1
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Varillas-Delgado D. Association of iron supplementation, HFE and AMPD1 polymorphisms and biochemical iron metabolism parameters in the performance of a men's World Tour cycling team: A pilot study. J Trace Elem Med Biol 2024; 84:127470. [PMID: 38744035 DOI: 10.1016/j.jtemb.2024.127470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/25/2024] [Accepted: 05/08/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Nutritional strategies with iron supplementation have been shown to be effective in preventing the decline of blood biochemical parameters and sports performance. The aim of the study was to describe biochemical iron metabolism parameters in association with iron supplementation and HFE and AMPD1 polymorphisms in a Union Cycliste Internationale (UCI) World Tour cycling team to evaluate performance during a whole season METHODS: Twenty-eight professional men cyclists took part in this longitudinal observational pilot study. AMPD1 c.34 C>T (rs17602729) and HFE c.187 C>G (rs1799945) polymorphisms were genotyped using Single Nucleotide Primer Extension (SNPE). All the professional cyclists took oral iron supplementation throughout the season. Four complete blood analyses were carried out corresponding to UCI controls in January (1st), April (2nd), June (3rd) and October (4th). Data on participation in three-week Grand Tours, kms of competition and wins were analyzed. RESULTS In performance, especially in wins, there was a significant effect in HFE on biochemical hemoglobin (F = 4.255; p = 0.021) and biochemical hematocrit (F = 5.335; p = 0.009) and a hematocrit biochemical × genotype interaction (F = 3.418; p = 0.041), with higher values in professional cyclist with GC genotype. In AMPD1 there were significant effects in the biochemical iron x genotype interaction in three-week Grand Tours (F = 3.874; p = 0.029) and wins (F = 3.930; p = 0.028) CONCLUSIONS: Blood biochemical iron metabolism parameters could be related to performance in the season due to increasing hemoglobin and hematocrit concentration under iron supplementation, associated with winning in the professional cyclists with GC genotype of the HFE polymorphism.
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Affiliation(s)
- David Varillas-Delgado
- Universidad Francisco de Vitoria, Faculty of Health Sciences, Research Unit, Pozuelo de Alarcón, Madrid, Spain; SPORTNOMICS S.L., Madrid, Spain.
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2
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Semenova EA, Hall ECR, Ahmetov II. Genes and Athletic Performance: The 2023 Update. Genes (Basel) 2023; 14:1235. [PMID: 37372415 DOI: 10.3390/genes14061235] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Phenotypes of athletic performance and exercise capacity are complex traits influenced by both genetic and environmental factors. This update on the panel of genetic markers (DNA polymorphisms) associated with athlete status summarises recent advances in sports genomics research, including findings from candidate gene and genome-wide association (GWAS) studies, meta-analyses, and findings involving larger-scale initiatives such as the UK Biobank. As of the end of May 2023, a total of 251 DNA polymorphisms have been associated with athlete status, of which 128 genetic markers were positively associated with athlete status in at least two studies (41 endurance-related, 45 power-related, and 42 strength-related). The most promising genetic markers include the AMPD1 rs17602729 C, CDKN1A rs236448 A, HFE rs1799945 G, MYBPC3 rs1052373 G, NFIA-AS2 rs1572312 C, PPARA rs4253778 G, and PPARGC1A rs8192678 G alleles for endurance; ACTN3 rs1815739 C, AMPD1 rs17602729 C, CDKN1A rs236448 C, CPNE5 rs3213537 G, GALNTL6 rs558129 T, IGF2 rs680 G, IGSF3 rs699785 A, NOS3 rs2070744 T, and TRHR rs7832552 T alleles for power; and ACTN3 rs1815739 C, AR ≥21 CAG repeats, LRPPRC rs10186876 A, MMS22L rs9320823 T, PHACTR1 rs6905419 C, and PPARG rs1801282 G alleles for strength. It should be appreciated, however, that elite performance still cannot be predicted well using only genetic testing.
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Affiliation(s)
- Ekaterina A Semenova
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, 119435 Moscow, Russia
- Research Institute of Physical Culture and Sport, Volga Region State University of Physical Culture, Sport and Tourism, 420138 Kazan, Russia
| | - Elliott C R Hall
- Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4UA, UK
| | - Ildus I Ahmetov
- Laboratory of Genetics of Aging and Longevity, Kazan State Medical University, 420012 Kazan, Russia
- Sports Genetics Laboratory, St Petersburg Research Institute of Physical Culture, 191040 St. Petersburg, Russia
- Department of Physical Education, Plekhanov Russian University of Economics, 115093 Moscow, Russia
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 5AF, UK
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3
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Lewis N, Hodgson A, Khanbhai T, Sygo J, Mazur J, Smith C, Catterson P, Pedlar C. Rise of intravenous nutrition products among professional team sport athletes: reasons to be concerned? Br J Sports Med 2022; 56:1204-1205. [PMID: 35973754 DOI: 10.1136/bjsports-2022-105883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Nathan Lewis
- Orreco Limited, Business Innovation Unit, NUIG, Galway, Ireland.,English Institute of Sport, Sports Training Village, University of Bath, Bath, UK
| | - Andrew Hodgson
- Department of Haematology, Sligo University Hospital, Sligo, Ireland
| | | | - Jennifer Sygo
- Toronto Raptors, OVO Athletic Training Center, Toronto, Ontario, Canada
| | - Jordan Mazur
- San Francisco 49ers, Santa Clara, California, USA
| | - Casey Smith
- Dallas Mavericks Inc, Mavericks Training Center, Dallas, Texas, USA
| | - Paul Catterson
- Newcastle United Football Club, Department of Medicine, Benton, UK
| | - Charles Pedlar
- Orreco Limited, Business Innovation Unit, NUIG, Galway, Ireland .,Faculty of Sport, Allied Health and Performance Sciences, St Mary's University Twickenham, London, UK.,Institute of Sport, Exercise and Health, University College London, London, UK
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4
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Abstract
Sports genomics is the scientific discipline that focuses on the organization and function of the genome in elite athletes, and aims to develop molecular methods for talent identification, personalized exercise training, nutritional need and prevention of exercise-related diseases. It postulates that both genetic and environmental factors play a key role in athletic performance and related phenotypes. This update on the panel of genetic markers (DNA polymorphisms) associated with athlete status and soft-tissue injuries covers advances in research reported in recent years, including one whole genome sequencing (WGS) and four genome-wide association (GWAS) studies, as well as findings from collaborative projects and meta-analyses. At end of 2020, the total number of DNA polymorphisms associated with athlete status was 220, of which 97 markers have been found significant in at least two studies (35 endurance-related, 24 power-related, and 38 strength-related). Furthermore, 29 genetic markers have been linked to soft-tissue injuries in at least two studies. The most promising genetic markers include HFE rs1799945, MYBPC3 rs1052373, NFIA-AS2 rs1572312, PPARA rs4253778, and PPARGC1A rs8192678 for endurance; ACTN3 rs1815739, AMPD1 rs17602729, CPNE5 rs3213537, CKM rs8111989, and NOS3 rs2070744 for power; LRPPRC rs10186876, MMS22L rs9320823, PHACTR1 rs6905419, and PPARG rs1801282 for strength; and COL1A1 rs1800012, COL5A1 rs12722, COL12A1 rs970547, MMP1 rs1799750, MMP3 rs679620, and TIMP2 rs4789932 for soft-tissue injuries. It should be appreciated, however, that hundreds and even thousands of DNA polymorphisms are needed for the prediction of athletic performance and injury risk.
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5
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Wahl Y, Achtzehn S, Schäfer Olstad D, Mester J, Wahl P. Training Load Measures and Biomarker Responses during a 7-Day Training Camp in Young Cyclists-A Pilot Study. ACTA ACUST UNITED AC 2021; 57:medicina57070673. [PMID: 34209610 PMCID: PMC8307195 DOI: 10.3390/medicina57070673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 06/24/2021] [Accepted: 06/25/2021] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Yvonne Wahl
- Institute of Exercise Training and Sport Informatics, German Sport University Cologne, 50933 Cologne, Germany;
| | - Silvia Achtzehn
- The German Research Centre of Elite Sport, German Sport University Cologne, 50933 Cologne, Germany; (S.A.); (J.M.)
| | | | - Joachim Mester
- The German Research Centre of Elite Sport, German Sport University Cologne, 50933 Cologne, Germany; (S.A.); (J.M.)
| | - Patrick Wahl
- Institute of Interdisciplinary Exercise Science and Sports Medicine, Medical School Hamburg, 20457 Hamburg, Germany
- Correspondence: ; Tel.: +49-40-36122649482
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6
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Gkouskou KK, Grammatikopoulou MG, Vlastos I, Sanoudou D, Eliopoulos AG. Genotype-guided dietary supplementation in precision nutrition. Nutr Rev 2020; 79:1225-1235. [PMID: 33367884 DOI: 10.1093/nutrit/nuaa132] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Achieving adequate micronutrient status, while avoiding deficiencies, represents a challenge for people globally. Consequently, many individuals resort to oral nutrient supplementation (ONS) in order to correct suboptimal dietary intakes. Advances in the fields of nutrigenetics and nutritional genomics have identified differences in response to micronutrient supplementation according to genetic makeup, adding dietary supplement use to the clinician's toolkit in the precision nutrition era. This review focuses on published evidence linking genetic variants to the responses associated with some of the most popular dietary supplements. With an increasing number of health professionals becoming involved in the prescription of ONS, identifying and matching individuals to the appropriate dietary supplement according to their genotype is important for achieving optimal health benefits and micronutrient equilibrium, while reducing the adverse events and financial costs often associated with excessive ONS.
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Affiliation(s)
- Kalliopi K Gkouskou
- Department of Biology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Embiodiagnostics, Biology Research Company, Heraklion, Crete, Greece
| | - Maria G Grammatikopoulou
- Department of Nutritional Sciences and Dietetics, Faculty of Health Sciences, International Hellenic University, Thessaloniki, Greece
| | - Ioannis Vlastos
- Department of Biology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Despina Sanoudou
- Clinical Genomics and Pharmacogenomics Unit, 4th Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Center for New Biotechnologies and Precision Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Center of Basic Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Aristides G Eliopoulos
- Department of Biology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Center for New Biotechnologies and Precision Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Center of Basic Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
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7
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Lippi G, Sanchis-Gomar F. Influence of chronic training workload on the hematological profile: a pilot study in sedentary people, amateur and professional cyclists. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020104. [PMID: 33525285 PMCID: PMC7927508 DOI: 10.23750/abm.v91i4.8460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 05/12/2019] [Indexed: 11/25/2022]
Abstract
Background and aim: The assessment of hematological profile requires to identify possible sources of biological variability, including exercise-related variations. This study was hence aimed to evaluate hematological profile variations in amateur and professional athletes, and establish their possible dependence on cumulative training volume. Materials and Methods: The study population consisted of 59 sedentary male subjects, 78 amateur and 80 professional male cyclists, in whom a large number of hematological variables were measured at rest. Results: Red blood cell (RBC) count and hemoglobin were decreased in the two athlete cohorts compared to sedentary subjects, but did not differ between amateur and professional cyclists. Hematocrit was gradually and significantly decreased in parallel with cumulative training volume. Amateur cyclists displayed higher mean corpuscular volume (MCV) and lower mean corpuscular hemoglobin concentration (MCHC) values than sedentary subjects and professional cyclists, whilst mean corpuscular hemoglobin (MCH) was higher in professional cyclists. The reticulocyte count and soluble transferrin receptor (sTFR) values were similar across all groups. Serum ferritin was higher in professional cyclists than in the other two groups, whilst transferrin gradually decreased from sedentary group to the two cohorts of amateur and professional cyclists. In univariate analysis, cumulative training volume was inversely associated with age, body mass index (BMI), RBC count, hematocrit, hemoglobin and transferrin, whilst a positive association was found with ferritin. In multivariate analysis, BMI, RBC count and ferritin remained significantly associated with training volume. Conclusions: These results show that the volume of endurance training may affect some hematological variables. (www.actabiomedica.it)
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Affiliation(s)
- Giuseppe Lippi
- Laboratory of Clinical Chemistry and Hematology, Academic Hospital of Parma..
| | - Fabian Sanchis-Gomar
- Department of Physiology, Faculty of Medicine, University of Valencia and INCLIVA Biomedical Research Institute, Valencia, Spain.
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8
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Semenova EA, Miyamoto-Mikami E, Akimov EB, Al-Khelaifi F, Murakami H, Zempo H, Kostryukova ES, Kulemin NA, Larin AK, Borisov OV, Miyachi M, Popov DV, Boulygina EA, Takaragawa M, Kumagai H, Naito H, Pushkarev VP, Dyatlov DA, Lekontsev EV, Pushkareva YE, Andryushchenko LB, Elrayess MA, Generozov EV, Fuku N, Ahmetov II. The association of HFE gene H63D polymorphism with endurance athlete status and aerobic capacity: novel findings and a meta-analysis. Eur J Appl Physiol 2020; 120:665-673. [PMID: 31970519 PMCID: PMC7042188 DOI: 10.1007/s00421-020-04306-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 01/16/2020] [Indexed: 12/04/2022]
Abstract
PURPOSE Iron is an important component of the oxygen-binding proteins and may be critical to optimal athletic performance. Previous studies have suggested that the G allele of C/G rare variant (rs1799945), which causes H63D amino acid replacement, in the HFE is associated with elevated iron indexes and may give some advantage in endurance-oriented sports. The aim of the present study was to investigate the association between the HFE H63D polymorphism and elite endurance athlete status in Japanese and Russian populations, aerobic capacity and to perform a meta-analysis using current findings and three previous studies. METHODS The study involved 315 international-level endurance athletes (255 Russian and 60 Japanese) and 809 healthy controls (405 Russian and 404 Japanese). Genotyping was performed using micro-array analysis or by PCR. VO2max in 46 male Russian endurance athletes was determined using gas analysis system. RESULTS The frequency of the iron-increasing CG/GG genotypes was significantly higher in Russian (38.0 vs 24.9%; OR 1.85, P = 0.0003) and Japanese (13.3 vs 5.0%; OR 2.95, P = 0.011) endurance athletes compared to ethnically matched controls. The meta-analysis using five cohorts (two French, Japanese, Spanish, and Russian; 586 athletes and 1416 controls) showed significant prevalence of the CG/GG genotypes in endurance athletes compared to controls (OR 1.96, 95% CI 1.58-2.45; P = 1.7 × 10-9). Furthermore, the HFE G allele was associated with high V̇O2max in male athletes [CC: 61.8 (6.1), CG/GG: 66.3 (7.8) ml/min/kg; P = 0.036]. CONCLUSIONS We have shown that the HFE H63D polymorphism is strongly associated with elite endurance athlete status, regardless ethnicities and aerobic capacity in Russian athletes.
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Affiliation(s)
- Ekaterina A. Semenova
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia
- Department of Biochemistry, Kazan Federal University, Kazan, Russia
| | - Eri Miyamoto-Mikami
- Graduate School of Health and Sports Science, Juntendo University, Chiba, Japan
| | | | - Fatima Al-Khelaifi
- Anti Doping Laboratory Qatar, Sports City, Doha, Qatar
- UCL-Medical School, Royal Free Campus, London, UK
| | - Haruka Murakami
- Department of Physical Activity Research, National Institutes of Biomedical Innovation, Health and Nutrition, NIBIOHN, Tokyo, Japan
| | - Hirofumi Zempo
- Graduate School of Health and Sports Science, Juntendo University, Chiba, Japan
- Faculty of Health and Nutrition, Tokyo Seiei College, Tokyo, Japan
| | - Elena S. Kostryukova
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia
| | - Nikolay A. Kulemin
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia
| | - Andrey K. Larin
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia
| | - Oleg V. Borisov
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia
- Institute for Genomic Statistics and Bioinformatics, University Hospital Bonn, Bonn, Germany
| | - Motohiko Miyachi
- Department of Physical Activity Research, National Institutes of Biomedical Innovation, Health and Nutrition, NIBIOHN, Tokyo, Japan
| | - Daniil V. Popov
- Laboratory of Exercise Physiology, Institute for Biomedical Problems of the Russian Academy of Sciences, Moscow, Russia
| | | | - Mizuki Takaragawa
- Graduate School of Health and Sports Science, Juntendo University, Chiba, Japan
| | - Hiroshi Kumagai
- Graduate School of Health and Sports Science, Juntendo University, Chiba, Japan
- Research Fellow of Japanese Society for the Promotion of Science, Tokyo, Japan
| | - Hisashi Naito
- Graduate School of Health and Sports Science, Juntendo University, Chiba, Japan
| | - Vladimir P. Pushkarev
- Medical Genetic Centre “Progen”, Moscow, Russia
- Moscow Center of Advanced Sport Technologies, Moscow, Russia
- Department of the Theory of Physical Culture and Biomechanics, Ural State University of Physical Culture, Chelyabinsk, Russia
| | - Dmitry A. Dyatlov
- Department of the Theory of Physical Culture and Biomechanics, Ural State University of Physical Culture, Chelyabinsk, Russia
| | - Eugene V. Lekontsev
- Methodical and Analytical Department, Regional Center for Sports Training, Chelyabinsk, Russia
- Research Institute of Olympic Sports, Ural State University of Physical Culture, Chelyabinsk, Russia
| | - Yuliya E. Pushkareva
- Department of Pediatrics, South Ural State Medical University, Chelyabinsk, Russia
| | | | | | - Edward V. Generozov
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia
| | - Noriyuki Fuku
- Graduate School of Health and Sports Science, Juntendo University, Chiba, Japan
| | - Ildus I. Ahmetov
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia
- Department of Physical Education, Plekhanov Russian University of Economics, Moscow, Russia
- Laboratory of Molecular Genetics, Kazan State Medical University, Kazan, Russia
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Byrom St, Liverpool, L3 5AF UK
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9
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Montagna R, Canonico R, Alfano L, Bucci E, Boffo S, Staiano L, Fulco B, D'Andrea E, Nicola A, Maiorano P, D'Angelo C, Chirico A, Nicola A, Giordano A. Genomic analysis reveals association of specific SNPs with athletic performance and susceptibility to injuries in professional soccer players. J Cell Physiol 2019; 235:2139-2148. [DOI: 10.1002/jcp.29118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 07/17/2019] [Indexed: 12/14/2022]
Affiliation(s)
| | - Raffaele Canonico
- Unità Operativa Complessa di Dietetica, Medicina dello Sport e Benessere Psico‐Fisico Università degli Studi della Campania Luigi Vanvitelli Naples Italy
| | - Luigi Alfano
- Cell Biology and Biotherapy Unit Istituto Nazionale Tumori ‐ IRCCS, Fondazione G. Pascale Naples Italy
| | - Enrico Bucci
- Sbarro Health Research Organization Wayne Pennsylvania
| | - Silvia Boffo
- Sbarro Health Research Organization Wayne Pennsylvania
| | - Leopoldo Staiano
- Laboratory of Cellular and Developmental Biology Stazione Zoologica Anton Dohrn Naples Italy
| | - Beniamino Fulco
- Department of Medical Biotechnologies University of Siena Italy
| | | | | | | | | | - Andrea Chirico
- Sbarro Health Research Organization Wayne Pennsylvania
- Department of Psychology of Development and Socialization Processes “Sapienza” University of Rome Italy
| | | | - Antonio Giordano
- Sbarro Health Research Organization Wayne Pennsylvania
- Department of Medical Biotechnologies University of Siena Italy
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10
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Rostoker G, Vaziri ND. Risk of iron overload with chronic indiscriminate use of intravenous iron products in ESRD and IBD populations. Heliyon 2019; 5:e02045. [PMID: 31338466 PMCID: PMC6627982 DOI: 10.1016/j.heliyon.2019.e02045] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 03/14/2019] [Accepted: 07/03/2019] [Indexed: 01/19/2023] Open
Abstract
The routine use of recombinant erythropoiesis-stimulating agents (ESA) over the past three decades has enabled the partial correction of anaemia in most patients with end-stage renal disease (ESRD). Since ESA use frequently leads to iron deficiency, almost all ESA-treated haemodialysis patients worldwide receive intravenous iron (IV) to ensure sufficient available iron during ESA therapy. Patients with inflammatory bowel disease (IBD) are also often treated with IV iron preparations, as anaemia is common in IBD. Over the past few years, liver magnetic resonance imaging (MRI) has become the gold standard method for non-invasive diagnosis and follow-up of iron overload diseases. Studies using MRI to quantify liver iron concentration in ESRD have shown a link between high infused iron dose and risk of haemosiderosis in dialysis patients. In September 2017, the Pharmacovigilance Committee (PRAC) of the European Medicines Agency (EMA) considered convergent publications over the last few years on iatrogenic haemosiderosis in dialysis patients and requested that companies holding marketing authorization for iron products should investigate the risk of iron overload, particularly in patients with end-stage renal disease on dialysis and, by analogy, patients with IBD. We present a narrative review of data supporting the views and decision of the EMA, and then give our expert opinion on this controversial field of anaemia therapeutics.
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Affiliation(s)
- Guy Rostoker
- Division of Nephrology and Dialysis, Hôpital Privé Claude Galien, Ramsay-Générale de Santé, Quincy-sous-Sénart, France
| | - Nosratola D Vaziri
- Division of Nephrology and Hypertension, University of California, Irvine, USA
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11
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Moretti D, Mettler S, Zeder C, Lundby C, Geurts-Moetspot A, Monnard A, Swinkels DW, Brittenham GM, Zimmermann MB. An intensified training schedule in recreational male runners is associated with increases in erythropoiesis and inflammation and a net reduction in plasma hepcidin. Am J Clin Nutr 2018; 108:1324-1333. [PMID: 30351387 DOI: 10.1093/ajcn/nqy247] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 08/21/2018] [Indexed: 01/24/2023] Open
Abstract
Background Iron status is a determinant of physical performance, but training may induce both low-grade inflammation and erythropoiesis, exerting opposing influences on hepcidin and iron metabolism. To our knowledge, the combined effects on iron absorption and utilization during training have not been examined directly in humans. Objective We hypothesized that 3 wk of exercise training in recreational male runners would decrease oral iron bioavailability by increasing inflammation and hepcidin concentrations. Design In a prospective intervention, nonanemic, iron-sufficient men (n = 10) completed a 34-d study consisting of a 16-d control phase and a 22-d exercise-training phase of 8 km running every second day. We measured oral iron absorption and erythroid iron utilization using oral 57Fe and intravenous 58Fe tracers administered before and during training. We measured hemoglobin mass (mHb) and total red blood cell volume (RCV) by carbon monoxide rebreathing. Iron status, interleukin-6 (IL-6), plasma hepcidin (PHep), erythropoietin (EPO), and erythroferrone were measured before, during, and after training. Results Exercise training induced inflammation, as indicated by an increased mean ± SD IL-6 (0.87 ± 1.1 to 5.17 ± 2.2 pg/mL; P < 0.01), while also enhancing erythropoiesis, as indicated by an increase in mean EPO (0.66 ± 0.42 to 2.06 ± 1.6 IU/L), mHb (10.5 ± 1.6 to 10.8 ± 1.8 g/kg body weight), and mean RCV (30.7 ± 4.3 to 32.7 ± 4.6 mL/kg) (all P < 0.05). Training tended to increase geometric mean iron absorption by 24% (P = 0.083), consistent with a decreased mean ± SD PHep (7.25 ± 2.14 to 5.17 ± 2.24 nM; P < 0.05). The increase in mHb and erythroid iron utilization were associated with the decrease in PHep (P < 0.05). Compartmental modeling indicated that iron for the increase in mHb was obtained predominantly (>80%) from stores mobilization rather than from increased dietary absorption. Conclusions In iron-sufficient men, mild intensification of exercise intensity increases both inflammation and erythropoiesis. The net effect is to decrease hepcidin concentrations and to tend to increase oral iron absorption. This trial was registered at clinicaltrials.gov as NCT01730521.
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Affiliation(s)
- Diego Moretti
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Swiss Federal Institute of Technology, ETH Zürich, Zurich, Switzerland
| | - Samuel Mettler
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Swiss Federal Institute of Technology, ETH Zürich, Zurich, Switzerland.,Swiss Federal Institute of Sports, Magglingen, Switzerland.,Department of Business, Health, and Social Work, Bern University of Applied Sciences, Bern, Switzerland
| | - Christophe Zeder
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Swiss Federal Institute of Technology, ETH Zürich, Zurich, Switzerland
| | - Carsten Lundby
- Zurich Center for Integrative Human Physiology, Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Anneke Geurts-Moetspot
- Hepcidinanalysis.com and Department of Laboratory Medicine, Translational Metabolic Laboratory, Radboud University Medical Center, Nijmegen, Netherlands
| | - Arnaud Monnard
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Swiss Federal Institute of Technology, ETH Zürich, Zurich, Switzerland
| | - Dorine W Swinkels
- Hepcidinanalysis.com and Department of Laboratory Medicine, Translational Metabolic Laboratory, Radboud University Medical Center, Nijmegen, Netherlands
| | - Gary M Brittenham
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Swiss Federal Institute of Technology, ETH Zürich, Zurich, Switzerland
| | - Michael B Zimmermann
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Swiss Federal Institute of Technology, ETH Zürich, Zurich, Switzerland
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12
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Pickering C, Kiely J. Understanding Personalized Training Responses: Can Genetic Assessment Help? ACTA ACUST UNITED AC 2017. [DOI: 10.2174/1875399x01710010191] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:Traditional exercise prescription is based on the assumption that exercise adaptation is predictable and standardised across individuals. However, evidence has emerged in the past two decades demonstrating that large inter-individual variation exists regarding the magnitude and direction of adaption following exercise.Objective:The aim of this paper was to discuss the key factors influencing this personalized response to exercise in a narrative review format.Findings:Genetic variation contributes significantly to the personalized training response, with specific polymorphisms associated with differences in exercise adaptation. These polymorphisms exist in a number of pathways controlling exercise adaptation. Environmental factors such as nutrition, psycho-emotional response, individual history and training programme design also modify the inter-individual adaptation following training. Within the emerging field of epigenetics, DNA methylation, histone modifications and non-coding RNA allow environmental and lifestyle factors to impact genetic expression. These epigenetic mechanisms are themselves modified by genetic and non-genetic factors, illustrating the complex interplay between variables in determining the adaptive response. Given that genetic factors are such a fundamental modulator of the inter-individual response to exercise, genetic testing may provide a useful and affordable addition to those looking to maximise exercise adaption, including elite athletes. However, there are ethical issues regarding the use of genetic tests, and further work is needed to provide evidence based guidelines for their use.Conclusion:There is considerable inter-individual variation in the adaptive response to exercise. Genetic assessments may provide an additional layer of information allowing personalization of training programmes to an individual’s unique biology.
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Diagnosis of hyperferritinemia in routine clinical practice. Presse Med 2017; 46:e329-e338. [PMID: 29150231 DOI: 10.1016/j.lpm.2017.09.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 09/06/2017] [Indexed: 01/29/2023] Open
Abstract
The discovery of hyperferritinemia is often fortuitous, revealed in results from a laboratory screening or follow-up test. The aim of the diagnostic procedure is therefore to identify its cause and to identify or rule out hepatic iron overload, in a three-stage process. In the first step, clinical findings and several simple laboratory tests are sufficient to detect four of the most frequent causes of high ferritin concentrations: alcoholism, inflammatory syndrome, cytolysis, and metabolic syndrome. None of these causes is associated with substantial hepatic iron overload. If transferrin saturation is high (> 50%), hereditary hemochromatosis will be considered in priority. In the second phase, rarer diseases will be sought. Among them, only chronic hematologic diseases (acquired or congenital) and excessive iron intake or infusions (patients on chronic dialysis and high-level athletes) are at risk of iron overload. In the third stage, if a doubt persists about the cause or if the ferritin concentration is very high or continues to rise, it is essential to verify the hepatic iron concentration to rule out overload. The principal examination to guide diagnosis and treatment is hepatic MRI to assess its iron concentration. It is essential to remember that more than 40% of patients with hyperferritinemia have several causes simultaneously present.
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Žákovská A, Knechtle B, Chlíbková D, Miličková M, Rosemann T, Nikolaidis PT. The Effect of a 100-km Ultra-Marathon under Freezing Conditions on Selected Immunological and Hematological Parameters. Front Physiol 2017; 8:638. [PMID: 28955243 PMCID: PMC5600930 DOI: 10.3389/fphys.2017.00638] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 08/14/2017] [Indexed: 12/18/2022] Open
Abstract
Although moderate exercise is beneficial for the human body and its immune system, exhaustive ultra-endurance performance in cold conditions might be harmful. The aim of this study was to examine the effect of a 100-km ultra-marathon under cold conditions (temperatures from −1°C to +1°C) on selected immunological, biochemical and hematological parameters. Participants were 15 runners (12 men and three women, age 40.3 ± 9.7 years, body mass 67.3 ± 9.0 kg and body height 1.74 ± 0.10 m, mean ± standard deviation). Leukocytes increased (p < 0.01) and, particularly, the number of leucocytes doubled in seven out of 15 athletes. Immature neutrophils, mature neutrophils and monocytes increased (p < 0.02), whereas lymphocytes and eosinophils did not change. IgG increased (p < 0.02), but IgA and IgM remained unchanged. Platelets increased (p < 0.01), whereas red blood cells, hematocrit and hemoglobin did not change. lactate dehydrogenase (LDH) and creatine kinase (CK) increased (p < 0.01), but alanine aminotransferase (ALT) did not change. There was an association between the markers of the acute inflammation of the organism (i.e., neutrophils, immature neutrophils, platelets, and monocytes) and the markers of muscle damage (i.e., CK, platelets, and LDH). There were no relationships among all the markers in relation to upper respiratory tract infections and liver damage. The highest change was noted in the increase of the number of immature neutrophils (1,019.2%) and CK levels (1,077.6%). In summary, this is the first study investigating immunological, hematological and biochemical parameters and showing that running a 100-km ultra-marathon under cold conditions leads to changes in several immunological, biochemical and hematological parameters indicating a severe stress on the body associated with increasing susceptibility to the development of infections.
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Affiliation(s)
- Alena Žákovská
- Department of Animal Physiology and Immunology, Research Centre for Toxic Compounds in the Environment, Institute of Experimental Biology, Faculty of Science, Masaryk UniversityBrno, Czechia
| | - Beat Knechtle
- Institute of Primary Care, University of ZurichZurich, Switzerland
| | - Daniela Chlíbková
- Centre of Sports Activities, Brno University of TechnologyBrno, Czechia
| | - Marie Miličková
- Department of Animal Physiology and Immunology, Research Centre for Toxic Compounds in the Environment, Institute of Experimental Biology, Faculty of Science, Masaryk UniversityBrno, Czechia
| | - Thomas Rosemann
- Institute of Primary Care, University of ZurichZurich, Switzerland
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15
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Ishibashi A, Maeda N, Kamei A, Goto K. Iron Supplementation during Three Consecutive Days of Endurance Training Augmented Hepcidin Levels. Nutrients 2017; 9:nu9080820. [PMID: 28758951 PMCID: PMC5579614 DOI: 10.3390/nu9080820] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 07/21/2017] [Accepted: 07/28/2017] [Indexed: 12/21/2022] Open
Abstract
Iron supplementation contributes an effort to improving iron status among athletes, but it does not always prevent iron deficiency. In the present study, we explored the effect of three consecutive days of endurance training (twice daily) on the hepcidin-25 (hepcidin) level. The effect of iron supplementation during this period was also determined. Fourteen male endurance athletes were enrolled and randomly assigned to either an iron-treated condition (Fe condition, n = 7) or a placebo condition (Control condition; CON, n = 7). They engaged in two 75-min sessions of treadmill running at 75% of maximal oxygen uptake on three consecutive days (days 1-3). The Fe condition took 12 mg of iron twice daily (24 mg/day), and the CON condition did not. On day 1, both conditions exhibited significant increases in serum hepcidin and plasma interleukin-6 levels after exercise (p < 0.05). In the CON condition, the hepcidin level did not change significantly throughout the training period. However, in the Fe condition, the serum hepcidin level on day 4 was significantly higher than that of the CON condition (p < 0.05). In conclusion, the hepcidin level was significantly elevated following three consecutive days of endurance training when moderate doses of iron were taken.
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Affiliation(s)
- Aya Ishibashi
- Department of Sports Science, Japan Institute of Sports Science, Nishigaoka, Kitaku, Tokyo 115-0056, Japan.
- Graduate School of Sport and Health Science, Ritsumeikan University, Kusatsu, Shiga 525-8577, Japan.
| | - Naho Maeda
- Graduate School of Sport and Health Science, Ritsumeikan University, Kusatsu, Shiga 525-8577, Japan.
| | - Akiko Kamei
- Department of Sports Science, Japan Institute of Sports Science, Nishigaoka, Kitaku, Tokyo 115-0056, Japan.
| | - Kazushige Goto
- Graduate School of Sport and Health Science, Ritsumeikan University, Kusatsu, Shiga 525-8577, Japan.
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16
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Moran CN, Pitsiladis YP. Tour de France Champions born or made: where do we take the genetics of performance? J Sports Sci 2016; 35:1411-1419. [PMID: 27498724 DOI: 10.1080/02640414.2016.1215494] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Cyclists in the Tour de France are endurance specialists. Twin and family studies have shown that approximately 50% of the variance in a number of performance-related phenotypes (whether measured at baseline, i.e., natural talent, or in response to training) including those important to cycling can be explained by genetic variation. Research into the specific genetic variants that are responsible has identified over 200 genes containing common genetic variants involved in the genetic predisposition to physical performance. However, typically these explain only a small portion of the variance, perhaps 1-2% and collectively they rarely explain anything approaching the 50% of the variance identified in the twin and family studies. Thus, there is a gap in our understanding of the relationship between heritability and performance. This gap may be bridged by investigation of rare variants or epigenetic variation or by altering study designs through increased collaborations to pool existing cohorts together. Initial findings from such efforts show promising results. This mini-review will touch on the genetics and epigenetics of sporting performance, how they relate to cyclists in the Tour de France and where best future efforts may be directed as well as discuss some preliminary research findings.
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Affiliation(s)
- Colin N Moran
- a Physiology, Exercise and Nutrition Research Group , University of Stirling , Stirling , Scotland
| | - Yannis P Pitsiladis
- b FIMS Reference Collaborating Centre of Sports Medicine for Anti-Doping Research , University of Brighton , Eastbourne , England
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17
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Hermine O, Dine G, Genty V, Marquet LA, Fumagalli G, Tafflet M, Guillem F, Van Lierde F, Rousseaux-Blanchi MP, Palierne C, Lapostolle JC, Cervetti JP, Frey A, Jouven X, Noirez P, Toussaint JF. Eighty percent of French sport winners in Olympic, World and Europeans competitions have mutations in the hemochromatosis HFE gene. Biochimie 2015; 119:1-5. [DOI: 10.1016/j.biochi.2015.09.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 09/23/2015] [Indexed: 01/01/2023]
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18
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Abstract
Understanding the genetic architecture of athletic performance is an important step in the development of methods for talent identification in sport. Research concerned with molecular predictors has highlighted a number of potentially important DNA polymorphisms contributing to predisposition to success in certain types of sport. This review summarizes the evidence and mechanistic insights on the associations between DNA polymorphisms and athletic performance. A literature search (period: 1997-2014) revealed that at least 120 genetic markers are linked to elite athlete status (77 endurance-related genetic markers and 43 power/strength-related genetic markers). Notably, 11 (9%) of these genetic markers (endurance markers: ACE I, ACTN3 577X, PPARA rs4253778 G, PPARGC1A Gly482; power/strength markers: ACE D, ACTN3 Arg577, AMPD1 Gln12, HIF1A 582Ser, MTHFR rs1801131 C, NOS3 rs2070744 T, PPARG 12Ala) have shown positive associations with athlete status in three or more studies, and six markers (CREM rs1531550 A, DMD rs939787 T, GALNT13 rs10196189 G, NFIA-AS1 rs1572312 C, RBFOX1 rs7191721 G, TSHR rs7144481 C) were identified after performing genome-wide association studies (GWAS) of African-American, Jamaican, Japanese, and Russian athletes. On the other hand, the significance of 29 (24%) markers was not replicated in at least one study. Future research including multicenter GWAS, whole-genome sequencing, epigenetic, transcriptomic, proteomic, and metabolomic profiling and performing meta-analyses in large cohorts of athletes is needed before these findings can be extended to practice in sport.
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Affiliation(s)
- Ildus I Ahmetov
- Sport Technology Research Center, Volga Region State Academy of Physical Culture, Sport and Tourism, Kazan, Russia; Laboratory of Molecular Genetics, Kazan State Medical University, Kazan, Russia.
| | - Olga N Fedotovskaya
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
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19
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Bardou-Jacquet E, Ben Ali Z, Beaumont-Epinette MP, Loreal O, Jouanolle AM, Brissot P. Non-HFE hemochromatosis: pathophysiological and diagnostic aspects. Clin Res Hepatol Gastroenterol 2014; 38:143-54. [PMID: 24321703 DOI: 10.1016/j.clinre.2013.11.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 11/04/2013] [Accepted: 11/13/2013] [Indexed: 02/04/2023]
Abstract
Rare genetic iron overload diseases are an evolving field due to major advances in genetics and molecular biology. Genetic iron overload has long been confined to the classical type 1 hemochromatosis related to the HFE C282Y mutation. Breakthroughs in the understanding of iron metabolism biology and molecular mechanisms led to the discovery of new genes and subsequently, new types of hemochromatosis. To date, four types of hemochromatosis have been identified: HFE-related or type1 hemochromatosis, the most frequent form in Caucasians, and four rare types, named type 2 (A and B) hemochromatosis (juvenile hemochromatosis due to hemojuvelin and hepcidin mutation), type 3 hemochromatosis (related to transferrin receptor 2 mutation), and type 4 (A and B) hemochromatosis (ferroportin disease). The diagnosis relies on the comprehension of the involved physiological defect that can now be explored by biological and imaging tools, which allow non-invasive assessment of iron metabolism. A multidisciplinary approach is essential to support the physicians in the diagnosis and management of those rare diseases.
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Affiliation(s)
- Edouard Bardou-Jacquet
- University Hospital of Rennes, French reference center for rare iron overload diseases of genetic origin, Rennes, France; University of Rennes1, Inserm UMR 991, 35000 Rennes, France; University Hospital of Rennes, Liver disease department, Rennes, France.
| | - Zeineb Ben Ali
- University Hospital of Rennes, French reference center for rare iron overload diseases of genetic origin, Rennes, France; University Hospital of Rennes, Liver disease department, Rennes, France
| | - Marie-Pascale Beaumont-Epinette
- University Hospital of Rennes, French reference center for rare iron overload diseases of genetic origin, Rennes, France; University Hospital of Rennes, Molecular Genetics Department, Rennes, France
| | - Olivier Loreal
- University Hospital of Rennes, French reference center for rare iron overload diseases of genetic origin, Rennes, France; University of Rennes1, Inserm UMR 991, 35000 Rennes, France
| | - Anne-Marie Jouanolle
- University Hospital of Rennes, French reference center for rare iron overload diseases of genetic origin, Rennes, France; University Hospital of Rennes, Molecular Genetics Department, Rennes, France
| | - Pierre Brissot
- University Hospital of Rennes, French reference center for rare iron overload diseases of genetic origin, Rennes, France; University of Rennes1, Inserm UMR 991, 35000 Rennes, France; University Hospital of Rennes, Liver disease department, Rennes, France
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20
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Latunde-Dada GO. Iron metabolism in athletes - achieving a gold standard. Eur J Haematol 2012; 90:10-5. [DOI: 10.1111/ejh.12026] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2012] [Indexed: 01/01/2023]
Affiliation(s)
- Gladys O. Latunde-Dada
- Diabetes and Nutritional Sciences Division; School of Medicine; King's College London; London; UK
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21
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Abstract
Physical exercise induces adaptations in metabolism considered beneficial for health. Athletic performance is linked to adaptations, training, and correct nutrition in individuals with genetic traits that can facilitate such adaptations. Intense and continuous exercise, training, and competitions, however, can induce changes in the serum concentrations of numerous laboratory parameters. When these modifications, especially elevated laboratory levels, result outside the reference range, further examinations are ordered or participation in training and competition is discontinued or sports practice loses its appeal. In order to correctly interpret commonly used laboratory data, laboratory professionals and sport physicians need to know the behavior of laboratory parameters during and after practice and competition. We reviewed the literature on liver, kidney, muscle, heart, energy, and bone parameters in athletes with a view to increase the knowledge about clinical chemistry applied to sport and to stimulate studies in this field. In liver metabolism, the interpretation of serum aminotransferases concentration in athletes should consider the release of aspartate aminotransferase (AST) from muscle and of alanine aminotransferase (ALT) mainly from the liver, when bilirubin can be elevated because of continuous hemolysis, which is typical of exercise. Muscle metabolism parameters such as creatine kinase (CK) are typically increased after exercise. This parameter can be used to interpret the physiological release of CK from muscle, its altered release due to rhabdomyolysis, or incomplete recovery due to overreaching or trauma. Cardiac markers are released during exercise, and especially endurance training. Increases in these markers should not simply be interpreted as a signal of cardiac damage or wall stress but rather as a sign of regulation of myocardial adaptation. Renal function can be followed in athletes by measuring serum creatinine concentration, but it should be interpreted considering the athlete's body-mass index (BMI) and phase of the competitive season; use of cystatin C could be a reliable alternative to creatinine. Exercise and training induce adaptations in glucose metabolism which improve glucose utilization in athletes and are beneficial for reducing insulin insensitivity in nonathletes. Glucose metabolism differs slightly for different sports disciplines, as revealed in laboratory levels. Sport activities induce a blood lipid profile superior to that of sedentary subjects. There are few reports for a definitive conclusion, however. The differences between athletes and sedentary subjects are mainly due to high-density lipoprotein cholesterol (HDLC) concentrations in physically active individuals, although some differences among sport disciplines exist. The effect of sports on serum and urinary markers for bone metabolism is not univocal; further studies are needed to establish the real and effective influence of sport on bone turnover and especially to establish its beneficial effect.
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22
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Morcet J, Perrin M, Trégaro M, Carré F, Deugnier Y. Mortalité d’une cohorte de 514 cyclistes de haut niveau. Sci Sports 2012. [DOI: 10.1016/j.scispo.2011.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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23
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Iron status in elite young athletes: gender-dependent influences of diet and exercise. Eur J Appl Physiol 2011; 112:513-23. [PMID: 21594695 DOI: 10.1007/s00421-011-2002-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Accepted: 05/09/2011] [Indexed: 01/01/2023]
Abstract
Iron depletion seems to occur more frequently among athletes than in the general population and may affect performance capacity. Only little information is available about the prevalence of iron status abnormalities in young elite athletes and whether iron depletion is associated with gender, sport, age or nutrition- and exercise-related factors in this group. Hence, diet, exercise and haematological data from 193 elite athletes (96 males, 97 females; 16.2 ± 2.7 years) from 24 different sports were analyzed retrospectively. Most female athletes failed to meet the recommended daily allowance for iron, even though dietary iron density was higher than in males (5.75 ± 0.78 vs. 6.17 ± 0.98 mg/1,000 kcal; P = 0.001). Iron depletion (serum ferritin < 35 μg/L) occurred in 31% of male and 57% of female athletes (P < 0.001). Low haemoglobin (males: <13 g/dL; females: <12 g/dL) and haematocrit (males: <40%; females: <36%) values were equally prevalent in both genders [haemoglobin: 7.3% (males), 6.2% (females); haematocrit: 13.5% (males); 15.5% (females)]. In females, reduced ferritin levels were associated with a lower dietary iron density (5.9 ± 0.8 vs. 6.6 ± 1.1 mg/1,000 kcal; P = 0.002). Males with iron depletion had a significantly higher estimated energy expenditure (48.7 ± 7.0 vs. 44.4 ± 7.6 kcal/kg/day; P = 0.009).
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25
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Deugnier Y, Lainé F, Le Lan C, Bardou-Jacquet E, Jouanolle AM, Brissot P. Hémochromatoses et autres surcharges hépatiques en fer. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/s1155-1976(11)40364-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Abstract
BACKGROUND/OBJECTIVES Iron deficiency and anemia may impair athletic performance, and iron supplements are commonly consumed by athletes. However, iron overload should be avoided because of the possible long-term adverse health effects. METHODS We investigated the iron status of 170 male and female recreational runners participating in the Zürich marathon. Iron deficiency was defined either as a plasma ferritin (PF) concentration <15 microg/l (iron depletion) or as the ratio of the concentrations of transferrin receptor (sTfR) to PF (sTfR:log(PF) index) of > or =4.5 (functional iron deficiency). RESULTS After excluding subjects with elevated C-reactive protein concentrations, iron overload was defined as PF >200 microg/l. Iron depletion was found in only 2 out of 127 men (1.6% of the male study population) and in 12 out of 43 (28.0%) women. Functional iron deficiency was found in 5 (3.9%) and 11 (25.5%) male and female athletes, respectively. Body iron stores, calculated from the sTfR/PF ratio, were significantly higher (P<0.001) among male compared with female marathon runners. Median PF among males was 104 microg/l, and the upper limit of the PF distribution in males was 628 microg/l. Iron overload was found in 19 out of 127 (15.0%) men but only 2 out of 43 in women (4.7%). Gender (male sex), but not age, was a predictor of higher PF (P<0.001). CONCLUSIONS Iron depletion was present in 28% of female runners but in <2% of males, whereas one in six male runners had signs of iron overload. Although iron supplements are widely used by athletes in an effort to increase performance, our findings indicate excess body iron may be common in male recreational runners and suggest supplements should only be used if tests of iron status indicate deficiency.
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27
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Eichner ER. Iron and irony. Curr Sports Med Rep 2009; 8:216-7. [PMID: 19741345 DOI: 10.1249/jsr.0b013e3181b7d2f1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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28
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Zunquin G, Rouleau V, Bouhallab S, Bureau F, Theunynck D, Rousselot P, Arhan P, Bougle D. Iron and exercise induced alterations in antioxidant status. Protection by dietary milk proteins. Free Radic Res 2009; 40:535-42. [PMID: 17390518 DOI: 10.1080/10715760500451202] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Lipid peroxidation stress induced by iron supplementation can contribute to the induction of gut lesions. Intensive sports lead to ischemia reperfusion, which increases free radical production. Athletes frequently use heavy iron supplementation, whose effects are unknown. On the other hand, milk proteins have in vitro antioxidant properties, which could counteract these potential side effects. The main aims of the study were: (1) to demonstrate the effects of combined exercise training (ET) and iron overload on antioxidant status; (2) to assess the protective properties of casein in vivo; (3) to study the mechanisms involved in an in vitro model. Antioxidant status was assessed by measuring the activity of antioxidant enzymes (superoxide dismutase (SOD); glutathione peroxidase (GSH-Px)), and on the onset of aberrant crypts (AC) in colon, which can be induced by lipid peroxidation. At day 30, all ET animals showed an increase in the activity of antioxidant enzymes, in iron concentration in colon mucosa and liver and in the number of AC compared to untrained rats. It was found that Casein's milk protein supplementation significantly reduced these parameters. Additional information on protective effect of casein was provided by measuring the extent of TBARS formation during iron/ascorbate-induced oxidation of liposomes. Free casein and casein bound to iron were found to significantly reduce iron-induced lipid peroxidation. The results of the overall study suggest that Iron supplementation during intensive sport training would decrease anti-oxidant status. Dietary milk protein supplementation could at least partly prevent occurrence of deleterious effects to tissue induced by iron overload.
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Affiliation(s)
- Gautier Zunquin
- Laboratoire de Physiologie digestive et nutritionnelle, CHU Caen, Caen, France
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29
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Watelet J. [Liver and sport]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2008; 32:960-972. [PMID: 18954954 DOI: 10.1016/j.gcb.2008.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2007] [Revised: 06/29/2008] [Accepted: 08/06/2008] [Indexed: 05/27/2023]
Abstract
The liver is a vital organ and plays a central role in energy exchange, protein synthesis as well as the elimination of waste products from the body. Acute and chronic injury may disturb a variety of liver functions to different degrees. Over the last three decades, the effects of physical activity and competitive sport on the liver have been described by various investigators. These include viral hepatitis and drug-induced liver disorders. Herein, we review acute and chronic liver diseases potentially caused by sport. Team physicians, trainers and others, responsible for the health of athletes, should be familiar with the risk factors, clinical features, and consequences of liver diseases that occur in sports.
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Affiliation(s)
- J Watelet
- Service d'hépato-gastroentérologie, hôpital de Brabois, CHU de Nancy, Vandoeuvre cedex, France.
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30
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Abstract
The cross-talk which has taken place in recent years between clinicians and scientists has resulted in a greater understanding of iron metabolism with the discovery of new iron-related genes including the hepcidin gene which plays a critical role in regulating systemic iron homeostasis. Consequently, the distinction between (a) genetic iron-overload disorders including haemochromatosis related to mutations in the HFE, hemojuvelin, transferrin receptor 2 and hepcidin genes and (b) non-haemochromatotic conditions related to mutations in the ferroportin, ceruloplasmin, transferrin and di-metal transporter 1 genes, and (c) acquired iron-overload syndromes has become easier. However, major challenges still remain which include our understanding of the regulation of hepcidin production, the identification of environmental and genetic modifiers of iron burden and organ damage in iron-overload syndromes, especially HFE haemochromatosis, indications regarding the new oral chelator, deferasirox, and the development of new therapeutic tools interacting with the regulation of iron metabolism.
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Affiliation(s)
- Yves Deugnier
- Service des maladies du Foie, INSERM CIC 0203, Université de Rennes 1 and IFR 140, CHU Pontchaillou, 35033 Rennes, France.
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31
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Brissot P, Troadec MB, Bardou-Jacquet E, Le Lan C, Jouanolle AM, Deugnier Y, Loréal O. Current approach to hemochromatosis. Blood Rev 2008; 22:195-210. [PMID: 18430498 DOI: 10.1016/j.blre.2008.03.001] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Iron overload diseases of genetic origin are an ever changing world, due to major advances in genetics and molecular biology. Five major categories are now established: HFE-related or type1 hemochromatosis, frequently found in Caucasians, and four rarer diseases which are type 2 (A and B) hemochromatosis (juvenile hemochromatosis), type 3 hemochromatosis (transferrin receptor 2 hemochromatosis), type 4 (A and B) hemochromatosis (ferroportin disease), and a(hypo)ceruloplasminemia. Increased duodenal iron absorption and enhanced macrophagic iron recycling, both due to an impairment of hepcidin synthesis, account for the development of cellular excess in types 1, 2, 3, and 4B hemochromatosis whereas decreased cellular iron egress is involved in the main form of type 4A) hemochromatosis and in aceruloplasminemia. Non-transferrin bound iron plays an important role in cellular iron excess and damage. The combination of magnetic resonance imaging (for diagnosing visceral iron overload) and of genetic testing has drastically reduced the need for liver biopsy. Phlebotomies remain an essential therapeutic tool but the improved understanding of the intimate mechanisms underlying these diseases paves the road for innovative therapeutic approaches.
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Affiliation(s)
- Pierre Brissot
- Liver Disease Unit, Liver Research Unit Inserm U-522, IFR 140, University of Rennes1, Hemochromatosis Reference Center, Laboratory of Molecular Genetics, University Hospital Pontchaillou, Rennes, France.
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Abstract
Although progress in imaging and genetics allow for a noninvasive diagnosis of most cases of genetic iron overload, liver pathology remains often useful (1) to assess prognosis by grading fibrosis and seeking for associated lesions and (2) to guide the etiological diagnosis, especially when no molecular marker is available. Then, the type of liver siderosis (parenchymal, mesenchymal or mixed) and its distribution throughout the lobule and the liver are useful means for suggesting its etiology: HLA-linked hemochromatosis gene (HFE) hemochromatosis or other rare genetic hemochromatosis, nonhemochromatotic genetic iron overload (ferroportin disease, aceruloplasminemia), or iron overload secondary to excessive iron supply, inflammatory syndrome, noncirrhotic chronic liver diseases including dysmetabolic iron overload syndrome, cirrhosis, and blood disorders.
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Affiliation(s)
- Yves Deugnier
- Liver Unit and CIC INSERM 0203, Pontchaillou University Hospital, Rennes 35033, France.
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Guinot M, Duclos M, Idres N, Souberbielle JC, Megret A, Le Bouc Y. Value of basal serum cortisol to detect corticosteroid-induced adrenal insufficiency in elite cyclists. Eur J Appl Physiol 2006; 99:205-16. [PMID: 17089154 DOI: 10.1007/s00421-006-0332-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2006] [Indexed: 10/24/2022]
Abstract
The frequent use of glucocorticoids by athletes necessitates testing for adrenal insufficiency because of the risk of death in cases of associated severe stress (trauma, infection). During the 2001 and 2002 sporting seasons, we assessed the value of measuring baseline serum cortisol concentrations and the frequency of corticosteroid use during compulsory medical tests carried out by the French Cycling Federation on 659 elite cyclists (585 men and 74 women); the risk of adrenal insufficiency is negatively correlated with the basal serum cortisol level. Adrenal insufficiency was suspected in 34 cyclists (5.2%; 22 in 2001 and 12 in 2002) on the basis of below normal cortisol concentrations and in three cyclists (in 2001) because they had received corticosteroid treatment. In 2001, 10 of the 25 cyclists convoked underwent baseline follow-up serum cortisol determinations and 15 underwent dynamic exploration of adrenal function with the short ACTH test. Adrenal function was found to be deficient in four of these cyclists, at the limits of the normal range in four and normal in seven. Based on these results, the FFC sent a questionnaire in 2002 to all the cyclists to assess the use of corticosteroid in this population. This survey revealed that 85 of 538 cyclists (15.8%) had received corticosteroid treatment in the previous 3 months. Moreover, 11 of the 12 cyclists (92%) with low basal serum cortisol concentrations had received corticosteroid therapy. These results show that basal serum cortisol is relevant to detect adrenal insufficiency in sportsmen, in particular in cases of values below the normal range. The high frequency of corticosteroid use among elite cyclists, and in particular road cyclists who are at risk of trauma and infection, justifies screening tests to detect adrenal insufficiency.
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Affiliation(s)
- M Guinot
- Explorations Fonctionnelles Endocriniennes, Assistance Publique Hôpitaux de Paris, Hôp. Trousseau, Paris, France.
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Lippi G, Franchini M, Salvagno GL, Guidi GC. Biochemistry, physiology, and complications of blood doping: facts and speculation. Crit Rev Clin Lab Sci 2006; 43:349-91. [PMID: 16769597 DOI: 10.1080/10408360600755313] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Competition is a natural part of human nature. Techniques and substances employed to enhance athletic performance and to achieve unfair success in sport have a long history, and there has been little knowledge or acceptance of potential harmful effects. Among doping practices, blood doping has become an integral part of endurance sport disciplines over the past decade. The definition of blood doping includes methods or substances administered for non-medical reasons to healthy athletes for improving aerobic performance. It includes all means aimed at producing an increased or more efficient mechanism of oxygen transport and delivery to peripheral tissues and muscles. The aim of this review is to discuss the biochemistry, physiology, and complications of blood doping and to provide an update on current antidoping policies.
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Affiliation(s)
- Giuseppe Lippi
- Dipartimento di Scienze Morfologico-Biomediche, Istituto di Chimica e Microscopia Clinica, Università Degli Studi di Verona, Verona, Italy
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Deugnier Y, Perrin M, Lainé F, Trégaro M, Carré F, Le Guellec M, Morcet J, Chaperon J. Mortalité et stock en fer chez 514 anciens coureurs cyclistes de haut niveau. Sci Sports 2005. [DOI: 10.1016/j.scispo.2005.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Akabas SR, Dolins KR. Micronutrient requirements of physically active women: what can we learn from iron? Am J Clin Nutr 2005; 81:1246S-1251S. [PMID: 15883459 DOI: 10.1093/ajcn/81.5.1246] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
The health benefits of physical activity are well established and there is increasing recognition of the importance of fitness as a key modulator of chronic disease. The impact of physical activity on micronutrient requirements is a topic of tremendous interest to the lay public, but the interest is in sharp contrast to data from well-designed studies. Research in this area is poorly controlled for nutritional status of the participants, standardized exercise protocols, markers and cutoff points for measurement of micronutrient status, and variability in subject characteristics. The micronutrient status of women in the general population is of concern, but it is not clear that physical activity increases the requirement of most micronutrients. When dietary intake is adequate, the results of most studies are either equivocal or show no benefit to performance of supplementation. In the few instances where exercise does appear to increase an individual's requirement, the increase can be obtained within the additional calories required for energy balance. In the absence of consistent data, micronutrient supplementation is often indiscriminate without regard to nutrient status. Because iron is such a key nutrient for physical activity, and the status in women is often compromised, it serves as a useful example of how current research limits the ability to make recommendations regarding the impact of exercise on micronutrients requirements in women. With the recent recognition of the importance of physical activity to the prevention and treatment of chronic diseases through the life span, more attention should be focused on the impact of exercise on micronutrient requirements, especially in the context of weight loss regimens.
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Affiliation(s)
- Sharon R Akabas
- Institute of Human Nutrition, Teacher's College, Columbia University, New York 10032, USA.
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Abstract
Although it generally does not improve performance, iron is often used by elite athletes. The physiologic changes induced by exercise can mimic iron deficiency and decrease hemoglobin and ferritin concentrations. Determination of serum transferrin receptor concentrations may identify true iron deficiency, which occurs particularly in young athletes. In contrast, increased iron stores in the body are a frequent finding in elite athletes who have used long-term iron supplementation. Elite runners have increased intestinal blood loss, but this usually can be compensated by enhanced absorption of dietary iron. The combination of exercise-induced hemolysis with enhanced intestinal blood loss in various endurance sports leads to severe abnormalities of routine tests, and extreme physical activity may be responsible for positive fecal occult blood determinations. Indiscriminate iron supplementation carries the risk of inducing hemochromatosis in individuals homozygous for the widespread C282Y allele of the HFE gene. This polymorphism is common and can be found in about 1% of individuals of Northern European descent; moreover, iron supplementation can modify the presentation of important underlying diseases such as celiac disease or colon carcinoma. In conclusion, iron supplements should be prescribed for athletes with iron-deficiency anemia and carefully monitored if given for prophylaxis; unless a therapeutic response occurs, investigations to establish the cause of iron deficiency should be initiated.
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Affiliation(s)
- Heinz Zoller
- Department of Medicine, University of Cambridge, Cambridge, UK.
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Chicharro JL, Hoyos J, Gómez-Gallego F, Villa JG, Bandrés F, Celaya P, Jiménez F, Alonso JM, Córdova A, Lucia A. Mutations in the hereditary haemochromatosis gene HFE in professional endurance athletes. Br J Sports Med 2005; 38:418-21. [PMID: 15273174 PMCID: PMC1724889 DOI: 10.1136/bjsm.2002.003921] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Hereditary haemochromatosis, a disease that affects iron metabolism, progresses with a greater or lesser tendency to induce iron overload, possibly leading to severe organ dysfunction. Most elite endurance athletes take iron supplements during their active sporting life, which could aggravate this condition. OBJECTIVE To determine the prevalence and discuss potential clinical implications of mutations of HFE (the gene responsible for hereditary haemochromatosis) in endurance athletes. METHODS Basal concentrations of iron, ferritin, and transferrin and transferrin saturation were determined in the period before competition in 65 highly trained athletes. Possible mutations in the HFE gene were evaluated in each subject by extracting genomic DNA from peripheral blood. The restriction enzymes SnaBI and BclI were used to detect the mutations 845G-->A (C282Y) and 187C-->G (H63D). RESULTS Our findings indicate a high prevalence of HFE gene mutations in this population (49.2%) compared with sedentary controls (33.5%). No association was detected in the athletes between mutations and blood iron markers. CONCLUSIONS The findings support the need to assess regularly iron stores in elite endurance athletes.
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Affiliation(s)
- J L Chicharro
- Departamento de Enfermería, Universidad Complutense, Madrid, Spain
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Abstract
BACKGROUND An international, longitudinal medical follow up examination of male professional road cyclists revealed excessively elevated serum ferritin levels. OBJECTIVE To evaluate the importance of elevated ferritin values among professional cyclists, their relationship with age and nationality, and their evolution over 3 years. METHODS Over 1000 serum ferritin values were collected. Other parameters were included in order to exclude conditions which might have increased ferritin levels without changing body iron stores. RESULTS In 1999, over 45% of riders displayed ferritin values above 300 ng/ml and one fourth levels over 500 ng/ml. These percentages had decreased to 27% and 9%, respectively, 3 years later, while the overall average, which was above the normal limits in 1999, had decreased by 33% in 3 years. Older cyclists had higher ferritin values than younger cyclists. There was also a relationship between ferritin levels and the nationality of the cyclists. Analysis of 714 riders in 2000 and 2002 showed only a slight and insignificant decrease in the mean ferritin value although those with initially elevated iron stores had a much greater decrease. CONCLUSION Professional road cyclists used excessive iron supplementation leading to high serum ferritin levels correlating with increased body iron stores. Although the situation progressively improved over 3 years, it remains worrying as increased body iron stores are related to health complications. Therefore, prevention in addition to the fight against doping should be a main goal of the UCI. Aggressive therapy for athletes with excessive ferritin values should be carried out at or before the end of their careers.
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Robinson N, Mangin P, Schattenberg L, Saugy M. Origine du suivi hématologique: Les contrôles hématocrites dans le cyclisme. ACTA ACUST UNITED AC 2003. [DOI: 10.1016/s0338-9898(03)80390-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Because hepatic siderosis is a frequent finding, there is a risk of making it trite when elaborating the pathology report. Iron is increasingly considered an important cofactor of morbidity. Its finding in hepatic cells must be recognized, indicated, qualified, quantified, and interpreted. A systematic reasoning based on a strict semiological approach allows for guiding the clinician. Iron overload syndromes do not amount to genetic hemochromatosis only.
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Affiliation(s)
- Bruno Turlin
- Department of Pathology and INSERM U 522, Pontchaillou University Hospital, 35033 Rennes, France.
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