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
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.
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.
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).
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.
KeywordsEndurance exercise Sports nutrition Serum albumin content Secondary hypervolemia Echocardiography Inflammation Membrane stability
Change calculated as post minus pre race
Late diastolic transmitral blood flow velocity
Late diastolic mitral annular velocity
Peak systolic trans-aortic valve blood flow velocity
Creatine kinase-MB isoform
Cardiac troponin I
Cohen’s effect size
Diastolic blood pressure
Early diastolic transmitral blood flow velocity
Early diastolic mitral annular velocity
End diastolic volume
End systolic volume
High sensitivity C-reactive protein
Left ventricular chamber diameter in diastole
Casein protein hydrolysate plus carbohydrate supplement
Peak systolic mitral annular velocity
Systolic blood pressure
Tissue Doppler imaging
This study was funded by the University of the Witwatersrand Faculty of Health Sciences Research Committee.
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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