Table 3.
Summary of studies included within review.
| Study | Design and Sample Size | Patient, Population. or Problem | Intervention, Prognostic Factor or Exposure |
Comparison or Intervention | Outcomes | Main Findings |
|---|---|---|---|---|---|---|
| Dreyer et al., 2013 [20] | RCT n = 28 | TKR patients | 20 g of essential amino acids (EAA) twice daily between meals for 1 week before and 2 weeks after TKR. | Placebo supplementation (20 g (100% alanine) | Muscle atrophy, muscle strength, and functional mobility. | The placebo group exhibited greater quadriceps muscle atrophy (−14.3 ± 3.6% change) from baseline to 2 weeks post-surgery. EAAs also attenuated atrophy in the non-operated quadriceps and in the hamstring and adductor muscles of both extremities. The EAA group demonstrated better functional mobility at 2 and 6 weeks post-operatively (all p < 0.05). |
| Nishizaki et al., 2015 [21] | RCT n = 23 | TKR patients | Beta-hydroxy beta-methylbutyrate (HMB; 2400 mg), l-arginine (Arg; 14,000 mg) and l-glutamine (Gln; 14,000 mg) (HMB/Arg/Gln) (158 kcal of energy) for 5 days before the surgery and for 28 days after the surgery. Patients fasted on the day of surgery. | Control food (orange juice, 226 kcal of energy and 280 mg of protein) | Body weight, bilateral knee extension strength, rectus femoris cross-sectional area. | Maximal quadriceps strength was 1.1 ± 0.62 Nm/kg pre-surgery and 0.7 ± 0.9 Nm/kg 14 days post-surgery in the control group (p = 0.02). In the HMB/Arg/Gln group, maximum quadriceps strength was 1.1 ± 0.3 Nm/kg before surgery and 0.9 ± 0.4 Nm/kg 14 days after surgery. The muscle loss was significant in the control group, but not in the intervention group. |
| Alito and de Aguilar-Nascimento 2016 [22] | Pilot RCT n = 32 | THR patients | 6 h pre-operative fasting for solids, an oral drink (200 mL of 12.5% maltodextrin) up to 2 h before induction of anesthesia, restricted intravenous fluids (only 1000 mL of cystalloid fluid after surgery), and pre-operative immune nutrition (600 mL/day of Impact—Nestle, Brazil) for 5 days prior to surgery. | Control group (traditional care, 6–8 h of pre-operative fasting, intravenous hydration until the 1st post-operative day and no pre-operative immune supplementation) | Length of stay, C-reactive protein. | Median length of stay (LOS) was 3 (2–5) days in the intervention group and 6 (3–8) days in controls (p < 0.01). Post-operative C-reactive protein was higher in the control group (p < 0.001). |
| Aronsson et al., 2008 [23] | Pilot RCT n = 29 | THR patients | Carbohydrate-rich drink (an iso-osmolar carbohydrate-rich solution: 12.5 g carbohydrate/100 mL, pH 5.0) pre-operatively. | Placebo drink (flavored water) | IGF-1 and IGFBP-1 were determined in serum by RIA. Body composition was determined by dual energy X-ray absorptiometry (performed the day before surgery and at 6–8 weeks after surgery) | Compared to placebo, the authors found a relative increase in IGF-1 bioavailability post-operatively after a carbohydrate-rich drink given shortly before surgery. There were no significant differences in the changes in fat or lean body mass between groups (p = 0.08). |
| Hartsen et al., 2012 [24] | RCT n = 60 | ASA physical status I–III patients scheduled for THR | 400 mL of an oral 12.5% carbohydrate solution | Placebo drink (flavored water) | Visual analog scales were used to score six discomfort parameters. | Immediately after surgery, carbohydrate-treated patients were less hungry (median scores 9.5 vs. 22 mm) and experienced less nausea (0 vs. 1.5 mm) (p < 0.05). |
| Ljunggren and Hahn 2012 [25] | RCT n = 57 | THR patients | Tap Water: 800 mL by mouth, 2 h before entering the operating room OR Nutrition: an iso-osmolar carbohydrate drink (50 kcal/100 mL) 800 mL in the evening before the surgery (day 0), and 400 mL 2 h before entering the operating room (day 1). |
Fasting (no food or water from midnight before the surgery) | Intravenous glucose tolerance, physical stress, muscle catabolism, body fluid volumes, complications, wellbeing, and insulin sensitivity. | Pre-operative ingestion of tap water or a nutritional drink had no statistically significant effect on glucose clearance, insulin sensitivity, post-operative complications, or wellbeing in patients undergoing THR. |
| Nygren et al., 1999 [26] | RCT n = 16 | THR patients | Pre-operative oral iso-osmolar carbohydrate administration (800 mL 12.5% carbohydrates), the evening before the operation. Another 400 mL of the same beverage was allowed 2 h after midnight, taken no later than 2 h before the initiation of anesthesia. | Placebo drink | Insulin sensitivity | Patients given a carbohydrate drink shortly before elective surgery displayed less reduced insulin sensitivity (−16% (not significant)) after surgery compared to patients undergoing surgery after an overnight fast (37% p < 0.05 vs. pre-operatively). Insulin sensitivity and whole-body glucose disposal were reduced in both groups. |
| Soop et al., 2001 [27] | RCT n = 15 | THR patients | Carbohydrate-rich drink (12.5 g/100 mL carbohydrate, 12% monosaccharides, 12% disaccharides, 76% polysaacharides, 285 mosmol/kg), 800 mL between 7 p.m. and 12:00 a.m. on the evening before surgery and 400 mL on the morning of surgery. | Placebo drink (acesulfame-K, 0.64 g/100 mL citrate, 107 mosmol/kg) | Glucose, lactate and insulin concentrations, glycerol, NEFA, glucoregulatory hormone concentrations, glucose kinetics, and substrate utilization. | Whole-body insulin sensitivity decreased by 18% in the intervention group vs. 43% in the placebo group. This was attributable to a less reduced glucose disposal in peripheral tissues and increased glucose oxidation rates. |
| Soop et al., 2004 [28] | RCT n = 14 | THR patients | Carbohydrate rich drink (12.5 g /100 mL carbohydrate, 12% monosaccharides, 12% disaccharides, 76% polysaacharides, 285 mosm/kg, 800 mL between 7 p.m. and 12:00 a.m. on the evening before surgery and 400 mL on the morning of surgery. | Placebo drink | Glucose kinetics, substrate utilization, nitrogen balance, ambulation time, food consumption, and LOS. | Whole-body glucose disposal and nitrogen balance were similar between groups. Pre-operative carbohydrate treatment significantly attenuated post-operative endogenous glucose release (0.69 (0.07) vs. 1.21 (0.13) mg kg−1, (p < 0.01), compared to the placebo group. Whole-body glucose disposal and nitrogen balance were similar between groups. |
RCT = Randomized Clinical Trial; IGF = Insulin like growth factor; IGFBP = Insulin like growth factor binding protein; RIA = Radioimmunoassay; ASA = American Society of Anesthesiologists; NEFA = nonesterified free fatty acid.