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Dünnwald T, Gatterer H, Faulhaber M, Arvandi M, Schobersberger W. Body Composition and Body Weight Changes at Different Altitude Levels: A Systematic Review and Meta-Analysis. Front Physiol 2019; 10:430. [PMID: 31057421 PMCID: PMC6477059 DOI: 10.3389/fphys.2019.00430] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 03/28/2019] [Indexed: 12/12/2022] Open
Abstract
Changes in body composition and weight loss frequently occur when humans are exposed to hypoxic environments. The mechanisms thought to be responsible for these changes are increased energy expenditure resulting from increased basal metabolic rate and/or high levels of physical activity, inadequate energy intake, fluid loss as well as gastrointestinal malabsorption. The severity of hypoxia, the duration of exposure as well as the level of physical activity also seem to play crucial roles in the final outcome. On one hand, excessive weight loss in mountaineers exercising at high altitudes may affect performance and climbing success. On the other, hypoxic conditioning is presumed to have an important therapeutic potential in weight management programs in overweight/obese people, especially in combination with exercise. In this regard, it is important to define the hypoxia effect on both body composition and weight change. The purpose of this study is to define, through the use of meta-analysis, the extent of bodyweight -and body composition changes within the three internationally classified altitude levels (moderate altitude: 1500–3500 m; high altitude: 3500–5300 m; extreme altitude: >5300 m), with emphasis on physical activity, nutrition, duration of stay and type of exposure.
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Affiliation(s)
- Tobias Dünnwald
- Institute for Sports Medicine, Alpine Medicine & Health Tourism, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Hannes Gatterer
- Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy
| | - Martin Faulhaber
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Marjan Arvandi
- Institute of Public Health, Medical Decision Making and HTA, Department for Public Health, Medical Decision Making and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Wolfgang Schobersberger
- Institute for Sports Medicine, Alpine Medicine & Health Tourism, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria.,Tirol Kliniken GmbH Innsbruck, Innsbruck, Austria
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Wandrag L, Siervo M, Riley HL, Khosravi M, Fernandez BO, Leckstrom CA, Martin DS, Mitchell K, Levett DZH, Montgomery HE, Mythen MG, Stroud MA, Grocott MPW, Feelisch M. Does hypoxia play a role in the development of sarcopenia in humans? Mechanistic insights from the Caudwell Xtreme Everest Expedition. Redox Biol 2017; 13:60-68. [PMID: 28570949 PMCID: PMC5451185 DOI: 10.1016/j.redox.2017.05.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 04/25/2017] [Accepted: 05/05/2017] [Indexed: 12/24/2022] Open
Abstract
Objectives Sarcopenia refers to the involuntary loss of skeletal muscle and is a predictor of physical disability/mortality. Its pathogenesis is poorly understood, although roles for altered hypoxic signaling, oxidative stress, adipokines and inflammatory mediators have been suggested. Sarcopenia also occurs upon exposure to the hypoxia of high altitude. Using data from the Caudwell Xtreme Everest expedition we therefore sought to analyze the extent of hypoxia-induced body composition changes and identify putative pathways associated with fat-free mass (FFM) and fat mass (FM) loss. Methods After baseline testing in London (75 m), 24 investigators ascended from Kathmandu (1300 m) to Everest base camp (EBC 5300 m) over 13 days. Fourteen investigators climbed above EBC, eight of whom reached the summit (8848 m). Assessments were conducted at baseline, during ascent and after one, six and eight week(s) of arrival at EBC. Changes in body composition (FM, FFM, total body water, intra- and extra-cellular water) were measured by bioelectrical impedance. Biomarkers of nitric oxide and oxidative stress were measured together with adipokines, inflammatory, metabolic and vascular markers. Results Participants lost a substantial, but variable, amount of body weight (7.3±4.9 kg by expedition end; p<0.001). A progressive loss of both FM and FFM was observed, and after eight weeks, the proportion of FFM loss was 48% greater than FM loss (p<0.008). Changes in protein carbonyls (p<0.001) were associated with a decline in FM whereas 4-hydroxynonenal (p<0.001) and IL-6 (p<0.001) correlated with FFM loss. GLP-1 (r=−0.45, p<0.001) and nitrite (r=−0.29, p<0.001) concentration changes were associated with FFM loss. In a multivariate model, GLP-1, insulin and nitrite were significant predictors of FFM loss while protein carbonyls were predicted FM loss. Conclusions The putative role of GLP-1 and nitrite as mediators of the effects of hypoxia on FFM is an intriguing finding. If confirmed, nutritional and pharmacological interventions targeting these pathways may offer new avenues for prevention and treatment of sarcopenia.
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Affiliation(s)
- Liesl Wandrag
- Nutrition and Dietetic Research Group, Department of Investigative Medicine, Imperial College London, UK; University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, 170 Tottenham Court Road, London W1T 7HA, UK
| | - Mario Siervo
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Campus for Ageing and Vitality, Newcastle on Tyne NE4 5PL, UK
| | - Heather L Riley
- Warwick Systems Biology Centre and Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Maryam Khosravi
- University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, 170 Tottenham Court Road, London W1T 7HA, UK; Department of Cell and Developmental Biology, Division of Biosciences, University College London, WC1B 6BT, UK
| | - Bernadette O Fernandez
- Warwick Systems Biology Centre and Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Carl A Leckstrom
- Warwick Systems Biology Centre and Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Daniel S Martin
- University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, 170 Tottenham Court Road, London W1T 7HA, UK; Division of Surgery and Interventional Science, University College London, 9th Floor, Royal Free Hospital, London NW3 2QG, UK
| | - Kay Mitchell
- University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, 170 Tottenham Court Road, London W1T 7HA, UK; University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton SO16 6YD, UK
| | - Denny Z H Levett
- University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, 170 Tottenham Court Road, London W1T 7HA, UK; University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton SO16 6YD, UK; Southampton NIHR Respiratory Biomedical Research Unit, UK
| | - Hugh E Montgomery
- University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, 170 Tottenham Court Road, London W1T 7HA, UK
| | - Monty G Mythen
- University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, 170 Tottenham Court Road, London W1T 7HA, UK
| | - Michael A Stroud
- University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton SO16 6YD, UK
| | - Michael P W Grocott
- University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, 170 Tottenham Court Road, London W1T 7HA, UK; Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton SO16 6YD, UK; Southampton NIHR Respiratory Biomedical Research Unit, UK
| | - Martin Feelisch
- Warwick Systems Biology Centre and Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton SO16 6YD, UK; Southampton NIHR Respiratory Biomedical Research Unit, UK.
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