Randomized clinical trial of the effects of immediate enteral nutrition on metabolic responses to major colorectal surgery in an enhanced recovery protocol

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Abstract
Background: The effects of immediate postoperative enteral nutrition on postoperative nitrogen balance and insulin resistance were studied in patients subjected to an enhanced-recovery protocol. Methods: Eighteen patients undergoing major colorectal surgery in an enhanced-recovery protocol were randomized to immediate postoperative enteral feeding for 4 days with either complete or hypocaloric nutrition. Nitrogen balance and changes in glucose kinetics, substrate utilization (indirect calorimetry) and insulin sensitivity (hyperinsulinaemic–euglycaemic clamp) were measured. Values are mean(s.e.m.). Results: Mean postoperative urinary nitrogen losses were low (10·7(1·0) versus 10·5(0·7) g per day for complete versus hypocaloric nutrition) and insulin resistance was insignificant (−20(7) versus − 27(11) per cent), with no difference between groups. Complete enteral feeding was given without hyperglycaemia (blood glucose concentration 5·8(0·4) versus 5·0(0·4) mmol/l) and resulted in nitrogen balance (+0·1(0·8) versus − 12·6(0·6) g nitrogen per day; P < 0·001). Conclusion: This enhanced-recovery protocol was associated with minimal postoperative insulin resistance and nitrogen losses after surgery. Immediate postoperative enteral nutrition was provided without hyperglycaemia and resulted in nitrogen balance.
Funding Information
  • Swedish Medical Research Council (09101)
  • European Society for Parenteral and Enteral Nutrition
  • Numico Research
  • The Swedish Institute
  • The Swedish Nutrition Foundation
  • The Swedish Society of Medicine Förenade Liv