New metric of hypoxic dose predicts altitude acclimatization status following various ascent profiles

Risk factors associated with high altitude sickness among travelers: A case control study in Himalaya district of Nepal

High elevation adventures are popular among travelers; however, they carry significant health risks, such as altitude sickness. This study aims to identify risk factors associated with high altitude sickness among travelers to Mustang district. A health-facility-based, age-sex matched 1:1 case-control study was conducted in Mustang district hospital, Nepal. Measurements included Acute Mountain Sickness/High Altitude Cerebral Edema/High Altitude Pulmonary Edema assessment via LLS questionnaire, demographics, medical history, ascent rate, and prophylactic medicine intake. Data were collected between September and November, 2023 via predesigned structured questionnaire by trained medical officers in, and analyzed using SPSS version 25. Using binary logistic regression, the study tested potential risk factors associated with altitude sickness. Ethical approval was obtained from the NHRC, and written informed consent was obtained from all participants. A total of 63 cases (individuals with altitude sickness) and 63 controls (without) were interviewed. The mean age of cases and controls was 48.5 years (SD = 16.5) and 48 years (SD = 16.9) respectively. 38 were rapid ascenders, and 88 were slow ascenders. Awareness of altitude sickness was reported by 65 individuals, with 36 taking prophylactic medication (Acetazolamide 125/250mg). Among cases, 8 experienced HACE, 42 had AMS, and 13 had HAPE. Rapid ascent (Adjusted Odds Ratio [AOR]: 6.41, 95% Confidence Interval [CI]: 2.36-17.54), individuals with a previous history of illness (AOR: 10.20, 95% CI: 2.70-38.46), and failing to take prophylactic medication (AOR: 10.01, 95% CI: 1.896-10.680) were linked to an increased risk of altitude sickness. Our study highlights the critical role of ascent speed, previous history of illness, and use of prophylactic measures in development of altitude sickness.

Taste and Appetite at Altitude: A Comprehensive Review of Sensory and Hunger Modulation in High-Altitude Environments

Introduction: Individuals living or working at high altitudes typically experience altered taste perceptions and reduced appetite. These changes can lead to nutritional deficiencies, affecting the energy balance and body composition. Methods: We conducted a nonsystematic review of PubMed to explore these phenomena and expound on their findings to offer additional insights. Results: Changes in taste and perception are common and typically lead to loss of mass. There are limited practical solutions to mitigate these challenges. Discussion: Gradual acclimatization and tailored nutritional strategies are required to enhance health and performance in high-altitude environments. This review provides critical insights into the intersection of altitude, nutrition, and health.

Effects of various living-low and training-high modes with distinct training prescriptions on sea-level performance: A network meta-analysis

This study aimed to separately compare and rank the effect of various living-low and training-high (LLTH) modes on aerobic and anaerobic performances in athletes, focusing on training intensity, modality, and volume, through network meta-analysis. We systematically searched PubMed, Web of Science, Embase, EBSCO, and Cochrane from their inception date to June 30, 2023. Based on the hypoxic training modality and the intensity and duration of work intervals, LLTH was divided into intermittent hypoxic exposure, continuous hypoxic training, repeated sprint training in hypoxia (RSH; work interval: 5-10 s and rest interval: approximately 30 s), interval sprint training in hypoxia (ISH; work interval: 15-30 s), short-duration high-intensity interval training (s-IHT; short work interval: 1-2 min), long-duration high-intensity interval training (l-IHT; long work interval: > 5 min), and continuous and interval training under hypoxia. A meta-analysis was conducted to determine the standardized mean differences (SMDs) among the effects of various hypoxic interventions on aerobic and anaerobic performances. From 2,072 originally identified titles, 56 studies were included in the analysis. The pooled data from 53 studies showed that only l-IHT (SMDs: 0.78 [95% credible interval; CrI, 0.52-1.05]) and RSH (SMDs: 0.30 [95% CrI, 0.10-0.50]) compared with normoxic training effectively improved athletes' aerobic performance. Furthermore, the pooled data from 29 studies revealed that active intermittent hypoxic training compared with normoxic training can effectively improve anaerobic performance, with SMDs ranging from 0.97 (95% CrI, 0.12-1.81) for l-IHT to 0.32 (95% CrI, 0.05-0.59) for RSH. When adopting a program for LLTH, sufficient duration and work intensity intervals are key to achieving optimal improvements in athletes' overall performance, regardless of the potential improvement in aerobic or anaerobic performance. Nevertheless, it is essential to acknowledge that this study incorporated merely one study on the improvement of anaerobic performance by l-IHT, undermining the credibility of the results. Accordingly, more related studies are needed in the future to provide evidence-based support. It seems difficult to achieve beneficial adaptive changes in performance with intermittent passive hypoxic exposure and continuous low-intensity hypoxic training.

Can acute high-altitude sickness be predicted in advance?

In high-altitude environments, the oxygen and air density are decreased, and the temperature and humidity are low. When individuals enter high-altitude areas, they are prone to suffering from acute mountain sickness (AMS) because they cannot tolerate hypoxia. Headache, fatigue, dizziness, and gastrointestinal reactions are the main symptoms of AMS. When these symptoms cannot be effectively alleviated, they can progress to life-threatening high-altitude pulmonary edema or high-altitude cerebral edema. If the risk of AMS can be effectively assessed before people enter high-altitude areas, then the high-risk population can be promptly discouraged from entering the area, or drug intervention can be established in advance to prevent AMS occurrence and avoid serious outcomes. This article reviews recent studies related to the early-warning biological indicators of AMS to provide a new perspective on the prevention of AMS.

Wilderness Medical Society Clinical Practice Guidelines for the Prevention, Diagnosis, and Treatment of Acute Altitude Illness: 2024 Update

To provide guidance to clinicians about best practices, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for prevention, diagnosis, and treatment of acute mountain sickness, high altitude cerebral edema, and high altitude pulmonary edema. Recommendations are graded based on the quality of supporting evidence and the balance between the benefits and risks/burdens according to criteria put forth by the American College of Chest Physicians. The guidelines also provide suggested approaches for managing each form of acute altitude illness that incorporate these recommendations as well as recommendations on how to approach high altitude travel following COVID-19 infection. This is an updated version of the original WMS Consensus Guidelines for the Prevention and Treatment of Acute Altitude Illness published in Wilderness & Environmental Medicine in 2010 and the subsequently updated WMS Practice Guidelines for the Prevention and Treatment of Acute Altitude Illness published in 2014 and 2019.