Effect of systemic insulin on protein kinetics in postoperative cancer patients Journal Article

Authors: Pearlstone, D. B.; Wolf, R. F.; Berman, R. S.; Burt, M.; Brennan, M. F.
Article Title: Effect of systemic insulin on protein kinetics in postoperative cancer patients
Abstract: Background: Cancer cachexia is a significant cause of postoperative morbidity and mortality in patients with tumors of the upper gastrointestinal tract. Standard parenteral nutrition (TPN) has failed to alter this. The anabolic effect of insulin has been well documented, and its positive effect on protein economy in cancer patients has been recently demonstrated. This study examines the effect of high-dose insulin and parenteral nutrition on protein kinetics in postoperative cancer patients. Methods: Eleven patients underwent surgery for pancreatic, esophageal, or gastric carcinoma. Postoperatively, patients received standard TPN for 4 days (1 g/kg/day amino acids, 1,000 kcal/day dextrose, 100 g/day lipid), and hyperinsulinemic parenteral nutrition for 4 days (same as standard TPN plus 1.44 U/kg/day regular human insulin) in a crossover design. All patients received both treatments, and the order of treatment was determined randomly. Euglycemia was maintained during insulin infusion via a variable 30% dextrose infusion. Patients underwent protein metabolic studies after each treatment period and rates of whole body and skeletal muscle protein synthesis, breakdown, and net balance were determined by radioisotopic tracer methods using14C-leucine and3H-phenylalanine. Results: Compared with standard TPN (STD), hyperinsulinemic TPN (INS) resulted in a significant increase in skeletal muscle protein synthesis (INS: 52.04±10.22 versus STD: 26.06±6.71 nmol phe/100 g/min, p<0.05) and net balance of protein (INS: 7.75±4.61 versus STD: -15.10±6.44 nmol phe/100 g/min, p<0.01), but no difference in skeletal muscle protein breakdown (INS: 44.29±11.54 versus STD: 41.17±5.89 nmol phe/100 g/min). Whole-body net balance of protein also significantly increased with insulin-based TPN, compared with standard TPN (INS: 0.04±0.05 versus STD: -0.08±0.07 μmol leu/kg/min, p<0.05), but no difference in whole-body protein synthesis (INS: 2.52±0.15 versus STD: 2.49±0.15 μmol leu/kg/min) or whole-body protein breakdown (INS: 2.48±0.16 versus STD: 2.58±0.19 μmol leu/kg/min) was observed. Patients received significantly more calories during the hyperinsulinemic TPN period than during the standard TPN period. There was no difference in total, essential, or branched-chain amino acids, and no difference in serum free fatty acids, triglycerides, or cholesterol was observed between the two treatment periods. Conclusion: High-dose insulin in conjunction with hypercaloric parenteral nutrition causes improved skeletal muscle protein synthesis, skeletal muscle protein net balance, and whole-body protein net balance compared with standard TPN in postoperative cancer patients. © 1994 The Society of Surgical Oncology, Inc.
Keywords: adult; controlled study; aged; middle aged; clinical trial; postoperative period; methodology; prospective study; prospective studies; nutritional status; metabolism; controlled clinical trial; randomized controlled trial; drug effect; gastrointestinal neoplasms; blood; protein synthesis; protein biosynthesis; insulin; total parenteral nutrition; amino acid; cachexia; amino acids; crossover procedure; skeletal muscle; muscle, skeletal; nutrition; gastrointestinal tumor; cross-over studies; parenteral nutrition, total; humans; human; male; female; article; protein kinetics; tpn
Journal Title: Annals of Surgical Oncology
Volume: 1
Issue: 4
ISSN: 1068-9265
Publisher: Springer  
Date Published: 1994-07-01
Start Page: 321
End Page: 332
Language: English
DOI: 10.1007/bf02303571
PROVIDER: scopus
PUBMED: 7850531
Notes: Export Date: 14 January 2019 -- Article -- Source: Scopus
Citation Impact
MSK Authors
  1. Murray F Brennan
    1012 Brennan
  2. Michael E. Burt
    187 Burt
  3. Ronald F. Wolf
    15 Wolf