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Long-Term Evaluation of Lipid Profile Changes in Olympic Athletes

Giuseppe Di Gioia, Lorenzo Buzzelli, Viviana Maestrini, Maria Rosaria Squeo, Erika Lemme, Sara Monosilio, Andrea Serdoz, Roberto Fiore, Domenico Zampaglione, Andrea Segreti, and Antonio Pelliccia

Dyslipidemia is a major contributor to the development of atherosclerotic cardiovascular disease. Despite high level of physical activity, athletes are not immune from dyslipidemia, but longitudinal data on the variation of lipids are currently lacking. We sought to assess lipid profile changes over time in Olympic athletes practicing different sports disciplines (power, skills, endurance, and mixed). We enrolled 957 consecutive athletes evaluated from London 2012 to Beijing 2022 Olympic Games. Dyslipidemia was defined as low-density lipoprotein (LDL) ≥115 mg/dl, high-density lipoprotein (HDL) <40 mg/dl for males, or HDL <50 mg/dl for females. Hypertriglyceridemia was defined as triglycerides >150 mg/dl. At the follow-up, a variation of ±40 mg/dl for LDL, ±6 mg/dl for HDL, and ±50 mg/dl for triglycerides was considered relevant. Athletes with follow-up <10 months or taking lower lipid agents were excluded. Follow-up was completed in 717 athletes (74.9%), with a mean duration of 55.6 months. Mean age was 27.2 ± 4.8 years old, 54.6% were male (n = 392). Overall, 19.8% (n = 142) athletes were dyslipidemic at both blood tests, being older, practicing nonendurance sports, and predominantly male. In 69.3% (n = 129) of those with elevated LDL at t 0, altered values were confirmed at follow-up, while the same occurred in 36.5% (n = 15) with hypo-HDL and 5.3% (n = 1) in those with elevated triglycerides. Weight and fat mass percentage modifications did not affect lipid profile variation. LDL hypercholesterolemia tends to persist over time especially among male, older, and nonendurance athletes. LDL hypercholesterolemia detection in athletes should prompt early preventive intervention to reduce the risk of future development of atherosclerotic disease.

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Acute and Chronic Weight-Making Practice in Professional Mixed Martial Arts Athletes: An Analysis of 33 Athletes Across 80 Fights

Reid Reale, Junzhu Wang, Charles Hu Stull, Duncan French, Dean Amasinger, and Ran Wang

Mixed martial arts’ popularity has increased in recent years, alongside descriptive research and evidence-based performance recommendations. Guidelines for (both chronic and acute) weight making exist; however, how these translate in real-life scenarios and detailed investigations on practices in larger groups deserve attention. The present study examined the body mass (BM) and composition of 33 professional mixed martial arts athletes preparing for 80 fights. Athletes were supported by on-site dietitians, who encouraged evidence-based practices. Fasted BM was measured throughout the last ∼10 days before all bouts (acute weight management phase). A subset of athletes had body composition assessed before and after the chronic weight loss phase for 40 fights. Most athletes engaged in chronic BM loss, and all engaged in acute weight loss. Many lost fat-free mass (FFM) during the chronic phase, with rates of BM loss <0.5% best preserving FFM. Regardless of losses, the present athletes possessed greater FFM than other combat sport athletes and engaged in greater acute weight loss. Dehydration in the 24–48 hr before the weigh-in was not reflective of weight regain after the weigh-in, rather BM 7–10 days before the weigh-in was most reflective. These findings suggest that many mixed martial arts athletes could increase FFM at the time of competition by maintaining leaner physiques outside of competition and/or allowing increased time to reduce BM chronically. Acutely, athletes can utilize evidence-based protocols, eliminating carbohydrates, fiber, sodium, and finally fluid in a staged approach, before the weigh-in, reducing the amount of sweating required, thus theoretically better protecting health and preserving performance.

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Test–Retest Reliability of Running Economy and Metabolic and Cardiorespiratory Parameters During a Multistage Incremental Treadmill Test in Male Middle- and Long-Distance Runners

Aidan J. Brady, Mark Roantree, and Brendan Egan

This study investigated the test–retest reliability of running economy (RE) and metabolic and cardiorespiratory parameters related to endurance running performance using a multistage incremental treadmill test. On two occasions separated by 21–28 days, 12 male middle- and long-distance runners ran at 10, 11, 12, 13, and 14 km/hr for 8 min each stage, immediately followed by a ramp test to volitional exhaustion. Carbohydrate (10% maltodextrin solution) was consumed before and during the test to provide ∼1 g/min of exercise. RE, minute ventilation ( V ˙ E ), oxygen consumption ( V ˙ O 2 ), carbon dioxide production ( V ˙ CO 2 ), respiratory exchange ratio (RER), heart rate (HR), ratings of perceived exertion (RPE), and blood glucose and lactate concentrations were recorded for each stage and at volitional exhaustion. Time-to-exhaustion (TTE) and peak oxygen consumption ( V ˙ O 2 peak ) during the ramp test were also recorded. Absolute reliability, calculated as the coefficient of variation (CV) between repeated measures, ranged from 2.3% to 3.1% for RE, whereas relative reliability, calculated as the intraclass correlation coefficient (ICC), ranged from .42 to .79. V ˙ E , V ˙ O 2 , V ˙ O 2 peak , V ˙ CO 2 , RER, and HR had a CV of 1.1%–4.3% across all stages. TTE and RPE had a CV of 7.2% and 2.3%–10.8%, respectively, while glucose and lactate had a CV of 4.0%–17.8%. All other parameters, except for blood glucose, were demonstrated to have good-to-excellent relative reliability assessed by ICC. Measures of RE, V ˙ O 2 peak , and TTE were reliable during this two-phase multistage incremental treadmill test in a cohort of trained and highly trained male middle- and long-distance runners.

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Energetics of a World-Tour Female Road Cyclist During a Multistage Race (Tour de France Femmes)

Jose L. Areta, Emily Meehan, Georgie Howe, and Leanne M. Redman

Despite the increased popularity of female elite road cycling, research to inform the fueling requirements of these endurance athletes is lacking. In this case study, we report for the first time the energetics of a female world-tour cyclist competing in the 2023 Tour de France Femmes, an 8-day race of the Union Cycliste Internationale. The 29-year-old athlete presented with oligomenorrhea and low T3 before the race. Total daily energy expenditure assessed with the doubly labeled water technique was 7,572 kcal/day (∼4.3 physical activity levels), among the highest reported in the literature to date for a female. Crank-based mean maximal power was consistent with female world-tour cyclists (5 min, mean 342 W, 4.8 W/kg; 20 min 289 W, 4.1 W/kg). The average daily energy intake measured with the remote food photography method (Stage Days 1–7) was 5,246 kcal and carbohydrate intake was 13.7 g/kg (range 9.7–15.9 g/kg), and 84 g/hr during stages, and an average fat intake of 15% of daily energy intake. An estimated 2,326 kcal/day energy deficit was evidenced in a 2.2 kg decrease in body mass. Notwithstanding the high carbohydrate intake, the athlete was unable to match the energy requirements of the competition. Despite signs of energy deficiency preexisting (oligomenorrhea and low T3), and other further developing during the race (weight loss), performance was in line with that of other world-tour cyclists and a best personal performance was recorded for the last stage. This case study emphasizes the need for further research to inform energy requirements for female athletes’ optimal performance and health.

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Skimmed, Lactose-Free Milk Ingestion Postexercise: Rehydration Effectiveness and Gastrointestinal Disturbances Versus Water and a Sports Drink in Physically Active People

Luis F. Aragón-Vargas, Julián C. Garzón-Mosquera, and Johnny A. Montoya-Arroyo

Postexercise hydration is fundamental to replace fluid loss from sweat. This study evaluated rehydration and gastrointestinal (GI) symptoms for each of three beverages: water (W), sports drink (SD), and skimmed, lactose-free milk (SLM) after moderate-intensity cycling in the heat. Sixteen college students completed three exercise sessions each to lose ≈2% of their body mass. They drank 150% of body mass loss of the drink assigned in randomized order; net fluid balance, diuresis, and GI symptoms were measured and followed up for 3 hr after completion of fluid intake. SLM showed higher fluid retention (∼69%) versus W (∼40%; p < .001); SD (∼56%) was not different from SLM or W (p > .05). Net fluid balance was higher for SLM (−0.26 kg) and SD (−0.42 kg) than W (−0.67 kg) after 3 hr (p < .001), resulting from a significantly lower diuresis with SLM. Reported GI disturbances were mild and showed no difference among drinks (p > .05) despite ingestion of W (1,992 ± 425 ml), SD (1,999 ± 429 ml), and SLM (1,993 ± 426 ml) in 90 min. In conclusion, SLM was more effective than W for postexercise rehydration, showing greater fluid retention for the 3-hr follow-up and presenting with low-intensity GI symptoms similar to those with W and SD. These results confirm that SLM is an effective option for hydration after exercise in the heat.

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Myths and Methodologies: Standardisation in Human Physiology Research—Should We Control the Controllables?

Lucy H. Merrell, Oliver J. Perkin, Louise Bradshaw, Harrison D. Collier-Bain, Adam J. Collins, Sophie Davies, Rachel Eddy, James A. Hickman, Anna P. Nicholas, Daniel Rees, Bruno Spellanzon, Lewis J. James, Alannah K.A. McKay, Harry A. Smith, James E. Turner, Francoise Koumanov, Jennifer Maher, Dylan Thompson, Javier T. Gonzalez, and James A. Betts

The premise of research in human physiology is to explore a multifaceted system whilst identifying one or a few outcomes of interest. Therefore, the control of potentially confounding variables requires careful thought regarding the extent of control and complexity of standardisation. One common factor to control prior to testing is diet, as food and fluid provision may deviate from participants’ habitual diets, yet a self-report and replication method can be flawed by under-reporting. Researchers may also need to consider standardisation of physical activity, whether it be through familiarisation trials, wash-out periods, or guidance on levels of physical activity to be achieved before trials. In terms of pharmacological agents, the ethical implications of standardisation require researchers to carefully consider how medications, caffeine consumption and oral contraceptive prescriptions may affect the study. For research in females, it should be considered whether standardisation between- or within-participants in regards to menstrual cycle phase is most relevant. The timing of measurements relative to various other daily events is relevant to all physiological research and so it can be important to standardise when measurements are made. This review summarises the areas of standardisation which we hope will be considered useful to anyone involved in human physiology research, including when and how one can apply standardisation to various contexts.

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Volume 34 (2024): Issue 3 (May 2024)

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Contaminants in Dietary Supplements: Toxicity, Doping Risk, and Current Regulation

Jesús Zapata-Linares and Guillermo Gervasini

Athletes, both amateur and professional, often resort to the consumption of nutritional supplements without professional supervision and without being aware of the risks they may entail. We conducted an exhaustive literature search to determine the most common substances found as contaminants in dietary supplements. For each substance, we analyzed its mechanism of action, clinical indication, health risk, and putative use as doping agent. In addition, we evaluated the current regulation of these supplements. Contamination of nutritional supplements (accidental or intentional), especially with steroids and stimulants, is a hazardous situation. The prolonged consumption of these products without being aware of their composition can cause serious health risks and, in the case of professional athletes, a possible sanction for doping.

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Effect of Menstrual Cycle Phase and Hormonal Contraceptives on Resting Metabolic Rate and Body Composition

Megan A. Kuikman, Alannah K.A. McKay, Clare Minahan, Rachel Harris, Kirsty J. Elliott-Sale, Trent Stellingwerff, Ella S. Smith, Rachel McCormick, Nicolin Tee, Jessica Skinner, Kathryn E. Ackerman, and Louise M. Burke

The cyclical changes in sex hormones across the menstrual cycle (MC) are associated with various biological changes that may alter resting metabolic rate (RMR) and body composition estimates. Hormonal contraceptive (HC) use must also be considered given their impact on endogenous sex hormone concentrations and synchronous exogenous profiles. The purpose of this study was to determine if RMR and dual-energy X-ray absorptiometry body composition estimates change across the MC and differ compared with HC users. This was accomplished during a 5-week training camp involving naturally cycling athletes (n = 11) and HC users (n = 7 subdermal progestin implant, n = 4 combined monophasic oral contraceptive pill, n = 1 injection) from the National Rugby League Indigenous Women’s Academy. MC phase was retrospectively confirmed via serum estradiol and progesterone concentrations and a positive ovulation test. HC users had serum estradiol and progesterone concentrations assessed at the time point of testing. Results were analyzed using general linear mixed model. There was no effect of MC phase on absolute RMR (p = .877), relative RMR (p = .957), or dual-energy X-ray absorptiometry body composition estimates (p > .05). There was no effect of HC use on absolute RMR (p = .069), relative RMR (p = .679), or fat mass estimates (p = .766), but HC users had a greater fat-free mass and lean body mass than naturally cycling athletes (p = .028). Our findings suggest that RMR and dual-energy X-ray absorptiometry body composition estimates do not significantly differ due to changes in sex hormones in a group of athletes, and measurements can be compared between MC phases or with HC usage without variations in sex hormones causing additional noise.

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Omega-3 Status Evaluation in Australian Female Rugby League Athletes: Ad Libitum Fish Oil Provision Results in a Varied Omega-3 Index

Ryan Anthony, Nicola Jaffrey, Caitlin Byron, Gregory E. Peoples, and Michael J. Macartney

Optimal omega-3 status, influenced by increased intake of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), is vital for physiological health. This study investigated the impact of ad libitum fish oil supplementation on the omega-3 status of female athletes in a professional rugby league team during a competitive season. Twenty-four (n = 24) athletes participated, and their omega-3 status was assessed using the Omega-3 Index (O3I) and arachidonic acid (AA) to EPA ratio through finger-prick blood samples taken at the start and end of the season. They were given access to a fish oil supplement (PILLAR Performance, Australia) with a recommended daily dose of four capsules per day (2,160 mg EPA and 1,440 mg docosahexaenoic acid). At the beginning of the season, the group mean O3I was 4.77% (95% confidence interval [CI: 4.50, 5.04]) and the AA to EPA ratio was 14.89 (95% CI [13.22, 16.55]). None of the athletes had an O3I exceeding 8%. By the season’s end, the O3I was a significantly increased to 7.28% (95% CI [6.64, 7.93], p < .0001) and AA to EPA ratio significantly decreased to a mean of 6.67 (95% CI [5.02, 8.31], p < .0001), driven primarily by the significant increase in EPA of +1.14% (95% CI [0.77, 1.51], p < .0001). However, these changes were varied between the athletes and most likely due to compliance. This study has demonstrated that using the objective O3I feedback scale is possible with elite female rugby athletes, but individual strategies will be required to achieve daily intake targets of EPA + DHA.