Gastric emptying, glucose metabolism and gut hormones: Evaluation of a common preoperative carbohydrate beverage

Jan 25, 2011Nutrition (Burbank, Los Angeles County, Calif.)

How a common pre-surgery carbohydrate drink affects stomach emptying, blood sugar, and gut hormones

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Abstract

Gastric emptying of a fruit-based lemonade was observed to have a later onset compared to a carbohydrate-rich beverage, with no significant differences in residual volumes.

The fruit-based lemonade induced a more limited response in glucose, insulin, and C-peptide levels after consumption.
Significantly higher levels of glucose, insulin, C-peptide, and glucagon were recorded between 15 and 90 minutes for the carbohydrate-rich beverage.
An inverse relationship was noted between GLP-1 levels and residual volume, suggesting efficient gastric emptying.
Differences in beverage composition and osmolarity may have influenced the varying gastric emptying rates and hormonal responses.

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OBJECTIVE: To study the gastric-emptying rate and gut hormonal response of two carbohydrate-rich beverages. A specifically designed carbohydrate-rich beverage is currently used to support the surgical patient metabolically. Fruit-based beverages may also promote recovery, due to natural antioxidant and carbohydrate content. However, gastric emptying of fluids is influenced by its nutrient composition; hence, safety of preoperative carbohydrate loading should be confirmed. Because gut hormones link carbohydrate metabolism and gastric emptying, hormonal responses were studied.

METHODS: In eight volunteers, gastric emptying rates of both 400 mL of a ready-to-use beverage (A: Nutricia preOp; 50.4 g carbohydrates-mainly polysaccharides; 260 mOsm/kg) and 400 mL over-the-counter fruit-based lemonade (B: Roosvicee Original; 48 g carbohydrates--mainly fruit-associated saccharides; 805 mOsm/kg) were determined scintigraphically (using hepatate Tc-99(m)) according to a crossover design. Plasma glucose, insulin, C-peptide, glucagon-like peptide (GLP-1), peptide YY, total glucagon, and ghrelin were studied.

RESULTS: Gastric emptying showed no differences in residual volumes. Earlier onset in emptying for beverage A versus B was observed (trend), with significantly higher glucose, insulin, C-peptide, and glucagon responses at 15-90 min. GLP-1 was inversely related to residual volume.

CONCLUSION: Fruit-based lemonade is a safe alternative for preoperative purposes. It induces a more limited glucose, insulin, and C-peptide response. Later onset in gastric emptying (B versus A: trend), lower glucagon release, and differences in beverage content and osmolarity may have contributed to those differences. Efficient emptying was reflected by early GLP-1 levels.

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Gastric emptying, glucose metabolism and gut hormones: Evaluation of a common preoperative carbohydrate beverage

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