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Short-term hypercaloric carbohydrate loading increases surgical stress resilience by inducing FGF21
Thomas Agius1,2,3, Raffaella Emsley1, Arnaud Lyon1
1Department of Vascular Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
Nature Communications
|February 5, 2024
Summary
Preoperative carbohydrate loading increases calorie intake and reduces protein intake, boosting fibroblast growth factor 21 (FGF21) to protect against surgical stress and injury.
Area of Science:
- Metabolism and stress response
- Surgical perioperative care
- Molecular mechanisms of injury and protection
Background:
- Dietary restriction enhances resistance to surgical stress.
- Current perioperative protocols recommend carbohydrate loading before surgery to improve recovery.
- Preclinical data on carbohydrate loading's effects in surgical contexts are limited.
Purpose of the Study:
- To investigate the preclinical effects of carbohydrate loading on surgical stress response.
- To elucidate the molecular mechanisms underlying carbohydrate loading's protective effects.
- To determine the role of fibroblast growth factor 21 (FGF21) in carbohydrate loading-mediated protection.
Main Methods:
- Mice were subjected to one week of liquid carbohydrate loading.
- Surgical stress models included renal and hepatic ischemia-reperfusion injury.
- Investigated the impact of amino acid add-back and FGF21 deletion on protection.
- Analyzed molecular pathways including integrated stress response and oxidative metabolism.
Main Results:
- Carbohydrate loading reduced solid food intake while nearly doubling total caloric intake in mice.
- Carbohydrate loading increased hepatic fibroblast growth factor 21 (FGF21) expression, independent of caloric intake.
- FGF21 mediated protection against renal and hepatic ischemia-reperfusion injury in mice.
- Protection was observed across different sexes and ages, and was blocked by amino acid add-back or FGF21 deletion.
Conclusions:
- Preoperative carbohydrate loading promotes protein dilution, leading to increased FGF21.
- FGF21 induction is crucial for protection against surgical stress via integrated stress response and oxidative metabolism.
- These findings support the use of carbohydrate loading drinks before surgery and highlight FGF21's protective role.
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