Nitrate ingestion blunts the increase in blood pressure during cool air exposure: a double-blind, placebo-controlled, randomized, crossover trial

Cold exposure increases blood pressure (BP) and salivary flow rate (SFR). Increased cold-induced SFR would be hypothesized to enhance oral nitrate delivery for reduction to nitrite by oral anaerobes and to subsequently elevate plasma [nitrite] and nitric oxide bioavailability. We tested the hypothesis that dietary nitrate supplementation would increase plasma [nitrite] and lower BP to a greater extent in cool compared with normothermic conditions. Twelve males attended the laboratory on four occasions. Baseline measurements were completed at 28°C. Subsequently, participants ingested 140 mL of concentrated nitrate-rich (BR; ∼13 mmol nitrate) or nitrate-depleted (PL) beetroot juice. Measurements were repeated over 3 h at either 28°C (Norm) or 20°C (Cool). Mean skin temperature was lowered compared with baseline in PL-Cool and BR-Cool. SFR was greater in BR-Norm, PL-Cool, and BR-Cool than PL-Norm. Plasma [nitrite] at 3 h was higher in BR-Cool (592 ± 239 nM) versus BR-Norm (410 ± 195 nM). Systolic BP (SBP) at 3 h was not different between PL-Norm (117 ± 6 mmHg) and BR-Norm (113 ± 9 mmHg). SBP increased above baseline at 1, 2, and 3 h in PL-Cool but not BR-Cool. These results suggest that BR consumption is more effective at increasing plasma [nitrite] in cool compared with normothermic conditions and blunts the rise in BP following acute cool air exposure, which might have implications for attenuating the increased cardiovascular strain in the cold.NEW & NOTEWORTHY Compared with normothermic conditions, acute nitrate ingestion increased plasma [nitrite], a substrate for oxygen-independent nitric oxide generation, to a greater extent during cool air exposure. Systolic blood pressure was increased during cool air exposure in the placebo condition with this cool-induced blood pressure increase attenuated after acute nitrate ingestion. These findings improve our understanding of environmental factors that influence nitrate metabolism and the efficacy of nitrate supplementation to lower blood pressure.

Characterising 24-h skeletal muscle gene expression alongside metabolic & endocrine responses under diurnal conditions

CONTEXT

Skeletal muscle plays a central role in the storage, synthesis, and breakdown of nutrients, yet little research has explored temporal responses of this human tissue, especially with concurrent measures of systemic biomarkers of metabolism.

OBJECTIVE

To characterise temporal profiles in skeletal muscle expression of genes involved in carbohydrate metabolism, lipid metabolism, circadian clocks, and autophagy and descriptively relate them to systemic metabolites and hormones during a controlled laboratory protocol.

METHODS

Ten healthy adults (9M/1F, mean ± SD: age: 30 ± 10 y; BMI: 24.1 ± 2.7 kg·m-2) rested in the laboratory for 37 hours with all data collected during the final 24 hours of this period (i.e., 0800-0800 h). Participants ingested hourly isocaloric liquid meal replacements alongside appetite assessments during waking before a sleep opportunity from 2200-0700 h. Blood samples were collected hourly for endocrine and metabolite analyses, with muscle biopsies occurring every 4 h from 1200 h to 0800 h the following day to quantify gene expression.

RESULTS

Plasma insulin displayed diurnal rhythmicity peaking at 1804 h. Expression of skeletal muscle genes involved in carbohydrate metabolism (Name - Acrophase; GLUT4 - 1440 h; PPARGC1A -1613 h; HK2 - 1824 h) and lipid metabolism (FABP3 - 1237 h; PDK4 - 0530 h; CPT1B - 1258 h) displayed 24 h rhythmicity that reflected the temporal rhythm of insulin. Equally, circulating glucose (0019 h), NEFA (0456 h), glycerol (0432 h), triglyceride (2314 h), urea (0046 h), CTX (0507 h) and cortisol concentrations (2250 h) also all displayed diurnal rhythmicity.

CONCLUSION

Diurnal rhythms were present in human skeletal muscle gene expression as well systemic metabolites and hormones under controlled diurnal conditions. The temporal patterns of genes relating to carbohydrate and lipid metabolism alongside circulating insulin are consistent with diurnal rhythms being driven in part by the diurnal influence of cyclic feeding and fasting.

Myths and Methodologies: Standardisation in Human Physiology Research-Should We Control the Controllables?

The premise of research in human physiology is to explore a multifaceted system whilst identifying one or a few outcomes of interest. Therefore, the control of potentially confounding variables requires careful thought regarding the extent of control and complexity of standardisation. One common factor to control prior to testing is diet, as food and fluid provision may deviate from participants' habitual diets, yet a self-report and replication method can be flawed by under-reporting. Researchers may also need to consider standardisation of physical activity, whether it be through familiarisation trials, wash-out periods, or guidance on levels of physical activity to be achieved before trials. In terms of pharmacological agents, the ethical implications of standardisation require researchers to carefully consider how medications, caffeine consumption and oral contraceptive prescriptions may affect the study. For research in females, it should be considered whether standardisation between- or within-participants in regards to menstrual cycle phase is most relevant. The timing of measurements relative to various other daily events is relevant to all physiological research and so it can be important to standardise when measurements are made. This review summarises the areas of standardisation which we hope will be considered useful to anyone involved in human physiology research, including when and how one can apply standardisation to various contexts.

Myths and Methodologies: Standardisation in human physiology research-should we control the controllables?

The premise of research in human physiology is to explore a multifaceted system whilst identifying one or a few outcomes of interest. Therefore, the control of potentially confounding variables requires careful thought regarding the extent of control and complexity of standardisation. One common factor to control prior to testing is diet, as food and fluid provision may deviate from participants' habitual diets, yet a self-report and replication method can be flawed by under-reporting. Researchers may also need to consider standardisation of physical activity, whether it be through familiarisation trials, wash-out periods, or guidance on levels of physical activity to be achieved before trials. In terms of pharmacological agents, the ethical implications of standardisation require researchers to carefully consider how medications, caffeine consumption and oral contraceptive prescriptions may affect the study. For research in females, it should be considered whether standardisation between- or within-participants in regards to menstrual cycle phase is most relevant. The timing of measurements relative to various other daily events is relevant to all physiological research and so it can be important to standardise when measurements are made. This review summarises the areas of standardisation which we hope will be considered useful to anyone involved in human physiology research, including when and how one can apply standardisation to various contexts.

Influence of acute dietary nitrate supplementation timing on nitrate metabolism, central and peripheral blood pressure and exercise tolerance in young men

PURPOSE

Dietary nitrate (NO3-) supplementation can lower systolic blood pressure (SBP) and improve exercise performance. Salivary flow rate (SFR) and pH are key determinants of oral NO3- reduction and purported to peak in the afternoon. We tested the hypotheses that NO3--rich beetroot juice (BR) would increase plasma [nitrite] ([NO2-]), lower SBP and improve exercise performance to a greater extent in the afternoon (AFT) compared to the morning (MORN) and evening (EVE).

METHOD

Twelve males completed six experimental visits in a repeated-measures, crossover design. NO3--depleted beetroot juice (PL) or BR (~ 13 mmol NO3-) were ingested in the MORN, AFT and EVE. SFR and pH, salivary and plasma [NO3-] and [NO2-], brachial SBP and central SBP were measured pre and post supplementation. A severe-intensity exercise tolerance test was completed to determine cycling time to exhaustion (TTE).

RESULTS

There were no between-condition differences in mean SFR or salivary pH. The elevation in plasma [NO2-] after BR ingestion was not different between BR-MORN, BR-AFT and BR-EVE. Brachial SBP was unchanged following BR supplementation in all conditions. Central SBP was reduced in BR-MORN (- 3 ± 4 mmHg), BR-AFT (- 4 ± 3 mmHg), and BR-EVE (- 2 ± 3 mmHg), with no differences between timepoints. TTE was not different between BR and PL at any timepoint.

CONCLUSION

Acute BR supplementation was ineffective at improving TTE and brachial SBP and similarly effective at increasing plasma [NO2-] and lowering central SBP across the day, which may have implications for informing NO3- supplementation strategies.

Substituting carbohydrate at lunch for added protein increases fat oxidation during subsequent exercise in healthy males

CONTEXT

How pre-exercise meal composition influences metabolic and health responses to exercise later in the day is currently unclear.

OBJECTIVE

Examine the effects of substituting carbohydrate for protein at lunch on subsequent exercise metabolism, appetite, and energy intake.

METHODS

Twelve healthy males completed three trials in randomized, counterbalanced order. Following a standardized breakfast (779 ± 66 kcal; ∼08:15), participants consumed a lunch (1186 ± 140 kcal; ∼13:15) containing either 0.2 g·kg-1 carbohydrate and ∼2 g·kg-1 protein (LO-CARB), 2 g·kg-1 carbohydrate and ∼0.4 g·kg-1 protein (HI-CARB), or fasted (FAST). Participants later cycled at ∼60% V̇O2peak for 1 h (∼16:15) and post-exercise ad-libitum energy intake was measured (∼18:30). Substrate oxidation, subjective appetite, and plasma concentrations of glucose, insulin, non-esterified fatty acids (NEFA), peptide YY (PYY), glucagon-like peptide-1 (GLP-1), and acylated ghrelin (AG) were measured for 5 h post-lunch.

RESULTS

Fat oxidation was greater during FAST (+11.66 ± 6.63 g) and LO-CARB (+8.00 ± 3.83 g) than HI-CARB (p < 0.001), with FAST greater than LO-CARB (+3.67 ± 5.07 g; p < 0.05). NEFA were lowest in HI-CARB and highest in FAST, with insulin demonstrating the inverse response (all p < 0.01). PYY and GLP-1 demonstrated a stepwise pattern, with LO-CARB greatest and FAST lowest (all p < 0.01). AG was lower during HI-CARB and LO-CARB versus FAST (p < 0.01). Energy intake in LO-CARB was lower than FAST (-383 ± 233 kcal; p < 0.001) and HI-CARB (-313 ± 284 kcal; p < 0.001).

CONCLUSION

Substituting carbohydrate for protein in a pre-exercise lunch increased fat oxidation, suppressed subjective and hormonal appetite, and reduced post-exercise energy intake.

Hypohydration induced by prolonged cycling in the heat increases biomarkers of renal injury in males

PURPOSE

Recent studies have shown that hypohydration can increase renal injury. However, the contribution of hypohydration to the extent of renal injury is often confounded by exercise induced muscle damage. Therefore, the aim of the present study was to investigate the effect of manipulating hydration status during moderate-intensity cycling in the heat on biomarkers of renal injury.

METHODS

Following familiarisation, fourteen active males (age: 21 [20-22] y; BMI: 22.1 ± 1.9 kg/m2; V ˙ O2peak: 55 ± 9 mL/kg/min) completed two experimental trials, in a randomised cross-over design. Experimental trials consisted of up to 120 min of intermittent cycling (~ 50% Wpeak) in the heat (~ 35 °C, ~ 50% relative humidity). During exercise, subjects consumed either a water volume equal to 100% body mass losses (EU) or minimal water (HYP; 75-100 mL) to induce ~ 3% body mass loss. Blood and urine samples were collected at baseline, 30 min post-exercise and 24 h post-baseline, with an additional urine sample collected immediately post-exercise.

RESULTS

Thirty minutes post-exercise, body mass and plasma volume were lower in HYP than EU (P < 0.001), whereas serum and urine osmolality (P < 0.001), osmolality-corrected urinary kidney injury molecule-1 concentrations (HYP: 2.74 [1.87-5.44] ng/mOsm, EU: 1.15 [0.84-2.37] ng/mOsm; P = 0.024), and percentage change in osmolality-corrected urinary neutrophil gelatinase-associated lipocalin concentrations (HYP: 61 [17-141] %, EU: 7.1 [- 4 to 24] %; P = 0.033) were greater in HYP than EU.

CONCLUSION

Hypohydration produced by cycling in the heat increased renal tubular injury, compared to maintaining euhydration with water ingestion.

Perceived dehydration impairs endurance cycling performance in the heat in active males

Dehydration of >3 % body mass impairs endurance performance irrespective of the individual's knowledge of their hydration status, but whether knowledge of hydration status influences performance at lower levels of dehydration is unknown. This study examined whether perception of hydration status influenced endurance performance. After familiarisation, nine active males (age 25 ± 2 y, V̇O2peak 52.5 ± 9.1 mL kg min-1) completed two randomised trials at 34 °C. Trials involved an intermittent exercise preload (8 × 10 min cycling/5 min rest), followed by a 15 min all-out cycling performance test. During the preload in both trials, water was ingested orally every 10 min (0.3 mL kg body mass-1), with additional water infused into the stomach via gastric feeding tube to produce dehydration of ∼1.5 % body mass pre-performance test. Participants were told intra-gastric infusion was manipulated to produce euhydration (0 % dehydration; Perceived-EUH) or dehydration (2 % dehydration; Perceived-DEH) pre-performance test, which was told to them pre-preload and confirmed after body mass measurement pre-performance test. Body mass loss during the preload (Perceived-EUH 1.6 ± 0.2 %, Perceived-DEH 1.7 ± 0.2 %; P = 0.459), heart rate, gastrointestinal temperature and RPE (P ≥ 0.110) were not different between trials. Thirst was greater at the end of the preload and performance test in Perceived-DEH (P ≤ 0.040). Work completed during the performance test was 5.6 ± 6.1 % lower in Perceived-DEH (187.4 ± 37.0 kJ vs. 176.9 ± 36.0 kJ; P = 0.038). These results suggest that at lower levels of dehydration (<2 % body mass), an individual's perception of their hydration status could impair their performance, as well as their thirst perception.

How Cool is That? The Effects of Menthol Mouth Rinsing on Exercise Capacity and Performance: A Systematic Review and Meta-analysis

BACKGROUND

Menthol (MEN) mouth rinsing (MR) has gained considerable interest in the athletic population for exercise performance; however, the overall magnitude of effect is unknown.

OBJECTIVE

The aim of this systematic review and meta-analysis was to determine the efficacy of menthol MEN MR and the impact it has on exercise capacity and performance.

METHODS

Three databases were searched with articles screened according to the inclusion/exclusion criteria. Three-level meta-analyses were used to investigate the overall efficacy of MEN MR and the impact it has on exercise capacity and performance. Meta-regressions were then performed with 1) mean VO2peak, 2) MEN swilling duration; 3) the MEN concentration of MR solution, 4) the number of executed swills throughout a single experiment, 5) the use of flavoured sweetened, non-caloric, or non-flavoured neutral solutions as controls, 6) mean environmental temperature at the time of exercise tests, and 7) exercise type as fixed factors to evaluate their influence on the effects of MEN MR.

RESULTS

Ten MEN MR studies included sufficient information pertaining to MEN MR and exercise performance and capacity. MR with MEN resulted in no significant change in capacity and performance (SMD = 0.12; 95% CI - 0.08, 0.31; p = 0.23, n = 1, tau21 < 0.0001, tau22 =  < 0.0001, I2 = 0%). No significant influence was detected in meta-regressions for VO2peak, (estimate: 0.03; df = 8; 95% CI - 0.03, 0.09; p = 0.27), swilling duration (5 vs. 10 s: 0.00; df = 16; 95% CI - 0.41, 0.41; p = 1.0), MEN concentration (low [0.01%] vs. high [0.1%]: - 0.08; df = 15; 95% CI - 0.49, 0.32; p = 0.67), number of swills (estimate: 0.02; df = 13; 95% CI - 0.05, 0.09; p = 0.56), the use of flavoured sweetener or non-caloric as control (non-flavoured vs. flavoured: 0.12; df = 16; 95% CI - 0.30, 0.55; p = 0.55) or mean room temperature during exercise tests (estimate: 0.01; df = 16; 95% CI - 0.02, 0.04; p = 0.62).

CONCLUSION

MEN MR did not significantly improve overall exercise capacity and performance, though those involved in endurance exercise may see benefits.

Serum osmolality measured in fingertip capillary blood is comparable to serum osmolality measured in venous blood

Blood osmolality is considered the gold standard hydration assessment, but has limited application for technical and invasive reasons. Paired antecubital-venous blood and fingertip-capillary blood were collected pre- and 30 min post-drinking 600 mL water in 55 male/female participants. No bias (0.2 mOsmo/kg, limits of agreement = -2.5 to 2.8 mOsmo/kg) was found between sampling methods, with high linear correlation (Spearman's r = 0.95, P < 0.001). Capillary blood sampling offers an accurate less-invasive method for determining serum osmolality than venous blood sampling.

The Effect of Specific Bioactive Collagen Peptides on Tendon Remodeling during 15 wk of Lower Body Resistance Training

PURPOSE

Collagen peptide supplementation has been reported to enhance synthesis rates or growth in a range of musculoskeletal tissues and could enhance tendinous tissue adaptations to resistance training (RT). This double-blind placebo-controlled study aimed to determine if tendinous tissue adaptations, size (patellar tendon cross-sectional area (CSA) and vastus lateralis (VL) aponeurosis area), and mechanical properties (patellar tendon), after 15 wk of RT, could be augmented with collagen peptide (CP) versus placebo (PLA) supplementation.

METHODS

Young healthy recreationally active men were randomized to consume either 15 g of CP ( n = 19) or PLA ( n = 20) once every day during a standardized program of lower-body RT (3 times a week). Measurements pre- and post-RT included patellar tendon CSA and VL aponeurosis area (via magnetic resonance imaging), and patellar tendon mechanical properties during isometric knee extension ramp contractions.

RESULTS

No between-group differences were detected for any of the tendinous tissue adaptations to RT (ANOVA group-time, 0.365 ≤ P ≤ 0.877). There were within-group increases in VL aponeurosis area (CP, +10.0%; PLA, +9.4%), patellar tendon stiffness (CP, +17.3%; PLA, +20.9%) and Young's modulus (CP, +17.8%; PLA, +20.6%) in both groups (paired t -tests (all), P ≤ 0.007). There were also within-group decreases in patellar tendon elongation (CP, -10.8%; PLA, -9.6%) and strain (CP, -10.6%; PLA, -8.9%) in both groups (paired t -tests (all), P ≤ 0.006). Although no within-group changes in patellar tendon CSA (mean or regional) occurred for CP or PLA, a modest overall time effect ( n = 39) was observed for mean (+1.4%) and proximal region (+2.4%) patellar tendon CSA (ANOVA, 0.017 ≤ P ≤ 0.048).

CONCLUSIONS

In conclusion, CP supplementation did not enhance RT-induced tendinous tissue remodeling (either size or mechanical properties) compared with PLA within a population of healthy young men.

Apple puree as a natural fructose source provides an effective alternative carbohydrate source for fuelling half-marathon running performance

Carbohydrate supplementation during endurance exercise is known to improve performance, but the effects of food-based approaches in running exercise are understudied. Therefore, this study investigated the performance and gastrointestinal (GI) effects of a carbohydrate supplement containing a natural fructose source compared with a highly processed fructose source in a combined glucose-fructose supplement, during a half-marathon. Eleven trained runners (9 males, 2 females; age 32 ± 8 y, 89:53 ± 13:28 min half-marathon personal record) completed a familiarisation (8 miles) and two experimental trials (13.1 miles) on an outdoor running course, with blood and urine samples collected before and after the run. Subjective GI measures were made throughout the run. Carbohydrate was provided as a natural fructose source in the form of apple puree (AP) or highly processed crystalline fructose (GF) in a 2:1 glucose-to-fructose ratio (additional required glucose was provided through maltodextrin). Half-marathon performance was not different between carbohydrate sources (AP 89:52 ± 09:33 min, GF 88:44 ± 10:09 min; P = 0.684). There were no interaction effects for GI comfort (P = 0.305) or other GI symptoms (P ≥ 0.211). There were no differences between carbohydrate sources in ad libitum fluid intake (AP 409 ± 206 mL; GF 294 ± 149 mL; P = 0.094) or any other urinary (P ≥ 0.724), blood-based (P ≥ 0.215) or subjective (P ≥ 0.421) measures. Apple puree as a natural fructose source was equivalent to crystalline fructose in supporting half-marathon running performance without increasing GI symptoms.HighlightsResearch examining food-first and food-based approaches to carbohydrate supplementation and endurance running performance are limited. Therefore, this study aimed to compare carbohydrate supplements either containing a natural or highly processed fructose source as part of a glucose-fructose supplement on half-marathon running performance and gastrointestinal comfort in trained runners.Running performance (apple puree 89:52 ± 09:33 min vs. crystalline fructose 88:44 ± 10:09 min), gastrointestinal comfort and symptoms were not different between the two fructose sources.Apple puree can be effectively used as a carbohydrate source to fuel half-marathon running performance.

Cannabidiol Oil Ingested as Sublingual Drops or Within Gelatin Capsules Shows Similar Pharmacokinetic Profiles in Healthy Males

Introduction: Cannabidiol (CBD) is a nonintoxicating phytocannabinoid used in clinical treatments and sold widely in consumer products. CBD products may be designed for sublingual or oral delivery, but it is unclear whether either is advantageous for CBD absorption. This study compared CBD pharmacokinetics after providing CBD oil as sublingual drops and within orally ingested gelatin capsules, at a dose relevant to consumer products. Materials and Methods: Eight males completed three conditions in a participant-blinded, randomized crossover design. Participants received the following combinations of placebo and CBD-containing (69 mg/mL) hemp oil in capsules and as sublingual drops: placebo capsules/placebo drops (Placebo), CBD capsules/placebo drops (CBD-Caps), and placebo capsules/CBD drops (CBD-Drops). Blood samples, blood pressure, and subjective scales were obtained/completed hourly for 6 h and at 24 h. Discussion: Plasma CBD concentrations were not different between CBD-Caps and CBD-Drops (interaction effect p=0.76). Peak CBD concentration (28.0±15.6 vs. 24.0±22.2 ng/mL), time of peak CBD concentration (4±1 vs. 4±2 h), and area under the concentration curve (45.3±20.3 vs. 41.8±23.3 ng/mL·6 h) were not different between conditions (p≥0.25). Cardiometabolic outcomes (plasma glucose/triacylglycerol, heart rate, blood pressure), liver function (plasma alanine aminotransferase/aspartate aminotransferase), kidney function (plasma creatinine), and subjective feelings/symptoms were not different between conditions (p≥0.07). Conclusions: Plasma CBD profiles were comparable between CBD-Caps and CBD-Drops, suggesting that there were not meaningful differences in routes of CBD absorption between conditions. This implies that CBD oil delivered sublingually is swallowed before oral mucosal CBD absorption occurs, which may have implications for research design, CBD product design, and consumer product choice.

A self-paced 15-minute cycling time trial is a reliable performance measure in recreationally active individuals

Cycling time trial (TT) protocols have been shown to be reliable in trained cyclists, but their reproducibility in lesser-trained individuals is unknown. This study examined the reliability of a self-paced 15-minute cycling TT in recreationally active individuals. Twelve recreationally active males (age 27 ± 3 y; body mass 75.2 ± 8.9 kg; V ˙ O2peak = 51.10 ± 7.53 ml∙kg∙min-1) completed a V ˙ O2peak test and four experimental trials, separated by > 48 h. Experimental trials consisted of 10 min cycling at 60% Wmax, followed by a self-paced 15-min TT. Heart rate and work done were recorded every 5 min during the TT; and coefficient of variation (CV) was calculated. Work done was not different (P = 0.706) between trials (193.2 ± 45.3 kJ; 193.2 ± 43.5 kJ; 192.0 ± 42.3 kJ; 193.9 ± 42.8 kJ). Within participant CV ranged from 0.5-4.9% for the four TTs, with a mean CV of 2.1%. Mean CV decreased from 2.0% (range 0.1-5.0%) for the first two TTs to 1.7% (range 0.2-5.6%) for the second and third TTs, and further decreased to 1.0% (range 0.2-1.8%) for the third and fourth TTs. In conclusion, the use of a short-duration self-paced cycling TT in recreationally active individuals is a reliable performance measure.

High-impact jumping mitigates the short-term effects of low energy availability on bone resorption but not formation in regularly menstruating females: A randomized control trial

Low energy availability (LEA) is prevalent in active individuals and negatively impacts bone turnover in young females. High-impact exercise can promote bone health in an energy efficient manner and may benefit bone during periods of LEA. Nineteen regularly menstruating females (aged 18-31 years) participated in two three-day conditions providing 15 (LEA) and 45 kcals kg fat-free mass-1  day-1 (BAL) of energy availability, each beginning 3 ± 1 days following the self-reported onset of menses. Participants either did (LEA+J, n = 10) or did not (LEA, n = 9) perform 20 high-impact jumps twice per day during LEA, with P1NP, β-CTx (circulating biomarkers of bone formation and resorption, respectively) and other markers of LEA measured pre and post in a resting and fasted state. Data are presented as estimated marginal mean ± 95% CI. P1NP was significantly reduced in LEA (71.8 ± 6.1-60.4 ± 6.2 ng mL-1 , p < 0.001, d = 2.36) and LEA+J (93.9 ± 13.4-85.2 ± 12.3 ng mL-1 , p < 0.001, d = 1.66), and these effects were not significantly different (time by condition interaction: p = 0.269). β-CTx was significantly increased in LEA (0.39 ± 0.09-0.46 ± 0.10 ng mL-1 , p = 0.002, d = 1.11) but not in LEA+J (0.65 ± 0.08-0.65 ± 0.08 ng mL-1 , p > 0.999, d = 0.19), and these effects were significantly different (time by condition interaction: p = 0.007). Morning basal bone formation rate is reduced following 3 days LEA, induced via dietary restriction, with or without high-impact jumping in regularly menstruating young females. However, high-impact jumping can prevent an increase in morning basal bone resorption rate and may benefit long-term bone health in individuals repeatedly exposed to such bouts.

A comparison of advertised versus actual cannabidiol (CBD) content of oils, aqueous tinctures, e-liquids and drinks purchased in the UK

BACKGROUND

Cannabidiol (CBD)-containing products are sold widely in consumer stores, but concerns have been raised regarding their quality, with notable discrepancies between advertised and actual CBD content. Information is limited regarding how different types of CBD products may differ in their deviation from advertised CBD concentrations. Therefore, CBD concentrations were quantified and compared in aqueous tinctures, oils, e-liquids and drinks.

METHODS

Products (13 aqueous tinctures, 29 oils, 10 e-liquids and 11 drinks) were purchased online in the UK. CBD concentrations were quantified in aqueous tinctures, oils and e-liquids via high performance liquid chromatography (HPLC), and in drinks via gas chromatograhy-mass spectrometry (GC-MS).

RESULTS

Measured concentrations fell -25.7 ± 17.3, -6.1 ± 7.8, -6.9 ± 4.6 and - 0.03 ± 0.06 mg/mL below advertised concentrations for aqueous tinctures, oils, e-liquids and drinks, respectively (medians ± interquartile ranges; p < .05). Oils deviated relatively less (-19.0 ± 14.5%) from advertised concentrations than e-liquids (-29.2 ± 10.2%), aqueous tinctures (-51.4 ± 41.4%) and drinks (-65.6 ± 36.5%; p < .01), whilst e-liquids deviated less than aqueous tinctures and drinks (p < .05), and deviation was not different between aqueous tinctures and drinks (p = .19). Only 5/63 (8%) products had measured concentrations within 10% of advertised concentrations.

DISCUSSION

Similarly to previous studies, few products had measured CBD concentrations within 10% of advertised concentrations, with most falling below advertised concentrations. All individual product types deviated from advertised concentrations, with oils deviating least. These findings may be indicative of poor manufacturing standards, or that CBD undergoes degradation in consumer products. This reinforces concerns over quality of CBD-containing consumer products and may highlight the need for improved regulation of such products.

Exercise-induced hypohydration impairs 3 km treadmill-running performance in temperate conditions

Research assessing exercise-induced hypohydration on running performance in a temperate environment is scarce. Given the weight-bearing nature of running, the negative effects of hypohydration might be offset by the weight-loss associated with a negative fluid balance. Therefore, this study investigated the effect of exercise-induced hypohydration on running performance in temperate conditions. Seventeen intermittent games players (age 22 ± 1 y; VO2peak 52.5 ± 4.1 mL∙kg-1∙min-1) completed preliminary and familiarisation trials, and two experimental trials consisting of 12 blocks of 6 min of running (65% VO2peak; preload) with 1 min passive rest in-between, followed by a 3 km time trial (TT). During the preload, subjects consumed minimal fluid (60 mL) to induce hypohydration (HYP) or water to replace 95% sweat losses (1622 ± 343 mL; EUH). Body mass loss (EUH -0.5 ± 0.3%; HYP -2.2 ± 0.4%; P < 0.001), and other changes indicative of hypohydration, including increased serum osmolality, heart rate, thirst sensation, and decreased plasma volume (P ≤ 0.022), were apparent in HYP by the end of the preload. TT performance was ~6% slower in HYP (EUH 900 ± 87 s; HYP 955 ± 110 s; P < 0.001). Exercise-induced hypohydration of ~2% body mass impaired 3 km running TT performance in a temperate environment.

Ad-libitum fluid intake was insufficient to achieve euhydration 20 h after intermittent running in male team sports athletes

This study documented 20 h rehydration from intermittent running while concealing the primary outcome of rehydration from subjects. Twenty-eight male team sports athletes (age 25 ± 3 y; predicted V̇O_2max 54 ± 3 mL∙kg^-1∙min^-1) were pair-matched to exercise (EX) or rest (REST) groups. To determine hydration status, body mass, urine and blood samples were collected at 08:00, pre-intervention (09:30), post-intervention (12:00), 3 h post-intervention and 08:00 the following morning (20 h). The intervention was 110 min intermittent running (EX) or seated rest (REST), with ad-libitum fluid provided in both. Subjects completed a weighed diet record and collected all urine for the 24 h. Changes typical of hypohydration were apparent in EX following the intervention period (body mass: EX -2.0 ± 0.5%; REST -0.2 ± 0.3%; serum osmolality: EX 293 ± 4 mOsm∙kgH₂O^-1; REST 287 ± 6 mOsm∙kgH₂O^-1; P≤0.022). Fluid intake during the intervention period (EX 704 ± 286 mL, REST 343 ± 230 mL) and fluid intake within the first 3 h post-intervention (EX 1081 ± 460 mL, REST 662 ± 230 mL) were greater (P≤0.004), and 24 h urine volume lower (EX 1697 ± 824 mL, REST 2370 ± 842 mL; P=0.039) in EX. Compared to baseline, body mass remained lower (-0.6 ± 0.5%; P=0.030) and urine osmolality elevated (20 h: 844 ± 197 mOsm∙kgH₂O^-1, 08:00: 698 ± 200 mOsm∙kgH₂O^-1; P=0.004) at 20 h in EX. When games players drank fluid ad-libitum during exercise and post-exercise in free-living conditions, a small degree of hypohydration remained 20 h post-exercise.

Effects of Morning Vs. Evening exercise on appetite, energy intake, performance and metabolism, in lean males and females

Exercise is an important component of a weight management strategy. However, little is known about whether circadian variations in physiological and behavioural processes can influence the appetite and energy balance responses to exercise performed at different times of the day. This study compared the effects of morning and evening exercise on appetite, post-exercise energy intake, and voluntary performance. In randomised, counterbalanced order, 16 healthy males and females (n = 8 each) completed two trials, performing morning exercise at 10:30 (AMEx) or evening exercise at 18:30 (PMEx). Exercise consisted of 30 min steady-state cycling (60% V˙ O_2peak), and a 15-min performance test. A standardised meal (543 ± 86 kcal) was consumed 2-h before exercise and ad-libitum energy intake was assessed 15 min after exercise, with subjective appetite measured throughout. Absolute ad-libitum energy intake was 152 ± 126 kcal greater during PMEx (P < 0.001), but there was no differences in subjective appetite between trials immediately pre-exercise, or immediately before the post-exercise meal (P ≥ 0.060). Resting energy expenditure (P < 0.01) and carbohydrate oxidation (P < 0.05) were greater during AMEx, but there were no differences in substrate oxidation or energy expenditure during exercise (P ≥ 0.155). Exercise performance was not different between trials (P = 0.628). In conclusion, acute morning and evening exercise prompt similar appetite responses, but post-exercise ad-libitum energy intake is greater following evening exercise. These findings demonstrate discordant responses between subjective appetite and ad-libitum energy intake but suggest that exercise might offset circadian variations in appetite. Longer-term studies are required to determine how exercise timing affects adherence and weight management outcomes to exercise interventions. TRIAL REGISTRATION: NCT04742530, February 8, 2021.

The effect of specific bioactive collagen peptides on function and muscle remodeling during human resistance training

AIM

Bioactive collagen peptides (CP) have been suggested to augment the functional, structural (size and architecture), and contractile adaptations of skeletal muscle to resistance training (RT), but with limited evidence. This study aimed to determine if CP vs. placebo (PLA) supplementation enhanced the functional and underpinning structural, and contractile adaptations after 15 weeks of lower body RT.

METHODS

Young healthy males were randomized to consume either 15 g of CP (n = 19) or PLA (n = 20) once every day during a standardized program of progressive knee extensor, knee flexor, and hip extensor RT 3 times/wk. Measurements pre- and post-RT included: knee extensor and flexor isometric strength; quadriceps, hamstrings, and gluteus maximus volume with MRI; evoked twitch contractions, 1RM lifting strength, and architecture (with ultrasound) of the quadriceps.

RESULTS

Percentage changes in maximum strength (isometric or 1RM) did not differ between-groups (0.684 ≤ p ≤ 0.929). Increases in muscle volume were greater (quadriceps 15.2% vs. 10.3%; vastus medialis (VM) 15.6% vs. 9.7%; total muscle volume 15.7% vs. 11.4%; [all] p ≤ 0.032) or tended to be greater (hamstring 16.5% vs. 12.8%; gluteus maximus 16.6% vs. 12.9%; 0.089 ≤ p ≤ 0.091) for CP vs. PLA. There were also greater increases in twitch peak torque (22.3% vs. 12.3%; p = 0.038) and angle of pennation of the VM (16.8% vs. 5.8%, p = 0.046), but not other muscles, for CP vs. PLA.

CONCLUSIONS

CP supplementation produced a cluster of consistent effects indicating greater skeletal muscle remodeling with RT compared to PLA. Notably, CP supplementation amplified the quadriceps and total muscle volume increases induced by RT.

Post-exercise rehydration: Comparing the efficacy of three commercial oral rehydration solutions

Introduction

This study compared the efficacy of three commercial oral rehydration solutions (ORS) for restoring fluid and electrolyte balance, after exercise-induced dehydration.

Method

Healthy, active participants (N = 20; ♀ = 3; age ∼27 y, V˙O₂peak ∼52 ml/kg/min) completed three randomised, counterbalanced trials whereby intermittent exercise in the heat (∼36°C, ∼50% humidity) induced ∼2.5% dehydration. Subsequently, participants rehydrated (125% fluid loss in four equal aliquots at 0, 1, 2, 3 h) with a glucose-based (G-ORS), sugar-free (Z-ORS) or amino acid-based sugar-free (AA-ORS) ORS of varying electrolyte composition. Urine output was measured hourly and capillary blood samples collected pre-exercise, 0, 2 and 5 h post-exercise. Sodium, potassium, and chloride concentrations in urine, sweat, and blood were determined.

Results

Net fluid balance peaked at 4 h and was greater in AA-ORS (141 ± 155 ml) and G-ORS (101 ± 195 ml) than Z-ORS (-47 ± 208 ml; P ≤ 0.010). Only AA-ORS achieved positive sodium and chloride balance post-exercise, which were greater for AA-ORS than G-ORS and Z-ORS (P ≤ 0.006), as well as for G-ORS than Z-ORS (P ≤ 0.007) from 1 to 5 h.

Conclusion

when provided in a volume equivalent to 125% of exercise-induced fluid loss, AA-ORS produced comparable/superior fluid balance and superior sodium/chloride balance responses to popular glucose-based and sugar-free ORS.

Dietary Nitrate Supplementation Enhances Performance and Speeds Muscle Deoxyhaemoglobin Kinetics during an End-Sprint after Prolonged Moderate-Intensity Exercise

Short-term dietary nitrate (NO3−) supplementation has the potential to enhance performance during submaximal endurance, and short-duration, maximal-intensity exercise. However, it has yet to be determined whether NO3− supplementation before and during submaximal endurance exercise can improve performance during a short-duration, maximal-intensity end-sprint. In a randomised, double-blind, crossover study, 9 recreationally active men ingested NO3−-rich (BR: 8 mmol NO3−/day) and NO3−-depleted (PL: 0.75 mmol NO3−/day) beetroot powder for 7 days. On day 7, participants completed 2 h of moderate-intensity cycling, which immediately transitioned into a 60 s maximal-intensity end-sprint, with supplements ingested 2 h before and 1 h into the moderate-intensity exercise bout. Plasma [NO3−] and [NO2−] were higher in BR compared to PL pre- and post-exercise (p < 0.05). Post-exercise plasma [NO3−] was higher than pre-exercise (562 ± 89 µM vs. 300 ± 73 µM; p < 0.05) and plasma [NO2−] was not significantly different pre- (280 ± 58 nM) and post-exercise (228 ± 63 nM) in the BR condition (p > 0.05). Mean power output during the final 30 s of the end-sprint was greater after BR (390 ± 38 W) compared to PL (365 ± 41 W; p < 0.05). There were no differences between BR and PL in any muscle oxygenation variables during moderate-intensity cycling (p > 0.05), but muscle [deoxyhaemoglobin] kinetics was faster during the end-sprint in BR (6.5 ± 1.4 s) compared to PL (7.3 ± 1.4 s; p < 0.05). These findings suggest that NO3− supplementation has the potential to improve end-sprint performance in endurance events when ingested prior to and during exercise.

Portions selected to stave off hunger are reduced when food is presented in an 'unusual' food-to-mealtime context: An implication for implicit satiety drivers

Research suggests that the role of expected satiety in influencing portion-size selection is reduced when food is presented in unusual food-to-mealtime contexts; however, the underlying mechanism has not been explored. Other research has revealed that different implicit satiety drivers (e.g., to stop momentary hunger or obtain complete fullness) are associated with different perceived levels of stomach fullness, portion-size selections and can change on instruction. The current study explored whether changes in expected satiety and ideal portions in congruous vs incongruous contexts can be explained by changes in implicit satiety drivers. Another aim was to investigate a previous exploratory finding suggesting that portions selected to stave off hunger are reduced when foods are presented in unusual food-to-mealtime contexts. At two trials (breakfast/lunch), participants (n = 40) selected a portion of typical lunch (pasta) and breakfast (porridge) foods via a psychophysical computer-based method 1) to stave off hunger for 5 h, and 2) as an ideal portion. Participants also indicated their perceived level of stomach fullness associated with 1) each portion, and 2) five implicit satiety drivers. Results revealed that a smaller average portion was selected to stave off hunger in incongruous (vs congruous) food-to-mealtime contexts (531 ± 229 vs 575 ± 236 kcal) (p = 0.008). This suggests that expected satiety is influenced by momentary context; foods are perceived to be more satiating when consumed in unusual (vs usual) contexts. Results also showed that implicit satiety drivers are malleable in regard to the portion size associated with a perceived level of stomach fullness and that this can vary contextually. These findings provide initial evidence to explain the psychological mechanism underlying the contextual differences observed in portion-size selections. Future work should explore longer-term impacts of consuming foods in unusual contexts.

Fluid Balance and Carbohydrate Intake of Elite Female Soccer Players during Training and Competition

This study examined sweat rate, sweat sodium concentration [Na⁺], and ad-libitum carbohydrate and fluid intakes in elite female soccer players during training (n = 19) and a match (n = 8); eight completed both for comparisons. Body mass (kg) was obtained before and after exercise to calculate sweat rate. The sweat [Na⁺] was determined from absorbent patches on the thigh or back. Sweat rate, percentage body mass change, and sweat [Na⁺] for 19 players during training were 0.47 ± 0.19 L·h⁻¹, +0.19 ± 0.65%, and 28 ± 10 mmol·L⁻¹, respectively. Sweat rate was higher during a match (0.98 ± 0.34 L·h⁻¹) versus training (0.49 ± 0.26 L·h⁻¹, p = 0.007). Body mass losses were greater post-match (−1.12 ± 0.86%) than training (+0.29 ± 0.34%, p = 0.003). Sweat [Na⁺] was similar for training (29 ± 9 mmol·L⁻¹) and a match (35 ± 9 mmol·L⁻¹) (p = 0.215). There were no differences in match versus training carbohydrate intakes (2.0 ± 2.3 g·h⁻¹, 0.9 ± 1.5 g·h⁻¹, respectively, p = 0.219) or fluid intakes (0.71 ± 0.30 L·h⁻¹, 0.53 ± 0.21 L·h⁻¹, respectively, p = 0.114). In conclusion, female soccer players’ sweat rates were higher during a match than during training, and carbohydrate intakes were below recommendations for matches and training.

Current appetite influences relative differences in the expected satiety of foods for momentary, but not hypothetical, expected satiety assessments

Research has shown that expected satiety is highly associated with portion-size selection and can vary (kcal-for-kcal) significantly between foods. However, research has not adequately investigated whether current appetite influences relative differences in the expected satiety of foods. This is important to explore to better understand how current motivational state influences food choice and portion selection. This study used 'hypothetical' and 'momentary' expected-satiety assessments to understand whether methods requiring a reflection on current motivational state [momentary] versus more hypothetical considerations when assessing expected satiety can influence the interpretation of results. It was hypothesised that current appetite would only influence relative differences in expected satiety between foods for momentary, but not hypothetical, expected satiety assessments. Participants (n = 54) were shown images of twelve foods, once when hungry and once when full. In each case, they selected a portion for each food to 1) match the expected satiety of a fixed-portion 'standard' food [hypothetical], and 2) stave off hunger until their next meal [momentary]. Results showed that the relative between-food comparison of expected satiety was stable for hypothetical (p=.73) but not momentary assessments (p<.001) suggesting that while current motivational state may influence food choice and portion selection in the moment, more generalised comparisons of the satiating abilities of foods (learned over a longer period) remain stable. This is important 1) for methods in future studies, as immediate dietary intake does not appear to influence hypothetical expected satiety, thus dietary control is not necessary before participants undertake these assessments, and 2) as it confirms that difficulties associated with dietary regulation may not be due to inaccurate hypothetical judgements about foods, but instead appear to be influenced by contextual nuances that occur in the moment.

A212 LIVER TRANSPLANTATION FOR PRIMARY SCLEROSING CHOLANGITIS (PSC): EXPERIENCE FROM THE LAST THREE DECADES

Background

In liver transplantation (LT) for PSC, pre-transplant colectomy may lower the risk of PSC recurrence (rPSC), and well-controlled or lack of IBD may protect against rPSC, however, these findings are not consistent across all studies. It is unknown whether recipient/donor sex plays a role in rPSC.

Aims

To study factors associated with PSC recurrence in the post-transplant population.

Methods

This is a retrospective study on adults who received an LT for PSC in Halifax NS from 1985 to 2020. Graft and patient outcomes are analyzed by logistic regression models.

Results

A total of 92 patients underwent deceased donor LT for PSC with a mean follow-up time of 9.2 yrs (SD 7.1). Fifty-three remain active in the program, 2 were lost to follow up and 37 died. The mean age at transplant was 43 (SD13, range 18.9–67.8). Seven patients had a second transplant. The five- and 10-year patient survival rate of the entire cohort was 78.7% and 66% respectively. In the active cohort, the prevalence of rPSC was 23.5% (12/51). Retransplantation for rPSC occurred in 8.3% (1/12). The prevalence of IBD was 82.4% (42/51), consisted of ulcerative pancolitis (64.7%, 33/51), ulcerative proctitis (3.9%), left-sided UC (2%) and Crohn’s disease (9.8%). Males are much more likely than females to undergo a colectomy at any time (OR 5.5, 95% CI 1.07–28.22, p 0.041). Refractory IBD was the predominant indication for a colectomy (10/16), followed by dysplasia or colon cancer (6/16). In the post-transplant period, 69% had stable IBD without therapy escalation, 11.9% were escalated to a biologic, 19% underwent a colectomy for active IBD symptoms. Pre-transplant colectomy negatively predicted rPSC, in this subgroup 0% (0/6) developed rPSC. Neither recipient sex (OR 1.14, 95% CI 0.26–5.0, p 0.86) or recipient age predicted the likelihood of rPSC. There was no association between donor sex on rPSC (OR 1.25, 95% CI 0.30–5.27, p 0.76). A trend towards increased rPSC was observed in male donors to female recipients versus female-to-female transplants (OR 6, 95% CI 0.33–107.42, p 0.224). Overall, having a post-transplant colectomy, subtotal or total, irrespective of timing, did not significantly impact rPSC (OR 0.389, 95% CI 0.09–1.66, p 0.20). Diagnosis of IBD was not associated with an increased risk of rPSC (OR 1.21, p 0.83).

Conclusions

Several factors were associated with rPSC after liver transplant in patients with PSC and IBD, pre-transplant colectomy was found to be protective, male donor to female recipient was a potential risk factor. It is important to study these factors in multi-centered cohorts to understand the pathogenesis of PSC. Pre-transplant total colectomy may be beneficial for several reasons, reducing rPSC, controlling IBD activities, and lowering dysplasia and colon cancer rates in the post-transplant population.

Funding Agencies

None

Effect of the perception of breakfast consumption on subsequent appetite and energy intake in healthy males

Purpose

This study aimed to assess the effects of consuming a very-low-energy placebo breakfast on subsequent appetite and lunch energy intake.

Methods

Fourteen healthy males consumed water-only (WAT), very-low-energy, viscous placebo (containing water, low-calorie flavoured squash, and xanthan gum; ~ 16 kcal; PLA), and whole-food (~ 573 kcal; FOOD) breakfasts in a randomised order. Subjects were blinded to the energy content of PLA and specific study aims. Venous blood samples were collected pre-breakfast, 60- and 180-min post-breakfast to assess plasma acylated ghrelin and peptide tyrosine tyrosine concentrations. Subjective appetite was measured regularly, and energy intake was assessed at an ad libitum lunch meal 195-min post-breakfast.

Results

Lunch energy intake was lower during FOOD compared to WAT (P < 0.05), with no further differences between trials (P ≥ 0.132). Cumulative energy intake (breakfast plus lunch) was lower during PLA (1078 ± 274 kcal) and WAT (1093 ± 249 kcal), compared to FOOD (1554 ± 301 kcal; P < 0.001). Total area under the curve (AUC) for hunger, desire to eat and prospective food consumption were lower, and fullness was greater during PLA and FOOD compared to WAT (P < 0.05). AUC for hunger was lower during FOOD compared to PLA (P < 0.05). During FOOD, acylated ghrelin was suppressed compared to PLA and WAT at 60 min (P < 0.05), with no other hormonal differences between trials (P ≥ 0.071).

Conclusion

Consuming a very-low-energy placebo breakfast does not alter energy intake at lunch but may reduce cumulative energy intake across breakfast and lunch and attenuate elevations in subjective appetite associated with breakfast omission.

Trial registration

NCT04735783, 2nd February 2021, retrospectively registered.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00394-021-02727-5.

Hypohydration produced by high-intensity intermittent running increases biomarkers of renal injury in males

Purpose

Whilst there is evidence to suggest that hypohydration caused by physical work in the heat increases renal injury, whether this is the case during exercise in temperate conditions remains unknown. This study investigated the effect of manipulating hydration status during high-intensity intermittent running on biomarkers of renal injury.

Methods

After familiarisation, 14 males (age: 33 ± 7 years; V̇O_2peak: 57.1 ± 8.6 ml/kg/min; mean ± SD) completed 2 trials in a randomised cross-over design, each involving 6, 15 min blocks of shuttle running (modified Loughborough Intermittent Shuttle Test protocol) in temperate conditions (22.3 ± 1.0 °C; 47.9 ± 12.9% relative humidity). During exercise, subjects consumed either a volume of water equal to 90% of sweat losses (EU) or 75 mL water (HYP). Body mass, blood and urine samples were taken pre-exercise (baseline/pre), 30 min post-exercise (post) and 24 h post-baseline (24 h).

Results

Post-exercise, body mass loss, serum osmolality and urine osmolality were greater in HYP than EU (P ≤ 0.024). Osmolality-corrected urinary kidney injury molecule-1 (uKIM-1) concentrations were increased post-exercise (P ≤ 0.048), with greater concentrations in HYP than EU (HYP: 2.76 [1.72–4.65] ng/mOsm; EU: 1.94 [1.1–2.54] ng/mOsm; P = 0.003; median [interquartile range]). Osmolality-corrected urinary neutrophil gelatinase-associated lipocalin (uNGAL) concentrations were increased post-exercise (P < 0.001), but there was no trial by time interaction effect (P = 0.073).

Conclusion

These results suggest that hypohydration produced by high-intensity intermittent running increases renal injury, compared to when euhydration is maintained, and that the site of this increased renal injury is at the proximal tubules.

Effects of Exercise on Acute Kidney Injury Biomarkers and the Potential Influence of Fluid Intake

Acute kidney injury (AKI) incidence (diagnosed by changes in serum creatinine [Cr]) following prolonged endurance events has been reported to be anywhere from 4 to 85%, and hypohydration may contribute to this. Whilst an increase in serum Cr indicates impaired kidney function, this might be influenced by muscle damage. Therefore, the use of other AKI biomarkers which can detect renal tubular injury may be more appropriate. The long-term consequences of AKI are not well understood, but there are some potential concerns of an increased subsequent risk of chronic kidney disease (CKD). Therefore, this brief review explores the effects of exercise training/competition on novel AKI biomarkers and the potential influence of fluid intake. The increase in novel AKI biomarkers following prolonged endurance events suggests renal tubular injury. This is likely due to the long duration and relatively high exercise intensity, producing increased sympathetic tone, body temperature, hypohydration, and muscle damage. Whilst muscle damage appears to be an important factor in the pathophysiology of exercise-associated AKI, it may require coexisting hypohydration. Fluid intake seems to play a role in exercise-associated AKI, as maintaining euhydration with water ingestion during simulated physical work in the heat appears to attenuate rises in AKI biomarkers. The composition of fluid intake may also be important, as high-fructose drinks have been shown to exacerbate AKI biomarkers. However, it is yet to be seen if these findings are applicable to athletes performing strenuous exercise in a temperate environment. Additionally, further work should examine the effects of repeated bouts of strenuous exercise on novel AKI biomarkers.

Planned morning aerobic exercise in a fasted state increases energy intake in the preceding 24 h

Purpose

We previously observed increased energy intake (EI) at the meal before planned afternoon exercise, but the proximity of the meal to exercise might have reduced the scale of the pre-exercise anticipatory eating. Therefore, this study examined EI in the 24 h before fasted morning exercise.

Methods

Fourteen males, experienced with gym-based aerobic exercise (age 25 ± 5 years, BMI 23.8 ± 2.5 kg/m²), completed counterbalanced exercise (EX) and resting (REST) trials. On day 1, subjects were told the following morning’s activity (EX/REST), before eating ad-libitum laboratory-based breakfast and lunch meals and a home-based afternoon/evening food pack. The following morning, subjects completed 30-min cycling and 30-min running (EX; 3274 ± 278 kJ) or 60-min supine rest (REST; 311 ± 34 kJ) fasted. Appetite was measured periodically, and EI quantified.

Results

Afternoon/evening EI (EX 7371 ± 2176 kJ; REST 6437 ± 2070 kJ; P = 0.017) and total 24-h EI (EX 14,055 ± 3672 kJ; REST 12,718 ± 3379 kJ; P = 0.011) were greater during EX, with no difference between trials at breakfast (P = 0.761) or lunch (P = 0.071). Relative EI (EI minus energy expended through EX/REST) was lower in EX (EX 10,781 ± 3539 kJ; REST 12,407 ± 3385 kJ; P = 0.004).

Conclusion

This study suggests planned fasted aerobic exercise increases EI during the preceding afternoon/evening, precipitating a ~ 10% increase in EI in the preceding 24-h. However, this increase did not fully compensate for energy expended during exercise; meaning exercise induced an acute negative energy balance.

Sports Drink Intake Pattern Affects Exogenous Carbohydrate Oxidation during Running

PURPOSE

This study aimed to determine whether the pattern of carbohydrate sports drink ingestion during prolonged submaximal running affects exogenous carbohydrate oxidation rates and gastrointestinal (GI) comfort.

METHODS

Twelve well-trained male runners (27 ± 7 yr; 67.9 ± 6.7 kg; V˙O2peak, 68 ± 7 mL·kg·min) completed two exercise trials of 100 min steady-state running at 70%V˙O2peak. In each of the trials, 1 L of a 10% dextrose solution, enriched with [U-C] glucose, was consumed as either 200 mL every 20 min (CHO-20) or 50 mL every 5 min (CHO-5). Expired breath and venous blood samples were collected at rest and every 20 min during exercise. Subjective scales of GI comfort were recorded at regular intervals.

RESULTS

Average exogenous carbohydrate oxidation rates were 23% higher during exercise in CHO-20 (0.38 ± 0.11 vs 0.31 ± 0.11 g·min; P = 0.017). Peak exogenous carbohydrate oxidation was also higher in CHO-20 (0.68 ± 0.14 g·min vs 0.61 ± 0.14 g·min; P = 0.004). During exercise, total carbohydrate oxidation (CHO-20, 2.15 ± 0.47; CHO-5, 2.23 ± 0.45 g·min, P = 0.412) and endogenous carbohydrate oxidation (CHO-20, 1.78 ± 0.45; CHO-5, 1.92 ± 0.40 g·min; P = 0.148) were not different between trials. Average serum glucose (P = 0.952) and insulin (P = 0.373) concentrations were not different between trials. There were no differences in reported symptoms of GI comfort and stomach bloatedness (P > 0.05), with only 3% of reported scores classed as severe (≥5 out of 10).

CONCLUSION

Ingestion of a larger volume of carbohydrate solution at less frequent intervals during prolonged submaximal running increased exogenous carbohydrate oxidation rates. Neither drinking pattern resulted in increased markers of GI discomfort to a severe level.

Fluid Balance, Sweat Na+ Losses, and Carbohydrate Intake of Elite Male Soccer Players in Response to Low and High Training Intensities in Cool and Hot Environments

Hypohydration increases physiological strain and reduces physical and technical soccer performance, but there are limited data on how fluid balance responses change between different types of sessions in professional players. This study investigated sweat and fluid/carbohydrate intake responses in elite male professional soccer players training at low and high intensities in cool and hot environments. Fluid/sodium (Na⁺) losses and ad-libitum carbohydrate/fluid intake of fourteen elite male soccer players were measured on four occasions: cool (wet bulb globe temperature (WBGT): 15 ± 7 °C, 66 ± 6% relative humidity (RH)) low intensity (rating of perceived exertion (RPE) 2–4, m·min⁻¹ 40–46) (CL); cool high intensity (RPE 6–8, m·min⁻¹ 82–86) (CH); hot (29 ± 1 °C, 52 ± 7% RH) low intensity (HL); hot high intensity (HH). Exercise involved 65 ± 5 min of soccer-specific training. Before and after exercise, players were weighed in minimal clothing. During training, players had ad libitum access to carbohydrate beverages and water. Sweat [Na⁺] (mmol·L⁻¹), which was measured by absorbent patches positioned on the thigh, was no different between conditions, CL: 35 ± 9, CH: 38 ± 8, HL: 34 ± 70.17, HH: 38 ± 8 (p = 0.475). Exercise intensity and environmental condition significantly influenced sweat rates (L·h⁻¹), CL: 0.55 ± 0.20, CH: 0.98 ± 0.21, HL: 0.81 ± 0.17, HH: 1.43 ± 0.23 (p =0.001), and percentage dehydration (p < 0.001). Fluid intake was significantly associated with sweat rate (p = 0.019), with no players experiencing hypohydration > 2% of pre-exercise body mass. Carbohydrate intake varied between players (range 0–38 g·h⁻¹), with no difference between conditions. These descriptive data gathered on elite professional players highlight the variation in the hydration status, sweat rate, sweat Na⁺ losses, and carbohydrate intake in response to training in cool and hot environments and at low and high exercise intensities.

Hot water immersion acutely increases postprandial glucose concentrations

Chronic hot water immersion (HWI) confers health benefits, including a reduction in fasting blood glucose concentration. Here we investigate acute glycemic control immediately after HWI. Ten participants (age: 25 ± 6 years, body mass: 84 ± 14 kg, height 1.85 ± 0.09 m) were immersed in water (39°C) to the neck (HWI) or sat at room temperature (CON) for 60 min. One hour afterward they underwent an oral glucose tolerance test (OGTT), with blood collected before and after HWI/CON and during the 2 h OGTT. Glucose incremental area under the curve (iAUC) during the OGTT was higher for HWI (HWI 233 ± 88, CON 156 ± 79 mmol·L^-1 ·2 h, P = 0.02). Insulin iAUC did not differ between conditions (HWI 4309 ± 3660, CON 3893 ± 3031 mU·L^-1 ·2 h, P = 0.32). Core temperature increased to 38.6 ± 0.2°C during HWI, but was similar between trials during the OGTT (HWI 37.0 ± 0.2, CON 36.9 ± 0.4°C, P = 0.34). Directly following HWI, plasma average adrenaline and growth hormone concentrations increased 2.7 and 10.7-fold, respectively (P < 0.001). Plasma glucagon-like peptide-1, peptide YY, and acylated ghrelin concentrations were not different between trials during the OGTT (P > 0.11). In conclusion, HWI increased postprandial glucose concentration to an OGTT, which was accompanied by acute elevations of stress hormones following HWI. The altered glycemic control appears to be unrelated to changes in gut hormones during the OGTT.

Oral nitrate reduction is not impaired after training in chlorinated swimming pool water in elite swimmers

This study tested the hypothesis that exposure to chlorine-sterilised pool water would impair oral nitrate reduction (ONR). ONR was assessed in elite swimmers before and after morning and afternoon pool-based training. Nonswimmers were only assessed in the morning. ONR was similar in swimmers and nonswimmers (P = 1.000) and unchanged before and after morning and afternoon training (P ≥ 0.341). Therefore, exposure to chlorinated pool water does not interfere with ONR. Novelty Exposure to chlorine-sterilised pool water does not impair oral nitrate reduction in elite swimmers.

The effect of hydration status on plasma FGF21 concentrations in humans: A subanalysis of a randomised crossover trial

Aim

Fibroblast growth factor 21 (FGF21) has recently been implicated in thirst in rodent models. The mechanisms for this are currently uncertain, and it is unclear whether hydration status can alter FGF21 concentrations, potentially providing an additional mechanism by which hypohydration induces thirst. The aim of this study is therefore to understand whether hydration status can alter circulating FGF21 in humans.

Methods

Using a heat tent and fluid restriction, we induced hypohydration (1.9% body mass loss) in 16 healthy participants (n = 8 men), and compared their glycaemic regulation to a rehydration protocol (heat tent and fluid replacement) in a randomised crossover design.

Results

After the hypohydration procedure, urine specific gravity, urine and serum osmolality, and plasma copeptin (as a marker for arginine vasopressin) increased as expected, with no change after the rehydration protocol. In the fasted state, the median paired difference in plasma FGF21 concentrations from the rehydrated to hypohydrated trial arm was -37 (interquartile range -125, 10) pg∙mL^-1(P = 0.278), with average concentrations being 458 ± 462 pg∙mL^-1 after hypohydration and 467 ± 438 pg∙mL^-1 after rehydration; mean difference -9 ± 173 pg∙mL^-1.

Conclusion

To our knowledge, these are the first causal data in humans investigating hydration and FGF21, demonstrating that an acute bout of hypohydration does not impact fasted plasma FGF21 concentrations. These data may suggest that whilst previous research has found FGF21 administration can induce thirst and drinking behaviours, a physiological state implicated in increased thirst (hypohydration) does not appear to impact plasma FGF21 concentrations in humans.

Does Hypohydration Really Impair Endurance Performance? Methodological Considerations for Interpreting Hydration Research

The impact of alterations in hydration status on human physiology and performance responses during exercise is one of the oldest research topics in sport and exercise nutrition. This body of work has mainly focussed on the impact of reduced body water stores (i.e. hypohydration) on these outcomes, on the whole demonstrating that hypohydration impairs endurance performance, likely via detrimental effects on a number of physiological functions. However, an important consideration, that has received little attention, is the methods that have traditionally been used to investigate how hypohydration affects exercise outcomes, as those used may confound the results of many studies. There are two main methodological limitations in much of the published literature that perhaps make the results of studies investigating performance outcomes difficult to interpret. First, subjects involved in studies are generally not blinded to the intervention taking place (i.e. they know what their hydration status is), which may introduce expectancy effects. Second, most of the methods used to induce hypohydration are both uncomfortable and unfamiliar to the subjects, meaning that alterations in performance may be caused by this discomfort, rather than hypohydration per se. This review discusses these methodological considerations and provides an overview of the small body of recent work that has attempted to correct some of these methodological issues. On balance, these recent blinded hydration studies suggest hypohydration equivalent to 2–3% body mass decreases endurance cycling performance in the heat, at least when no/little fluid is ingested.

Effect of Plain Versus Sugar-Sweetened Breakfast on Energy Balance and Metabolic Health: A Randomized Crossover Trial

OBJECTIVE

This study investigated the effect of 3 weeks of high-sugar ("Sweet") versus low-sugar ("Plain") breakfast on energy balance, metabolic health, and appetite.

METHODS

A total of 29 healthy adults (22 women) completed this randomized crossover study. Participants had pre- and postintervention appetite, health, and body mass outcomes measured, and they recorded diet, appetite (visual analogue scales), and physical activity for 8 days during each intervention. Interventions were 3 weeks of isoenergetic Sweet (30% by weight added sugar; average 32 g of sugar) versus Plain (no added sugar; average 8 g of sugar) porridge-based breakfasts.

RESULTS

Pre- to postintervention changes in body mass were similar between Plain (Δ 0.1 kg; 95% CI: -0.3 to 0.5 kg) and Sweet (Δ 0.2 kg; 95% CI: -0.2 to 0.5 kg), as were pre- to postintervention changes for biomarkers of health (all P ≥ 0.101) and psychological appetite (all P ≥ 0.152). Energy, fat, and protein intake was not statistically different between conditions. Total carbohydrate intake was higher during Sweet (287 ± 82 g/d vs. 256 ± 73 g/d; P = 0.009), driven more by higher sugar intake at breakfast (116 ± 46 g/d vs. 88 ± 38 g/d; P < 0.001) than post-breakfast sugar intake (Sweet 84 ± 42 g/d vs. Plain 80 ± 37 g/d; P = 0.552). Participants reported reduced sweet desire immediately after Sweet but not Plain breakfasts (trial × time P < 0.001).

CONCLUSIONS

Energy balance, health markers, and appetite did not respond differently to 3 weeks of high- or low-sugar breakfasts.

Viscous placebo and carbohydrate breakfasts similarly decrease appetite and increase resistance exercise performance compared with a control breakfast in trained males

Given the common view that pre-exercise nutrition/breakfast is important for performance, the present study investigated whether breakfast influences resistance exercise performance via a physiological or psychological effect. Twenty-two resistance-trained, breakfast-consuming men completed three experimental trials, consuming water-only (WAT), or semi-solid breakfasts containing 0 g/kg (PLA) or 1·5 g/kg (CHO) maltodextrin. PLA and CHO meals contained xanthan gum and low-energy flavouring (approximately 122 kJ), and subjects were told both 'contained energy'. At 2 h post-meal, subjects completed four sets of back squat and bench press to failure at 90 % ten repetition maximum. Blood samples were taken pre-meal, 45 min and 105 min post-meal to measure serum/plasma glucose, insulin, ghrelin, glucagon-like peptide-1 and peptide tyrosine-tyrosine concentrations. Subjective hunger/fullness was also measured. Total back squat repetitions were greater in CHO (44 (sd 10) repetitions) and PLA (43 (sd 10) repetitions) than WAT (38 (sd 10) repetitions; P < 0·001). Total bench press repetitions were similar between trials (WAT 37 (sd 7) repetitions; CHO 39 (sd 7) repetitions; PLA 38 (sd 7) repetitions; P = 0·130). Performance was similar between CHO and PLA trials. Hunger was suppressed and fullness increased similarly in PLA and CHO, relative to WAT (P < 0·001). During CHO, plasma glucose was elevated at 45 min (P < 0·05), whilst serum insulin was elevated (P < 0·05) and plasma ghrelin suppressed at 45 and 105 min (P < 0·05). These results suggest that breakfast/pre-exercise nutrition enhances resistance exercise performance via a psychological effect, although a potential mediating role of hunger cannot be discounted.

A96 PERIOPERATIVE RATE OF CHANGE IN SODIUM CONCENTRATION AND ITS IMPACT ON LENGTH OF STAY IN CRITICAL CARE UNIT POST LIVER TRANSPLANTATION: BENCHMARKING FOR QUALITY MANAGEMENT PROGRAM

Aims

The aim of this quality improvement project was to benchmark the rate of change in serum sodium (delta-Na) in the perioperative period for liver transplantation (OLT) to correlate it with neurological complications as well as length of stay in critical care unit.

Methods

Data for total of 46 patients who underwent liver transplantation in Halifax between January 2015 and December 2016 were extracted from Atlantic Multi-Organ Transplant Program and QEII-HSC Information Systems. Pre-operative, immediate post-operative and 24–48 hours post-operative serum sodium concentrations were entered into EXCEL worksheet. In addition post-transplant neurological complications were identified in addition to length of stay in critical care unit.

Results

During the review period, 23 males and 23 females underwent OLT. Their mean age was 56 yrs (ranging from 23 - 70 yrs). The primary indication for transplantation was cirrhosis (57%) and hepatocellular carcinoma (35%). Fatty liver disease was most common etiology for cirrhosis (46%), followed by PBC (27%), Alcohol-related (15%). Average natural MELD-Na score was 20 (with a range from 7 – 41). Average OR time was 7hr 23min (range 4hr 15min – 15hr).

In 22% of patients, the rate of delta-Na levels were rapid (more than 8 mEq/L) between the pre-operative and immediate post-operative period. Only 2% of patients had more than 8 mEq/L change in their serum sodium levels between the first and second post-operative days. Prior to OLT 21 (46%) patients had hepatic encephalopathy but this was mild or controlled in the majority of patients. In 8 (17%) patients there was multiple-etiology encephalopathy/delirium in the post-operative period. None of these patients developed neurological deficits. Only in 3 patients, tremors were documented (probably multifactorial including calcineurin-inhibitor toxicity). In this project, none of these findings correlated with a high rate of delta-Na.

The average number of days in critical care unit was 6 (range 1 – 62 days). There was no clear correlation between length of stay (surrogate marker for neurologic complications) and rate of delta-Na.

Conclusions

In this benchmarking project, we were unable to identify a specific cut-off rate for delta-Na to correlate with either neurologic complication or length of stay in critical care unit. Rapid correction of serum sodium is often associated with various neurologic complications including central pontine myelinosis. Larger data-base with more numbers of liver transplant patients are needed to show any significant relationship and optimize the electrolyte and volume management. Rapid change in serum sodium could not help with our attempt to classify this benchmarking metric into one of four categories: productivity, quality, time and cost-related.

Funding Agencies

NoneKEVORK M PELTEKIAN

Addition of sodium alginate and pectin to a carbohydrate-electrolyte solution does not influence substrate oxidation, gastrointestinal comfort, or cycling performance

Eight well-trained cyclists ingested 68 g·h^-1 of a carbohydrate-electrolyte solution with sodium alginate and pectin (CHO-ALG) or a taste and carbohydrate type-matched carbohydrate-electrolyte solution (CHO) during 120 min of cycling at 55% maximal power followed by an ∼20 min time trial. Oxygen uptake, carbon dioxide production, blood glucose concentration, substrate oxidation, gastrointestinal symptoms, and time trial performance (CHO-ALG: 1219 ± 84 s, CHO: 1267 ± 102 s; P = 0.185) were not different between trials. Novelty Inclusion of sodium alginate and pectin in a carbohydrate drink does not influence blood glucose, substrate oxidation, gastrointestinal comfort, or performance in cyclists.

High-Fat Overfeeding Impairs Peripheral Glucose Metabolism and Muscle Microvascular eNOS Ser1177 Phosphorylation

CONTEXT

The mechanisms responsible for dietary fat-induced insulin resistance of skeletal muscle and its microvasculature are only partially understood.

OBJECTIVE

To determine the impact of high-fat overfeeding on postprandial glucose fluxes, muscle insulin signaling, and muscle microvascular endothelial nitric oxide synthase (eNOS) content and activation.

DESIGN

Fifteen non-obese volunteers consumed a high-fat (64%) high-energy (+47%) diet for 7 days. Experiments were performed before and after the diet. Stable isotope tracers were used to determine glucose fluxes in response to carbohydrate plus protein ingestion. Muscle insulin signaling was determined as well as the content and activation state of muscle microvascular eNOS.

RESULTS

High-fat overfeeding impaired postprandial glycemic control as demonstrated by higher concentrations of glucose (+11%; P = 0.004) and insulin (+19%; P = 0.035). Carbohydrate plus protein ingestion suppressed endogenous glucose production to a similar extent before and after the diet. Conversely, high-fat overfeeding reduced whole-body glucose clearance (-16%; P = 0.021) and peripheral insulin sensitivity (-26%; P = 0.006). This occurred despite only minor alterations in skeletal muscle insulin signaling. High-fat overfeeding reduced eNOS content in terminal arterioles (P = 0.017) and abolished the increase in eNOS Ser1177 phosphorylation that was seen after carbohydrate plus protein ingestion.

CONCLUSION

High-fat overfeeding impaired whole-body glycemic control due to reduced glucose clearance, not elevated endogenous glucose production. The finding that high-fat overfeeding abolished insulin-mediated eNOS Ser1177 phosphorylation in the terminal arterioles suggests that impairments in the vasodilatory capacity of the skeletal muscle microvasculature may contribute to early dietary fat-induced impairments in glycemic control.