Is Overnight Fasting before Surgery Too Much or Not Enough? How Basic Aging Research Can Guide Preoperative Nutritional Recommendations to Improve Surgical Outcomes: A Mini-Review

Abstract

Dietary restriction (DR) is best known for extending lifespan in experimental model organisms, but also increases resistance to a variety of clinically relevant stressors, including those associated with surgery. Extended periods of DR, lasting months to years, are required for optimal longevity benefits in rodents, but short-term dietary preconditioning (less than 1 week) remarkably protects from acute injury. Here, we discuss recent advances in our understanding of the mechanistic basis of short-term DR and fasting in the context of surgical stress resistance, including upstream amino acid sensing by the GCN2 and mTORC1 pathways, and downstream effector mechanisms including increased insulin-dependent prosurvival signaling and elevated endogenous hydrogen sulfide production. We also review the current trend in preoperative nutrition away from preoperative fasting and towards carbohydrate loading. Finally, we discuss the rationale for the nonmutually exclusive use of brief DR or pharmacological DR mimetics to precondition against the stress and potential complications of surgery.

Acute Fasting Does Not Induce Cognitive Impairment in Mice

“…Clinically, the patients usually have more than 12 h fasting before their anesthesia and surgery. Fasting, and more generally, calorie restriction has been shown to exert controversial outcomes (Benau et al, 2014; Longchamp et al, 2017). In various animal models of neurological diseases, such as epilepsy, Parkinson’s disease and Alzheimer’s disease (Greene et al, 2001; Maswood et al, 2004; Halagappa et al, 2007), calorie restriction is reported to mitigate the neurological damage.…”

Local Experimental Intracerebral Hemorrhage in Rats

“…Before the operation, the animals were subjected to food deprivation for 6 h, without restricting access to water. Fasting prior to surgery was used as preconditions against a variety of complications in preclinical models [ 24 ].…”

The Fact and Fiction of Nutritional Claims About Health and Longevity

“…In women with breast cancer, a randomised clinical trial (de -10 -Groot et al 2020) with 131 patients suggested that fasting before chemotherapy could reduce the tumour more than chemotherapy alone in a per-protocol analysis (comparing patients that really complied with the protocol), the results being less clear in intention to treat (groups are compared even if some subjects did not respect the protocol, as in real life). Fasting is thus studied by scientists and, for instance, some authors wonder whether a preoperative fasting lasting more than the usual night could improve surgical outcomes (Longchamp et al 2017).…”