Iranian Heart Journal

Iranian Heart Journal

Insulin Resistance Improvement After Cardiac Surgery by Preoperative Carbohydrate Loading: A Randomized Controlled Trial

Document Type : Original Article

Authors
Shirin Hosseini 1
Zahra Vahdat Shariatpanahi 1
Majid Maleki 2
Fereydoon Noohi 2
Ziya Totonchi 3
Nejat Mahdieh 3
Saeid Hosseini 4
1 Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.
2 Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
3 Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
4 Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Abstract
Background: The idea of preoperative overnight fasting was challenged and verified to have no benefits compared with drinking clear liquids up until 2 hours before surgery. In this study, we explored the possible effects of preoperative oral carbohydrate loading (OCL) on insulin resistance and the clinical outcomes of patients undergoing cardiac surgery.
 
Methods: Totally, 260 patients were recruited and allocated randomly to intervention (n=130) and control (n=130) groups. The intervention group received 250 mL of an oral carbohydrate fluid containing 25 g of glucose, and the control group received standard care. Insulin resistance, glycemic indices, and clinical outcomes were assessed before and after surgery.
 
Results: Totally, 107 patients in the intervention group and 103 in the control group completed the study and were, thus, included in the final analysis. Preoperative OCL 2 hours before surgery improved postoperative fasting blood sugar and clinical outcomes after cardiac surgery including thirst, hunger, anxiety, pain, the length of stay in the hospital, and the length of stay in the ICU (all Ps<0.05).
 
Conclusions: OCL administered preoperatively seems to be beneficial in improving the biochemical and clinical outcomes of patients undergoing cardiac surgery. Notably, preoperative OCL as a safe, simple, and cost-benefit approach is associated with no or negligible harm and, therefore, could be recommended in the setting of cardiac surgery, with careful attention to contraindications. (Iranian Heart Journal 2022; 23(3): 49-58)
Keywords
Preoperative fasting
Carbohydrate loading
Insulin resistance
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Iranian Heart Journal
Volume 23, Issue 3
Summer 2022
Pages 49-58