Carbohydrate Supplementation Research Articles

Development and Validation of the Scale of Hypoglycemia Self-Care Behavior in Type 2 Diabetes.

Inappropriate dietary, exercise, and medication self-care behaviors among persons with diabetes can easily trigger hypoglycemia. Clinically, it is necessary to quickly identify high-risk groups for hypoglycemic events to provide targeted hypoglycemia education. However, there is currently a lack of precise tools to assess self-care behaviors related to hypoglycemia. To develop and validate a hypoglycemia self-care behavior scale for evaluating the behaviors of persons with diabetes in handling and preventing hypoglycemic events. A cross-sectional study with purposive sampling was conducted to recruit 300 persons with type 2 diabetes who had experienced hypoglycemic events from a medical center and a primary care clinic in southern Taiwan. Data were collected using a structured questionnaire from December 2021 to September 2023. The original hypoglycemia self-care behavior scale, comprising 26 items, was reduced to 17 items, measuring six factors after exploratory factor analysis. Subsequently, the scale was further refined to 10 items covering four factors through structural equation modeling. The validity and reliability were assessed during this process, and the developed scale was subsequently verified for both. Factor loadings ranged from .50-.97, explaining 76% of the total variance. The four factors included "hypoglycemia recognition and carbohydrate supplementation," "prevention of hypoglycemia during exercise," "carbohydrate assessment," and "seeking medical assistance." The hypoglycemia self-care behavior scale-developed and validated through structural equation modeling-demonstrates satisfactory model fit, convergent validity, and discriminant validity. Internal consistency was within the range of .73-.94, indicating strong reliability. The hypoglycemia self-care behavior scale not only functions as a tool for the rapid assessment of self-care behaviors during hypoglycemic events by clinical health care professionals but can also serve as reference for hypoglycemia-related health education.

Carbohydrate supplementation maintains physical performance during short-term energy deficit despite reductions in exogenous glucose oxidation.

Exogenous glucose oxidation is reduced 55% during aerobic exercise after three days of complete starvation. Whether energy deficits more commonly experienced by athletes and military personnel similarly affect exogenous glucose oxidation and what impact this has on physical performance remains undetermined. This randomized, longitudinal parallel study aimed to assess the effects of varying magnitudes of energy deficit (DEF) on exogenous glucoseoxidation and physical performance compared to energy balance (BAL). Participants consumed a4-day BAL diet, followed by a 6-day 20% (n=10), 40% (n=10), or 60% (n=10) DEF diet. At the end of each energy phase participants performed 90-min of steady-state cycle ergometry (56±3% V̇O2peak) while consuming a glucose drink (80 g), followed by a time to exhaustion (TTE) performance test. Substrate oxidation (g/min) was determined by indirect calorimetry and 13C glucose. Muscle glycogen (mmol/kg dry weight) and transcript accumulation were assessed in rested fasted muscle collected before exercise in each phase. Muscle glycogen was lower (P = 0.002) during DEF (365±179) than BAL (456±125), regardless of group. Transcriptional regulation of glucose uptake (GLUT4italic> and IRS2) and glycogenolysis (HKII and PKM) were lower (P < 0.05) during DEF than BAL, independent of group. Regardless of group, exogenous glucose oxidation was 10% lower (P < 0.001) during DEF (0.38±0.08) than BAL (0.42±0.08). There was no evidence of a difference in TTE between BAL and DEF or between groups. In conclusion, despite modest reduction in exogenous glucose oxidative capacity during energy deficit, physical performance was similar compared with balance.

Carbohydrate Ingestion Eliminates Hypoglycemia & Improves Endurance Exercise Performance in Triathletes Adapted to Very Low & High Carbohydrate Isocaloric Diets.

Very-low-carbohydrate diets (LCHF; <50g/day) have been debated for their potential to lower pre-exercise muscle and liver glycogen stores and metabolic efficiency, risking premature fatigue. It is also hypothesized that carbohydrate ingestion during prolonged exercise delays fatigue by increasing carbohydrate oxidation, thereby sparing muscle glycogen. Leveraging a randomized crossover design, we evaluated performance during strenuous time-to-exhaustion (70%⩒O2max) tests in trained triathletes following 6-week high-carbohydrate (HCLF, 380g/day) or very-low-carbohydrate (LCHF, 40g/day) diets to determine (i) if adoption of the LCHF diet impairs time-to-exhaustion performance, (ii) whether carbohydrate ingestion (10g/hour) 6-12x lower than current CHO fuelling recommendations during low glycogen availability (>15-hour pre-exercise overnight fast and/or LCHF diet) improves time-to-exhaustion by preventing exercise-induced hypoglycemia (EIH; <3.9mmol/L; <70mg/dL), and (iii) the "keto-adaptation" time course through continuous substrate monitoring while caloric intake, physical activity, and fat-free mass are maintained. Time-to-exhaustion performance was similar across both dietary interventions. Minimal carbohydrate supplementation prevented EIH and significantly increased time-to-exhaustion equivalently in LCHF and HCLF interventions (22%). The LCHF diet significantly lowered 24-hour glucose concentrations, which normalized after 4 weeks, at the same timepoint peak blood ketone (R-β-hydroxybutyrate) concentrations normalized. These findings (i) demonstrate that a LCHF diet sustains strenuous endurance performance, (ii) establish that minimal carbohydrate supplementation was sufficient to enhances exercise performance on LCHF and HCLF diets by mitigating EIH, and (iii) indicate that a minimum 4-week adaptation period to an LCHF diet is required to ensure normalization of metabolic homeostasis, glycemic control and exercise performance.

Self-reported carbohydrate supercompensation and supplementation strategies adopted by Olympic triathlon athletes.

The aim of the present study was to describe the use of tapering, carbohydrate (CHO) supercompensation, and supplementation strategies self-reported by athletes in the Olympic triathlon category. A total of 72 triathletes (61 males and 11 females) answered an online questionnaire about their training and performance, supercompensation strategies, carbohydrate supplementation, and use of supplements and other ergogenic substances. The information was summarized and subjected to descriptive analysis. Shapiro-Wilk test was applied to check data normality. The t-test was used to investigate differences in the analyzed variables between sexes. Almost all triathletes reported to have performed tapering (93.05%) and approximately half of them adopted a CHO supercompensation strategy (48.61%); updated CHO supercompensation was the most used strategy (27.77%). Most participants (86.11%) used CHO supplementation during competitions, but in amounts below the 60 g/h recommended for most athletes (96.77%). Thus, since few triathletes performed supercompensation, in addition to the insufficient amount of supplemented carbohydrate taken by them, it could be concluded that triathletes were not sufficiently aware of nutritional recommendations or did not adopt them.

Influence of Varied Carbon Sources and Carbon-Nitrogen Ratio on Microbial Community in a Biofloc-Based Culture System and Their Effects on Growth Performance, Proximate Composition, Hematology and Oxidative Stress in Nile Tilapia

This study investigates the influence of varied carbon sources and carbon-nitrogen ratio on microbial community in a biofloc-based culture system and their effects on growth performance, proximate composition, hematology, and oxidative stress in Nile tilapia. The experiment involved three different carbon-nitrogen ratios (10:1, 15:1, 20:1) and two carbohydrate sources (molasses: ML-10, ML-15, ML-20, starch: S-10, S-15, and S-20) with three replicates each. A diet containing 25% crude protein was fed to fish in 18 experimental units for 120 days. Carbohydrate supplementation significantly increased the total heterotrophic bacterial (THB) count from C/N10 to C/N20 while decreasing pH, total ammonia nitrogen, and nitrate nitrogen contents. In addition, growth was considerably greater in the ML-10 and ML-15 groups compared to the C/N20 group. Increasing the C/N ratio increased body protein and ash, decreased lipid contents, and increased the activities of lysozyme, SOD, CAT, and GPx. Finally, the C/N10 and C/N15 groups showed significantly lower GLU and COR concentrations in biofloc compared to the C/N20 group. Furthermore, increasing the C/N ratio up to 15 resulted in improved outcomes in terms of Hb, WBCs, RBCs, and Ht content. Overall, the utilization of the C/N15 group resulted in suitable growth, proximate composition, and immunity in Nile tilapia.

Sleep quality in children with hepatic glycogen storage diseases, a prospective observational pilot study.

Hepatic glycogen storage diseases (GSDs) are characterised by enzyme defects affecting liver glycogen metabolism, where carbohydrate supplementation to prevent overnight hypoglycaemia is common. Concerns around sleep quality in hepatic GSDs relate to emerging evidence that overnight dysglycaemia impacts sleep quality. This prospective observational study reported sleep quality and duration in children with hepatic GSDs over 7 days utilising: actigraphy (Actiwatch 2 by Phillips Respironics), sleep diaries, proxy reported age-appropriate sleep and quality-of-life (QoL) questionnaires, in the context of nocturnal glycaemic profiles continuous glucose monitor (CGM, Dexcom G6) and nocturnal dietary management strategies. Significant hypo- and hyperglycaemia were defined as ≥1% of sleep diary documented nocturnal period, recording <3.5 and >10.0 mmol/L, respectively. Seven children with hepatic GSD (aged 1-17 years) participated. Objective sleep quality was poor, with actigraphy demonstrating that no child achieved the minimum sleep duration recommended for age. Subjective sleep quality was also poor, with 4/5 documenting significant daytime sleepiness and 6/6 reporting poor sleep hygiene. Children prescribed overnight bolus feeds (OBF) (n = 2) recorded shorter sleep duration compared to other nocturnal management strategies. Parent-reported QoL suggested poor disease-related QoL outcomes for this cohort. Objective and subjective sleep disturbances and reduced QoL are common within our sample of children with hepatic GSD. From our observations these outcomes may be linked to nutritional overnight interventions, especially OBFs, rather than overnight glucose levels. Consideration of the impacts of overnight feeding strategies on sleep quality and QoL in children with hepatic GSD should inform future management strategies.

Fatiguing high-intensity intermittent exercise depresses maximal Na+-K+-ATPase activity in human skeletal muscle assessed using a novel NADH-coupled assay

The Na+-K+-ATPase is a critical regulator of ion homeostasis during contraction, buffering interstitial K+ accumulation, which is linked to muscle fatigue during intense exercise. Within this context, we adopted a recently reported methodology to examine exercise-induced alterations in maximal Na+-K+-ATPase activity. Eighteen trained healthy young males completed a repeated high-intensity cycling protocol consisting of three periods (EX1-EX3) of intermittent exercise. Each period comprised 10 × 45-s cycling at ~ 105% Wmax and a repeated sprint test. Muscle biopsies were sampled at baseline and after EX3 for determination of maximal in vitro Na+-K+-ATPase activity. Blood was drawn after each period and in association with a 2-min cycling test at a standardized high intensity (~ 90% Wmax) performed before and after the session to assess plasma K+ accumulation. Further, a 5-h recovery period with the ingestion of carbohydrate or placebo supplementation was implemented to explore potential effects of carbohydrate availability before sampling a final biopsy and repeating all tests. A ~ 12% reduction in maximal Na+-K+-ATPase activity was demonstrated following EX3 compared to baseline (25.2 ± 3.9 vs. 22.4 ± 4.8 μmol·min−1·g−1 protein, P = 0.039), which was sustained at the recovery time point (~ 15% decrease compared to baseline to 21.6 ± 5.9 μmol·min−1·g−1 protein, P = 0.008). No significant effect of carbohydrate supplementation was observed on maximal Na+-K+-ATPase activity after recovery (P = 0.078). In conclusion, we demonstrate an exercise-induced depression of maximal Na+-K+-ATPase activity following high-intensity intermittent exercise, which was sustained during a 5-h recovery period and unrelated to carbohydrate availability under the present experimental conditions. This was shown using a novel NADH coupled assay and confirms previous findings using other methodological approaches.

Assessing Energy Availability and Glucose Dynamics in Adolescent Cyclists: Implications for Nutritional Interventions During the Competitive Season.

The risk of developing a state of low energy availability (LEA) (<30 kcals/kg free-fat mass) in endurance athletes is known and recommendations for nutrition are available. However, information on male adolescent cyclists and the influence of hot temperatures is limited. The aim of this study was to investigate the impact on energy availability of two 4-day nutritional intervention strategies: (1) supplementary carbohydrate (CHO) intake during exercise and (2) designing and implementing individual nutritional interventions. Each intervention was preceded by a 4-day basal assessment. Eight competitive male junior road cyclists (aged 16-17 years) were investigated using a 4-day diet and activity records, alongside bioelectric impedance analysis. Their real-time power output, interstitial glucose, and temperature were recorded via sensors and a bike computer. Their energy intake (EI) was estimated from daily, self-reported food diaries. Overall, 100% and 71% of the cyclists were in a state of LEA during the baseline assessment of the supplementary CHO and nutritional interventions, respectively. LEA prevalence, not modified by supplementary CHO intake alone (from 100% to 87%, ns), was markedly reduced by the individual nutritional intervention (from 71% to 14%, p < 0.05). When considering all the data as a whole, LEA was positively influenced by the training load (OR 1.06; 95% Cl 1.03 to 1.09) and free-fat mass (OR 1.46; 1.04 to 2.04) and was negatively affected by EI (OR 0.994; 0.991 to 0.997). A hot environment (air temperature) failed to influence the LEA or glucose dynamics. the nutritional intervention, but not the supplementary CHO intake, markedly reduced the prevalence of LEA in adolescents, who often fail to match their energy expenditure with their energy intake during the competitive season. Nutritional education is essential for adolescent endurance cycling teams.

The Effect of Pre-Exercise Caffeine and Glucose Ingestion on Endurance Capacity in Hypoxia: A Double-Blind Crossover Trial.

The impact of caffeine and glucose supplementation in a hypoxic environment on endurance exercise performance remains inconclusive. The current study examined the effect of pre-exercise carbohydrate and caffeine supplementation on endurance exercise performance in an acute hypoxic environment. Eight healthy active young males participated in this double-blind, within-subjects crossover study. Participants ingested the test drink 60 min before exercising at 50% Wmax for 90 min on a cycle ergometer (fatiguing preload); there followed an endurance performance test at 85% Wmax until exhaustion in a hypoxic chamber (~15%O2). Participants completed four experimental trials in a randomized order: caffeine (6 mg·kg-1; Caff), glucose (1 g·kg-1; CHO), caffeine (6 mg·kg-1) + glucose (1 g·kg-1; Caff-CHO), and taste- and color-matched placebo with no caffeine or CHO (PLA). Blood samples were collected during fasting, pre-exercise, every 30 min throughout the exercise, and immediately after exhaustion. The caffeine and glucose trials significantly enhanced endurance capacity in hypoxic conditions by Caff, 44% (68.8-31.5%, 95% confidence interval), CHO, 31% (44.7-15.6%), and Caff-CHO, 46% (79.1-13.2%). Plasma-free fatty-acid and glycerol concentrations were higher in Caff and PLA than in CHO and Caff-CHO (p < 0.05). The estimated rate of fat oxidation was higher in Caff and PLA than in CHO and Caff-CHO (p < 0.05). There were no significant differences in ratings of perceived exertion between trials. In conclusion, the ingestion of caffeine, glucose, or caffeine + glucose one hour before exercising in hypoxic conditions significantly improved 85% Wmax endurance performance after prolonged exercise.

Effects of Maltodextrin-Fructose Supplementation on Inflammatory Biomarkers and Lipidomic Profile Following Endurance Running: A Randomized Placebo-Controlled Cross-Over Trial.

Managing metabolism for optimal training, performance, and recovery in medium-to-high-level endurance runners involves enhancing energy systems through strategic nutrient intake. Optimal carbohydrate intake before, during, and after endurance running can enhance glycogen stores and maintain optimal blood glucose levels, influencing various physiological responses and adaptations, including transitory post-endurance inflammation. This randomized trial investigates the impact of a high-dose 2:1 maltodextrin-fructose supplementation to medium-to-high-level endurance runners immediately before, during, and after a 15 km run at 90% VO2max intensity on post-exercise inflammatory stress. We evaluated inflammatory biomarkers and lipidomic profiles before the endurance tests and up to 24 h after. We focused on the effects of high-dose 2:1 maltodextrin-fructose supplementation on white blood cell count, neutrophil number, IL-6, cortisol, and CRP levels, as well as polyunsaturated fatty acids, ω-3 index, and AA/EPA ratio. This supplementation significantly reduced inflammatory markers and metabolic stress. Additionally, it may enhance the post-activity increase in blood ω-3 fatty acid levels and reduce the increase in ω-6 levels, resulting in a lower trend of AA/EPA ratio at 24 h in the treated arm. Adequate carbohydrate supplementation may acutely mitigate inflammation during a one-hour endurance activity of moderate-to-high intensity. These effects could be beneficial for athletes engaging in frequent, high-intensity activities.

No Effects of Carbohydrate Ingestion on Muscle Metabolism or Performance During Short-Duration High-Intensity Intermittent Exercise.

Carbohydrates are critical for high-intensity exercise performance. However, the effects of carbohydrate supplementation on muscle metabolism and performance during short-duration high-intensity intermittent exercise remain inadequately explored. Our aim was to address this aspect in a randomized, counterbalanced, double-blinded crossover design. Eleven moderately-to-well-trained males performed high-intensity intermittent cycling receiving carbohydrate (CHO, ~55 g/h) or placebo (PLA) fluid supplementation. Three exercise periods (EX1-EX3) were completed comprising 10 × 45 s at ~105% Wmax interspersed with 135 s rest between bouts and ~20 min between periods. Repeated sprint ability (5 × 6 s sprints with 24 s recovery) was assessed at baseline and after each period. Thigh muscle biopsies were obtained at baseline and before and after EX3 to determine whole-muscle and fiber-type-specific glycogen depletion. No differences were found in muscle glycogen degradation at the whole-muscle (p = 0.683) or fiber-type-specific level (p = 0.763-0.854) with similar post-exercise whole-muscle glycogen concentrations (146 ± 20 and 122 ± 15 mmol·kg-1 dw in CHO and PLA, respectively). Repeated sprint ability declined by ~9% after EX3 with no between-condition differences (p = 0.971) and no overall differences in ratings of perceived exertion (p = 0.550). This was despite distinctions in blood glucose concentrations throughout exercise, reaching post-exercise levels of 5.3 ± 0.2 and 4.1 ± 0.2 mmol·L-1 (p < 0.001) in CHO and PLA, respectively, accompanied by fivefold higher plasma insulin levels in CHO (p < 0.001). In conclusion, we observed no effects of carbohydrate ingestion on net muscle glycogen breakdown or sprint performance during short-duration high-intensity intermittent exercise despite elevated blood glucose and insulin levels. These results therefore question the efficacy of carbohydrate supplementation strategies in high-intensity intermittent sports.

The Influence of Nutrition Intervention on the P1NP and CTX-1 Response to an Acute Exercise Bout: A Systematic Review with Meta-Analysis.

Although nutrition and exercise both influence bone metabolism, little is currently known abouttheir interaction, or whether nutritional intervention can modulate the bone biomarker response to acute exercise. Improved understanding of the relationships between nutrition, exercise and bone metabolism may have substantial potential to inform nutritional interventions to protect the bone health of exercising individuals, and to elucidate mechanisms by which exercise and nutrition influence bone. The aim was to synthesise available evidence related to the influence of nutrition on the response of the bone biomarkers procollagen type 1 N-terminal propeptide (P1NP) and C-terminal telopeptide of type 1 collagen (CTX-1) to acute exercise, using a systematic review and meta-analytic approach. Studies evaluating the influence of nutritional status or intervention on the bone biomarker response to an acute exercise bout were included and separated into four categories: (1) feeding status and energy availability, (2) macronutrients, (3) micronutrients and (4) other. Studies conducted on healthy human populations of any age or training status were included. Meta-analysis was conducted when data from at least five studies with independent datasets were available. In the case of insufficient data to warrant meta-analysis, results from individual studies were narratively synthesised and standardised mean effect sizes visually represented. Twenty-two articles were included. Of these, three investigated feeding status or energy availability, eight macronutrients, eight micronutrients (all calcium) and six other interventions including dairy products or collagen supplementation. Three studies had more than one intervention and were included in all relevant outcomes. The largest and most commonly reported effects were for the bone resorption marker CTX-1. Meta-analysis indicated that calcium intake, whether provided via supplements, diet or infusion, reduced exercise-induced increases in CTX-1 (effect size - 1.1; 95% credible interval [CrI] - 2.2 to - 0.05), with substantially larger effects observed in studies that delivered calcium via direct infusion versus in supplements or foods. Narrative synthesis suggests that carbohydrate supplementation may support bone during acute exercise, via reducing exercise-induced increases in CTX-1. Conversely, a low-carbohydrate/high-fat diet appears to induce the opposite effect, as evidenced by an increased exercise associated CTX-1 response, and reduced P1NP response. Low energy availability may amplify the CTX-1 response to exercise, but it is unclear whether this is directly attributable to energy availability or to the lack of specific nutrients, such as carbohydrate. Nutritional intervention can modulate the acute bone biomarker response to exercise, which primarily manifests as an increase in bone resorption. Ensuring adequate attention to nutritional factors may be important to protect bone health of exercising individuals, with energy, carbohydrate and calcium availability particularly important to consider. Although a wide breadth of data were availablefor this evidence synthesis, there was substantial heterogeneity in relation to design and intervention characteristics. Direct and indirect replication is required to confirm key findings and to generate better estimates of true effect sizes.

The Impact of Carbohydrate, Protein, and Combined Carbohydrate-Protein Supplementation on Muscle Damage and Oxidative Stress Markers During Prolonged Cycling Performance in the Heat

Background: The impact of oxidative stress (OS) on exercise performance and recovery depends on the mode, intensity, and duration of physical activity, which can lead to inflammation, fatigue, and muscle dysfunction. The effects of carbohydrate (CHO) and protein (PRO) supplementation, as well as their combination (CHO-PRO), on exercise performance remain controversial, particularly under normal and hot environmental conditions. Objectives: The present study examined the influence of locally based isocaloric carbohydrate (CHO) and protein (PRO) supplements on muscle damage and oxidative stress (OS) biomarkers during cycling in the heat (31°C, 70% relative humidity), compared to a placebo (PL). Methods: Sago (Sa), Soy (So), and Sago+Soy (SS) were used as the carbohydrate (CHO), protein (PRO), and CHO-PRO supplements, respectively. The Sa, So, and SS supplements contained 7.5% Sa, 7.5% So, and 6.0% Sa+1.5% So, respectively. Twelve well-trained male cyclists (age: 19.0 ± 5.6 years, height: 170.8 ± 7.6 cm, body weight: 60.1 ± 11.2 kg, and VO2max: 56.5 ± 6.5 mL·kg⁻¹·min⁻¹) participated in four experimental trials. Each trial involved 90 minutes of steady-state cycling on an ergometer at 60% VO2max, followed by a 20-km exhaustive cycling time-trial performance. During the steady-state cycling, participants received supplements five times at 0, 20, 40, 60, and 80 minutes. Results: Plasma concentrations of creatine kinase and F2-isoprostanes, which are biomarkers of muscle damage and oxidative stress (OS), significantly decreased after the trials (P &lt; 0.05). The reduction in these biomarkers in the placebo group indicated that Sa, So, and SS supplementation did not provide additional benefits, as the placebo exhibited similar effects. Conclusions: In conclusion, despite the unexpected results, endurance athletes exercising in hot and humid conditions may potentially reduce symptoms of muscle damage and oxidative stress by consuming greater amounts of carbohydrate and protein supplements.

Trehalose Improved 20-min Cycling Time-Trial Performance After 100-min Cycling in Amateur Cyclists.

Carbohydrate (CHO) supplementation during endurance exercise can improve performance. However, it is unclear whether low glycemic index (GI) CHO leads to differential ergogenic and metabolic effects compared with a standard high GI CHO. This study investigated the ergogenic and metabolic effects of CHO supplementation with distinct GIs, namely, (a)trehalose (30g/hr), (b)isomaltulose (30g/hr), (c)maltodextrin (60g/hr), and (d)placebo (water). In this double-blind, crossover, counterbalanced, placebo-controlled study, 13 male cyclists cycled a total of 100min at varied exercise intensity (i.e.,10-min stages at 1.5, 2.0, and 2.5W/kg; repeated three times plus two 5-min stages at 1.0W/kg before and after the protocol), followed by a 20-min time trial on four separated occasions. Blood glucose and lactate (every 20min), heart rate, and ratings of perceived exertion were collected throughout, and muscle biopsies were taken before and immediately after exercise. The results showed that trehalose improved time-trial performance compared with placebo (total work done 302 ± 39 vs. 287 ± 48kJ; p = .01), with no other differences between sessions (all p ≥ .07). Throughout the 100-min protocol, blood glucose was higher with maltodextrin compared with the other supplements at all time points (all p < .05). Heart rate, ratings of perceived exertion, muscle glycogen content, blood glucose, and lactate were not different between conditions when considering the 20-min time trial (all p > .05). Trehalose supplementation throughout endurance exercise improved cycling performance and appears to be an appropriate CHO source for exercise tasks up to 2hr. No ergogenic superiority between the different types of CHO was established.

Narrowing inequity gap: ERAS home delivery kit

ObjectiveTo enhance adherence to Enhanced Recovery After Surgery (ERAS) protocols and address pre-operative preparation equity gaps, a system was developed to automatically mail chlorhexidine (CHG) and nutritional carbohydrate supplements (ERAS Kits) to surgical patients. BackgroundThis retrospective observational study focused on adult patients undergoing abdominal surgeries at a large academic hospital, using a pre-post design. MethodsThe study compared adherence to pre-operative ERAS pathways, involving nutritional supplements and chlorhexidine soap usage, before (September 2021-March 2022) and after (September 2022-March 2023) implementing automatic ERAS Kits mailing. A Chi square test analyzed adherence rates. ResultsPost-implementation, adherence to preoperative nutrition rose from 49.6 % to 57.7 % (P = 0.006), and surgical site preparation from 73.8 % to 78.7 % (P = 0.06). Notable improvements were seen among Black patients, Medicaid recipients, and those from lower-income neighborhoods in nutrition adherence, and among younger patients and Medicaid recipients in site preparation. ConclusionMailing ERAS Kits directly to patients significantly enhanced compliance with preoperative protocols, demonstrating an effective strategy to improve care accessibility and reduce disparities for vulnerable groups.

Effects of In-Exercise Carbohydrate Supplementation on Prolonged High-Intensity Exercise Performance in Oral Contraceptive Users.

To examine the impact of oral contraceptive (OC) phases on performance, physiological, and subjective responses to prolonged, intensive exercise when carbohydrate (CHO) stores are reduced. Ten well-trained female cyclists using monophasic OC completed 4 identical trials (>150min) under conditions of in-trial 60-g·h-1 CHO supplementation (CHO+) or placebo (CHO-) during the sugar- (SUG) and active-pill (ACT) phases of their OC cycle. Each trial comprised two 400-kcal time trials (TT) separated by 1hour of submaximal cycling at first ventilatory threshold. Change in completion time from TT1 to TT2 was minimized in CHO+ compared with CHO- (4.06 [2.55] vs 6.08 [5.33]min; P = .019, effect size = -0.36). An interaction effect of OC and CHO was observed for time to complete TT (P = .006), mean TT power (P = .002), mean TT heart rate (P = .002), and posttrial emotional balance (P = .020) and negative emotional state (P = .033). In ACT, mean TT power and heart rate were higher in CHO+ when compared with CHO-, resulting in faster TTs in CHO+ and improved posttrial emotional well-being. When CHO was not supplemented, TT power and heart rate were higher in SUG when compared with ACT, resulting in faster TTs in SUG and improved posttrial emotional balance. CHO depletion during ACT negatively influenced TT performance and emotional well-being when compared with SUG. Irrespective of OC pill phase, CHO supplementation should be prioritized to sustain performance and improve postexercise recovery-stress balance.

Abstract MP59: Associations of Plasma Inosine With Lipid Profiles in the Bogalusa Heart Study

Introduction: Inosine, a naturally occurring purine nucleotide, has been used as a dietary supplement to enhance overall health. An emerging study in a rat model has indicated that inosine holds promise as a potential treatment for atherosclerosis by reducing cholesterol-driven inflammation and improving vascular function, providing a foundational concept for further investigation in humans. Hypothesis: We hypothesize that inosine can improve lipid profiles among humans. Methods: We profiled inosine and 886 known metabolites using plasma samples from 1,261 participants of the Bogalusa Heart Study (BHS) 2013-2016 survey. Linear regression models were used to evaluate the relationship between inosine and four lipid phenotypes, including total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides, while controlling for age, sex, race, education, smoking, drinking, BMI, lipid medication, and total physical activity. Statistically significant findings in the BHS were validated in the Protein and Blood Pressure (ProBP) study, where 80 adults with available stored samples underwent 8-week dietary supplementation of carbohydrate, milk protein, and soy protein in a random order with 2-week washouts. Inosine and lipids were measured at baseline and post-intervention. We tested associations of longitudinal changes of inosine with changes in lipids profile. We also performed formal mediation analyses in the BHS to identify metabolites and metabolic pathways that might mediate inosine’s association with lipids. Results: In the BHS, inosine was significantly associated with HDL cholesterol (β=1.85, 95% CI: 0.72- 2.98) but not with LDL cholesterol, triglycerides, or TC. In the ProBP trial, inosine change was positively associated with HDL cholesterol change during the soy protein intervention (β=2.13, 95% CI: 0.59-3.66). Our mediation analysis identified 74 metabolites that nominally mediated (p&lt;0.05) the inosine-HDL association. After Bonferroni correction for 228 independent metabolite clusters, three metabolites, including PC(18:2(9Z,12Z)/20:4(5Z,8Z,11Z,14Z)), arachidonic acid, and LysoPC(18:2/0:0) were significant mediators (p&lt;0.05/228). The 74 nominally significant metabolites were enriched in the sphingolipid metabolic pathway (False Discovery Rate= 0.00312). Conclusion: Inosine appears to enhance HDL cholesterol, possibly through the sphingolipid metabolic pathway.

Abstract MP78: A Comprehensive Investigation of the Effect of Dietary Intervention on Perfluorooctanoic Acid and Perfluorooctane Sulfonate

Introduction: The US Environment Protection Agency has proposed National Primary Drinking Water Regulation for six per- and polyfluoroalkyl substances including perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS). The health effects of the two chemicals need to be thoroughly evaluated. In addition, few studies have investigated interventions that can help clear the two chemicals from the human body. Hypothesis: We hypothesize that the plasma metabolome reflects reactions of the human body to PFOA/PFOS exposures and dietary supplements can reduce PFOA/PFOS. Methods: In the Protein and Blood Pressure (ProBP) trial, 80 participants were randomly assigned to take 40 grams/day of soy protein, milk protein, or carbohydrate supplementation each for 8 weeks in a cross-over design. Plasma PFOA and PFOS levels were tracked from baseline to each of the three intervention phases. We analyzed the associations of serum PFOS and PFOA with a total of 964 known metabolites at baseline and each dietary intervention, respectively. Age, sex, and race were adjusted in all analyses. ProBP findings were evaluated for replication among 1261 participants of the Bogalusa Heart Study (BHS). Results: PFOA and PFOS were significantly reduced after phase I and were decreased further with intervention phases. Soy protein showed the strongest reduction on both PFOA (net change: -0.13, p=1.13х10 -5 ) and PFOS (net change: -0.18, p=4.32х10 -5 ) compared with carbohydrate and milk protein. After Bonferroni correction for 77 independent metabolite clusters (p&lt;6.49х10 -4 ), PFOS was positively associated with 54 metabolites (47 at baseline, 9 at soy protein, 8 at milk protein, and 6 at carbohydrate, respectively). Of which, 20 associations were replicated in BHS ( Table ). PFOA was positively associated with 3-methyladipate at soy protein and bilirubin (E,E) at milk protein. Conclusions: Dietary intervention reduced serum PFOA and PFOS. Several metabolites may play important roles in PFOA/PFOS related health effects.

Effects of dietary carbohydrate levels on growth performance, feed utilization, liver histology and intestinal microflora of juvenile tiger puffer, Takifugu rubripes

An 8-week feeding trial was conducted to investigate the effects of dietary carbohydrate levels on growth performance, body composition, and plasma biochemical parameters, liver and gut histology, and intestinal microbiota of Takifugu rubripes. Five isonitrogenous and isolipidic experimental diets were formulated with graded levels of cassava starch: 0% (C0), 8% (C8), 16% (C16), 24% (C24), and 32% (C32). The results showed that weight gain rate, specific growth rate (SGR) and protein efficiency ratio significantly increased in C16 and C24 groups (P < 0.05), while the feed conversion ratio expressed an opposite trend. Feeding rate is decreased with the increasing of carbohydrate levels (P < 0.05). Liver lipid content was dramatically increased in C24 treatment (P < 0.05). The intestinal amylase activity and muscle glycogen content were higher than other groups (P < 0.05). Plasma glucose levels were increased in C24 and C32 groups (P < 0.05). In addition, the abundance of intestinal potentially pathogenic bacteria (Staphylococcus) decreased, and the intestinal probiotics (Lactobacillus) increased with the increasing of dietary carbohydrate level (P < 0.05). The intestinal bacteria, indicated by Sobs, Chao and Shannon indexes, were more diverse with the increasing of the carbohydrate level (P < 0.05), meanwhile the abundance of transport and metabolism of carbohydrate, lipid and amino acid were enhanced with the increasing of carbohydrate levels (P < 0.05). In conclusion, appropriate supplementation of carbohydrate in diet promoted growth performance and feed utilization of juvenile Takifugu rubripes, and increased the liver lipid and muscle glycogen content, as well as intestinal microbial diversity. Based on the quadratic regression between SGR and carbohydrate levels, the optimal dietary carbohydrate level of juvenile Takifugu rubripes is 21.6%.

Impact of preoperative carbohydrate loading on postoperative course and morbidity in debulking surgery for epithelial ovarian cancer.

Despite the theoretical benefits, the favorable effect of preoperative carbohydrate loading on postoperative morbidity remains controversial. Most of the outcomes reported in the literature are derived from non-gynecologic surgery data, with only one study involving a limited number of patients specifically in gynecological oncology. The present study aimed to investigate the impact of carbohydrate loading, as a single element of enhanced recovery after surgery protocols, on postoperative course and morbidity in patients undergoing debulking surgery for epithelial ovarian cancer (EOC). The present study was a non-randomized, prospective cohort trial enrolling patients with EOC who underwent surgery between June 2018 and December 2021. An oral carbohydrate supplement with a dose of 50 g was given to patients 2-3 h before anesthesia. Data on postoperative course and morbidity were collected and compared with data of a historical cohort including consecutive patients who underwent surgery without a carbohydrate loading between January 2015 and June 2018. Analyses were performed on a total of 162 patients, including 72 patients in the carbohydrate loading group and 90 patients in the control group. Median length of hospital stay (11 days vs. 11 days; P=0.555), postoperative days 1-7 serum c-reactive protein levels (P=0.213), 30-day readmission (11.6% vs. 11.5%, P=0.985), 30-day relaparotomy (2.8% vs. 3.4%, P=0.809) and 30-day morbidity (48.6% vs. 46.7%; P=0.805) were comparable between the cohorts. No significant differences in grades of morbidities were identified between the cohorts (P=0.511). Multivariate analysis revealed that the sole independent risk factor for any postoperative morbidity was operative time. In conclusion, based on the results of the present study, postoperative course and morbidity seemed to be unaffected by carbohydrate loading in patients undergoing debulking surgery for EOC.