Case Study: Extreme Weight Making Causes Relative Energy Deficiency, Dehydration, and Acute Kidney Injury in a Male Mixed Martial Arts Athlete

in International Journal of Sport Nutrition and Exercise Metabolism
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The aim of the present case study was to quantify the physiological and metabolic impact of extreme weight cutting by an elite male mixed martial arts athlete. Throughout an 8-week period, we obtained regular assessments of body composition, resting metabolic rate, peak oxygen uptake, and blood clinical chemistry to assess endocrine status, lipid profiles, hydration, and kidney function. The athlete adhered to a “phased” weight loss plan consisting of 7 weeks of reduced energy (ranging from 1,300 to 1,900 kcal/day) intake (Phase 1), 5 days of water loading with 8 L/day for 4 days followed by 250 ml on Day 5 (Phase 2), 20 hr of fasting and dehydration (Phase 3), and 32 hr of rehydration and refueling prior to competition (Phase 4). Body mass declined by 18.1% (80.2 to 65.7 kg) corresponding to changes of 4.4, 2.8, and 7.3 kg in Phases 1, 2, and 3, respectively. We observed clear indices of relative energy deficiency, as evidenced by reduced resting metabolic rate (−331 kcal), inability to complete performance tests, alterations to endocrine hormones (testosterone: <3 nmol/L), and hypercholesterolemia (>6 mmol/L). Moreover, severe dehydration (reducing body mass by 9.3%) in the final 24 hr prior to weigh-in-induced hypernatremia (plasma sodium: 148 mmol/L) and acute kidney injury (serum creatinine: 177 μmol/L). These data, therefore, support publicized reports of the harmful (and potentially fatal) effects of extreme weight cutting in mixed martial arts athletes and represent a call for action to governing bodies to safeguard the welfare of mixed martial arts athletes.

Kasper, Crighton, Langan-Evans, Close, and Morton are with the Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom. Riley is with Pure Sports Medicine, Cabot Place West, Canary Wharf, London, United Kingdom. Sharma is with the Dept. of Nephrology, The Royal Liverpool University Hospital, Liverpool, United Kingdom.

Address author correspondence to James P. Morton at J.P.Morton@ljmu.ac.uk.
International Journal of Sport Nutrition and Exercise Metabolism
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References
  • AldermanB.LandersD.M.CarlsonJ. & ScottJ.R. (2004). Factors related to rapid weight loss practices among international-style wrestlers. Medicine & Science in Sports & Exercise 36249252. PubMed ID: 14767247 doi:10.1249/01.MSS.0000113668.03443.66

    • Crossref
    • Search Google Scholar
    • Export Citation
  • BarrabiT. (2013 September). Leandro ‘Feijao’ souza dead: ‘Shooto Brazil 43’ cancelled after Brazilian MMA fighter dies while ‘cutting weight’. International Buisness Times (IBT). Retrieved from http://www.ibtimes.com/leandro-feijao-souza-dead-shooto-brazil-43-canceled-after-brazilian-mma-fighter-dies-while-cutting

    • Search Google Scholar
    • Export Citation
  • BartlettJ.Hwa JooC.JeongT.S.LouhelinenJ.CochranA.GibalaM.J. . . . MortonJ.P. (2012). Matched work high-intensity interval and continuous running induce similar increases in PGC-1α mRNA, AMPK, p38, and p53 phosphorylation in human skeletal muscle. Journal of Applied Physiology 11211351143. PubMed ID: 22267390 doi:10.1152/japplphysiol.01040.2011

    • Crossref
    • Search Google Scholar
    • Export Citation
  • BeachamG. (2017). Nurmagomedov weight issues scrap UFC 209 bout with Ferguson. U.S. News. Retrieved from https://www.usnews.com/news/sports/articles/2017-03-03/nurmagomedov-weight-issues-scrap-ufc-209-bout-with-ferguson

    • Search Google Scholar
    • Export Citation
  • BoneJ. & BurkeL.M. (2018). No difference in young adult athletes’ resting energy expenditure when measured under inpatient or outpatient conditions. International Journal of Sport Nutrition and Exercise Metabolism 2514. PubMed ID: 29140154 doi:10.1123/ijsnem.2016-0315

    • Search Google Scholar
    • Export Citation
  • ChandrasekarT.SharmaA.TennentL.WongC.ChamberlainP. & AbrahamK.A. (2017). A whole system approach to improving mortality associated with acute kidney injury. QJM: Monthly Journal of the Association of Physicians 110657666. PubMed ID: 28521019 doi:10.1093/qjmed/hcx101

    • Crossref
    • Search Google Scholar
    • Export Citation
  • CoswigV.S.FukudaD.H. & Del VecchioF.B. (2015). Rapid weight loss elicits harmful biochemical and hormonal responses in mixed martial arts athletes. International Journal of Sport Nutrition and Exercise Metabolism 25480486. PubMed ID: 25811230 doi:10.1123/ijsnem.2014-0267

    • Crossref
    • Search Google Scholar
    • Export Citation
  • CrightonB.CloseG.L. & MortonJ.P. (2016). Alarming weight cutting behaviours in mixed martial arts: A cause for concern and a call for action. British Journal of Sports Medicine 50446447. PubMed ID: 26459278 doi:10.1136/bjsports-2015-094732

    • Crossref
    • Search Google Scholar
    • Export Citation
  • DarmonM.TimsitJ.F.FrancaisA.Nguile-MakaoM.AdrieC.CohenY. . . . AzoulayE. (2010). Association between hypernatraemia acquired in the ICU and mortality: A cohort study. Nephrology Dialysis Transplantation 2525102515. PubMed ID: 20167570 doi:10.1093/ndt/gfq067

    • Crossref
    • Search Google Scholar
    • Export Citation
  • DavisS.E.HoltzappleN.DwyerG.B.ReedK. & StosicJ. (2001). Nutrition knowledge assessment of collegiate wrestlers. Medicine & Science in Sports & Exercise 3370. doi:10.1097/00005768-200105001-00400

    • Crossref
    • Search Google Scholar
    • Export Citation
  • DrahotaM. (2017 July). Breaking: Amanda Nunes hospitalized, UFC 213 main event in trouble. Low Kick MMA. Retrieved from http://www.lowkickmma.com/News/breaking-amanda-nunes-hospitalized-ufc-213-main-event-in-trouble/

    • Search Google Scholar
    • Export Citation
  • DullooA.G.JacquetJ.MontaniJ.P. & SchutzY. (2015). How dieting makes the lean fatter: From a perspective of body composition autoregulation through adipostats and proteinstats awaiting discovery. Obesity Reviews 162535. PubMed ID: 25614201 doi:10.1111/obr.12253

    • Crossref
    • Search Google Scholar
    • Export Citation
  • FriedlK.E.MooreR.J.HoytR.W.MarchitelliL.J.Martinez-LopezL.E. & AskewE.W. (2000). Endocrine markers of semistarvation in healthy lean men in a multistressor environment. Journal of Applied Physiology 8818201830. PubMed ID: 10797147 doi:10.1152/jappl.2000.88.5.1820

    • Crossref
    • Search Google Scholar
    • Export Citation
  • HiergesellD. (2018 January). Uriah Hall fainted at UFC St. Louis weigh ins, may have suffered seizure. MMA Mania. Retrieved from https://www.mmamania.com/2018/1/13/16889130/report-uriah-hall-fainted-at-ufc-st-louis-weigh-ins-may-have-suffered-seizure-mma-belfort

    • Search Google Scholar
    • Export Citation
  • IshaniA.XueJ.L.HimmelfarbJ.EggersP.W.KimmelP.L.MolitorisB.A. & CollinsA.J. (2009). Acute kidney injury increases risk of ESRD among elderly. Journal of the American Society of Nephrology 20223228. PubMed ID: 19020007 doi:10.1681/ASN.2007080837

    • Crossref
    • Search Google Scholar
    • Export Citation
  • KellumJ.A. & LameireN. (2013). Diagnosis, evaluation, and management of acute kidney injury: A KDIGO summary (Part 1). Critical Care 17(1) 204. PubMed ID: 23394211 doi:10.1186/cc11454

    • Crossref
    • Search Google Scholar
    • Export Citation
  • KininghamR.B. & GorenfloD.W. (2001). Weight loss methods of high school wrestlers. Medicine & Science in Sports & Exercise 33810813. PubMed ID: 11323553 doi:10.1097/00005768-200105000-00021

    • Crossref
    • Search Google Scholar
    • Export Citation
  • KordiR.ZiaeeV.RostamiM. & WallaceW.A. (2011). Patterns of weight loss and supplement consumption of male wrestlers in Tehran. Sports Medicine Arthroscopy Rehabilitation Therapy & Technology 34. PubMed ID: 21314982 doi:10.1186/1758-2555-3-4

    • Crossref
    • Search Google Scholar
    • Export Citation
  • LonglandT.M.OikawaS.Y.MitchellC.J.DevriesM.C. & PhillipsS.M. (2016). Higher compared with lower dietary protein during an energy deficit combined with intense exercise promotes greater lean mass gain and fat mass loss: A randomized trial. American Journal of Clinical Nutrition 103738746. PubMed ID: 26817506 doi:10.3945/ajcn.115.119339

    • Crossref
    • Search Google Scholar
    • Export Citation
  • MatthewsJ.J. & NicholasC. (2017). Extreme rapid weight loss and rapid weight gain observed in UK mixed martial arts athletes preparing for competition. International Journal of Sport Nutrition and Exercise Metabolism 27122129. PubMed ID: 27710145 doi:10.1123/ijsnem.2016-0174

    • Crossref
    • Search Google Scholar
    • Export Citation
  • MendesS.H.TrittoA.C.GuilhermeJ.P.L.F.SolisM.Y.VieiraD.E.FranchiniE. . . . ArtioliG.G. (2013). Effect of rapid weight loss on performance in combat sport male athletes: Does adaptation to chronic weight cycling play a role? British Journal of Sports Medicine 4711551160. PubMed ID: 24047570 doi:10.1136/bjsports-2013-092689

    • Crossref
    • Search Google Scholar
    • Export Citation
  • MMA Junkie Staff. (2017 June). Past weight-cut issues for Renan Barao push UFC 214 fight vs. Aljamain Sterling to catchweight. MMA Junkie. Retrieved from http://mmajunkie.com/2017/06/weight-cut-renan-barao-ufc-214-aljamain-sterling-catchweight-california

    • Search Google Scholar
    • Export Citation
  • MortonJ.P.RobertsonC.SuttonL. & MacLarenD.P.M. (2010). Making the weight: A case study from professional boxing. International Journal of Sport Nutrition and Exercise Metabolism 208085. PubMed ID: 20190355 doi:10.1123/ijsnem.20.1.80

    • Crossref
    • Search Google Scholar
    • Export Citation
  • MortonR.W.MurphyK.T.McKellarS.R.SchoenfeldB.J.HenselmansM.HelmsE. . . . PhillipsS.M. (2018). A systematic review, meta-analysis and meta-regression of the effect of protein supplementation on resistance training-induced gains in muscle mass and strength in healthy adults. British Journal of Sports Medicine 52(6) 376384. PubMed ID: 28698222

    • Search Google Scholar
    • Export Citation
  • MountjoyM.Sundgot-BorgenJ.BurkeL.M.CarterS.ConstantiniN.LebrunC. . . . LjungqvistA. (2014). The IOC consensus statement: Beyond the female athlete triad—Relative Energy Deficiency in Sport (RED-S). British Journal of Sports Medicine 48491497. PubMed ID: 24620037 doi:10.1136/bjsports-2014-093502

    • Crossref
    • Search Google Scholar
    • Export Citation
  • NanaA.SlaterG.J.StewartA.D. & BurkeL.M. (2015). Methodology review: Using dual-energy X-ray absorptiometry (DXA) for the assessment of body composition in athletes and active people. International Journal of Sport Nutrition and Exercise Metabolism 25198215. PubMed ID: 25029265 doi:10.1123/ijsnem.2013-0228

    • Crossref
    • Search Google Scholar
    • Export Citation
  • NindlB.C.FriedlK.E.FrykmanP.N.MarchitelliL.J.ShippeeR.L. & PattonJ.F. (1997). Physical performance and metabolic recovery among lean, healthy men following a prolonged energy deficit. International Journal of Sports Medicine 18317324. PubMed ID: 9298770 doi:10.1055/s-2007-972640

    • Crossref
    • Search Google Scholar
    • Export Citation
  • OkamotoB. (2015 December). China’s Yang Jian Bing dies one day after trying to make weight. ESPN. Retrieved from http://www.espn.co.uk/mma/story/_/id/14344041/chinese-mma-fighter-yang-jian-bing-dies-trying-make-weight

    • Search Google Scholar
    • Export Citation
  • OkamotoB. (2017 March). Ten-point plan intended to curb weight cutting coming to California. ESPN. Retrieved from http://www.espn.co.uk/mma/story/_/id/19023891/mma-ten-point-plan-intended-curb-weight-cutting-coming-california

    • Search Google Scholar
    • Export Citation
  • OppligerR.A.Nelson-SteenS.A. & ScottJ.R. (2003). Weight loss practices of college wrestlers. International Journal of Sport Nutrition and Exercise Metabolism 132946. PubMed ID: 12660404 doi:10.1123/ijsnem.13.1.29

    • Crossref
    • Search Google Scholar
    • Export Citation
  • PasiakosS.M.CaoJ.J.MargolisL.M.SauterE.R.WhigmanL.D.McClungJ.P. . . . YoungA.J. (2013). Effects of high-protein diets on fat-free mass and muscle protein synthesis following weight loss: A randomized controlled trial. FASEB Journal 2738373847. PubMed ID: 23739654 doi:10.1096/fj.13-230227

    • Crossref
    • Search Google Scholar
    • Export Citation
  • RalphM. (2017 March). ‘Not far from death’: How fighters are risking their lives to make weight. BBC. Retrieved from http://www.bbc.co.uk/bbcthree/item/a4372439-aef4-4f18-bd9a-d914e3f37f2a

    • Search Google Scholar
    • Export Citation
  • RealeR.SlaterG. & BurkeL.M. (2017a). Individualised dietary strategies for Olympic combat sports: Acute weight loss, recovery and competition nutrition. European Journal of Sports Science 17727740. PubMed ID: 28316263 doi:10.1080/17461391.2017.1297489

    • Crossref
    • Search Google Scholar
    • Export Citation
  • RealeR.SlaterG.DunicanI.C.CoxG.R. & BurkeL.M. (2017b). The effect of water loading on acute weight loss following fluid restriction in combat sports athletes. International Journal of Sport Nutrition and Exercise Metabolism 28122. PubMed ID: 29182412

    • Search Google Scholar
    • Export Citation
  • Rimes-StigareC.FrumentoP.BottaiM.MartenssonJ.MartlingC.R.WaltherS.M. . . . BellM. (2015). Evolution of chronic renal impairment and long-term mortality after de novo acute kidney injury in the critically ill; a Swedish multi-centre cohort study. Critical Care 19221231. PubMed ID: 25944032 doi:10.1186/s13054-015-0920-y

    • Crossref
    • Search Google Scholar
    • Export Citation
  • StewartA. & Marfell-JonesM. (2011). International standards for anthropometric assessment. Lower Hutt, New Zealand: International Society for the Advancement of Kinanthropometry.

    • Search Google Scholar
    • Export Citation
  • ThomasL. (2013 December). Brian Melancon explains kidney issue that forced his early MMA retirement. MMA Fighting. Retrieved from https://www.mmafighting.com/2013/12/3/5171862/brian-melancon-explains-kidney-issue-that-forced-his-early-mma

    • Search Google Scholar
    • Export Citation
  • WilsonG.ChesterN.EubankM.CrightonB.DrustB.MortonJ.P. & CloseG.L. (2012). An alternative dietary strategy to make weight while improving mood, decreasing body fat, and not dehydrating: A case study of a professional jockey. International Journal of Sport Nutrition and Exercise Metabolism 22225231. PubMed ID: 22693243 doi:10.1123/ijsnem.22.3.225

    • Crossref
    • Search Google Scholar
    • Export Citation
  • WilsonG.FraserW.D.SharmaA.EubankM.DrustB.MortonJ.P. & CloseG.L. (2013). Markers of bone health, renal function, liver function, anthropometry and perception of mood: A comparison between flat and National Hunt Jockeys. International Journal of Sports Medicine 34453459. PubMed ID: 23184478

    • Search Google Scholar
    • Export Citation
  • WilsonG.PritchardP.P.PapageorgiouC.PhillipsS.KumarP.Langan-EvansC. . . . CloseG.L. (2015). Fasted exercise and increased dietary protein reduces body fat and improves strength in jockeys. International Journal of Sports Medicine 3610081014. PubMed ID: 26212241 doi:10.1055/s-0035-1549920

    • Crossref
    • Search Google Scholar
    • Export Citation
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