Plasma urea, creatinine, uric acid, albumin, and total protein concentrations before and after 15-, 25-, and 42-km contests

Comparing the Metabolic Profiles Associated with Fitness Status between Insulin-Sensitive and Insulin-Resistant Non-Obese Individuals

(1) Background: Young non-obese insulin-resistant (IR) individuals could be at risk of developing metabolic diseases including type 2 diabetes mellitus. The protective effect of physical activity in this apparently healthy group is expected but not well characterized. In this study, clinically relevant metabolic profiles were determined and compared among active and sedentary insulin-sensitive (IS) and IR young non-obese individuals. (2) Methods: Data obtained from Qatar Biobank for 2110 young (20-30 years old) non-obese (BMI ≤ 30) healthy participants were divided into four groups, insulin-sensitive active (ISA, 30.7%), insulin-sensitive sedentary (ISS, 21.4%), insulin-resistant active (IRA, 20%), and insulin-resistant sedentary (IRS, 23.3%), using the homeostatic model assessment of insulin resistance (HOMA-IR) and physical activity questionnaires. The effect of physical activity on 66 clinically relevant biochemical tests was compared among the four groups using linear models. (3) Results: Overall, non-obese IR participants had significantly (p ≤ 0.001) worse vital signs, blood sugar profiles, inflammatory markers, liver function, lipid profiles, and vitamin D levels than their IS counterparts. Physical activity was positively associated with left handgrip (p ≤ 0.01) and levels of creatine kinase (p ≤ 0.001) and creatine kinase-2 (p ≤ 0.001) in both IS and IR subjects. Furthermore, physical activity was positively associated with levels of creatinine (p ≤ 0.01) and total vitamin D (p = 0.006) in the IR group and AST (p = 0.001), folate (p = 0.001), and hematocrit (p = 0.007) in the IS group. Conversely, physical inactivity was negatively associated with the white blood cell count (p = 0.001) and an absolute number of lymphocytes (p = 0.003) in the IR subjects and with triglycerides (p = 0.005) and GGT-2 (p ≤ 0.001) in the IS counterparts. (4) Conclusions: An independent effect of moderate physical activity was observed in non-obese apparently healthy individuals a with different HOMA-IR index. The effect was marked by an improved health profile including higher vitamin D and lower inflammatory markers in IRA compared to IRS, and a higher oxygen carrying capacity and lipid profile in ISA compared to the ISS counterparts.

Venous creatinine as a biomarker for loss of fat-free mass and disease progression in patients with amyotrophic lateral sclerosis

BACKGROUND AND PURPOSE

To establish the utility of venous creatinine as a biomarker to monitor loss of fat-free mass in patients with amyotrophic lateral sclerosis (ALS).

METHODS

In this multicenter natural history study, body composition and venous creatinine were assessed in 107 patients with ALS and 52 healthy controls. Longitudinal patterns of venous creatinine and its association with the risk of death during follow-up were determined in a cohort of patients with ALS from Australia (n = 69) and the Netherlands (n = 38).

RESULTS

The mean levels of venous creatinine were 75.78 ± 11.15 μmol/L for controls, 70.25 ± 12.81 μmol/L for Australian patients, and 59.95 ± 14.62 μmol/L for Dutch patients with ALS. The relationship between measures of venous creatinine and fat-free mass was similar between all groups (r = 0.36, p < 0.001). Within patients, fat-free mass declined by 0.31 (95% confidence interval [CI]: 0.22-0.40) kg/month, and venous creatinine declined by 0.52 (95% CI: 0.38-0.66) μmol/L/month, with a longitudinal correlation of 0.57 (95% CI: 0.35-0.76, p < 0.001). Lower levels of venous creatinine were associated with increased risk for earlier death in patients with ALS (hazard ratio = 0.94, 95% CI: 0.90-0.98, p = 0.007).

CONCLUSIONS

Venous creatinine is decreased in ALS and declines alongside a decline in fat-free mass over the course of the disease, and may serve as a practical marker to monitor the change of fat-free mass in patients with ALS. This could inform clinical care and provide an alternative endpoint for the evaluation of therapeutic interventions that focus on slowing the loss of fat-free mass and disease progression in ALS.

Training Load Measures and Biomarker Responses during a 7-Day Training Camp in Young Cyclists-A Pilot Study

Background and Objectives: During intense training periods, there is a high need to monitor the external and especially the internal training load in order to fine-tune the training process and to avoid overreaching or overtraining. However, data on stress reactions, especially of biomarkers, to high training loads in children and youth are rare. Therefore, in this study, we aimed to investigate the training load of youth athletes during a training camp using a multilevel approach. Materials and Methods: Six trained youth male cyclists performed a 7-day preseason training camp. To investigate the internal training load, every morning, minimally invasive “point-of-care testing” (POCT) devices were used to analyze the following biomarkers: creatine kinase (CK), blood urea nitrogen (BUN), albumin (Alb), bilirubin (Bil), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total protein (TP). Additionally, data of training load measures (HR: heart rate, RPE: rating of perceived exertion, sRPE: session-RPE, TRIMP: training impulse, intensity (RPE:HR), and load (sRPE:TRIMP) ratios), self-perception (person’s perceived physical state, questionnaires on muscle soreness, and sleep quality), and measures of the autonomic nervous system (resting heart rate, heart rate variability) were collected. Two days before and after the training camp, subjects performed performance tests (Graded Exercise Test, Wingate Anaerobic Test, Counter Movement Jump). Results: Primarily, the biomarkers CK, BUN, and Alb, as well as the self-perception showed moderate to large load-dependent reactions during the 7-day training camp. The biomarkers returned to baseline values two days after the last training session. Power output at lactate threshold showed a small increase, and no changes were found for other performance parameters. Conclusions: The study suggests that a multilevel approach is suitable to quantify the internal training load and that different parameters can be used to control the training process. The biomarkers CK, BUN, and Alb are suitable for objectively quantifying the internal training load. The self-perception provides additional subjective information about the internal training load.

Association between collapse and serum creatinine and electrolyte concentrations in marathon runners: a 9-year retrospective study

OBJECTIVE

Abnormal biochemical measurements have previously been described in runners following marathons. The incidence of plasma sodium levels outside the normal range has been reported as 31%, and the incidence of raised creatinine at 30%. This study describes the changes seen in electrolytes and creatinine in collapsed (2010-2019 events) and noncollapsed (during the 2019 event) runners during a UK marathon.

METHODS

Point-of-care sodium, potassium, urea and creatinine estimates were obtained from any collapsed runner treated by the medical team during the Brighton Marathons, as part of their clinical care, and laboratory measurements from control subjects.

RESULTS

Results from 224 collapsed runners were available. Serum creatinine was greater than the normal range in 68.9%. About 6% of sodium results were below, and 3% above the normal range, with the lowest 132 mmol/l. Seventeen percent of potassium readings were above the normal range; the maximum result was 8.4 mmol/l, but 97% were below 6.0 mmol/l. In the control group, mean creatinine was significantly raised in both the collapse and control groups, with 55.4% meeting the criteria for acute kidney injury, but had resolved to baseline after 24 h. Sodium concentration but not the potassium was significantly raised after the race compared with baseline, but only 15% were outside the normal range.

CONCLUSION

In this study, incidence of a raised creatinine was higher than previously reported. However, the significance of such a rise remains unclear with a similar rise seen in collapsed and noncollapsed runners, and resolution noted within 24 h. Abnormal sodium concentrations were observed infrequently, and severely abnormal results were not seen, potentially reflecting current advice to drink enough fluid to quench thirst.

A Randomized Controlled Trial Investigating the Effects of Undulatory, Staggered, and Linear Load Manipulations in Aerobic Training on Oxygen Supply, Muscle Injury, and Metabolism in Male Recreational Runners

Background

Taper is considered as a strategy to avoid overtraining and increase peak performance in athletes. Because aerobic exercise increases the level and duration of independence during the lifespan, the participation of recreational athletes has increased in running events around the world. However, the effects of using load reduction in their training and aerobic performance are still not well known.

Objectives

Our goal was to compare load manipulations, using tapering-like periods in the end of recreational athletes training evaluating alterations in oxygen supply, muscle injury, and metabolism markers.

Methods

Healthy males (n = 88, 20–35 years old) were randomly distributed in groups using a combination of two mesocycles of 4 weeks, undulatory and staggered, with two daily microcycles, undulatory and linear. Undulatory-undulatory (Und-Und) and undulatory-linear (Und-Lin) groups had load reduction in the final week of training while the staggered-undulatory (Sta-Und) and staggered-linear (Sta-Lin) groups did not. Cardiorespiratory capacity (V̇O_2max), body mass index (BMI), and body fat % were evaluated. Blood samples were also collected to analyze hematocrit (Ht), mean corpuscular hemoglobin (MCHC), circulating levels of hemoglobin (Hb), creatine kinase (CK), lactate dehydrogenase (LDH), aspartate aminotransferase (AST), alanine aminotransferase (ALT), urea (U), cortisol (C), free testosterone (FT), and free T/C ratio.

Results

After 8 weeks of training, Und-Und had the highest trend to increase V̇O_2max. Both Und-Und and Sta-Lin reduced body fat %. Und-Und showed a significant increase in MCHC, T and Free T/C ratio, a positive trend to increase Ht% and Hb levels, and a trend to decrease CK, LDH, and C circulating levels. Sta-Lin presented a trend to decrease Ht% and Hb levels, a significant increase in CK, LDH, AST, ALT circulating levels, and a decrease in Free T/C ratio.

Conclusion

The use of daily undulatory training load provides better gains for aerobic fitness while the use of staggered load, mainly associated with linear load, promotes inadequate recovery in recreational runners.

Effect of oral vitamin C supplementation on serum uric acid: a meta-analysis of randomized controlled trials

OBJECTIVE

To assess the effect of vitamin C supplementation on serum uric acid (SUA) by pooling the findings from published randomized controlled trials (RCTs).

METHODS

A total of 2,082 publications identified through systematic search were subjected to the following inclusion criteria: 1) RCTs conducted on human subjects, 2) reported end-trial SUA means and variance, 3) study design with oral vitamin C supplementation and concurrent control groups, and 4) trial duration of at least 1 week. Trials that enrolled children or patients receiving dialysis were excluded. Two investigators independently abstracted trial and participant characteristics. SUA effects were pooled by random-effects models and weighted by inverse variance.

RESULTS

Thirteen RCTs were identified in the Medline, EMBase, and Cochrane Central Register of Controlled Trials databases. The total number of participants was 556, the median dosage of vitamin C was 500 mg/day, trial size ranged from 8-184 participants, and the median study duration was 30 days. Pretreatment SUA values ranged from 2.9-7.0 mg/dl (Système International d'Unités [SI units]: 172.5-416.4 μmoles/liter). The combined effect of these trials was a significant reduction in SUA of -0.35 mg/dl (95% confidence interval -0.66, -0.03 [P = 0.032]; SI units: -20.8 μmoles/liter). Trial heterogeneity was significant (I(2) = 77%, P < 0.01). Subgroup analyses based on trial characteristics indicated larger reductions in uric acid in trials that were placebo controlled.

CONCLUSIONS

In aggregate, vitamin C supplementation significantly lowered SUA. Future trials are needed to determine whether vitamin C supplementation can reduce hyperuricemia or prevent incident and recurrent gout.

ATriple Iron triathlon leads to a decrease in total body mass but not to dehydration

A loss in total body mass during an ultraendurance performance is usually attributed to dehydration. We identified the changes in total body mass, fat mass, skeletal muscle mass, and selected markers of hydration status in 31 male nonprofessional ultratriathletes participating in a Triple Iron triathlon involving 11.4 km swimming, 540 km cycling and 126.6 km running. Measurements were taken prior to starting the race and after arrival at the finish line. Total body mass decreased by 1.66 kg (SD = 1.92; -5.3 kg to +1.2 kg; p < .001), skeletal muscle mass by 1.00 kg (SD = 0.90; -2.54 kg to +2.07 kg; p < .001), and fat mass by 0.58 kg (SD = 0.78; -1.74 kg to +0.87 kg; p < .001). The decrease in total body mass was associated with the decrease in skeletal muscle mass (r = .44; p < .05) and fat mass (r = .51; p < .05). Total body water and urinary specific gravity did not significantly change. Plasma urea increased significantly (p < .001); the decrease in skeletal muscle mass and the increase in plasma urea were associated (r = .39; p < .05). We conclude that completing a Triple Iron triathlon leads to decreased total body mass due to reduced fat mass and skeletal muscle mass but not to dehydration. The association of decrease in skeletal muscle mass and increased plasma urea suggests a loss in skeletal muscle mass.

No dehydration in mountain bike ultra-marathoners

OBJECTIVE

To assess the change in body composition and hydration status in cyclists in a mountain bike ultra-marathon.

DESIGN

Prospective observational field study.

SETTING

"Swiss Bike Masters" 2008 over 120 km with a total climb of 5000 m in altitude.

PARTICIPANTS

Thirty-seven male mountain bikers.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Prerace and postrace, body mass, percent body fat, skeletal muscle mass, and selected hematologic and urinary parameters were measured to quantify changes in body mass and hydration status. Athletes reported their fluid intake during the race.

RESULTS

The athletes lost 1.4 kg in body mass (P < 0.001), equal to 1.9% body mass. Fat mass remained stable and skeletal muscle mass decreased by 0.4 kg (P < 0.05). Prerace fat mass was correlated to total race time (r = 0.37, P < 0.05). The cyclists drank 6.5 (1.8) L of fluids during the race corresponding to 0.7 (0.2) L per hour. A significant inverse relationship was seen between change in body mass and race time when controlled for change in skeletal mass and fluid intake during the race (P > 0.05). Plasma sodium decreased by 0.7% (P < 0.05), plasma volume increased by 1.4%, and plasma urea increased by 40% (P < 0.05). Urinary-specific gravity increased by 0.4% (P < 0.05). The decrease in skeletal muscle mass was associated with the increase in plasma urea (r = -0.34; P < 0.05). Fluid intake was associated with the change in urinary-specific gravity (r = -0.45; P < 0.01).

CONCLUSIONS

We conclude that these mountain bike ultra-marathoners suffered a significant decrease in body mass and skeletal muscle mass but no dehydration.

Position related analysis of the appearance of and relationship between post-match physical and mental fatigue in university rugby football players

OBJECTIVE

The relationship between physical and mental fatigue in rugby players after a match was examined, taking into account the position played.

METHODS

The Profile of Mood State (POMS) test, blood biochemical parameters, and serum opsonic activity were measured for 37 university rugby football players before and after a match.

RESULTS

There were no differences in parameter changes except for blood urea nitrogen (a marker for protein catabolism) between the forwards and the backs. Regarding correlation between physical and mental fatigue, in forwards, changes in POMS scores showed a positive correlation with changes in the levels of enzymes of skeletal muscle origin, such as glutamate oxaloacetic transaminase (GOT) and lactate dehydrogenase (LDH), and free fatty acid (FFA) level and white blood cell count (for example, in the Total Mood Disturbance (TMD) score, Spearman's correlation coefficient was 0.417 and p<0.05 with GOT, 0.413 and p<0.05 with LDH, 0.462 and p<0.05 with FFA, and 0.442 and p<0.05 with white blood cell count). In backs, changes in the POMS scores showed a positive correlation with changes in the levels of lipid related parameters such as FFA and total cholesterol (for example, as regards the TMD score, Spearman's correlation coefficient was 0.481 and p<0.05 with FFA, and 0.550 and p<0.05 with total cholesterol), and showed a negative correlation with change in blood glucose level (TMD score, -0.517 and p<0.05).

CONCLUSIONS

The different exercise loading of the position played during a rugby match may cause differences in the relationship between physical and mental fatigue.

Effects of exercise on the physical condition of college rugby players during summer training camp

OBJECTIVES

To determine the effects of exercise training on physical condition in 25 college rugby players during a summer training camp, and to compare these variables by the different players' positions.

METHODS

Changes in body composition parameters and blood biochemistry were examined before and after a summer training camp.

RESULTS

Body weight and percentage body fat did not change significantly during the camp. There were significant decreases in levels of serum total cholesterol, triglycerides, phosphate, uric acid, and immunoglobulin G and M. In contrast, there were significant increases in levels of serum potassium, markers of renal, hepatic, and muscular damage (BUN, GOT, GPT, LDH, CK), and complement C4. Comparison of the changes in biochemical parameters between rugby players playing in different positions showed a significant increase in serum albumin level in the forwards, and significant decreases in serum triglyceride and sodium levels in the backs. The magnitude of change in serum LDH during the camp was significantly greater (p<0.05) for the forwards than for the backs.

CONCLUSIONS

These data suggest that, in rugby players attending a 20 day camp, exercise training resulted in muscular damage, loss of electrolytes due to sweating, and changes in immune function. Backs exhibited a higher rate of fat metabolism and loss of electrolytes than forwards, possibly because they did more running during the camp. In contrast, forwards experienced more physical contact, performed more physically strenuous exercise, and exhibited higher levels of muscular damage and tissue protein degradation.

Comparison of serum creatinine, uric acid, albumin and glucose in male professional endurance athletes compared with healthy controls

Owing to considerable physical, endocrinological and metabolic adaptations, the analysis of biochemical data in elite and top-class athletes requires caution. With the aim to identify metabolic and biochemical adaptations to particular lifestyle conditions, such as regular and strenuous physical exercise, we measured the concentration of serum albumin, creatinine, uric acid and glucose in 80 male professional cyclists, 37 male members of the Italian national cross-country ski team and 60 male healthy sedentary controls at rest. At variance with earlier investigations, endurance athletes showed significantly decreased concentrations of serum creatinine (controls: 83.1±11.0 μmol/l; skiers: 78.0±8.4 μmol/l; p<0.05; cyclists: 73.8±10.4 μmol/l; p<0.01), uric acid (controls: 362±69 μmol/l; skiers: 331±70 μmol/l; p<0.05; cyclists: 312±61 μmol/l; p<0.01) and glucose (controls: 5.35±0.54 mmol/l; skiers: 4.94±0.41 mmol/l; p<0.01; cyclists: 4.94±0.42 mmol/l; p<0.01). The concentration of serum albumin was also decreased in athletes, but the difference did not reach statistical significance (controls: 4.76±0.26 g/l; skiers: 4.71±0.22 g/l; p=0.384; cyclists: 4.68±0.22 g/l; p=0.393). Results of the present investigation demonstrate that values of laboratorytesting lying outside conventional reference limits calculated on sedentary populations might express physiological adaptations to regular and demanding physical aerobic activity, emphasizing the need for the estimation of reliable reference limits in elite and professional athletes, to avoid equivocal interpretation of results within clinical and anti-doping contests.

Biochemical changes as a result of prolonged strenuous exercise

OBJECTIVE

To briefly review biochemical changes that may result from prolonged strenuous exercise and to relate these changes to health risk.

METHODS

Medline and Sports Discus databases were searched for relevant articles. Additional articles were found using cross referencing and the authors' knowledge of the subject area.

RESULTS

Prolonged strenuous exercise may result in a series of biochemical changes that are of concern from a health point of view. Generally, these changes are benign, but some, especially hyponatraemia, are potentially life threatening occurrences.

CONCLUSION

Doctors and athletes should be aware of the potentially adverse biochemical changes, especially hyponatraemia, that may result from prolonged strenuous exercise.

Postexercise recovery period: carbohydrate and protein metabolism

The essence of the postexercise recovery period is normalization of function and homeostatic equilibrium, and replenishment of energy resources and accomplishment of the reconstructive function. The repletion of energy stores is actualized in a certain sequence and followed by a transitory supercompensation. The main substrate for repletion of the muscle glycogen store is blood glucose derived from hepatic glucose output as well as from consumption of carbohydrates during the postexercise period. The repletion of liver glycogen is realized less rapidly. It depends to a certain extent on hepatic gluconeogenesis but mainly on supply with exogenous carbohydrates. The constructive function is founded on elevated protein turnover and adaptive protein synthesis. Whereas during and shortly after endurance exercise intensive protein breakdown was found in less active fast-twitch glycolytic fibers, during the later course of the recovery period the protein degradation rate increased together with intensification of protein synthesis rate in more active fast-twitch glycolytic oxidative and slow-twitch oxidative fibers.

Plasma accumulation of hypoxanthine, uric acid and creatine kinase following exhausting runs of differing durations in man

During exhausting exercise adenylate kinase in the muscle cells is activated and a degradation of adenosine 5'-diphosphate occurs. Consequently, degradation products of adenosine 5'-monophosphate including hypoxanthine and uric acid, accumulate in plasma. The aim of this study was to compare the concentration changes of hypoxanthine and uric acid in plasma following running of varying duration and intensity. In addition, plasma creatine kinase activity was measured to assess the possible relationship between metabolic stress and protein release. Four groups of competitive male runners ran 100 m (n = 7), 800 m (n = 11), 5000 m (n = 7) and 42,000 m (n = 7), respectively, at an exhausting pace. Subsequent to the 100 m event (mean running time 11 s) plasma concentrations of hypoxanthine and uric acid increased by 364% and 36% respectively (P less than 0.05), indicating a very high rate of adenine nucleotide degradation during the event. Following the 800-m event (mean running time 125 s), hypoxanthine and uric acid concentrations had increased by 1598% and 66%, respectively (P less than 0.05). Both the events of longer duration, 5000 m and 42,000 m, also caused a significant increase in plasma concentration of hypoxanthine (742% and 237% respectively, P less than 0.05) and plasma uric acid (54% and 34% respectively, P less than 0.05). Plasma activities of creatine kinase were significantly increased at 24 h only following the 5000 m and 42,000 m events (64% and 1186% respectively, P less than 0.05). Changes in plasma creatine kinase activity showed no correlation with changes in plasma concentration of either hypoxanthine or uric acid for the 5000 m and 42,000 m events (r = 0.00-0.45, P greater than 0.05).