Short-Term Preoperative Calorie and Protein Restriction Is Feasible in Healthy Kidney Donors and Morbidly Obese Patients Scheduled for Surgery

Franny Jongbloed, Ron W F de Bruin, René A Klaassen, Piet Beekhof, Harry van Steeg, Frank J M F Dor, Erwin van der Harst, Martijn E T Dollé, Jan N M IJzermans, Franny Jongbloed, Ron W F de Bruin, René A Klaassen, Piet Beekhof, Harry van Steeg, Frank J M F Dor, Erwin van der Harst, Martijn E T Dollé, Jan N M IJzermans

Abstract

Introduction: Surgery-induced oxidative stress increases the risk of perioperative complications and delay in postoperative recovery. In mice, short-term preoperative dietary and protein restriction protect against oxidative stress. We investigated the feasibility of a calorie- and protein-restricted diet in two patient populations.

Methods: In this pilot study, 30 live kidney donors and 38 morbidly obese patients awaiting surgery were randomized into three groups: a restricted diet group, who received a synthetic liquid diet with 30% fewer calories and 80% less protein for five consecutive days; a group who received a synthetic diet containing the daily energy requirements (DER); and a control group. Feasibility was assessed using self-reported discomfort, body weight changes, and metabolic parameters in blood samples.

Results: Twenty patients (71%) complied with the restricted and 13 (65%) with the DER-diet. In total, 68% of the patients reported minor discomfort that resolved after normal eating resumed. The mean weight loss on the restricted diet was significantly greater (2.4 kg) than in the control group (0 kg, p = 0.002), but not in the DER-diet (1.5 kg). The restricted diet significantly reduced levels of serum urea and plasma prealbumin (PAB) and retinol binding protein (RBP).

Conclusions: A short-term preoperative calorie- and protein-restricted diet is feasible in kidney donors and morbidly obese patients. Compliance is high and can be objectively measured via changes in urea, PAB, and RBP levels. These results demonstrate that this diet can be used to study the effects of dietary restriction on surgery-induced oxidative stress in a clinical setting.

Keywords: compliance; dietary restriction; feasibility; preoperative diet; protein restriction.

Figures

Figure 1
Figure 1
The number of side effects as percentages of participants in groups consuming a restricted diet and a daily energy requirements diet (DER-diet). (A) Side effects of the dietary restriction and protein restriction diet in the kidney donors were mostly related to nutritional intake and to the gastrointestinal tract; (B) Morbidly obese patients showed relatively more gastrointestinal discomfort; (C) A total of 90% of the kidney donors reported gastrointestinal discomfort during the DER-diet; (D) This percentage was lower in the morbidly obese patients and was the same as discomfort related to nutritional intake. Effects are clustered based on the origin of the symptoms. Within each cluster, each side effect is depicted in a different shade of color.
Figure 2
Figure 2
Visual Analogue Scores (VAS) for nausea, pain, and wellbeing before, during, and after each dietary intervention. (A) The nausea scores increased significantly for patients on the restricted diet and the DER-diet but normalized to baseline levels directly after the intervention period was over; (B) The pain scores did not change significantly during the dietary interventions; (C) The restricted diet resulted in significant decreased VAS wellbeing scores during the diet compared to before, but normalized again directly after the intervention period was over; * p < 0.05. Bars represent the standard error of the mean; DER = daily energy requirements.
Figure 3
Figure 3
Body weight changes in the three dietary intervention groups. Patients on the restricted diet lost an average of 2.5% of their body weight, corresponding to 2.4 ± 1.4 kg; This body weight loss was significantly greater than in the control group, which showed no change; The DER-diet resulted in a 1.7% loss in body weight (1.5 ± 1.4 kg), which was not significantly different than the two other groups; Changes are shown as percentages compared to the body weight at baseline; ** p < 0.01. Bars represent the standard error of the mean. DER = daily energy requirements.
Figure 4
Figure 4
Serum levels of albumin, urea, valine and leucine after the three dietary interventions. (A) Serum albumin did not significantly change in any of the groups; (B) serum urea was decreased significantly after the restricted diet, while it did not change after the DER diet or in the control group; both serum valine (C) and leucine (D) did not differ between groups, but did show a trend towards a decrease after the restricted diet; red symbols = kidney donors, as opposed to morbidly obese individuals (black or gray symbols); DER = daily energy requirements.
Figure 5
Figure 5
Plasma levels of prealbumin (PAB) and retinol binding protein (RBP) after the three dietary interventions. (A) Prealbumin (PAB) and (B) retinol binding protein (RBP) both decreased significantly after the restricted diet, with no changes seen in the DER-diet group or in the control group; (C) PAB and (D) RBP did not change in patients who did not complete the restricted diet. The two corresponding values for the individual patients are connected with a line. * p ≤ 0.002. Red symbols = kidney donors in the restricted diet group. DER = daily energy requirements.

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