From the Guidelines
Cyclic dextrin is generally preferred over maltodextrin in Enhanced Recovery After Surgery (ERAS) protocols. The most recent and highest quality study, 1, emphasizes the importance of early oral feeding and avoidance of long periods of preoperative fasting in the ERAS protocol. Although this study does not directly compare cyclic dextrin and maltodextrin, the principles outlined support the use of carbohydrates with favorable gastric emptying profiles to reduce the risk of delayed gastric emptying and potential aspiration during anesthesia induction.
Key aspects of perioperative care, as highlighted in 1 and further elaborated in 1, include the integration of nutrition into the overall management of the patient, avoidance of long periods of preoperative fasting, re-establishment of oral feeding as early as possible after surgery, and metabolic control, such as managing blood glucose levels.
Cyclic dextrin, with its lower osmolality and faster gastric emptying time compared to maltodextrin, aligns better with these principles. It provides a sustained energy release due to its unique molecular structure, which undergoes slower digestion. This can help reduce insulin resistance, minimize protein catabolism, and decrease postoperative nausea and vomiting, as suggested by the benefits of preoperative carbohydrate loading discussed in 1 and 1.
While maltodextrin can be used as an alternative, its higher osmolality may slow gastric emptying and potentially increase aspiration risk, making cyclic dextrin a preferable choice in the context of ERAS protocols for its potential to improve patient outcomes by reducing morbidity and mortality, and enhancing quality of life through better recovery profiles.
The physiological benefits of preoperative carbohydrate loading, as discussed in 1, include reduced postoperative insulin resistance, preserved muscle mass, and improved patient comfort by reducing hunger and thirst before surgery, further supporting the preference for cyclic dextrin in ERAS protocols due to its favorable properties.
From the Research
Cyclic Dextrin vs Malto Dextrin in ERAS Protocol
- The Enhanced Recovery After Surgery (ERAS) protocol aims to optimize patient recovery after surgery, and nutrition plays a crucial role in this process.
- When considering the choice between cyclic dextrin and malto dextrin (maltodextrin) in the ERAS protocol, it is essential to examine the properties and effects of each.
Properties and Effects of Cyclic Dextrin and Malto Dextrin
- Cyclic dextrin, specifically highly branched cyclic dextrin (HBCD), has been shown to influence gastric emptying rates, with a solution of 10% HBCD adjusted to 150 mOsm evacuating significantly faster than a 10% HBCD solution or a sports drink based on 10% commercially available dextrin 2.
- HBCD has also been found to reduce the rating of perceived exertion (RPE) during endurance exercise compared to maltodextrin, with a relatively low dose of 15g 3.
- Malto dextrin, on the other hand, has been studied in various exercise contexts, including its effects on blood glucose and insulin levels, as well as its impact on exercise performance 4, 5.
- A study on pre-exercise maltodextrin ingestion found that it produced similar glucose and insulin responses in cycling and running, but did not observe any differences in exercise performance 4.
- Another study on acute maltodextrin supplementation during resistance exercise found that it did not improve leg press performance to fatigue, despite increasing metabolic substrate availability 5.
Considerations for ERAS Protocol
- When selecting between cyclic dextrin and malto dextrin for the ERAS protocol, considerations should include gastric emptying rates, digestive comfort, and the potential impact on patient recovery and exercise performance.
- The use of HBCD may offer advantages in terms of gastric emptying and reducing perceived exertion, which could be beneficial for patients undergoing surgery and subsequent recovery 2, 3.
- However, more research is needed to directly compare the effects of cyclic dextrin and malto dextrin in the context of the ERAS protocol and to determine the optimal choice for patient recovery.