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Effects of protein–carbohydrate vs. carbohydrate alone supplementation on immune inflammation markers in endurance athletes: a randomized controlled trial

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The impact of ingesting carbohydrates alone or combined with proteins to support exercise immune adaptation in endurance athletes is scarcely investigated. The present study compares the effect of ingesting a combined protein–carbohydrate supplement vs. a carbohydrate-only supplement post-workout on immune inflammation markers following a 10 week periodized endurance training program in well-trained athletes.


Twenty-five men completed the study after being randomly assigned to one of the following intervention groups: combined protein–carbohydrate (PRO-CHO n = 12, 31 ± 9 years, \(\dot{\mathrm{V}}\)O2peak 61.0 ± 5.6−1.min−1) or non-protein isoenergetic carbohydrate (CHO, n = 13, 33 ± 8 years, \(\dot{\mathrm{V}}\)O2peak 60.6 ± 6.9−1.min−1). Treatment consisted of ingesting 24 g of assigned supplement, mixed with 250 ml of orange juice, once a day for 10 weeks immediately post-workout (or before breakfast on non-training days). Measurements were conducted pre- and post-intervention on total leukocytes, leukocyte subsets (i.e., neutrophils, eosinophils, basophils, monocytes, and lymphocytes), and platelets. The inflammatory status was assessed by the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), and the systemic-immune inflammation index (SII).


Post-intervention, significant increases were observed for CHO group only for the three inflammatory markers: NLR (p = 0.050, d = 0.58), PLR (p = 0.041, d = 0.60), and SII (p = 0.004, d = 0.81) but not for PRO-CHO (p > 0.05).


Ingesting a post-workout protein–carbohydrate combined beverage promoted a more favourable immune status than carbohydrate-only ingestion by attenuating cellular inflammation over a 10 week training period in endurance male athletes.

Trial Registration

The study was registered in with the following ID: NCT02954367. The study was registered by 3 November 2016.

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Data availability

Data are available upon request to the corresponding author.


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The authors wish to thank the subjects for their invaluable contribution to the study.


Research funding Real Madrid-European University of Madrid 2016/RM05. M. L. holds a Ramón y Cajal Fellowship 2012 11910. However, these do not affect this original research content and purpose.

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Authors and Affiliations



The study was designed by FN. Data were collected by DM and ML, and data were analysed by MR, AL, ELZ, and FN. Interpretation and manuscript preparation were undertaken by FN, DM, ML, ELZ, JR, and AL. All authors approved the final version of the paper. We would like to thank the “Run Faster & Better training group” for their participation in this project.

Corresponding author

Correspondence to Álvaro López-Samanes.

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The authors declare that they have no conflicts of interest relevant to the content of this manuscript.

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Communicated by Fabio Fischetti.

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Moreno-Pérez, D., López-Samanes, Á., Larrosa, M. et al. Effects of protein–carbohydrate vs. carbohydrate alone supplementation on immune inflammation markers in endurance athletes: a randomized controlled trial. Eur J Appl Physiol 123, 1495–1505 (2023).

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