage of kidney, bowel and liver after surgical trauma, and we evaluated the wound healing process. (3) Results: Glycemic levels were improved in the intermittent fasting group, especially in the post-operative period after laparotomy. Comparing both groups' tubular damage showed interdependency with mice with worse glycemic level (Z = 2.3; p = 0.0215) and wound-healing parameters showed interdependency with rats with better glycemic status for neovascularization (Z = 2.2; p = 0.0273) and the presence of sebaceous and sweat gland in the healing process (Z = 2.30; p = 0.0215). (4) Conclusions: Intermittent fasting before surgery can be a tool to improve glycemic levels in diabetic rats, with improvement especially in the post-operative period.

Keywords: diabetes; intermittent fasting; perioperative care.

Figure 1

Schematic image of experimental protocol in diabetic rats of our study.

Figure 2

Green represents IF group. Blue represents FF group. * p < 0.05 ** p < 0.01 *** p < 0.001. The lower and upper bounds of the box represent the first and third quartiles of the data, respectively; the horizontal line plus space inside the box indicates the median; the diamond indicates the mean; black circles indicate outliers; comparisons were performed by mixed linear models. (A) Pre-laparotomy fasting protocol glucose levels showing comparison between groups (A1) and comparison over time in relation to the first time-point for only intermittent fasting group (A2) and free food intake group (A3). (B) Comparison of the weight and abdominal circumference between groups (B1/B2) and comparison over time in relation to the starting time-point for only intermittent fasting group (B3/B4) and free food intake group (B5/B6). (C) Post-laparotomy fasting protocol glucose levels showing comparison between groups (C1) and comparison over time in relation to the first time-point for only the intermittent fasting group (C2) and free food intake group (C3).

Figure 2

Green represents IF group. Blue represents FF group. * p < 0.05 ** p < 0.01 *** p < 0.001. The lower and upper bounds of the box represent the first and third quartiles of the data, respectively; the horizontal line plus space inside the box indicates the median; the diamond indicates the mean; black circles indicate outliers; comparisons were performed by mixed linear models. (A) Pre-laparotomy fasting protocol glucose levels showing comparison between groups (A1) and comparison over time in relation to the first time-point for only intermittent fasting group (A2) and free food intake group (A3). (B) Comparison of the weight and abdominal circumference between groups (B1/B2) and comparison over time in relation to the starting time-point for only intermittent fasting group (B3/B4) and free food intake group (B5/B6). (C) Post-laparotomy fasting protocol glucose levels showing comparison between groups (C1) and comparison over time in relation to the first time-point for only the intermittent fasting group (C2) and free food intake group (C3).

Figure 2

Green represents IF group. Blue represents FF group. * p < 0.05 ** p < 0.01 *** p < 0.001. The lower and upper bounds of the box represent the first and third quartiles of the data, respectively; the horizontal line plus space inside the box indicates the median; the diamond indicates the mean; black circles indicate outliers; comparisons were performed by mixed linear models. (A) Pre-laparotomy fasting protocol glucose levels showing comparison between groups (A1) and comparison over time in relation to the first time-point for only intermittent fasting group (A2) and free food intake group (A3). (B) Comparison of the weight and abdominal circumference between groups (B1/B2) and comparison over time in relation to the starting time-point for only intermittent fasting group (B3/B4) and free food intake group (B5/B6). (C) Post-laparotomy fasting protocol glucose levels showing comparison between groups (C1) and comparison over time in relation to the first time-point for only the intermittent fasting group (C2) and free food intake group (C3).

Figure 3

Perceptual map of the first and second dimensions of the multiple correspondence analysis with the qualitative findings of histopathology, experimental groups and glucose classes. In (A), all the qualitative variables applied in the analysis are presented, and in figure (B) only those with interdependencies by the chi-square test.

Figure 4

Box 1;2 represents IF group while Box 3;4 represents FF group. (A)—Kidney: tp: proximal tube; g: glomerulus; arrows: tubular damage; *: proximal and distal tubular damage. (B)—Liver: vc: centrilobular vein; arrows: hepatocytes; *: necrosis. (C)—Duodenal segment: arrows: intestinal villi; *: inflammatory cells. (D)—Operative Wound: E: epithelium; p: hair follicles.

Figure 4

Box 1;2 represents IF group while Box 3;4 represents FF group. (A)—Kidney: tp: proximal tube; g: glomerulus; arrows: tubular damage; *: proximal and distal tubular damage. (B)—Liver: vc: centrilobular vein; arrows: hepatocytes; *: necrosis. (C)—Duodenal segment: arrows: intestinal villi; *: inflammatory cells. (D)—Operative Wound: E: epithelium; p: hair follicles.