Influence of preoperative intravenous nutrition upon hepatic protein synthesis and plasma proteins and amino acids.
The influence of 3 and 7 days of preoperative intravenous nutrition (IVN) on the capacity for protein synthesis in liver and on concentrations of plasma proteins and amino acids were investigated in patients with gastrointestinal malignancy. Thirty patients with gastrointestinal neoplasms who had lost more than 5 kg of weight over 3 months were randomized into three groups to receive preoperatively: (a) no IVN, (b) IVN for 3 days (0.18 gN/kg/day as amino acid; 30 kcal/kg/day as glucose), or (c) IVN for 7 days. Free access to a hospital diet was available to all patients including 10 patients who had not lost weight who served as controls. In the three groups of patients who had lost weight, median transferrin and fibronectin were lower than for controls, whereas other proteins and amino acids were comparable. After feeding, samples of liver were obtained peroperatively and the potential rates of protein synthesis were calculated from the in vitro incorporation of (14C)-leucine, into protein. Preoperative IVN significantly increased the potential rate of protein synthesis in liver after 3 days. Plasma amino acids were comparable with controls whereas in the unfed-group concentrations suggested utilization of alanine and breakdown of muscle. Three days of IVN also increased plasma fibronectin and IgA but increases of prealbumin, IgM, and complement C3 were only significant in the group fed for 7 days. On the 7th postoperative day plasma proteins were decreased similarly in each group. This study shows that concentrations of several plasma proteins, in preoperative patients reflect net rates of hepatic protein synthesis and are susceptible to depletion during starvation and repletion by 3 or 7 days of IVN.