Soop, Mattias

It has been shown ingestion of whey protein (WP) results in rapid systemic appearance rates of amino acids (AA) but in higher amino acid (AA) oxidation and whole body protein synthesis than in with casein (cas) ingestion which inhibits protein breakdown. To determine whether combined ingestion of both cas and WP in a meal containing carbohydrate has any disparate effects on protein economy in splanchnic and muscle beds we studied 12 healthy volunteers who ingested intrinsically labeled WP and Cas protein fractions. Following ingestion of 0.625 g·kg FFM −1 each of [ 15 N]WP and [ 13 C]Cas and 0.9 g·kg FFM −1 of lactose; or 0.625 g·kg FFM −1 each of [ 13 C]WP and [ 15 N]CAS and 0.9 g·kg FFM −1 of lactose blood samples were collected from femoral artery and vein and hepatic vein at frequent intervals. At 80–120 min, the rate of appearance (PheRa) of Phe at hepatic vein from WP and Cas were similar (5.5 (0.9) vs 5.2 (0.7) μmol, min −1 , but at 220–260 min, PheRa from WP was slower than PheRa from Cas (2.4 (0.5) vs 5.3 (1.2) μmol, min −1 , P<0.05). Retention rates of Phe in muscle (PheRd) absorbed from WP and Cas were similar at 80–120 min (0.8 (0.1) vs 0.9 (0.2) μmol, min −1 , ns) but was significantly lower for WP than Cas at 220–260 min (0.5 (0.1) vs 1.1 (0.3) μmol, min −1 , P<0.05). In conclusion Cas has more sustained systemic effects and muscle protein accretion than WP. The different metabolic effects of co‐ingested protein fractions have potential implications in designing appropriate nutritional support.

Abstract Background This is the fourth updated Enhanced Recovery After Surgery (ERAS ® ) Society guideline presenting a consensus for optimal perioperative care in colorectal surgery and providing graded recommendations for each ERAS item within the ERAS ® protocol. Methods A wide database search on English literature publications was performed. Studies on each item within the protocol were selected with particular attention paid to meta‐analyses, randomised controlled trials and large prospective cohorts and examined, reviewed and graded according to Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Results All recommendations on ERAS ® protocol items are based on best available evidence; good‐quality trials; meta‐analyses of good‐quality trials; or large cohort studies. The level of evidence for the use of each item is presented accordingly. Conclusions The evidence base and recommendation for items within the multimodal perioperative care pathway are presented by the ERAS ® Society in this comprehensive consensus review.

Elective surgery was performed after overnight fasting, a routine that may affect the metabolic response to surgery. We investigated the effects of insulin and glucose infusions before and during surgery on postoperative substrate utilization and insulin sensitivity. Seven patients were given insulin and glucose infusions 3 h before and during surgery (insulin group), and a control group of six patients underwent surgery after fasting overnight. Insulin sensitivity and glucose kinetics (d-[6,6-2H2]glucose) were measured before and immediately after surgery using a hyperinsulinemic, normoglycemic clamp. Glucose infusion rates and whole body glucose disposal decreased after surgery in the control group (−40 and −29%, respectively), whereas no significant change was found in the insulin group (+16 and +25%). Endogenous glucose production remained unchanged in both groups. Postoperative changes in cortisol, glucagon, fat oxidation, and free fatty acids were attenuated in the insulin group (vs. control). We conclude that perioperative insulin and glucose infusions minimize the endocrine stress response and normalize postoperative insulin sensitivity and substrate utilization.

When consumed separately, whey protein (WP) is more rapidly absorbed into circulation than casein (Cas), which prompted the concept of rapid and slow dietary protein. It is unclear whether these proteins have similar metabolic fates when coingested as in milk. We determined the rate of appearance across the splanchnic bed and the rate of disappearance across the leg of phenylalanine (Phe) from coingested, intrinsically labeled WP and Cas. Either [15N]Phe or [13C- ring C6]Phe was infused in lactating cows, and the labeled WP and Cas from their milk were collected. To determine the fate of Phe derived from different protein sources, 18 healthy participants were studied after ingestion of one of the following: 1) [15N]WP, [13C]Cas, and lactose; 2) [13C]WP, [15N]Cas, and lactose; 3) lactose alone. At 80–120 min, the rates of appearance (Ra) across the splanchnic bed of Phe from WP and Cas were similar [0.068 ± 0.010 vs. 0.070 ± 0.009%/min; not significant (ns)]. At time 220–260 min, Phe appearance from WP had slowed (0.039 ± 0.008%/min, P < 0.05) whereas Phe appearance from Cas was sustained (0.068 ± 0.013%/min). Similarly, accretion rates across the leg of Phe absorbed from WP and Cas were not different at 80–120 min (0.011 ± 0.002 vs. 0.012 ± 0.003%/min; ns), but they were significantly lower for WP (0.007 ± 0.002%/min) at 220–260 min than for Cas (0.013 ± 0.002%/min) at 220–260 min. Early after meal ingestion, amino acid absorption and retention across the leg were similar for WP and Cas, but as rates for WP waned, absorption and assimilation into skeletal muscle were better retained for Cas.