Impact of vigorous effort on blood morphological indicators in triathletes participating in the XTERRA Poland 2017 competition

Purpose: The aim of the study was to determine the influence of participation in the XTERRA Poland 2017 triathlon on blood morphology indicators. Material and methods: The study was performed in a group among 10 triathletes aged 30-40 years. Blood was collected 24 hours before, immediately after , and 16 hours after the competition. Blood morphological indicators were evaluated using the ABXMicros60 analyser. Results: Comparison of the results among the first (24 hours before the competition), second (immediately after the competition), and third assessment (16 hours after the competition) revealed statistically significant changes for WBC [109/l], RBC [1012/l], HGB [g/l], HCT [l/l], MCV [fl] and PLT [109/l]. Conclusions: The intensity of effort in the XTERRA Poland 2017 triathlon competitors was confirmed in the results of blood morphology. Blood counts in those practicing triathlon well characterise the actual scope and direction of exercise changes and allow for the diagnosis of transient adaptive effects. The results of the research confirmed that vigorous physical effort during the triathlon increased leukocyte and platelet counts, but 16 hours after completing the competition, their value was close to baseline level. Most likely, this phenomenon was caused by the intense effort, stress or even eating a large meal before the competition. Analysing the red blood cell system showed a tendency towards decrease in the number of red blood cells, HGB and HCT both after the competition and 16 hours after its completion, which results from increased post-exercise haemolysis or the risk of anaemia.

A man with intolerant vomiting

Case presentationA 57-year-old man was in a healthy state until 6 hours before presenting to the emergency department, when he suffered from more than 10 episodes of vomiting after a large meal at lunchtime. On physical examination, vital signs were unremarkable. Tenderness was noted over the epigastrium on palpation. Point-of-care ultrasound (POCUS) of the abdomen is shown in figure 1 and online supplementary video 1.Supplementary videoFigure 1Transverse (A) and longitudinal (B) ultrasonography of the epigastrium.QuestionWhat is the most likely diagnosis?Hypertrophic pylorus stenosisAortic dissectionSuperior mesentery artery (SMA) syndromeVolvulusFor answer see page 2

An observational analysis of meal patterns in overweight and obese pregnancy: exploring meal pattern behaviours and the association with maternal and fetal health measures

Background Nutrient intakes are known to be poorer among pregnant women with raised body mass index (BMI) than those with a healthy BMI. While meal patterns have the potential to influence obstetric, metabolic and anthropometric measures for mother and infant, limited data exists regarding meal patterns among pregnant women with raised BMI. Aim To identify categories of meal patterns among pregnant women with overweight and obesity and determine whether patterns change with advancing gestation. To determine if maternal meal patterns are associated with dietary intakes and pregnancy outcomes. Methods Prospective, observational analysis of pregnant women (n = 143) (BMI 25–39.9 kg/m2). Meal pattern data were analysed from 3-day food diaries at 16 and 28 weeks’ gestation. Outcomes include maternal blood glucose, insulin resistance, gestational diabetes, gestational weight gain and infant anthropometry. Results Three meal pattern categories were identified: ‘main meal dominant’ (3 main eating occasions + 0–3 snacks), ‘large meal dominant’ (≤ 2 main eating occasions + < 2 snacks), and ‘snack dominant’ (3 main eating occasions + > 3 snacks and ≤ 2 main + ≥ 2 snacks). A main meal–dominant pattern prevailed at 16 weeks’ (85.3%) and a snack-dominant pattern at 28 weeks’ (68.5%). Dietary glycaemic index was lower among the main meal versus large meal–dominant pattern at 28 weeks (P = 0.018). Infant birth weight (kg) and macrosomia were highest among participants with a large meal–dominant pattern at 28 weeks (P = 0.030 and P = 0.008, respectively). Conclusion Women with raised BMI changed eating patterns as pregnancy progressed, moving from main meal–dominant to snack-dominant patterns. Large meal–dominant meal patterns in later pregnancy were associated with higher glycaemic index and greater prevalence of macrosomia.

Chronic stable angina: Addressing the needs of patients through risk reduction, education and support

Chronic stable angina (CSA) is one of the most common symptoms experienced by persons with heart disease. CSA is defined by the physical symptoms resulting from blockage of blood flow through the coronary arteries. Anginal symptoms generally occur as a result of increased demands for blood flow, such as with physical activity, eating a large meal, emotional upset or exposure to cold weather. Symptoms vary widely and can include discomfort in the chest, arms, back and jaw, shortness of breath and a sense of increased fatigue. Many patients with chronic stable angina do not describe their symptoms as “pain” but have a sense of burning, tightness, pressure or heaviness in the chest and upper body. Chronic stable angina is usually relieved by stopping the activity that precipitated the symptoms, by resting, and by the use of Nitroglycerine. Anginal symptoms are called “chronic and stable” when they occur in a predictable fashion and are in response to “triggers” such as those mentioned above.

Effects of a Fixed Meal Pattern on Ghrelin Secretion: Evidence for a Learned Response Independent of Nutrient Status

Circulating levels of the orexigenic peptide ghrelin increase during fasting and decrease with refeeding. Exogenous ghrelin administration is a potent stimulus for food intake in rodents and humans. In subjects on fixed feeding schedules, ghrelin increases before each meal, raising the possibility that anticipation of meals, in addition to effects of fasting and feeding, contributes to ghrelin secretion. To distinguish among these regulatory influences, plasma ghrelin profiles were generated in freely fed rats and in meal-fed rats trained to consume their daily calories over a 4-h period in the light phase. In freely feeding rats, plasma ghrelin levels increased to a peak of 778 ± 95 pg/ml just before the onset of the dark. Similarly, in meal-fed rats anticipating a large meal of either chow or Ensure at their usual feeding time, plasma ghrelin increased steadily over the 2 h preceding the meal to peaks of 2192 ± 218 and 2075 ± 92 pg/ml, respectively. When freely fed rats were food deprived for a time equivalent to meal-fed rats, there was no peak of plasma ghrelin. In addition, eating-induced suppression of the ghrelin response differed significantly between meal-fed rats and ad libitum-fed rats receiving meals of similar size. These findings indicate that anticipation of eating, as well as fasting/feeding status, influences pre- and postprandial plasma ghrelin levels in rats. Together, these data are consistent with a role for ghrelin in the regulation of anticipatory processes involved in food intake and nutrient disposition.

Resource allocation in fledglings of the rhinoceros auklet under different feeding conditions: an experiment manipulating meal size and frequency

By manipulating meal size and frequency in an alcid, the rhinoceros auklet (Cerorhinca monocerata (Pallas, 1811)), we examined two hypotheses: (1) poorly fed chicks allocate resources preferentially to developing organs essential for fledging, and (2) intermittently fed chicks deposit more lipids than regularly fed ones. Chicks were fed normal (NORMAL; 40–80 g, mean meal mass in a normal year), small (LOW; 26–54 g, half of NORMAL), or large (HIGH; 80–160 g, twice as much as NORMAL) amounts of sandlance (Ammodytes personatus Girard, 1856) every day or the large meal (80–160 g) every 2 days (INTERMITTENT). Chicks fed more food grew faster. The HIGH group had the greatest fledging mass and shortest fledging period. The wingspan and brain mass of fledglings did not differ among groups. The heart, liver, and breast muscle at fledging were 15%–25% smaller in the LOW group than in the NORMAL group but did not differ between the NORMAL and HIGH groups. The total lipid was 43% greater in the HIGH group than in the NORMAL group, and that of the LOW group was 38% smaller. The INTERMITTENT group had a similar lipid mass to the NORMAL group. Chicks feeding on small meals seemed to maintain the growth of organs essential for fledging, while chicks feeding on large meals seemed to deposit a surplus as lipid rather than allocate more to the development of organs.

Metabolic response to small and large 13C-labelled pasta meals following rest or exercise in man

The metabolic response to a 150 or 400 g 13C-labelled pasta meal was studied for 8 h following rest or exercise at low or moderate workload (n 6). Following rest, the 400 g meal totally suppressed fat oxidation (v. 14.1 g following the 150 g meal) and a small amount of glucose was converted into fat (4.6 g), but fat oxidation remained high in subjects who had exercised following both the small (21.8 and 34.1 g) and large meal (14.1 and 32.3 g). Exogenous glucose oxidation was significantly higher in subjects who had remained at rest both following the small (67.6 g v. 60.4 and 51.3 g in subjects who exercised at low and moderate workloads) and large meal (152.2 v. 123.0 and 127.2 g). Endogenous glucose oxidation was similar in the three groups following the 150 g meal (42.3–58.0 g), but was significantly lower following the 400 g meal in subjects who had exercised at low workload (24.2 v. 72.2 g following rest; P<0.05), and was totally suppressed in those who had exercised at moderate workload. As a consequence, a larger positive glycogen balance was observed in subjects who exercised before the large meal (182.8–205.1 g v. 92.4 g following rest; P<0.05). Total fat oxidation calculated from 08.00 hours to 20.00 hours was similar in subjects who exercised at low and moderate workloads. These results indicate that: (1) de novo lipogenesis, which plays only a minor role for the disposal of an acute dietary carbohydrate load, is totally suppressed following exercise, even when a very large carbohydrate load is ingested; (2) the reduction in glycogen turnover as well as a preferential conversion of glucose into glycogen are responsible for the increase in glycogen stores following exercise; (3) for a similar energy expenditure, exercise at low workload for a longer period does not favour fat oxidation when the post-exercise period is taken into account.