Effect of intensive vs conventional insulin therapy on perioperative nutritional substrates metabolism in patients undergoing gastrectomy

doi:10.3748/wjg.v18.i21.2695

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Jun 7, 2012 (publication date) through Dec 29, 2024

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastroenterol. Jun 7, 2012; 18(21): 2695-2703
Published online Jun 7, 2012. doi: 10.3748/wjg.v18.i21.2695

Table 1 Baseline characteristics of patients

Variable	IIT	CIT	Statistics	Sig
Age (yr)	59.13 ± 10.06	58.94 ± 10.99	t-tests	0.943
Male-no/total (no %)	24/32 (75%)	24/32 (75%)	χ² tests	1
Weight (kg)	61.18 ± 6.82	60.47 ± 5.49	t-tests	0.411
BMI (kg/m²)	23.83 ± 1.37	24.15 ± 1.12	t-tests	0.309
Waistline (cm)	84.38 ± 7.76	87.94 ± 8.71	t-tests	0.089
CEA (ng/mL)	4.52 ± 5.61	3.37 ± 4.88	t-tests	0.384
CA-199φ (U/mL)	23.94 ± 23.20	10.69 ± 13.64	t-tests	0.07
Surgery time (min)	145.81 ± 19.57	141.25 ± 26.24	t-tests	0.387
Ln-HOMA-IR	0.586 ± 0.104	0.633 ± 0.116	t-tests	0.769
Hypertension	10/32	10/32	χ² tests	1
SOFA (organs dysfunction)
Blood/lung/renal/hepatic	2/0/4/0	2/2/2/0	χ² tests	0.446
Child-Pugh (A/B/C)	28/4/0 (32)	30/2/0 (32)	χ² tests	0.518
ASA grading (I/II/III/> III)	2/22/8/0 (32)	2/22/8/0 (32)	χ² tests	1
NYHA (I/II/III/IV)	8/18/6/0 (32)	10/16/6/0 (32)	χ² tests	0.496
NRS 1-2/3-4/5-6 scores	10/20/2 (32)	18/14/0 (32)	χ² tests	0.1
MNA 26-24/24-17/17-14	6/24/2 (32)	8/24/0 (32)	χ² tests	0.09

IIT: Intensive insulin therapy; CIT: Conventional insulin therapy; BMI: Body mass index; CEA: Carcinoembryonic antigen; SOFA: Sequential organ failure assessment; HOMA-IR: Homeostasis model assessment of insulin resistance; ASA: American Society of Anesthesiologists; NRS: Nutrition risk screen; MNA: Mini-nutrition assessment; NYHA: New York Heart Association; φplus: Levenes’test for equality of variances F not assumed (P < 0.05), need Satterthwaite t test; Sig: Significant. All values with t test are mean ± SD and with χ² tests are ratio (n/N).

Table 2 Body composition

Values	Group	n	Day 0	1st	3rd	7th	P value
ICF	IIT	32	22.42 ± 2.55	21.90 ± 2.57	21.48 ± 2.64	21.09 ± 2.19^c,e	0.026
	CIT	32	22.66 ± 2.69	21.97 ± 2.69	21.34 ± 2.54	20.17 ± 2.02^c
ECF	IIT	32	11.31 ± 1.64	11.57 ± 1.75	11.34 ± 1.62	11.06 ± 1.55^c	0.381
	CIT	32	11.35 ± 1.71	11.63 ± 1.63	11.40 ± 1.58	11.11 ± 1.63^c
FM	IIT	32	11.76 ± 3.43	11.18 ± 3.55	10.65 ± 2.87	10.17 ± 2.40^c,e	0.042
	CIT	32	11.83 ± 4.15	10.93 ± 3.88	10.02 ± 2.84	9.18 ± 2.24^c
BM	IIT	32	2.70 ± 0.34	2.68 ± 0.33	2.63 ± 0.35	2.64 ± 0.39	0.418
	CIT	32	2.69 ± 0.36	2.61 ± 0.34	2.60 ± 0.34	2.62 ± 0.36
PM	IIT	32	12.13 ± 1.68	11.41 ± 1.53^a	11.08 ± 1.62	11.01 ± 1.41^e	0.009
	CIT	32	12.19 ± 1.52	11.38 ± 1.53	10.89 ± 1.52	10.45 ± 1.24^c
TBW	IIT	32	33.73 ± 5.09	33.47 ± 4.94	32.83 ± 4.49	32.15 ± 4.51	0.263
	CIT	32	34.01 ± 4.86	33.6 ± 4.84	32.74 ± 4.73	32.28 ± 4.85
MM	IIT	32	45.86 ± 6.05	44.88 ± 5.84	43.91 ± 5.70	43.16 ± 5.32^c	0.146
	CIT	32	46.20 ± 5.85	44.98 ± 5.74	43.63 ± 5.42	42.73 ± 5.24^c
FFM	IIT	32	48.56 ± 7.24	47.56 ± 6.98	46.54 ± 6.85	45.80 ± 7.01	0.179
	CIT	32	48.89 ± 7.11	47.59 ± 7.01	46.23 ± 6.94	45.35 ± 6.86^c
BW	IIT	32	60.32 ± 8.45	58.74 ± 8.55	57.19 ± 7.84	55.97 ± 7.55^c	0.094
	CIT	32	60.72 ± 8.88	58.52 ± 8.32	56.25 ± 7.68	54.53 ± 7.12^c

ICF: Internal cell fluid; ECF: External cell fluid; FM: Fat mass; BM: Bone mass; PM: Protein mass; TBW: Total body water; FFM: Free fat mass; MM: Muscle mass; BW: Body weight; IIT: Intensive insulin therapy; CIT: Conventional insulin therapy. There were significant differences between preoperative day 0 and postoperative day 1 (^aP < 0.05), between day 0 and postoperative day 7 (^cP < 0.05) and between the two groups at the same time (^eP < 0.05), respectively.

Table 3 Changes in plasma proteins and lipids (mean ± SD)

Values	Group	n	Day 0	1st	3rd	7th	P value
ALB (g/L)	IIT	32	35.50 ± 2.36	33.72 ± 2.02^a,g	31.70 ± 2.37^c,g	34.64 ± 2.29^e,g	0.009
	CIT	32	36.09 ± 2.47	32.47 ± 2.47	30.34 ± 3.13	33.45 ± 2.93
TP (g/L)	IIT	32	61.90 ± 3.97	57.97 ± 3.83^a,g	55.85 ± 3.53^c,g	59.81 ± 3.56^e	0.023
	CIT	32	62.18 ± 4.26	56.09 ± 3.57	54.13 ± 2.96	58.89 ± 3.78
TG (mol/L)	IIT	32	1.45 ± 0.40	0.70 ± 0.16^a	0.83 ± 0.18^c	1.44 ± 0.21^e	0.267
	CIT	32	1.64 ± 0.30	0.76 ± 0.23	0.94 ± 0.18	1.52 ± 0.19
TC (μmol/L)	IIT	32	4.36 ± 0.16	3.64 ± 0.12^a	3.55 ± 0.10	3.92 ± 0.13^e	0.207
	CIT	32	4.74 ± 0.16	3.81 ± 0.12	3.60 ± 0.10	4.30 ± 0.13
FFAn (nmol/L)	IIT	32	0.43 ± 0.084	0.92 ± 0.114^a,g	0.86 ± 0.097^c,g	0.71 ± 0.086^e,g	0.016
	CIT	32	0.40 ± 0.092	1.03 ± 0.148	0.93 ± 0.104	0.84 ± 0.106

IIT: Intensive insulin therapy; CIT: Conventional insulin therapy; TP: Total protein; ALB: Albumin; TG: Triglyceride; TC: Total cholesterol; FFA: Free fat acid. There were significant differences in values between preoperative days 0 and postoperative day 1 (^aP < 0.05), between postoperative days 1 and 3 (^cP < 0.05) and between postoperative days 3 and 7 respectively (^eP < 0.05) respectively. There was a significant difference between the two groups at the same time (^gP < 0.05).

Citation: Liu HC, Zhou YB, Chen D, Niu ZJ, Yu Y. Effect of intensive vs conventional insulin therapy on perioperative nutritional substrates metabolism in patients undergoing gastrectomy. World J Gastroenterol 2012; 18(21): 2695-2703
URL: https://www.wjgnet.com/1007-9327/full/v18/i21/2695.htm
DOI: https://dx.doi.org/10.3748/wjg.v18.i21.2695