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Webb KL, Gorman EK, Morkeberg OH, Klassen SA, Regimbal RJ, Wiggins CC, Joyner MJ, Hammer SM, Senefeld JW. The relationship between hemoglobin and [Formula: see text]: A systematic review and meta-analysis. PLoS One 2023; 18:e0292835. [PMID: 37824583 PMCID: PMC10569622 DOI: 10.1371/journal.pone.0292835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 09/29/2023] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVE There is widespread agreement about the key role of hemoglobin for oxygen transport. Both observational and interventional studies have examined the relationship between hemoglobin levels and maximal oxygen uptake ([Formula: see text]) in humans. However, there exists considerable variability in the scientific literature regarding the potential relationship between hemoglobin and [Formula: see text]. Thus, we aimed to provide a comprehensive analysis of the diverse literature and examine the relationship between hemoglobin levels (hemoglobin concentration and mass) and [Formula: see text] (absolute and relative [Formula: see text]) among both observational and interventional studies. METHODS A systematic search was performed on December 6th, 2021. The study procedures and reporting of findings followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Article selection and data abstraction were performed in duplicate by two independent reviewers. Primary outcomes were hemoglobin levels and [Formula: see text] values (absolute and relative). For observational studies, meta-regression models were performed to examine the relationship between hemoglobin levels and [Formula: see text] values. For interventional studies, meta-analysis models were performed to determine the change in [Formula: see text] values (standard paired difference) associated with interventions designed to modify hemoglobin levels or [Formula: see text]. Meta-regression models were then performed to determine the relationship between a change in hemoglobin levels and the change in [Formula: see text] values. RESULTS Data from 384 studies (226 observational studies and 158 interventional studies) were examined. For observational data, there was a positive association between absolute [Formula: see text] and hemoglobin levels (hemoglobin concentration, hemoglobin mass, and hematocrit (P<0.001 for all)). Prespecified subgroup analyses demonstrated no apparent sex-related differences among these relationships. For interventional data, there was a positive association between the change of absolute [Formula: see text] (standard paired difference) and the change in hemoglobin levels (hemoglobin concentration (P<0.0001) and hemoglobin mass (P = 0.006)). CONCLUSION These findings suggest that [Formula: see text] values are closely associated with hemoglobin levels among both observational and interventional studies. Although our findings suggest a lack of sex differences in these relationships, there were limited studies incorporating females or stratifying results by biological sex.
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Affiliation(s)
- Kevin L. Webb
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Ellen K. Gorman
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Olaf H. Morkeberg
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Stephen A. Klassen
- Department of Kinesiology, Brock University, St. Catharines, Ontario, Canada
| | - Riley J. Regimbal
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Chad C. Wiggins
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Michael J. Joyner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Shane M. Hammer
- Department of Kinesiology, Applied Health, and Recreation, Oklahoma State University, Stillwater, Oklahoma, United States of America
| | - Jonathon W. Senefeld
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, United States of America
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois
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Trudel G, Melkus G, Sheikh A, Ramsay T, Laneuville O. Marrow adipose tissue gradient is preserved through high protein diet and bed rest. A randomized crossover study. Bone Rep 2019; 11:100229. [PMID: 31799339 PMCID: PMC6883331 DOI: 10.1016/j.bonr.2019.100229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 10/21/2019] [Indexed: 12/17/2022] Open
Abstract
CONTEXT Marrow adipose tissue (MAT) has a peripheral to central distribution in adults, higher in peripheral bones. Similarly, the spine has a caudal to cephalad MAT distribution, higher in lumbar vertebras. Diet and the level of physical activities are known modulators of MAT with significant impact on bone; however, whether these can modulate the MAT gradient is unknown. OBJECTIVE To measure the effect of high protein diet and bed rest interventions on the lumbar MAT gradient. DESIGN PARTICIPANTS INTERVENTION In a prospective randomized crossover trial, 10 healthy men participated in 2 consecutive campaigns of 21days head-down-tilt-bed-rest (HDTBR). They received either whey protein and potassium bicarbonate-supplemented or control diet separated by a 4-month washout period. MAIN OUTCOME MEASURES Ten serial MRI measures of lumbar vertebral fat fraction (VFF) were performed at baseline, 10days and 20days of HDTBR and 3 and 28days after HDTBR of each bed rest campaign. RESULTS The mean L5-L1 VFF difference of 4.2 ± 1.2 percentage point higher at L5 (p = 0.008) constituted a caudal to cephalad lumbar MAT gradient. High protein diet did not alter the lumbar VFF differences during both HDTBR campaigns (all time points p > 0.05). Similarly, 2 campaigns of 21days of HDTBR did not change the lumbar VFF differences (all time points p > 0.05). CONCLUSIONS This pilot study established that the lumbar vertebral MAT gradient was not altered by a high protein nor by 2 × 21days bed rest interventions. These findings demonstrated that this lack of mechanical stimulus was not an important modulator of the lumbar MAT gradient. The highly preserved MAT gradient needs to be measured in more situations of health and disease and may potentially serve to detect pathological situations.
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Key Words
- BDC, baseline data collection
- Bed rest study
- DLR, German Aerospace Center
- FOV, field of view
- HDT, head-down tilt
- HDTBR, head-down-tilt-bed-rest
- IOP, in-phase and out-phase imaging
- Lumbar vertebral fat fraction
- MAT, marrow adipose tissue
- MEP, whey protein study
- MR, magnetic resonance
- Magnetic resonance imaging
- Marrow adipose tissue
- PDFF, proton-density fat fraction
- R, recovery
- ROI, region of interest
- TR, repetition time
- VFF, vertebral fat fraction
- Whey protein
- in-phase, echo time 1 (TE1)
- out-phase, echo time 2 (TE2)
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Affiliation(s)
- Guy Trudel
- Bone and Joint Research Laboratory, Department of Physical Medicine and Rehabilitation, Department of Medicine, Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ontario, Canada
| | - Gerd Melkus
- The Ottawa Hospital Research Institute, Ontario, Canada
- Department of Radiology, University of Ottawa, Ontario, Canada
| | - Adnan Sheikh
- The Ottawa Hospital Research Institute, Ontario, Canada
- Department of Radiology, University of Ottawa, Ontario, Canada
| | - Tim Ramsay
- The Ottawa Hospital Research Institute, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada
| | - Odette Laneuville
- Bone and Joint Research Laboratory, Department of Physical Medicine and Rehabilitation, Department of Medicine, Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ontario, Canada
- Department of Biology, Faculty of Science, University of Ottawa, Ontario, Canada
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Montero D, Lundby C. Regulation of Red Blood Cell Volume with Exercise Training. Compr Physiol 2018; 9:149-164. [DOI: 10.1002/cphy.c180004] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Montero D, Breenfeldt-Andersen A, Oberholzer L, Haider T, Goetze JP, Meinild-Lundby AK, Lundby C. Erythropoiesis with endurance training: dynamics and mechanisms. Am J Physiol Regul Integr Comp Physiol 2017; 312:R894-R902. [DOI: 10.1152/ajpregu.00012.2017] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 03/06/2017] [Accepted: 03/31/2017] [Indexed: 11/22/2022]
Abstract
The purpose of the present study was to characterize the progression of red blood cell volume (RBCV) expansion and potential volumetric and endocrine regulators of erythropoiesis during endurance training (ET). Nine healthy, untrained volunteers (age = 27 ± 4 yr) underwent supervised ET consisting of 3–4 × 60 min cycle ergometry sessions per week for 8 wk. Plasma volume (PV), RBCV, and overnight fasting hematological markers were determined before and at weeks 2, 4, and 8 of ET. In addition, plasma erythropoietin (EPO), cortisol, copeptin, and proatrial natriuretic peptide concentrations were measured during a 3-h morning period at baseline and postexercise at weeks 1 and 8. PV increased from baseline (2,405 ± 335 ml) at weeks 2, 4, and 8 (+374 ± 194, +505 ± 156, and +341 ± 160 ml, respectively, P < 0.001). Increases in RBCV from baseline (1,737 ± 442 ml) were manifested at week 4 (+109 ± 114 ml, P = 0.030) and week 8 (+205 ± 109 ml, P = 0.001). Overnight fasting plasma EPO concentration increased from baseline (11.3 ± 4.8 mIU/ml) at week 2 (+2.5 ± 2.8 mIU·ml−1, P = 0.027) and returned to baseline concentration at weeks 4 and 8. Higher 3-h-postexercise EPO concentration was observed at week 1 (11.6 mIU/ml) compared with week 8 (8.4 ± 3.9 mIU/ml, P = 0.009) and baseline (9.0 ± 4.2 mIU/ml, P = 0.019). Linear relationships between EPO concentration and hematocrit (β = −56.2, P < 0.001) and cortisol (β = 0.037, P < 0.001) were detected throughout the ET intervention. In conclusion, ET leads to mild, transient increases in circulating EPO concentration, concurring with early PV expansion and lowered hematocrit, preceding gradual RBCV enhancement.
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Affiliation(s)
- David Montero
- Zurich Center for Integrative Human Physiology, Institute of Physiology, University of Zurich, Zurich, Switzerland
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Andreas Breenfeldt-Andersen
- Zurich Center for Integrative Human Physiology, Institute of Physiology, University of Zurich, Zurich, Switzerland
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark; and
| | - Laura Oberholzer
- Zurich Center for Integrative Human Physiology, Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Thomas Haider
- Zurich Center for Integrative Human Physiology, Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Jens P. Goetze
- Department of Clinical Biochemistry, Copenhagen, and Aarhus University, Aarhus, Denmark
| | - Anne-Kristine Meinild-Lundby
- Zurich Center for Integrative Human Physiology, Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Carsten Lundby
- Zurich Center for Integrative Human Physiology, Institute of Physiology, University of Zurich, Zurich, Switzerland
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Lombardi G, Lanteri P, Fiorella PL, Simonetto L, Impellizzeri FM, Bonifazi M, Banfi G, Locatelli M. Comparison of the hematological profile of elite road cyclists during the 2010 and 2012 GiroBio ten-day stage races and relationships with final ranking. PLoS One 2013; 8:e63092. [PMID: 23646180 PMCID: PMC3639959 DOI: 10.1371/journal.pone.0063092] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 03/28/2013] [Indexed: 11/18/2022] Open
Abstract
Cycling stage races are strenuous endurance events during which exercise-induced variations in hematological parameters are consistently observed. However, specific literature on such changes is scarce and published data have been derived from small samples of athletes. The aims of this study were: (1) to determine the hematological response to middle-term strenuous endurance; and (2) to determine whether a relationship exists between the athlete-specific hematological profile and final placement in a cycling stage race. The study population was male professional cyclists (n = 253) competing in the 2010 (n = 144) and 2012 (n = 109) GiroBio 10-day stage races. Blood draws taken before the start of the race, at mid-race, and at end-race were performed in strict compliance with academic and anti-doping pre-analytical warnings. Blood chemistry included white blood cell, red blood cell, hemoglobin concentration, hematocrit, mean corpuscular volume (MCV), mean hemoglobin content (MCH), mean corpuscular hemoglobin content (MCHC), platelets, and reticulocyte relative and absolute counts. Compared to baseline values, erythrocyte, hemoglobin, hematocrit, MCHC, platelet and reticulocyte counts were all consistently lower at mid-race, but returned to normal by race-end, while leukocytes were increased in the final phase. MCV increased during both events. MCH increased in the first part to then return to baseline in the 2012 race. The calculated OFF-score consistently decreased in the first half of the race before increasing, but remained lower than the baseline value. The trends of variation in hematological parameters were substantially similar in both events. There was an inverse, albeit weak, relationship between placement and erythrocyte, platelet, hemoglobin, hematocrit and OFF-score values in the 2010, but not in the 2012 race. In conclusion, the data confirm that, in this large series of elite road cyclists, the strenuous effort a rider sustains during a stage race induces appreciable changes in the hematological profile.
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Affiliation(s)
- Giovanni Lombardi
- Laboratory of Experimental Biochemistry and Molecular Biology, I.R.C.C.S. Istituto Ortopedico Galeazzi, Milano, Italia.
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Hu M, Lin W. Effects of exercise training on red blood cell production: implications for anemia. Acta Haematol 2012; 127:156-64. [PMID: 22301865 DOI: 10.1159/000335620] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 11/29/2011] [Indexed: 12/24/2022]
Abstract
Exercise training can increase total Hb and red cell mass, which enhances oxygen-carrying capacity. The possible underlying mechanisms are proposed to come mainly from bone marrow, including stimulated erythropoiesis with hyperplasia of the hematopoietic bone marrow, improvement of the hematopoietic microenvironment induced by exercise training, and hormone- and cytokine-accelerated erythropoiesis. Anemia is one of the most common medical conditions in chronic disease. The effects of exercise training on counteracting anemia have been explored and evaluated. The results of the research available to date are controversial, and it seems that significant methodological limitations exist. However, exercise training might be a promising, additional, safe and economical method to help improve anemia. There is a need for further investigation into the effects of and guidelines for exercise interventions (especially strength training) in this population of patients, particularly among cancer patients who are undergoing or have undergone chemotherapy or radiation treatments. As the available data are limited, additional research to uncover the underlying mechanisms associated with the effects of exercise training on anemia is clearly warranted.
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Affiliation(s)
- Min Hu
- Laboratory Center for Sport Science and Medicine, Guangzhou Institute of Physical Education, China.
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Vogt S, Altehoefer C, Bueltermann D, Pottgiesser T, Prettin S, Schmid A, Roecker K, Schmidt W, Heinicke K, Heinrich L. Magnetic resonance imaging of the lumbar spine and blood volume in professional cyclists. Eur J Appl Physiol 2007; 102:411-6. [DOI: 10.1007/s00421-007-0599-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2007] [Accepted: 10/15/2007] [Indexed: 10/22/2022]
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Ghanem N, Lerche A, Lohrmann C, Altehoefer C, Henke M, Langer M. Quantitative and semiquantitative evaluation of erythropoietin-induced bone marrow signal changes in lumbar spine MRI in patients with tumor anemia. Oncol Res Treat 2007; 30:303-8. [PMID: 17551253 DOI: 10.1159/000101525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The topic of this article is the quantitative and semiquantitative assessment of bone marrow signal alteration in magnetic resonance imaging (MRI) of the lumbar spine in patients with tumor anemia during therapy with epoietin beta or placebo. PATIENTS AND METHODS We examined 32 patients with head or neck cancer (16 epoietin beta, 16 placebo) during radiotherapy in a double-blind multicenter trial. During radiotherapy, the patients underwent epoietin beta therapy for 7-9 weeks. Lumbar spine measurements using T1-w SE, OPP and Turbo- STIR were taken prior to the first epoietin beta or placebo therapy, after the acquired hemoglobin level had been reached, and after the final radiotherapy. The semiquantitative assessment was made blinded by 2 independent radiologists. RESULTS We found significant differences between both groups. The first MRI showed normal marrow signals. The second MRI revealed a quantified decrease in bone marrow signal in T1-w SE (p < 0.018) and an increase in OPP (p < 0.01) and Turbo-TIR (p < 0.048) sequences. At the third MR imaging, quantified relative marrow signals returned to baseline level in all sequences. Semiquantitative assessment confirmed these results. CONCLUSION In both analyses, lumbar spine MRI demonstrates significant bone marrow changes in T1-w SE, OPP and Turbo-STIR sequences during epoietin beta therapy.
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Affiliation(s)
- Nadir Ghanem
- Department of Diagnostic Radiology, University Hospital Freiburg, Germany.
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