Serum iron availability, but not iron stores, is lower in naturally menstruating than in oral contraceptive athletes.

This study measured serum markers of iron status in naturally menstruating and oral contraceptive (OC) athletes during the main hormonal milieus of these two profiles to identify potential differences confounding the diagnosis of iron deficiency in female athletes. Resting blood samples were collected from 36 naturally menstruating athletes during the early-follicular phase (EFP), mid- late-follicular phase (MLFP) and mid-luteal phase (MLP) of the menstrual cycle. Simultaneously, blood samples were collected from 24 OC athletes during the withdrawal and active-pill phase of the OC cycle. Serum iron, ferritin, transferrin, transferrin saturation (TSAT), C-reactive protein (CRP), interleukin-6 and sex hormones were analyzed. Naturally menstruating athletes showed lower levels of TSAT, iron and transferrin than OC athletes when comparing the bleeding phase of both profiles (p<0.05) as well as when comparing all analyzed phases of the menstrual cycle to the active pill phase of the OC cycle (p<0.05). Interestingly, only lower transferrin was found during MLFP and MLP compared to the withdrawal phase of the OC cycle (p>0.05), with all other iron markers showing no differences (p>0.05). Intracycle variations were also found within both types of cycle, presenting reduced TSAT and iron during menstrual bleeding phases (p<0.05). In conclusion, in OC athletes, serum iron availability, but not serum ferritin, seems higher than in naturally menstruating ones. However, such differences are lost when comparing the MLFP and MLP of the menstrual cycle with the withdrawal phase of the OC cycle. This should be considered in the assessment of iron status in female athletes.Highlights Naturally menstruating athletes present lower TSAT, iron and transferrin in all analyzed phases of the menstrual cycle compared to OC athletes during their active pill phase. However, both the mid-late follicular and mid-luteal phases of the menstrual cycle do not differ from the withdrawal phase of the oral contraceptive cycle.Intracycle variations are found for TSAT and iron in both naturally menstruating and oral contraceptive athletes, which are mainly driven by a reduction in TSAT and iron during menstrual bleeding phases.As serum iron availability changes significantly as a function of the athlete's hormonal status, it should be considered in the assessment of the athlete's iron status as well as standardise the phase of the menstrual cycle in which to assess iron markers to avoid misdiagnosis or misleading results.In contrast, the assessment of iron stores through serum ferritin is substantially stable and the athlete's hormonal status does not seem to be of relevance for this purpose.

Menstrual cycle affects iron homeostasis and hepcidin following interval running exercise in endurance-trained women.

PURPOSE: Menstrual cycle phase affects resting hepcidin levels, but such effects on the hepcidin response to exercise are still unclear. Thus, we investigated the hepcidin response to running during three different menstrual cycle phases. METHODS: Twenty-one endurance-trained eumenorrheic women performed three identical interval running protocols during the early-follicular phase (EFP), late-follicular phase (LFP), and mid-luteal phase (MLP). The protocol consisted of 8 × 3 min bouts at 85% of the maximal aerobic speed, with 90-s recovery. Blood samples were collected pre-exercise and at 0 h, 3 h and 24 h post-exercise. RESULTS: Data presented as mean ± SD. Ferritin were lower in the EFP than the LFP (34.82 ± 16.44 vs 40.90 ± 23.91 ng/ml, p = 0.003), while iron and transferrin saturation were lower during the EFP (58.04 ± 19.70 µg/dl, 14.71 ± 5.47%) compared to the LFP (88.67 ± 36.38 µg/dl, 22.22 ± 9.54%; p < 0.001) and the MLP (80.20 ± 42.05 µg/dl, 19.87 ± 10.37%; p = 0.024 and p = 0.045, respectively). Hepcidin was not affected by menstrual cycle (p = 0.052) or menstrual cycle*time interaction (p = 0.075). However, when comparing hepcidin at 3 h post-exercise, a moderate and meaningful effect size showed that hepcidin was higher in the LFP compared to the EFP (3.01 ± 4.16 vs 1.26 ± 1.25 nMol/l; d = 0.57, CI = 0.07-1.08). No effect of time on hepcidin during the EFP was found either (p = 0.426). CONCLUSION: The decrease in iron, ferritin and TSAT levels during the EFP may mislead the determination of iron status in eumenorrheic athletes. However, although the hepcidin response to exercise appears to be reduced in the EFP, it shows no clear differences between the phases of the menstrual cycle (clinicaltrials.gov: NCT04458662).

Hepcidin and interleukin-6 responses to endurance exercise over the menstrual cycle.

The aim of the current study was to investigate iron metabolism in endurance trained women through the interleukin-6, hepcidin and iron responses to exercise along different endogenous hormonal states. Fifteen women performed 40 min treadmill running trials at 75% vVO2peak during three specific phases of the menstrual cycle: early follicular phase (day 3 ± 0.85), mid-follicular phase (day 8 ± 1.09) and luteal phase (day 21 ± 1.87). Venous blood samples were taken pre-, 0 h post- and 3 h post-exercise. Interleukin-6 reported a significant interaction for menstrual cycle phase and time (p=0.014), showing higher interleukin-6 levels at 3 h post-exercise during luteal phase compared to the early follicular phase (p=0.004) and the mid-follicular phase (p=0.002). Iron levels were significantly lower (p=0.009) during the early follicular phase compared to the mid-follicular phase. However, hepcidin levels were not different across menstrual cycle phases (p>0.05). The time-course for hepcidin and interleukin-6 responses to exercise was different from the literature, since hepcidin peak levels occurred at 0 h post-exercise, whereas the highest interleukin-6 levels occurred at 3 h post-exercise. We concluded that menstrual cycle phases may alter interleukin-6 production causing a higher inflammation when progesterone levels are elevated (days 19-21). Moreover, during the early follicular phase a significant reduction of iron levels is observed potentially due to a loss of haemoglobin through menses. According to our results, high intensity exercises should be carefully monitored in these phases in order not to further compromise iron stores.

Hepcidin response to interval running exercise is not affected by oral contraceptive phase in endurance-trained women.

The use of oral contraceptives (OCs) by female athletes may lead to improved iron status, possibly through the regulation of hepcidin by sex hormones. The present work investigates the response of hepcidin and interleukin-6 (IL-6) to an interval exercise in both phases of the OC cycle. Sixteen endurance-trained OC users (age 25.3 ± 4.7 years; height 162.4 ± 5.7 cm; body mass 56.0 ± 5.7 kg; body fat percentage 24.8 ± 6.0%; peak oxygen consumption [VO2peak ]: 47.4 ± 5.5 mL min-1 kg-1 ) followed an identical interval running protocol during the withdrawal and active pill phases of the OC cycle. This protocol consisted of 8 × 3 minutes bouts at 85% VO2peak speed with 90 seconds recovery intervals. Blood samples were collected pre-exercise, and at 0 hour, 3 hours, and 24 hours post-exercise. Pre-exercise 17ß-estradiol was lower (P = .001) during the active pill than the withdrawal phase (7.91 ± 1.81 vs 29.36 ± 6.45 pg/mL [mean ± SEM]). No differences were seen between the OC phases with respect to hepcidin or IL-6 concentrations, whether taking all time points together or separately. However, within the withdrawal phase, hepcidin concentrations were higher at 3 hours post-exercise (3.33 ± 0.95 nmol/L) than at pre-exercise (1.04 ± 0.20 nmol/L; P = .005) and 0 hour post-exercise (1.41 ± 0.38 nmol/L; P = .045). Within both OC phases, IL-6 was higher at 0 hour post-exercise than at any other time point (P < .05). Similar trends in hepcidin and IL-6 concentrations were seen at the different time points during both OC phases. OC use led to low 17ß-estradiol concentrations during the active pill phase but did not affect hepcidin. This does not, however, rule out estradiol affecting hepcidin levels.

Influence of the Menstrual Cycle on Blood Markers of Muscle Damage and Inflammation Following Eccentric Exercise.

The aim of this study was to evaluate whether the menstrual cycle and its underlying hormonal fluctuations affect muscle damage and inflammation in well-trained females following an eccentric exercise. Nineteen eumenorrheic women performed an eccentric squat-based exercise in the early follicular phase, late follicular phase and mid-luteal phase of their menstrual cycle. Sex hormones and blood markers of muscle damage and inflammation -creatine kinase, myoglobin, lactate dehydrogenase, interleukin-6, tumoral necrosis factor-, and C reactive protein- were analyzed in each phase. No effect of menstrual cycle phase was observed (p > 0.05), while an interaction for interleukin-6 was shown (p = 0.047). Accordingly, a moderate effect size [0.68 (0.53)-0.84 (0.74)], indicated that interleukin-6 values 2 h post-trial (2.07 1.26 pg/mL) were likely to be higher than baseline (1.59 0.33 pg/mL), 24 h (1.50 0.01 pg/mL) and 48 h (1.54 0.13 pg/mL) in the mid-luteal phase. Blood markers of muscle damage and inflammation were not affected by the menstrual cycle in well-trained women. The eccentric exercise barely triggered muscle damage and hence, no inflammation was observed, possibly due to participants training status. The mid-luteal phase was the only phase reflecting a possible inflammatory response in terms of interleukin-6, although further factors than sex hormones seem to be responsible for this finding.

Cierre percutáneo de fístula arteriovenosa pulmonar en una adolescente: Reporte de un caso / Transcatheter closure of pulmonary arteriovenous fistula in adolescent: Case report

Las fístulas arteriovenosas, también llamadas malformaciones arteriovenosas pulmonares (MAVP), corresponden a un reducido grupo de patologías vasculares que en un 85% se originan de la comunicación de una arteria aferente con una vena eferente. Las congénitas son las menos frecuentes. Se presenta el caso de una adolescente de 13 años, asintomática, con soplo continuo y saturación periférica de 88%. Mediante estudios de imagen se corrobora la presencia de una fistula arteriovenosa a nivel pulmonar, que es cerrada por intervencionismo con dispositivo oclusor. Una vez tratado el defecto, la evolución de la paciente es satisfactoria. Conclusiones: Mediante el caso se abordan las herramientas clínicas y diagnósticas de las MAVP, así como las indicaciones de los modos terapéuticos.

Arteriovenous fistulas also called pulmonary arteriovenous malformations (PAVM) are a small group of vascular pathologies in 85% originate from the communication afferent efferent artery to a vein. Congenital are less frequent. The case of a 13-year-old asymptomatic continuous murmur and peripheral saturation of 88% is presented. By imaging the presence of an arteriovenous fistula in the lung, which is closed by intervention with occluder device is corroborated. Once treated the defect, the evolution of the patient is satisfactory. Conclusions: Using the case of clinical and diagnostic tools MAVP addresses, and the particulars of the therapeutic modes.

Parámetros bioquímicos a lo largo de tres microciclos de entrenamiento intenso en triatletas de élite / Biochemical parameters along three intense training microcycles in elite triathletes

Algunos investigadores han utilizado la información que suministran determinados parámetros sanguíneos para el control biológico del entrenamiento. Entre estos parámetros los más utilizados como indicadores de sobreentrenamiento son: creatina kinasa (CK), urea (U), cortisol (C), testosterona (T) y relación testosterona/cortisol (T/C). El objetivo de este estudio fue determinar la evolución de CK, U, C,T y T/C a lo largo de 3 microciclos (M) de entrenamiento, comparando los valores tras una sesión de entrenamiento intenso con los obtenidos tras una sesión de recuperación. Seis triatletas masculinos de élite participaron en el estudio y fueron seguidos durante un periodo de entrenamiento de 31 semanas. Se estudiaron los microciclos 8, 22 y 31 (M1, M2 y M3, respectivamente). Se realizaron 7 extracciones sanguíneas en los siguientes momentos: una analítica en octubre en el periodo de descanso, y dos analíticas al final de cada M (tras una sesión de entrenamiento y una de recuperación). En cada M se registraron los datos de entrenamiento así como los de percepción de la carga y recuperación. La CK descendió de forma significativa tras una sesión de recuperación después de haber alcanzado valores significativamente superiores a los de referencia (129,5±80,2 U/l) en el M1 (Entrenamiento: 303,2±141,8 U/l vs. Recuperación: 211,3±65,4 U/l; P < 0,05), en el M2 (Entrenamiento: 316,2±134,1 U/l vs. Recuperación: 238,2±149 U/l; P < 0,05) y M3 (Entrenamiento: 383,3±231,0U/l vs. Recuperación: 209,8±98,2 U/l; P < 0,05). Ni la U ni la T experimentaron variaciones significativas tras una sesión de recuperación, mientras que el C sólo descendió significativamente en M3 (Entrenamiento: 23±2,3 μg/dl vs. Recuperación: 18,9±2,7 μg/dl: P < 0,05). En conclusión, este estudio muestra las variaciones que experimentan varios parámetros sanguíneos a lo largo de tres microciclos de entrenamiento intenso, en los que ninguno de los deportistas experimentó ningún síntoma de sobreentrenamiento (AU)

Some researchers have used the information provided by certain blood parameters for training control. The parameters which are normally used as indicators of overtraining are: creatine kinase (CK), urea (U), cortisol (C), testosterone (T) and the ratio testosterone/cortisol (T/C). The aim of this study was to determine the evolution of CK, U, C, T and T/C along three training microcycles (M), comparing the values obtained after an intense training session with those obtained after a recovery session. Six elite male triathletes participated in the study and they were followed for a period of 31 weeks. The microcycles 8,22 and 31 were studied (M1, M2 and M3, respectively). Seven blood samples were obtained at the following moments: one sample in October in the rest period, and two more at the end of each M (after a training session and a recovery session). The following variables were measured: CK, U, C, T and T/C. Data training and perceived effort were recorded in each M. Creatine kinase decreased significantly after a recovery session after reaching significantly higher values than the reference (129.5±80.2 U/l) in the M1 (Training: 303.2±141.8 U/l vs. Recovery: 211.3±65.4 U/l; P < 0.05), in the M2 (Training: 316.2±134.1 U/l vs. Recovery: 238.2±149 U/l; P < 0.05) and M3 (Training: 383.3±231.0 U/l vs. Recovery: 209.8±98.2U/l; P < 0.05). Neither U or T changed significantly after a recovery session, while C decreased significantly only in M3 (Training: 23±2.3 μg/dl vs. Recovery: 18.9±2.7 μg/dl; P <0.05). In conclusion, this study shows the changes experienced by several blood parameters through three intense training microcycles, in which none of the triathletes experienced any symptoms of overtraining (AU)

Cardiovascular adaptation, functional capacity and Angiotensin-converting enzyme I/D polymorphism in elite athletes.

INTRODUCTION AND OBJECTIVES: Angiotensin-converting enzyme (ACE) is associated with the development of cardiac hypertrophy and improved physical fitness. The objective of this study was to investigate the relationship between the ACE gene insertion/deletion (I/D) polymorphism and adaptation to sports training. METHODS: The study included 299 elite Spanish athletes (193 men and 106 women) from 32 different sports disciplines, which were grouped according to their static and dynamic components. All participants underwent body composition analysis, Doppler echocardiography at rest, and ergospirometry. Their ACE genotype was determined using the polymerase chain reaction. RESULTS: The most common genotype in both males and females was the deletion-insertion (DI) heterozygote (57.5% and 54.7%, respectively), followed by the DD homozygote (30.6% and 34.9%), and the II homozygote (11.9% and 10.4%). Differences in morphometric and functional cardiac adaptation were observed between the different sports disciplines, but there was no statistically significant relationship with the ACE I/D polymorphism. Moreover, when athletes with different genotypes were compared, the only differences observed were between the DD and DI groups in female athletes, who differed in body mass index and longitudinal right atrial dimension. CONCLUSIONS: The ACE I/D polymorphism did not appear to influence cardiovascular adaptation in response to training. However, the DI genotype was the most common, probably because the sample was biased by being made up of elite athletes.

Adaptación cardiovascular, capacidad funcional y polimorfismo inserción/deleción de la enzima de conversión de angiotensina en deportistas de élite / Cardiovascular adaptation, functional capacity and angiotensin-converting enzyme I/D polymorphism in elite athletes

Introducción y objetivos. La enzima de conversión de angiotensina (ECA) se relaciona con el desarrollo de hipertrofia cardiaca y mejora de la condición física. El objetivo del estudio es analizar la relación entre el polimorfismo inserción/deleción (I/D) del gen de la ECA y la adaptación al entrenamiento. Métodos. Se estudió a 299 deportistas españoles de alto nivel (193 varones y 106 mujeres) de 32 disciplinas deportivas, agrupadas según sus componentes estático y dinámico, mediante análisis de la composición corporal, eco-Doppler en reposo y ergoespirometría. El genotipo de la ECA se determinó mediante la técnica de la reacción en cadena de la polimerasa (PCR). Resultados. El genotipo más frecuente fue el heterocigoto DI (el 57,5 y el 54,7%), seguido de los homocigotos DD (el 30,6 y el 34,9%) e II (el 11,9 y el 10,4%), en varones y mujeres respectivamente. Hay diferencias en las adaptaciones morfológicas y funcionales entre las modalidades deportivas, pero no se obtuvo asociación estadísticamente significativa con relación al polimorfismo I/D de la ECA. En el estudio comparativo entre los distintos genotipos, sólo en la muestra femenina se encontraron diferencias entre los grupos DD y DI en el índice de masa corporal y en la dimensión superoinferior de la aurícula derecha. Conclusiones. El polimorfismo I/D del gen de la ECA parece que no influye en la adaptación cardiovascular al entrenamiento; sin embargo, el genotipo DI es el más frecuente, probablemente debido a un sesgo de la muestra, compuesta por deportistas de élite (AU)

Introduction and objectives. Angiotensin-converting enzyme (ACE) is associated with the development of cardiac hypertrophy and improved physical fitness. The objective of this study was to investigate the relationship between the ACE gene insertion/deletion (I/D) polymorphism and adaptation to sports training. Methods. The study included 299 elite Spanish athletes (193 men and 106 women) from 32 different sports disciplines, which were grouped according to their static and dynamic components. All participants underwent body composition analysis, Doppler echocardiography at rest, and ergospirometry. Their ACE genotype was determined using the polymerase chain reaction. Results. The most common genotype in both males and females was the deletion-insertion (DI) heterozygote (57.5% and 54.7%, respectively), followed by the DD homozygote (30.6% and 34.9%), and the II homozygote (11.9% and 10.4%). Differences in morphometric and functional cardiac adaptation were observed between the different sports disciplines, but there was no statistically significant relationship with the ACE I/D polymorphism. Moreover, when athletes with different genotypes were compared, the only differences observed were between the DD and DI groups in female athletes, who differed in body mass index and longitudinal right atrial dimension. Conclusions. The ACE I/D polymorphism did not appear to influence cardiovascular adaptation in response to training. However, the DI genotype was the most common, probably because the sample was biased by being made up of elite athletes (AU)