Tissue Composition of Weight Loss in Surgical Patients I. Elective Operation

Kinney, John M.; Long, Calvin L.; Gump, Frank E.; Duke, Joshua

doi:10.1097/00000658-196809000-00013

Cited by 105 publications

(40 citation statements)

References 17 publications

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“…Only half of the energy requirement is met from intravenous dextrose and food; and in order to achieve energy balance, body fat stores and to a lesser extent glycogen and protein stores are burned. In 1968 Kinney and his colleagues conducted a study of energy balance in 10 patients undergoing major surgery [7]. This remarkable detailed study of energy intake and energy expenditure showed that resting energy expenditure--in health around 22 kcal/kg/day--increases slightly early after surgery but from then on, unless there is a complication, remains at normal values (Fig.…”

Section: Perioperative Energeticsmentioning

confidence: 99%

Metabolic basis for the management of patients undergoing major surgery

1993

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After reviewing our current knowledge of the metabolic response to major abdominal surgery, we present two new studies in which we have followed the changes in body composition, physiologic function, and psychological function for up to 1 year after major surgery. In the first study, 46 patients had changes in body composition, physiologic function, and psychological function measured perioperatively and again at intervals up to 1 year. There was an average loss of weight of 3000 grams Imaximum at 2 weeks/, and the tissue composition of this weight loss was composed of 1400 grams fat. 600 grams protein, and 1000 grams water. Normal body composition had returned to normal in most patients by 6 months. In the second study of 84 patients, deficits of skeletal muscle function and fatigue were found to be greatest at postoperative day 7. Most patients were back to preoperative levels of muscle function and fatigue 30 days after surgery, and nearly all had normal values 90 days after surgery. Based on these studies we outline our management program for the metabolic care of patients undergoing major abdominal surgery.Over many years surgeons have been interested in the early metabolic responses in patients undergoing major surgery particularly while the patients are still in the hospital, but it is only recently that long-term changes in metabolism, body composition. physiology, and psychological function have been studied over the weeks and months following surgery. Here we look at what is known about the metabolic changes brought about by the surgical procedure and show how these changes may persist for weeks and in some cases months before the patient is restored to full health. On this basis we set out a management program for the metabolic care of patients undergoing uncomplicated major elective surgery. Metabolic Response to SurgeryCuthbertson [1] divided the metabolic response to injury into an early ebb phase, characterized by hypovolemia and subsequent sympathetic and adrenal response, and a later flow phase, during which the injured patient loses protein at an accelerated rate. The duration of the flow phase depends on the severity of the injury, and it is gradually replaced by a convalescent anabolic phase, during which the protein and energy stores lost in the early postinjury period are repleted (Table 1). Ebb PhaseThe ebb phase is largely a result of hypovolemia, and it lasts until circulating blood volume is restored. The pale, clammy, tachycardiac patient visited by the surgeon soon after surgery is in the ebb phase. Hume and Egdahl [2] demonstrated the importance of the brain to the early endocrine response to injury. They disconnected an anesthetized animal's limb from its body, leaving only the sciatic nerve and femoral vessels. When they measured the level of corticosteroids in adrenal venous blood in response to a burn to the isolated limb they found an immediate rise; when the sciatic nerve was divided, this response did not occur. These same workers showed subsequently that the early hormone res...

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Section: Perioperative Energeticsmentioning

confidence: 99%

Metabolic basis for the management of patients undergoing major surgery

1993

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“…Under extreme physical exertion TEE can rise up to 25-30 MJ day 21 , which contrasts with disease states, where it usually decreases to 6-12 MJ day…”

Section: Acute Diseases In Childrenmentioning

confidence: 90%

“…The mean TEE/REE (n ¼ 8) was 1.18^0.17, and TEE/BMR predicted (Harris Benedict equation) was 1.33^0.27 (n ¼ 18). TEE was only 6.72^2.92 MJ day 21 .…”

Section: Acute Diseases In Childrenmentioning

confidence: 93%

“…Two studies 47 used control values from the literature and reported no increase in TEE in children aged 4-36 months. Another study 48 using control groups of subjects reported a significant increase in TEE and TEE kg 21 20 . The group also had low FFM, REE and TEE compared to the control group.…”

Section: Chronic Diseases In Childrenmentioning

confidence: 93%

“…There is very limited information about the energy cost of physical activity in disease 21,22 . Royall et al…”

Section: Measurement Of Bmrmentioning

confidence: 99%

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Insights into energy requirements in disease

Elia

2005

Public Health Nutr.

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Accurate information about the energy needs of a range of acute and chronic diseases and morbidity is lacking and often complicated by the medication prescribed to treat the condition and also because of the presence of pre-existing malnutrition. Assessing the energy requirements of patients with acute and chronic diseases is more complex than for those in good health. These requirements not only depend on the aggressiveness of the disease and level of inactivity it causes, but also on the treatment, and the presence of prior malnutrition. It used to be generally believed that the energy requirements were increased in a number of diseases. It is now realised that this is not usually the case. Therefore, it is necessary to put these changing ideas into context by considering a wide range of acute and chronic diseases which this paper proposes to do. This paper is almost exclusively restricted to studies that have measured total energy expenditure (TEE) using tracer techniques in both hospital and the community (mostly doubly labelled water and to a lesser extent bicarbonateurea), and continuous 24-hour indirect calorimetry in artificially ventilated patients in hospital.

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Respiratory Changes Induced by the Large Glucose Loads of Total Parenteral Nutrition

Askanazi

1980

JAMA

371

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Total parenteral nutrition (TPN) using glucose as nonprotein calories was associated with increases in O2 consumption (VO2) and CO2 production (VCO2). The magnitude of the changes was a function of the patient's clinical state and glucose load. Depleted patients showed a minimal increase in VO2, while VCO2 increased 23%. Minute ventilation (VE) increased 32%. Hypermetabolic patients (major trauma, sepsis) had a 30% increase in VO2 and a 57% increase in VCO2, while VE increased 71%. Patients with mild to moderate injuries (energy expenditure +/- 15% of normal) showed a 21% increase in VO2 and a 53% increase in VCO2, while VE increased 121%. Large carbohydrate intakes were associated with increases in CO2 production in all patients, while increases in O2 consumption were seen primarily in hypermetabolic patients. These changes suggest that the high glucose loads of TPN may be a physiologic stress.

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Tissue Composition of Weight Loss in Surgical Patients I. Elective Operation

Cited by 105 publications

References 17 publications

Metabolic basis for the management of patients undergoing major surgery

Metabolic basis for the management of patients undergoing major surgery

Insights into energy requirements in disease

Respiratory Changes Induced by the Large Glucose Loads of Total Parenteral Nutrition

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