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Effect of ingesting carbohydrate only or carbohydrate plus casein protein hydrolysate during a multiday cycling race on left ventricular function, plasma volume expansion and cardiac biomarkers

  • Tanja OosthuyseEmail author
  • Andrew N. Bosch
  • Aletta M. E. Millen
Original Article

Abstract

Purpose

Multiday racing causes mild left ventricular (LV) dysfunction from day 1 that persists on successive days. We evaluated ingesting casein protein hydrolysate–carbohydrate (PRO) compared with carbohydrate-only (CHO) during a 3-day mountain bike race.

Methods

Eighteen male cyclists were randomly assigned to ingest 6.7% carbohydrate without (CHO) or with 1.3% casein hydrolysate (PRO) during racing (~ 4–5 h/day; 68/71/71 km). Conventional LV echocardiography, plasma albumin content, plasma volume (PV) and blood biomarkers were measured before day 1 and post race on day 3.

Results

Fourteen cyclists (n = 7 per group) completed the race. PV increased in CHO (mean increase (95% CI), 10.2% (0.1 to 20.2)%, p = 0.045) but not in PRO (0.4% (− 6.1 to 6.9)%). Early diastolic transmitral blood flow (E) was unchanged but deceleration time from peak E increased post race (CHO: 46.7 (11.8 to 81.6) ms, p = 0.019; PRO: 24.2 (− 0.5 to 48.9) ms, p = 0.054), suggesting impaired LV relaxation. Tissue Doppler mitral annular velocity was unchanged in CHO, but in PRO septal early-to-late diastolic ratio decreased (p = 0.016) and was compensated by increased lateral early (p = 0.034) and late (p = 0.012) velocities. Systolic function was preserved in both groups; with increased systolic lateral wall velocity in PRO (p = 0.002). Effect size increase in serum creatine kinase (CK) activity, CK-MB and C-reactive protein concentrations was less in PRO than CHO (Cohen’s d mean ± SD, PRO: 2.91 ± 2.07; CHO: 7.56 ± 4.81, p = 0.046).

Conclusion

Ingesting casein hydrolysate with carbohydrate during a 3-day race prevented secondary hypervolemia and failed to curb impaired LV relaxation despite reducing tissue damage and inflammatory biomarkers. Without PV expansion, systolic function was preserved by lateral wall compensating for septal wall dysfunction.

Keywords

Endurance exercise Sports nutrition Serum albumin content Secondary hypervolemia Echocardiography Inflammation Membrane stability 

Abbreviations

Change calculated as post minus pre race

A

Late diastolic transmitral blood flow velocity

a

Late diastolic mitral annular velocity

Ao

Aortic diameter

ALB

Plasma albumin

AV_Vmax

Peak systolic trans-aortic valve blood flow velocity

BV

Blood volume

CHO

Carbohydrate-only supplement

CI

Confidence interval

CK

Creatine kinase

CK-MB

Creatine kinase-MB isoform

cTnI

Cardiac troponin I

d

Cohen’s effect size

DBP

Diastolic blood pressure

E

Early diastolic transmitral blood flow velocity

e

Early diastolic mitral annular velocity

EDV

End diastolic volume

EF

Ejection fraction

ESV

End systolic volume

Hct

Haematocrit

Hb

Haemoglobin

hsCRP

High sensitivity C-reactive protein

LA

Left atrium

LV

Left ventricular

LVIDd

Left ventricular chamber diameter in diastole

PRO

Casein protein hydrolysate plus carbohydrate supplement

PV

Plasma volume

PWD

Pulsed-wave Doppler

s

Peak systolic mitral annular velocity

SBP

Systolic blood pressure

SD

Standard deviation

SV

Stroke volume

TDI

Tissue Doppler imaging

Notes

Acknowledgements

This study was funded by the University of the Witwatersrand Faculty of Health Sciences Research Committee.

Author contributions

TO, AB and AM conceived and designed the study. TO and AM conducted data collection and analysis. TO prepared the manuscript. AB and AM reviewed the manuscript. All authors approved the final version.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.School of Physiology, Faculty of Health SciencesUniversity of the Witwatersrand, Medical SchoolParktownSouth Africa
  2. 2.Division of Exercise Science and Sports Medicine, Department of Human BiologyUniversity of Cape TownCape TownSouth Africa

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