# Preoperative carbohydrate loading: evolution, trends, and future directions

## TL;DR

This study analyzes the research trends and developments in preoperative carbohydrate loading, highlighting its clinical use and future directions.

## Contribution

The paper provides the first bibliometric analysis of preoperative carbohydrate loading research, identifying key trends and gaps.

## Key findings

- China leads in publications but lacks collaboration, while England has strong international cooperation.
- Research has shifted from physiological validation to clinical integration in ERAS protocols.
- Key gaps remain in personalizing and technologically supporting PCL in clinical practice.

## Abstract

Preoperative carbohydrate loading (PCL) counteracts the catabolic effects of fasting by alleviating insulin resistance and maintaining metabolic homeostasis. Despite its widespread use in clinical settings, there is no existing literature examining past achievements and breakthroughs in this area. The purpose of this study is to characterize its publication patterns, academic influence, research trends, and recent developments worldwide.

The Web of Science Core Collection and PubMed were searched for documents published from the time the databases began to include relevant articles to March 27, 2025. Using VOSviewer, Citespace, and SciExplorer, a cross-sectional bibliometric analysis was conducted to extract and calculate evaluative indices. Publications were categorized by country, institution, author, journal, highly cited papers, and keywords. The variables were compared in terms of publication and academic influence, which also included citation count, journal impact factor, total link strength, collaboration metrics, and impact relative to the global community.

There were 269 publications, involving the contributions of 1,478 authors affiliated with 439 institutions across 38 countries/regions, and 141 clinical trials. China has the highest number of publications, albeit with limited collaboration, while England exhibits the highest centrality and a dense international cooperation network. The top ten journals in terms of publications are mostly high-quality journals. The author who has made the most outstanding and irreplaceable contribution is Olle Ljungqvist. Institutional cooperation is primarily geographically limited, with few links to transnational cooperation. We determine that “metabolic responses,” “recovery and clinical outcomes,” “preoperative management,” and “research techniques” are the most discussed research topics and identify four research frontiers and directions.

Research on PCL has transitioned from early physiological validation to widespread clinical integration within ERAS protocols. The bibliometric patterns indicate that, despite substantial progress in understanding metabolic responses and perioperative management, key gaps remain in translating PCL evidence into personalized, harmonized, and technologically supported clinical nutrition practices. Clinicians and dietitians should prioritize tailoring PCL strategies to patient-specific factors, while integrating harmonized outcomes and technology to better assess individual responses. Besides, multidisciplinary collaboration between surgeons, anesthetists, and dietitians is essential to ensure consistent implementation.