High Protein, Low Calorie Diet Helps Obese Surgical Patients

November 24, 1997

COLUMBUS, Ohio -- A study at Ohio State University has shown that a high-protein, low-calorie diet may help obese hospital patients control their blood sugar levels.

The study, which appeared in a recent issue of the American Journal of Clinical Nutrition, showed that the new diet allows obese patients to burn body fat for energy without endangering their health -- and maintain a stable blood sugar level, which helps them avoid diabetes and hyperglycemia.

These two conditions have been shown to slow healing and increase the chance of acquiring post-operative infections.

“Until now, there hasn’t been a good strategy for providing nutrition to obese patients, even though they make up as much as one third of the typical patient population,” said Patricia Choban, assistant professor of surgery and lead author of the study. “Some doctors just let them live off their body fat, but then the patients lose muscle instead, and we wanted to avoid that. We also didn’t want to overfeed them, because their high blood sugar levels would slow wound healing. So we came up with a low-calorie diet that helped them burn fat for energy but maintained their protein levels, and it seemed to work.”

At issue in the study was not how to help patients lose weight, but rather how to best provide them with good nutrition while in the hospital.

Thirty obese surgical patients at Ohio State University Hospitals participated in the study, including 10 patients with diabetes. The patients weighed an average 63 percent above their ideal body weight.

The patients were all to undergo surgery for conditions such as cancer, pancreatic disease, internal hemorrhage, and trauma. Two patients died during the course of the study, one of adult respiratory distress syndrome and the other of cardiac arrest, both unrelated to the hospital diet.

The researchers divided the patients into two groups, with 16 patients on the experimental low-fat, low-sugar, high-protein diet, and the other 14 on a standard hospital diet. Each group contained five diabetic patients.

The researchers tested the nutritional health of the patients by measuring the amount of nitrogen in their urine. According to those tests, the patients on the experimental diet were just as nutritionally balanced as the patients on the regular diet. Choban said that these results supported the idea that obese patients can be placed on a diet that will lower their risk of blood-sugar-related conditions, without compromising their overall health.

Because the five diabetic patients on the new diet consumed much less sugar, they required smaller doses of insulin to maintain healthy blood sugar levels, and also required the drug for fewer days during their hospital stay.

Choban pointed to previous research in which patients with lower blood sugar levels heal faster and lessen their risk of postoperative infection. She cited this possibility as an advantage of the high-protein, low-calorie diet.

Choban added that the diet would most benefit patients with type II diabetes -- the kind of diabetes most common in adults -- in which the person produces plenty of insulin, but his or her cells don’t respond to it as much as they should. Choban said that when type II diabetics get sick, their cells respond even less to insulin, and sugary diets intensify the effect.

The patients in this study received their food intravenously, but Choban said that the same diet would benefit patients who are fed through a stomach tube or who are healthy enough to eat normally. The regimen requires only that a patient possess normal liver and kidney function, so they can process the high-protein portion of the diet.

Choban said that hospitals may adopt this technique immediately. Physicians only have to pick a mixture of protein, fat, and sugar, and dose it at a rate based on the patients’ deviation from their ideal body weight. The technique doesn’t require any special technology -- only the inexpensive equipment for testing nitrogen excretion in patients’ urine that is already available at most hospitals.

“Obese patients are not just cared for at large university hospitals, but also at tiny fifty-bed hospitals in rural areas. It’s important that anyone can apply this method at any hospital equally safely,” said Choban. Choban and her colleagues are now examining the medical records of all the patients who needed nutritional support from the hospital during the last two years, to see how long they stayed on their diet, and whether or not they experienced any complications. Choban said the results will help the researchers double-check the safety and efficacy of the high-protein, low-calorie diet plan.

Ohio State University

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