J.Jpn. Surg. Soc.. 116(4): 249-253, 2015

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Feature topic

EFFECTS AND LIMITATIONS OF PREOPERATIVE CARBOHYDRATE LOADING: A REVIEW FROM THE VIEWPOINT OF ITS MECHANISM OF ACTION

Preoperative carbohydrate loading has been adopted as an integral part of many enhanced-recovery or fast-track surgery programs. The main aim is to reduce postoperative insulin resistance (IR), thereby allowing for effective postoperative nutrition with more anabolic properties and less risk of hyperglycemia, which may improve postoperative outcomes. Based on the mechanism underlying postoperative IR, preoperative carbohydrate loading can inhibit only the exacerbating peripheral IR caused by excessive circulating concentrations of free fatty acids secondary to starvation but not the peripheral and central IR induced by stress hormones and inflammatory cytokines released as part of the surgical stress response, suggesting that preoperative carbohydrate loading may have only limited benefit. The Cochrane review of the effects of preoperative carbohydrate treatment (published in 2014) provided results that were completely consistent with the legitimate expectation described above, i.e., a small reduction of uncertain clinical significance in the length of hospital stay and little or no effect on postoperative complications or other important clinical outcomes, despite increased postoperative peripheral insulin sensitivity. Because preoperative carbohydrate loading has only limited benefit both theoretically and clinically, we should complement its effect through the introduction of a less-invasive approach capable of attenuating surgical stress-mediated IR.

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