Improved oxidative status in major abdominal surgery patients after N-acetyl cystein supplementation

Nutr J. 2015 Jan 6;14:4. doi: 10.1186/1475-2891-14-4.


Background: Increased levels of reactive oxygen species during and after surgery may affect inflammatory response, post-operative adhesion molecule formation, and hemodynamic stability. The glutathione redox cycle is an important regulator in oxidative stress and its reduced forms scavenge free radicals. N-acetyl cysteine, a precursor of reduced glutathione, is considered as a potentially therapeutic wide spectrum agent in clinical practice. We therefore examined whether N-acetyl cysteine improves some biochemical parameters in cancer patients undergoing major abdominal surgery.

Methods: Thirty-three patients diagnosed with pancreas, stomach, rectum, colon malignancies, and undergoing major abdominal surgery at Ankara Numune Training and Research Hospital were randomly divided into two groups; control (CON) and N-acetyl cysteine (NAC). The NAC group had 1,200 mg N-acetyl cysteine starting two days before the operation day, in addition to isonitrogenous and isocaloric total parenteral nutrition of 1.2 g/kg protein, 25 kcal/kg, and 60:40 carbohydrate/fat ratio. Blood and urine samples were drawn two days before the operation, on operation day, and on the first, third, and fifth days post-operation.

Results: Plasma malondialdehyde was significantly lower in the NAC group (P < 0.001). N-acetyl cysteine treatment did not affect plasma levels of vitamin A, C or E. The NAC group exhibited a higher ratio of reduced glutathione to oxidised glutathione (P = 0.019). Urinary nitrate level was also significantly lower in the NAC group (P = 0.016).

Conclusion: The study demonstrated the clinical importance of N-acetyl cysteine supplementation on antioxidant parameters in abdominal surgery patients. In these patients N-acetyl cysteine and vitamin administration can be considered as an effective method for improvement of oxidative status.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abdomen / surgery*
  • Acetylcysteine / administration & dosage*
  • Aged
  • Antioxidants / analysis*
  • Colonic Neoplasms / surgery
  • Female
  • Glutathione / blood
  • Humans
  • Male
  • Malondialdehyde / blood
  • Middle Aged
  • Nitrates / urine
  • Oxidative Stress / drug effects*
  • Pancreatic Neoplasms / surgery
  • Preoperative Care / methods*
  • Reactive Oxygen Species / blood
  • Rectal Neoplasms / surgery
  • Stomach Neoplasms / surgery


  • Antioxidants
  • Nitrates
  • Reactive Oxygen Species
  • Malondialdehyde
  • Glutathione
  • Acetylcysteine