Franny Jongbloed

175 7 FEASIBILITY AND SAFETY OF A PREOPERATIVE DIET Of the serum amino acids measured, none differed significantly between the groups (Figure 4C/D). The relative decrease of 18% in valine levels was significant compared to the relative difference of the DER-diet and the control group (Table 2). The cumulative sum of BCAAs, namely isoleucine, leucine and valine, showed a trend towards a decrease after the restricted diet ( P= 0.005), but not after the DER-diet or in the control group. The relative decrease of 16% in the combined BCAAs also showed a trend compared to the relative change after the DER-diet ( P= 0.004) and the control group ( P= 0.004). Other amino acid levels were not significantly changed after any of the diets. Before After Before After Before After 0 10 20 30 40 50 Restricted DER-diet Control Albumin (g/L) Before After Before After Before After 0 2 4 6 8 10 Restricted DER-diet Control * Urea (mmol/L) A B Before After Before After Before After 0.0 0.1 0.2 0.3 Restricted DER-diet Control Valine (mmol/L) Before After Before After Before After 0.00 0.05 0.10 0.15 Restricted DER-diet Control Leucine (mmol/L) C D Figure 4. Serum levels of albumin, urea, valine and leucine after the three dietary interventions. (A) Serum albumin did not significantly change in any of the groups. (B) Serum urea was decreased significantly after the restricted diet, while it did not change after the DER diet or in the control group; both serum valine (C) and leucine (D) did not differ between groups, but did show a trend towards a decrease after the restricted diet; red symbols = kidney donors, as opposed to morbidly obese individuals (black or gray symbols); DER = daily energy requirements. Neither serum markers glucose nor insulin changed significantly before versus after the intervention in three diet groups (Table 3). After the restricted diet, high-density- lipoprotein (HDL) was significantly decreased ( P= 0.006), but did not remain significant after the Bonferroni correction for multiple testing.