Insights From a Short-Term Protein-Calorie Restriction Exploratory Trial in Elective Carotid Endarterectomy Patients.
Autor: | Kip P; 1 Division of Vascular and Endovascular Surgery, Brigham & Women's Hospital, Boston, MA, USA.; 2 Department of Genetics and Complex Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA.; 3 Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands., Trocha KM; 1 Division of Vascular and Endovascular Surgery, Brigham & Women's Hospital, Boston, MA, USA.; 2 Department of Genetics and Complex Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA., Tao M; 1 Division of Vascular and Endovascular Surgery, Brigham & Women's Hospital, Boston, MA, USA., O'leary JJ; 1 Division of Vascular and Endovascular Surgery, Brigham & Women's Hospital, Boston, MA, USA., Ruske J; 1 Division of Vascular and Endovascular Surgery, Brigham & Women's Hospital, Boston, MA, USA., Giulietti JM; 1 Division of Vascular and Endovascular Surgery, Brigham & Women's Hospital, Boston, MA, USA., Trevino-Villareal JH; 2 Department of Genetics and Complex Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA., MacArthur MR; 2 Department of Genetics and Complex Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA., Bolze A; 1 Division of Vascular and Endovascular Surgery, Brigham & Women's Hospital, Boston, MA, USA., Burak MF; 1 Division of Vascular and Endovascular Surgery, Brigham & Women's Hospital, Boston, MA, USA.; 2 Department of Genetics and Complex Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA., Patterson S; 1 Division of Vascular and Endovascular Surgery, Brigham & Women's Hospital, Boston, MA, USA., Ho KJ; 4 Department of Vascular Surgery, Northwestern Medicine Feinberg School of Medicine, Chicago, IL, USA., Carmody RN; 5 Department of Human Evolutionary Biology, Harvard University, Cambridge, MA, USA., Guzman RJ; 6 Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA., Mitchell JR; 2 Department of Genetics and Complex Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA., Ozaki CK; 1 Division of Vascular and Endovascular Surgery, Brigham & Women's Hospital, Boston, MA, USA. |
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Jazyk: | angličtina |
Zdroj: | Vascular and endovascular surgery [Vasc Endovascular Surg] 2019 Aug; Vol. 53 (6), pp. 470-476. Date of Electronic Publication: 2019 Jun 19. |
DOI: | 10.1177/1538574419856453 |
Abstrakt: | Background: Open vascular surgery interventions are not infrequently hampered by complication rates and durability. Preclinical surgical models show promising beneficial effects in modulating the host response to surgical injury via short-term dietary preconditioning. Here, we explore short-term protein-calorie restriction preconditioning in patients undergoing elective carotid endarterectomy to understand patient participation dynamics and practicalities of robust research approaches around nutritional/surgical interventions. Methods: We designed a pilot prospective, multicenter, randomized controlled study in patients undergoing carotid endarterectomy. After a 3:2 randomization to a 3-day preoperative protein-calorie restriction regimen (30% calorie/70% protein restriction) or ad libitum group, blood, clinical parameters, and stool samples were collected at baseline, pre-op, and post-op days 1 and 30. Subcutaneous and perivascular adipose tissues were harvested periprocedurally. Samples were analyzed for standard chemistries and cell counts, adipokines. Bacterial DNA isolation and 16S rRNA sequencing were performed on stool samples and the relative abundance of bacterial species was measured. Results: Fifty-one patients were screened, 9 patients consented to the study, 5 were randomized, and 4 completed the trial. The main reason for non-consent was a 3-day in-hospital stay. All 4 participants were randomized to the protein-calorie restriction group, underwent successful endarterectomy, reported no compliance difficulties, nor were there adverse events. Stool analysis trended toward increased abundance of the sulfide-producing bacterial species Bilophila wadsworthia after dietary intervention ( P = .08). Conclusions: Although carotid endarterectomy patients held low enthusiasm for a 3-day preoperative inpatient stay, there were no adverse effects in this small cohort. Multidisciplinary longitudinal research processes were successfully executed throughout the nutritional/surgical intervention. Future translational endeavors into dietary preconditioning of vascular surgery patients should focus on outpatient approaches. |
Databáze: | MEDLINE |
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