IJCS | Volume 32, Nº2, May/June 2019

272 1. Iida Y, Yamazaki T, Arina H, Kawabe T, Yamada S. Predictors of surgery- induced muscle proteolysis in patients undergoing cardiac surgery. J Cardiol. 2016;68(6):536-41. 2. New York Heart Association. Nomenclature and criteria for diagnosis of diseases of the heart and great vessels. New York: Brown Little;1964. 3. Sociedade Brasileira de Cardiologia, Sociedade Brasileira de Hipertensão, Sociedade Brasileira de Nefrologia. VI Diretrizes Brasileiras de Hipertensão. Arq Bras Cardiol. 2010;95(1 Suppl):1-51. 4. Sociedade Brasileira de Diabetes . Diretrizes da Sociedade Brasileira de Diabetes. 2014-2015. São Paulo;2015. References Costa et al. Effect of surgery on loss of muscle mass Int J Cardiovasc Sci. 2019;32(3)269-273 Original Article of visceral protein reserve should be carefully evaluated in the presence of an inflammatory process. We also observed BMI reduction due to weight loss, but without statistical significance. Similar results were found by Dimaria-Ghalili. 8 He reported that BMI reduction was due to the continuous inflammatory response related to surgical stress. Although the study has limitations because it did not quantify the energetic and protein content of the liquid diet offered 24 hours postoperatively, this diet certainly did not reach the energy and protein requirements, despite the early reintroduction of the oral feeding, as recommended by Evans et al. 7 Based on these preliminary results, an additional study can be proposed with the aim of improving the composition of the liquid diet offered 24 hours postoperatively in order to minimize muscle mass loss. The metabolic response to trauma is more intense on the first and second postoperative days, is proportional to the type of surgery 9 and justifies a higher protein requirement at this moment. Conclusion Elective coronary artery bypass grafting had an effect on muscle mass reduction on the seventh postoperative day. The impact of muscle mass reduction after cardiac surgery justifies additional studies. Study limitations The study had a small number of participants. Author contributions Conception and design of the research: Costa BO, Maciel G, Huguenin AB, Silva G, Guimarães SMS, Cruz WMS, Colanfranceschi AS, Boaventura GT. Acquisition of data: Costa BO, Maciel G, Huguenin AB, Silva G, Guimarães SMS, Cruz WMS, Colanfranceschi AS, Boaventura GT. Analysis and interpretation of the data: Costa BO, Silva G, Guimarães SMS, Cruz WMS. Statistical analysis: Costa BO, Guimarães SMS, Cruz WMS. Obtaining financing: Costa BO, Guimarães SMS, Cruz WMS, Colanfranceschi AS, Boaventura GT. Writing of the manuscript: Costa BO, Guimarães SMS, Cruz WMS. Critical revision of the manuscript for intellectual content: Costa BO, Maciel G, Huguenin AB, Silva G, Guimarães SMS, Cruz WMS, Colanfranceschi AS, Boaventura GT. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding The study was funded by the researchers and supported by the Institutional Scholarship Program of Scientific Initiation of the National Council of Scientific and Technological Development. Study Association This paper is part of the clinical trial (Doctoral thesis) of Sheila Moreira da Silva Guimarães from Universidade Federal Fluminense . Ethics approval and consent to participate This study was approved by the Ethics Committee of the for Medical Research of Faculdade de Medicina/ Hospital Universitário Antônio Pedro . under the protocol number CAAE: 37659314.4.0000.5243. It was registered in the Brazilian Registry of Clinical Trials (RBR-7376mq). All the procedures in this study were in accordance with the 1975 Helsinki Declaration, updated in 2013. Informed consent was obtained from all participants included in the study.