Effect Of Preoperative Oral Carbohydrate On The Changes Of Adipokines Levels In Patients With Radical Gastrectomy: A Single-center, Double-blind, Randomized Clinical Trial

Objective To investigate the effect of preoperative oral carbohydrate to adipokines levels in patients with gastric cancer.Methods The clinical date of 80 patients undergoing radical gastrectomy for gastric cancer at the Affiliated Hospital of Qingdao University from April 2011 to October 2011 were prospectively analyzed. A double-blind, randomized, controlled study was performed, and they were divided into oral carbohydrate group and placebo group based on a random table. The resting energy expenditure(REE) was tested 4 hours before the surgery, the patients in the both group were allowed to oral carbohydrate and placebo 2 hours before surgery, respectively,and in the morning before surgery the patients were drawn fasting blood glucose, insulin, and homeostasis model assessment calculated using insulin resistance index. Two groups of patients received gastrectomy were all in epidural anesthesia compounded intravenous. The adipose tissue was taken and fixed in 2.5% glutaraldehyde solution when the patients, during the surgery there is no infusion of glucose, insulin and blood products.After surgery to the patients was extracted their blood to determine glucose, insulin, and calculated homeostasis model assessment using insulin resistance index, and application of energy tester was measured resting energy expenditure(REE). Two groups of patients were compared in adiponectin, leptin, glucose, insulin, insulin resistance index and REE.Results There were no difference between both groups in blood glucose, insulin, insulin resistance index, adiponectin, leptin(P> 0.05).After the surgery blood glucose levels in the experimental group and the control group were 7.64 ± 0.78 mmol / L and 9.32 ± 1.31 mmol / L(t =-5.37);The insulin levels were 16.72 ± 3.88 and 30.72 ± 6.66U(t =-8.89); Insulin resistance index were 5.68 ± 1.40 and 12.68 ± 3.13(t =-9.98); REE levels were 1341.00 ± 110.28 Kcal / d and 58.21 ± 168.54 Kcal / d(t =-2.58); Adiponectin levels were 9.16 ± 3.73 mg / L and 6.18 ± 2.11 mg / L(t = 3.41);Leptin levels were 10.92 ± 2.45 ug / L and 13.54 ± 2.93 ug / L(t =-3.36);Differences were statistically significant(P <0.05).Conclusion Preoperative oral carbohydrate can improve the secretion levels of adipokines decrease the insulin resistance, reduce the resting energy expenditure and improving metabolism, the possible mechanism maybe related to the enhanced insulin resistance.