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The Impact of Carbohydrate Loading and Muscle Glycogen Supercompensation on Anaerobic Performance in Elite Jiu-Jitsu Athletes. JEPonline 2024;27(5):26-42. The purpose of this study was to examine the effect of dietary patterns on muscle glycogen storage in Jiu-Jitsu athletes and to explore the relationship between muscle glycogen levels and athletic performance. A randomized controlled trial (RCT) design was employed that involved 10 Thai national Jiu-Jitsu athletes (5 males and 5 females; Mean = 22.80 years, SD = 3.35, Max = 27 years, Min = 18 years). The participants were randomly divided into 2 groups of 5: a Control Group (Mean = 23.20 years, SD = 4.08, Max = 27 years, Min = 18 years) and a Carbohydrate Loading Group (Mean = 22.40 years, SD = 2.88, Max = 26 years, Min = 19 years). Data collection consisted of 3 days of 24-hour dietary recall and body composition measurements, were used to develop a 4-day diet plan based on individualized estimated energy requirements (EER). The Control Group received a balanced diet while the Carbohydrate Loading Group was provided with a high-carbohydrate diet, paired with high-intensity intermittent training. Ultrasound scans using image segmentation methods assessed initial muscle glycogen levels concurrent with the Running-Based Anaerobic Sprint Test (RAST) protocol. The data were analyzed using means, standard deviations, and percentages. Differences in mean scores of the RAST were compared using a t-test, with statistical significance set at an alpha level of 0.05. The research results were as follows: (a) The Carbohydrate Loading Group consumed significantly higher quantities of carbohydrates (7.29 ± 0.67 g/kg/day) compared to the Control Group (4.32 ± 1.18 g/kg/day). (b) Glycogen storage in the carbohydrate loading group increased significantly by 43.30% (P < 0.05). (c) This increase in glycogen storage exhibited a strong negative correlation with the fatigue index (r = -0.998, P < 0.05). In conclusion, participants in the Carbohydrate Loading Group who consumed a highcarbohydrate diet for 4 days and underwent high-intensity intermittent exercise showed a significant increase in muscle glycogen stores, which was associated with a reduced fatigue index that indicated a decrease in muscle fatigue, potentially reflecting enhanced lactate tolerance and improved utilization of the anaerobic energy system in athletes. [ABSTRACT FROM AUTHOR]

The preoperative use of carbohydrate loading (CHO) is recommended in patients undergoing abdominal surgery, even if the advantages remain debatable. The aim was to evaluate the CHO benefits in patients undergoing abdominal surgery. A systematic search of randomized clinical trials was made. A frequentist random-effects network meta-analysis was carried out, reporting the surface under the cumulative ranking (SUCRA). The primary endpoint regarded the morbidity rate. The secondary endpoints were aspiration/regurgitation rates, the length of stay (LOS), the rate of postoperative nausea and vomiting (PONV), the changes (Δ) in insulin sensitivity or resistance, and the postoperative C- reactive protein (CRP) values. CHO loading and water administration had a similar probability of being the approach with a lower morbidity rate (SUCRA = 62.4% and 64.7%). CHO and clear water also had a similar chance of avoiding the PONV (SUCRA of 80.8% and 77%). The aspiration regurgitation rate was not relevant in non-fasting patients (0.06%). CHO administration was associated with the shorter hospitalization (SUCRA 86.9%), with the best metabolic profile (SUCRA values for insulin resistance and sensitivity were 81.1% and 76%). CHO enriched was the best approach for postoperative CRP values. Preoperative fasting was the worst approach for morbidity, PONV, insulin resistance and sensitivity, and CRP (SUCRA values of 32.1%, 21.7%, 10.2%, 3.2%, and 2.0%). Both preoperative CHO loading and clear water use were superior to the fasting about morbidity. CHO drinks use could provide specific advantages, reduce the PONV rate, and improve carbohydrate homeostasis, inflammatory pathway, and hospitalization. [ABSTRACT FROM AUTHOR]

The purpose of this project was to implement carbohydrate loading in patients undergoing thoracic surgery in an effort to decrease postoperative pain, nausea, and length of stay as a part of an enhanced recovery after surgery protocol. This quality-improvement project used a preintervention and postintervention design. Carbohydrate loading was given to 50 patients before undergoing thoracic surgery. Chart review was performed for 47 patients who received standard preoperative instructions in the preintervention group as historical control. Patients who received carbohydrate loading had a decreased use of opioids in the first 4 hours after surgery (P =.028) and decreased use of antiemetic medication in the first 24 hours after surgery compared with the preintervention group (P =.066). Patients who were instructed to consume carbohydrate loading complied 87% of the time. Carbohydrate loading can decrease postoperative nausea and pain in patients undergoing thoracic surgery. [ABSTRACT FROM AUTHOR]

Objectives: To determine if a 4 d period of high carbohydrate intake can supercompensate muscle glycogen and exercise work capacity on back-to-back occasions.Design: Seven trained cyclists (6 male, VO2peak: 57 ± 4 mL kg-1 min-1) completed a 9-d experimental period, consisting of three intermittent exhaustive cycling trials on days 1 (trial 1), 5 (trial 2) and 9 (trial 3). Following trial 1 cyclists were fed a high carbohydrate diet (˜10 g kg-1 day-1) for eight days to assess their capacity to repeatedly supercompensate muscle glycogen with 4 d recovery.Methods: A resting muscle biopsy was obtained prior to each trial consisting of 2 min work intervals (90-60% peak power output) interspersed with 2 min recovery (40% peak power output) repeated until exhaustion. Each 72-h period between trial days included two days of low volume cycling and a rest day. Resting muscle glycogen and total work completed was determined for each trial day.Results: Baseline muscle glycogen on day 1 (583.6 ± 111.0 mmol kg-1 dry mass) was supercompensated on day 5 (835.1 ± 112.8 mmol kg-1 dry mass; p = 0.04, d = 2.25) and again on day 9 (848.3 ± 111.4 mmol kg-1 dry mass; p = 0.01, d = 2.38). Total cycling work capacity increased from trial 1 to trial 2 (+8.7 ± 5.4 kJ kg-1; p = 0.01; d = 1.41); a large effect was observed in trial 3 compared to trial 1 (+6.4 ± 6.8 kJ kg-1; p = 0.10; d = 1.10).Conclusions: A 4 d high carbohydrate feeding strategy is sufficient to repeatedly supercompensate muscle glycogen content following exhaustive exercise and results in enhanced work capacity. [ABSTRACT FROM AUTHOR]

Malnutrition is a common and often unrecognized problem which increases the risk of postoperative morbidity and mortality. To identify those at risk, all patients should be screened on admission to hospital using a validated reliable tool (e.g. the Malnutrition Universal Screening Tool, MUST). Minimal perioperative fasting, carbohydrate loading and early enteral feeding all reduce postoperative complications and enhance recovery. Refeeding syndrome needs to be diagnosed and treated prior to initiating feeding. Enteral is the preferred route of feeding as it provides nourishment directly to the gut. If parenteral nutrition (PN) is indicated then close monitoring and strict guidelines need to be followed to reduce the risk of metabolic complications and line sepsis. PN is an integral part of the management of high-output enterocutaneous fistulae (ECF). A high-output ileostomy causes malnutrition and electrolyte abnormalities. Alterations to diet and fluids alongside medical management are necessary to reduce the high-output stoma. [ABSTRACT FROM AUTHOR]

The paper addresses the issue of selection of nutritional strategies, i.e. low- or high-carbohydrate diets, for athletes. On the basis of recent research the authors discuss in detail both dietary models and present their advantages and disadvantages. The paper includes practical implications and one-day low-carbohydrate and high-carbohydrate sample menus. [ABSTRACT FROM AUTHOR]

Abstract: Malnutrition is a common and often unrecognized problem which increases the risk of postoperative morbidity and mortality. To identify those at risk, all patients should be screened on admission to hospital using a validated reliable tool (e.g. the Malnutrition Universal Screening Tool, MUST). Minimal perioperative fasting, carbohydrate loading and early enteral feeding all reduce postoperative complications and enhance recovery. Refeeding syndrome needs to be diagnosed and treated prior to initiating feeding. Enteral is the preferred route of feeding as it provides nourishment directly to the gut. If parenteral nutrition (PN) is indicated then close monitoring and strict guidelines need to be followed to reduce the risk of metabolic complications and line sepsis. PN is an integral part of the management of high-output enterocutaneous fistulae (ECF). A high-output ileostomy causes malnutrition and electrolyte abnormalities. Alterations to diet and fluids alongside medical management are necessary to reduce the high-output stoma. [Copyright &y& Elsevier]

Abstract: Malnutrition is a common and often unrecognized problem which increases the risk of postoperative morbidity and mortality. To identify those at risk, all patients should be screened on admission to hospital using a validated reliable tool (e.g. the malnutrition universal screening tool, MUST). Minimal perioperative fasting, carbohydrate loading and early enteral feeding all reduce postoperative complications and enhance recovery. Refeeding syndrome needs to be diagnosed and treated prior to initiating feeding. Enteral is the preferred route of feeding as it provides nourishment directly to the gut. If parenteral nutrition (PN) is indicated then close monitoring and strict guidelines need to be followed to reduce the risk of metabolic complications and line sepsis. PN is an integral part of the management of high output enterocutaneous fistulae (ECF). A high output ileostomy causes malnutrition and electrolyte abnormalities. Alterations to diet and fluids alongside medical management are necessary to reduce the high output stoma. [ABSTRACT FROM AUTHOR]

Summary: Enhanced recovery represents a quantum leap in peri-operative management of patients undergoing colorectal surgery. Each of the elements of enhanced recovery are evidence based and together when used in concert provide an easy framework upon which to base future peri-operative care. The following article outlines the facets of enhanced recovery and the evidence base behind them. The role of the anaesthetist is central to the implementation of enhanced recovery and as such particular emphasis is given to fasting guidelines and carbohydrate loading pre-operatively and peri-operative fluid therapy. [Copyright &y& Elsevier]

Because patients' preoperative nutritional status influences the outcomes, we have used a preoperative nutrition program for surgical patients for a 2-year period and compared the results with those from a cohort treated in the previous 2 years. We retrospectively reviewed curative thoracic neoplasm resections from July 15, 2016, to July 15, 2018, in patients who had received a preoperative nutritional-enhanced recovery after surgery (N-ERAS) protocol. The protocol consisted of 5 days of an oral immunonutrition drink 3 times daily, daily receipt of probiotics, and a carbohydrate-loading drink the night before surgery. The historical control cohort (standard group) included those patients who had undergone surgery by the same surgeon during the previous 24 months. We excluded patients who had undergone esophageal, diagnostic, benign, emergency, or palliative procedures. Nonparametric and parametric statistical tests were used to analyze the data. The data from 462 patients were analyzed: 229 N-ERAS patients and 233 standard patients. No significant demographic or caseload differences were found between the 2 groups. The major significant outcome differences included fewer postoperative complications (30 [13.1%] in the N-ERAS group vs 60 [25.8%] in the standard group; P <.001) and shorter hospital stays (3.8 ± 1.9 days for the N-ERAS group vs 4.4 ± 2.6 days for the standard group; P =.001). Use of the N-ERAS protocol resulted in a 16% reduction ($2198; P <.001) in the mean direct hospital costs/patient. Consequently, for the N-ERAS cohort, the hospital was likely saved $503,342 during the 2-year period for the 229 patients just by using the N-ERAS protocol. Thoracic surgeons should consider using the nontoxic, patient-compliant N-ERAS protocol for their patients, with an expectation of improved clinical results at lower hospital costs—an important consideration when exploring methods to decrease costs because hospitals are increasingly being paid by a negotiated prospective bundled payment reimbursement model. Graphical representation of the methodology and major benefits of the preoperative nutritional-enhanced recovery after surgery (N-ERAS) protocol. [Display omitted] [ABSTRACT FROM AUTHOR]

Summary: Background & aims: There are minimal data regarding perioperative care practices and enhanced recovery after surgery (ERAS) protocols in colorectal surgery from an anaesthetic standpoint. Method: An electronic survey was administered to randomly selected anaesthetists from the United Kingdom (UK, n = 2000) and Australia/New Zealand (AUS/NZ, n = 500). Information was sought regarding individual aspects of perioperative care in elective colorectal surgery. Results: The overall response rate was 35% from the UK and 34% from AUS/NZ with 599 anaesthetists. ERAS protocols were more common in the UK compared to respondents in AUS/NZ (p < 0.01). The use of routine bowel preparation was more common in AUS/NZ (p < 0.01). Preoperative carbohydrate loading was infrequently used overall but was more commonly used in the UK (p < 0.01). The majority of respondents (76%) in AUS/NZ never used preoperative carbohydrate loading. A considerable proportion of respondents never utilised fluid restriction perioperatively. Conclusion: Within the limitations of its moderate response rate, this survey of anaesthetists suggests that ERAS principles are heterogeneously applied in clinical care. [ABSTRACT FROM AUTHOR]