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Background and aims: In response to surgical stress, the body reacts with a change in metabolism to a catabolic state. This is further aggravated by the fasting state preoperatively. We aimed to determine the effects on catabolism i.e., body composition and IGF-I bioavailability as measured by the serum IGF-I/IGFBP-1 ratio, of a carbohydrate rich drink given shortly before surgery. Methods: Twenty-nine patients scheduled for a total hip replacement (THR) were randomized in a double-blind placebo-controlled pilot study to a carbohydrate-rich drink or to placebo pre-operatively. The nutritional supplementation consisted of an iso-osmolar carbohydrate-rich drink (12.5 g carbohydrates/100 ml, pH 5.0). Fasting blood samples were collected before surgery and repeated after 5 days and after 2 months. IGF-I and IGFBP-1 were determined in serum by RIA. Body composition was determined by dual energy X-ray absorptiometry (DXA). Results: Compared with placebo we found a relative increase in IGF-I bioavailability post-operatively after a carbohydrate-rich drink given shortly before surgery. There were no significant long-term differences in the changes in fat or lean body mass between groups, but, in a subgroup with late scheduled surgery, there was a tendency to a difference (p=0.08) of fat loss after 2 months, with less fat loss in those who received another carbohydrate drink close to surgery. The pre-operative intake of a 200-200x2 ml carbohydrate drink was well tolerated and safe. There were no adverse events such as pulmonary aspiration before, during or after operation. Conclusions: A carbohydrate-rich drink given shortly before surgery increases IGF-I bioavailability post-operatively in patients undergoing a THR, but has no significant effects on body composition after 2 months in physically active people. We suggest that, if the operation is postponed for more than four hours on the same day, an additional carbohydrate drink should be given. [ABSTRACT FROM AUTHOR]