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Ultra-endurance cycling, particularly in events such as the Brevet de Randonneurs Mondiaux (BRMs), demands exceptional physical exertion and sustained energy management. In India, BRMs events, which span distances of 200 to 1000 kilometres, pose unique challenges for cyclists, necessitating prolonged physical preparation and consistent performance under demanding conditions. Nutrition plays a critical role in optimising energy availability, enhancing recovery and sustaining performance throughout these events. Despite the wealth of information available through social media, there remains a significant gap in scientifically grounded nutritional guidance specifically tailored to ultra-endurance cyclists. The aim of the present narrative review is to highlight the critical nutritional requirements and strategies essential for ultra-endurance cyclists participating in BRMs events. The review emphasises the need for evidence-based dietary practices to support optimal performance and recovery while addressing the current gap in scientific understanding. It also provides practical, research-informed nutritional guidance for athletes involved in these ultraendurance events. Pre-event preparation focuses on carbohydrate loading, hydration and balanced nutrition to maximise glycogen stores and ensure optimal hydration. During the event, continuous carbohydrate intake, electrolyte replenishment and hydration are critical for maintaining energy levels and preventing dehydration. Post-event recovery emphasises protein consumption for muscle repair, glycogen replenishment and rehydration. The findings underscore the importance of tailored nutritional strategies for ultraendurance cyclists to achieve optimal performance and recovery. Despite the abundance of general information available, there is a clear need for more research-based, practical nutritional guidelines specifically for ultra-endurance cycling. Future research should address this gap to provide athletes with evidence-based recommendations that support their unique nutritional needs. [ABSTRACT FROM AUTHOR]

Ultra-endurance cycling, particularly in events such as the Brevet de Randonneurs Mondiaux (BRMs), demands exceptional physical exertion and sustained energy management. In India, BRMs events, which span distances of 200 to 1000 kilometres, pose unique challenges for cyclists, necessitating prolonged physical preparation and consistent performance under demanding conditions. Nutrition plays a critical role in optimising energy availability, enhancing recovery and sustaining performance throughout these events. Despite the wealth of information available through social media, there remains a significant gap in scientifically grounded nutritional guidance specifically tailored to ultra-endurance cyclists. The aim of the present narrative review is to highlight the critical nutritional requirements and strategies essential for ultra-endurance cyclists participating in BRMs events. The review emphasises the need for evidence-based dietary practices to support optimal performance and recovery while addressing the current gap in scientific understanding. It also provides practical, research-informed nutritional guidance for athletes involved in these ultra-endurance events. Pre-event preparation focuses on carbohydrate loading, hydration and balanced nutrition to maximise glycogen stores and ensure optimal hydration. During the event, continuous carbohydrate intake, electrolyte replenishment and hydration are critical for maintaining energy levels and preventing dehydration. Post-event recovery emphasises protein consumption for muscle repair, glycogen replenishment and rehydration. The findings underscore the importance of tailored nutritional strategies for ultra-endurance cyclists to achieve optimal performance and recovery. Despite the abundance of general information available, there is a clear need for more research-based, practical nutritional guidelines specifically for ultra-endurance cycling. Future research should address this gap to provide athletes with evidence-based recommendations that support their unique nutritional needs.

Many runners experience decreased performance and premature fatigue, influenced by various factors, including nutrition. The results of the observations show a high level of fatigue and a need for more performance among runners who are members of the running community in Makassar, especially beginner runners. This research aims to examine the effect of the carbohydrate loading method on improving the performance of the amateur runner community in Makassar. This research used an experimental design involving 60 runners from the amateur runner community in Makassar. Subjects were divided into two groups: an experimental group that applied the carbohydrate loading method and a control group that followed a normal eating pattern. Training to measure runner performance The multistage fitness test (MFT) is the instrument to measure runner performance. Data analysis techniques with t-test (paired sample t-test) to see differences using spss version 20. Data analysis showed significant improvements in performance improvement with the carbohydrate application method. The average performance value increased in the experimental group to 46.18 compared to the control group to 37.21. This increase can be seen from the calculated t-value of 13.75. So, the carbohydrate loading method influences performance. The carbohydrate loading method is an effective strategy for improving the performance of running athletes, especially in the Makassar runner community. With proper application, this method can help runners achieve peak performance, reduce fatigue, and increase efficiency during training and competition.

The Impact of Carbohydrate Loading and Muscle Glycogen Supercompensation on Anaerobic Performance in Elite Jiu-Jitsu Athletes. JEPonline 2024;27(5):26-42. The purpose of this study was to examine the effect of dietary patterns on muscle glycogen storage in Jiu-Jitsu athletes and to explore the relationship between muscle glycogen levels and athletic performance. A randomized controlled trial (RCT) design was employed that involved 10 Thai national Jiu-Jitsu athletes (5 males and 5 females; Mean = 22.80 years, SD = 3.35, Max = 27 years, Min = 18 years). The participants were randomly divided into 2 groups of 5: a Control Group (Mean = 23.20 years, SD = 4.08, Max = 27 years, Min = 18 years) and a Carbohydrate Loading Group (Mean = 22.40 years, SD = 2.88, Max = 26 years, Min = 19 years). Data collection consisted of 3 days of 24-hour dietary recall and body composition measurements, were used to develop a 4-day diet plan based on individualized estimated energy requirements (EER). The Control Group received a balanced diet while the Carbohydrate Loading Group was provided with a high-carbohydrate diet, paired with high-intensity intermittent training. Ultrasound scans using image segmentation methods assessed initial muscle glycogen levels concurrent with the Running-Based Anaerobic Sprint Test (RAST) protocol. The data were analyzed using means, standard deviations, and percentages. Differences in mean scores of the RAST were compared using a t-test, with statistical significance set at an alpha level of 0.05. The research results were as follows: (a) The Carbohydrate Loading Group consumed significantly higher quantities of carbohydrates (7.29 ± 0.67 g/kg/day) compared to the Control Group (4.32 ± 1.18 g/kg/day). (b) Glycogen storage in the carbohydrate loading group increased significantly by 43.30% (P < 0.05). (c) This increase in glycogen storage exhibited a strong negative correlation with the fatigue index (r = -0.998, P < 0.05). In conclusion, participants in the Carbohydrate Loading Group who consumed a highcarbohydrate diet for 4 days and underwent high-intensity intermittent exercise showed a significant increase in muscle glycogen stores, which was associated with a reduced fatigue index that indicated a decrease in muscle fatigue, potentially reflecting enhanced lactate tolerance and improved utilization of the anaerobic energy system in athletes. [ABSTRACT FROM AUTHOR]

Abstract Background Effects of preoperative drinks on muscle metabolism are unclear despite general recommendations. The aim of the present study was therefore to compare metabolic effects of a preoperative oral nutrition drink, recommended by protocols for enhanced recovery after surgery (ERAS), compared to overnight preoperative peripheral total parenteral nutrition (PPN) on skeletal muscle metabolism in patients aimed at major gastrointestinal cancer surgery. Methods Patients were randomized, based on diagnosis and clinical characteristics, to receive either a commercial carbohydrate-rich nutrition drink (Drink); or overnight (12 h) peripheral parenteral nutrition (PPN) as study regimens; compared to isotone Ringer-acetate as Control regimen. Arterial blood- and abdominal muscle tissue specimens were collected at start of surgery. Blood chemistry included substrate- and hormone concentrations. Muscle mRNA transcript analyses were performed by microarray and evaluated for changes in gene activities by Gene Ontology algorithms. Results Patient groups were comparable in all measured preoperative assessments. The Nutrition Drink had significant metabolic alterations on muscle glucose metabolism (p

Background: Sports games with aerobic and anaerobic energy systems require muscular and cardiovascular endurance, as well as high dietary intake. Carbohydrate loading before training can maximize glycogen storage and carbohydrate oxidation, thereby increasing performance. Chocolate milk powder, as much as 45 g, contains 55 g of carbohydrates, contributing to 6-8% of total carbohydrate needs. Objectives: Analyzing the effect of chocolate milk consumption on muscle endurance and maximum oxygen volume capacity (VO2 Max) in sports athletes at the BPPLOP Central Java Student Sports Education and Training Center. Methods: Research with pretest-posttest control design with the same sample with a washout period. A sample of 47 athletes was taken using a total sampling technique, all used as a control group and treated for 6 days with 200 ml 2 hours before training. Measurement of endurance using the multistage fitness test. Test the difference in effect before and after treatment using the Paired Samples T-Test, while testing the difference between control and treatment groups using Mann Whitney. Results: There was a significant effect between before and after consuming chocolate milk on increasing muscle endurance by 2150.64 ± 420.72 to 2314.47 ± 400.14 m and VO2 Max capacity by 53.95 ± 5.96 to 56.30 ± 5.62 ml/kg/minute with a p-value=0.00. There was a significant difference between the consumption of placebo and chocolate milk in increasing muscle endurance by 163.83 m and VO2 Max capacity by 2.34 ml/kg/minute with a p-value=0.00. Conclusions: Carbohydrate loading by consuming 45 g of chocolate milk in 200 ml containing 55 g of carbohydrates before training for 6 days can affect increasing muscle endurance and VO2 Max capacity in sports athletes.

Abstract Background Preoperative carbohydrate loading in Enhanced Recovery After Surgery is an independent predictor of postoperative outcomes. By reducing the impact of surgical stress response, fasting-induced insulin resistance is modulated. As a clear fluid, consuming carbohydrate drink is safe up to 2 h preoperatively. Widely practiced in abdominal surgeries, its implementation in hip fracture surgeries is yet to be recognized. This study aimed to identify the feasibility of preoperative carbohydrate loading in hip fracture surgery and assess its clinical effects. Methods This was a randomized controlled, open labelled trial. Patients ≥ 65 years old without diabetes mellitus, has hip fracture were recruited in a tertiary hospital between November 2020 and May 2021. The intervention was carbohydrate loading versus standard preoperative fasting. Results Thirty-four ASA I-III patients (carbohydrate loading and control, n = 17 each), mean age 78 years (SEM ± 1.5), mean body mass index 23.7 (SEM ± 0.6 kg/m2) were recruited. Analysis for feasibility of carbohydrate loading (n = 17) demonstrated attrition rate of 29% (n = 5). Otherwise, all recruited patients were compliant (100% compliance) with no adverse events reported. There was no significant difference among groups in the postoperative nausea and vomiting, pain score, fatigue level, muscle strength, postoperative infection and length of hospital stay assessed at 24–48 h postoperatively. Conclusion The implementation of preoperative carbohydrate loading was found to be feasible preoperatively in hip fracture surgeries but requires careful coordination among multidisciplinary teams. An adequately powered randomized controlled study is needed to examine the full benefits of preoperative carbohydrate loading in this group of patients. Trial registration This study was registered in ClinicalTrial.gov (ClinicalTrials.gov identifier: NCT04614181, date of registration: 03/11/2020).

Background: Sports games with aerobic and anaerobic energy systems require muscular and cardiovascular endurance, as well as high dietary intake. Carbohydrate loading before training can maximize glycogen storage and carbohydrate oxidation, thereby increasing performance. Chocolate milk powder, as much as 45 g, contains 55 g of carbohydrates, contributing to 6-8% of total carbohydrate needs. Objectives: Analyzing the effect of chocolate milk consumption on muscle endurance and maximum oxygen volume capacity (VO2 Max) in sports athletes at the BPPLOP Central Java Student Sports Education and Training Center. Methods: Research with pretest-posttest control design with the same sample with a washout period. A sample of 47 athletes was taken using a total sampling technique, all used as a control group and treated for 6 days with 200 ml 2 hours before training. Measurement of endurance using the multistage fitness test. Test the difference in effect before and after treatment using the Paired Samples T-Test, while testing the difference between control and treatment groups using Mann Whitney. Results: There was a significant effect between before and after consuming chocolate milk on increasing muscle endurance by 2150.64 ± 420.72 to 2314.47 ± 400.14 m and VO2 Max capacity by 53.95 ± 5.96 to 56.30 ± 5.62 ml/kg/minute with a p-value=0.00. There was a significant difference between the consumption of placebo and chocolate milk in increasing muscle endurance by 163.83 m and VO2 Max capacity by 2.34 ml/kg/minute with a p-value=0.00. Conclusions: Carbohydrate loading by consuming 45 g of chocolate milk in 200 ml containing 55 g of carbohydrates before training for 6 days can affect increasing muscle endurance and VO2 Max capacity in sports athletes. [ABSTRACT FROM AUTHOR]

Background: Preoperative carbohydrate loading in Enhanced Recovery After Surgery is an independent predictor of postoperative outcomes. By reducing the impact of surgical stress response, fasting-induced insulin resistance is modulated. As a clear fluid, consuming carbohydrate drink is safe up to 2 h preoperatively. Widely practiced in abdominal surgeries, its implementation in hip fracture surgeries is yet to be recognized. This study aimed to identify the feasibility of preoperative carbohydrate loading in hip fracture surgery and assess its clinical effects. Methods: This was a randomized controlled, open labelled trial. Patients ≥ 65 years old without diabetes mellitus, has hip fracture were recruited in a tertiary hospital between November 2020 and May 2021. The intervention was carbohydrate loading versus standard preoperative fasting. Results: Thirty-four ASA I-III patients (carbohydrate loading and control, n = 17 each), mean age 78 years (SEM ± 1.5), mean body mass index 23.7 (SEM ± 0.6 kg/m2) were recruited. Analysis for feasibility of carbohydrate loading (n = 17) demonstrated attrition rate of 29% (n = 5). Otherwise, all recruited patients were compliant (100% compliance) with no adverse events reported. There was no significant difference among groups in the postoperative nausea and vomiting, pain score, fatigue level, muscle strength, postoperative infection and length of hospital stay assessed at 24–48 h postoperatively. Conclusion: The implementation of preoperative carbohydrate loading was found to be feasible preoperatively in hip fracture surgeries but requires careful coordination among multidisciplinary teams. An adequately powered randomized controlled study is needed to examine the full benefits of preoperative carbohydrate loading in this group of patients. Trial registration: This study was registered in ClinicalTrial.gov (ClinicalTrials.gov identifier: NCT04614181, date of registration: 03/11/2020). [ABSTRACT FROM AUTHOR]

Objective: Preoperative fasting leads to a catabolic state aggravated by surgical stress. This leads to poor patient outcomes. This study aimed to determine the effect of preoperative oral carbohydrate administration on perioperative hyperglycemia and patient comfort. Methods: This prospective, randomized study was conducted on 60 adult American Society of Anesthesiologist I/II patients undergoing hip fracture fixation after obtaining institutional ethical committee clearance. Patients were randomly kept conventionally fasted before surgery (group F, n = 30) or were given oral carbohydrate 2 h before surgery (group C, n = 30). Under all aseptic precautions, a combined spinal epidural block was administered, and surgery was allowed. The primary outcome was blood glucose, and secondary outcomes included incidence of postoperative hyperglycemia, insulin level, blood urea, hunger, thirst, and anxiety. Results: Blood glucose levels were not statistically different between the two groups at baseline (T0; P=0.400), immediately after surgery (T1; P=0.399) and 24h after surgery (T2; P=0.619). The incidence of postoperative hyperglycemia was significantly higher in group F than in group C (P=0.045) at T2. Insulin levels, blood urea levels, and hunger scores were also not statistically different between the groups. The thirst and anxiety scores were lower at T0 and T1 in group C. Conclusion: Preoperative oral carbohydrate administration does not prevent perioperative increases in blood glucose levels. However, it reduces the incidence of perioperative hyperglycemia and decreases perioperative thirst and anxiety, thereby improving the quality of perioperative patient care.

We assessed our institutional practice of individualized insulin dosing for patients with type 2 diabetes receiving preoperative carbohydrate loading (CHO-L) within an enhanced recovery after surgery (ERAS®) protocol. Patients enrolled in an ERAS® protocol with concomitant type 2 diabetes received rapid acting insulin (Novolog®[insulin aspart]) prior to 50 g CHO-L on the day of surgery. Following CHO-L and the administration of insulin, no hypoglycemic episodes occurred with preoperative POC glucose values between 6.8 and 12.3 mmol/L (123 and 221 mg/dL). Our experience demonstrates that administering rapid acting insulin prior to CHO-L in patients with type 2 diabetes is feasible and targets the potentially negative influence CHO-L may impose on preoperative glycemia in this population. Important considerations of this approach are highlighted and an insulin dosing algorithm designed for non-specialty providers is suggested.

Objective: Preoperative fasting leads to a catabolic state aggravated by surgical stress. This leads to poor patient outcomes. This study aimed to determine the effect of preoperative oral carbohydrate administration on perioperative hyperglycemia and patient comfort. Methods: This prospective, randomized study was conducted on 60 adult American Society of Anesthesiologist I/II patients undergoing hip fracture fixation after obtaining institutional ethical committee clearance. Patients were randomly kept conventionally fasted before surgery (group F, n = 30) or were given oral carbohydrate 2 h before surgery (group C, n = 30). Under all aseptic precautions, a combined spinal epidural block was administered, and surgery was allowed. The primary outcome was blood glucose, and secondary outcomes included incidence of postoperative hyperglycemia, insulin level, blood urea, hunger, thirst, and anxiety. Results: Blood glucose levels were not statistically different between the two groups at baseline (T0; P=0.400), immediately after surgery (T1; P=0.399) and 24h after surgery (T2; P=0.619). The incidence of postoperative hyperglycemia was significantly higher in group F than in group C (P=0.045) at T2. Insulin levels, blood urea levels, and hunger scores were also not statistically different between the groups. The thirst and anxiety scores were lower at T0 and T1 in group C. Conclusion: Preoperative oral carbohydrate administration does not prevent perioperative increases in blood glucose levels. However, it reduces the incidence of perioperative hyperglycemia and decreases perioperative thirst and anxiety, thereby improving the quality of perioperative patient care. [ABSTRACT FROM AUTHOR]

Background: Stress hormones and inflammatory mediators provoked by any injury including surgery catabolise glycogen, fat and protein yielding glucose, free fatty acids, and amino acids in the circulation to be used in the immune response and tissue healing. On the other hand, these catabolic reactions inversely affect the process of post-operative recovery both on the short and long run. Hence nutrition for surgical patient must be properly planned to avoid these consequences. Aim of the study: to prove the alleviating effect of pre-operative carbohydrate load and early post-operative feeding on post-operative catabolic stress response. Methods: This prospective randomized comparative study included patients operated for colorectal cancer ending with anastomosis not stoma. The patients were randomly divided into two groups; with the study group adopted carbohydrate loading pre-operatively and early post-operative feeding, while the control group submitted to the traditional pre- and post-operative feeding protocols. Results: There were statistically significant difference between both groups in which application of study protocal decreases the post-operative ICU stay (P = 0.0005) and hence overall hospital stay. On the other hand, postoperative blood glucose level and pH showed significant difference in the study protocol adopting group (P = 0.00002, 0.00004 respectively), whereas other complications as anastmotic leakage showed no statistically significant difference between the two groups (P = 0.552). Conclusions: Pre-operative carbohydrate loading and early post-operative feeding as components of Early Recovery After Surgery (ERAS) have a remarkable improving effect on post-operatives outcomes. [ABSTRACT FROM AUTHOR]

Foods rich in saturated fatty acids (SFAs) have been discouraged by virtue of their cholesterol-raising potential, but this effect is modulated by the food source and background level of carbohydrate. We aimed to compare the consumption of palm stearin (PS) versus butter on circulating cholesterol responses in the setting of both a low-carbohydrate/high-fat (LC/HF) and high-carbohydrate/low-fat (HC/LF) diet in healthy subjects. We also explored effects on plasma lipoprotein particle distribution and fatty acid composition. We performed a randomized, controlled-feeding, cross-over study that compared a PS- versus a Butter-based diet in a group of normocholesterolemic, non-obese adults. A controlled canola oil-based 'Run-In' diet preceded the experimental PS and Butter diets. All diets were eucaloric, provided for 3-weeks, and had the same macronutrient distribution but varied in primary fat source (40% of the total fat). The same Run-In and cross-over experiments were done in two separate groups who self-selected to either a LC/HF (n = 12) or a HC/LF (n = 12) diet track. The primary outcomes were low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein (HDL)-C, triglycerides, and LDL particle distribution. Compared to PS, Butter resulted in higher LDL-C in both the LC/HF (13.4%, p = 0.003) and HC/LF (10.8%, p = 0.002) groups, which was primarily attributed to large LDL I and LDL IIa particles. There were no differences between PS and Butter in HDL-C, triglycerides, or small LDL particles. Oxidized LDL was lower after PS than Butter in LC/HF (p = 0.011), but not the HC/LF group. These results demonstrate that Butter raises LDL-C relative to PS in healthy normocholesterolemic adults regardless of background variations in carbohydrate and fat, an effect primarily attributed to larger cholesterol-rich LDL particles.

The use of carbohydrate (CHO) drinks prior to elective cesarean section has gained momentum, but its effect on maternal and neonatal outcomes remains controversial. The aim of this meta-analysis was to assess the effect of an oral CHO load prior to cesarean delivery on insulin sensitivity, insulin resistance, maternal glycemia, neonatal glycemia, and breastfeeding. As of May 21, 2023, we searched through five databases for English-language experimental studies on pre-cesarean oral CHO. A total of 3,940 citations were received, of which seven were selected. The concentrations of CHO used in these studies ranged from 5.9% to 14.2%, and the amounts used were 300-400 ml. We found that pre-cesarean CHO loading reduced maternal insulin resistance and increased maternal glucose levels. CHO loading activates the insulin pathway of critical enzymes to some extent, increasing glucose utilization by peripheral tissues and ultimately reducing postoperative insulin resistance. Of course, this is also beneficial in improving maternal blood sugar. We did not find that CHO increased maternal insulin sensitivity or neonatal blood glucose levels. Future prospective randomized controlled trials can use nutritional load to increase colostrum production after Caesarean section to enhance the confidence of these mothers in breastfeeding. In addition, our preoperative beverage could be more individualized to accommodate diabetic women. [ABSTRACT FROM AUTHOR]

Preoperative carbohydrate beverages have been shown to be beneficial in improving patient outcomes. There have been several investigations into the safety of maltodextrin as a preoperative carbohydrate. Although alternative preoperative carbohydrate sources have been proposed, there have been few investigations into the safety and gastric emptying of novel carbohydrate beverages. The present study aimed to compare the gastric emptying of phytoglycogen and maltodextrin to evaluate safety for use as presurgical carbohydrate beverages. In a quasi-experimental design, ten healthy participants orally consumed either a 12.5% maltodextrin or a 12.5% phytoglycogen solution. Gamma scintigraphy was used to evaluate gastric emptying at baseline at 45, 90, and 120 min. Serum insulin and serum glucose were measured at baseline at 15, 30, 45, 60, 90, and 120 min. Gastric volume was significantly lower in the phytoglycogen group at 45 min (p = 0.01) and 90 min (p = 0.01), but this difference lost significance at 120 min (p = 0.17). There were no significant differences between treatments for serum insulin or serum glucose at any time point. This study indicates that the gastric emptying of phytoglycogen is comparable to maltodextrin at 120 min after ingestion, opening the opportunity for the study of alternative carbohydrates for utilization as preoperative carbohydrates. [ABSTRACT FROM AUTHOR]

Introduction: It is suggested that preoperative carbohydrate loading may have beneficial effects, which is emphasised in Enhanced Recovery After Surgery protocols (ERAS). Recent data confirmed that carbohydrate loading shortens length of hospital stay. Aim: In this systematic review we aimed to determine whether carbohydrate loading have positive effects in patients undergoing 1-day surgery. Material and methods: We searched 5 databases and identified some randomized controlled trials which were reviewed independently by two reviewers. In the end 6 RCTs were included, involving 411 patients. Studies compared effects of carbohydrate loading vs. fasting and/or placebo on the following outcomes: thirst, hunger, postoperative nausea and vomiting (PONV), fatigue, pain and postoperative insulin resistance. In most cases data are inconclusive as studies reported opposite results. Conclusions: It seems that carbohydrate loading did not have a significant impact when compared to fasting or placebo. Preoperative carbohydrate loading seems not to have significant benefits over fasting or placebo in patients qualified for 1-day surgery. [ABSTRACT FROM AUTHOR]

Background: The purpose of this case study was to implement an evidence-based dietary approach to peaking for a bodybuilding competition and monitor its impact on body composition, muscle thickness (MT), intra-to-extra-cellular fluid shifts, subcutaneous thickness (ST), and hydration status. Secondarily, to document any adverse events of this peak week approach in a small, controlled setting. Methods Dietary practices were recorded, and laboratory testing was conducted throughout peak week, including competition morning. Assessments included: dual-energy X-ray absorptiometry (DEXA) for body composition, B-mode ultrasound for MT and ST, bioimpedance spectroscopy (BIS) for total body water (TBW)/intracellular water (ICW)/extracellular water (ECW), and raw BIS data (i.e., resistance, reactance, and phase angle), urine specific gravity (USG) for hydration status, and subjective fullness. Sequential dietary manipulations were made (i.e., CHO depletion/fat loading, CHO/water loading, and a refinement phase) with specific physiological goals. This was reflected in changes observed across all assessments throughout the peak week. Results: From the carbohydrate-depleted state (three days out) to competition day, we observed increases in lean body mass, MT, TBW (primarily ICW), and subjective fullness. Kendall's Tau B revealed a strong relationship between carbohydrate intake and ∑MT (τ = 0.733, p = 0.056). Additionally, novel ST data demonstrated a 10% reduction for the summation of all seven sites, with some drastic changes in specific regions (e.g., −43% for triceps ST) from three days out to competition day. Conclusions: These data suggest that the prototypical goals of bodybuilders' peak week (i.e., increasing muscle fullness, decreasing subcutaneous thickness) to enhance their aesthetics/muscularity presented can be achieved with a drug-free protocol involving dietary manipulations. [ABSTRACT FROM AUTHOR]

The recent popularization of low-glycemic foods has expanded interest in glycemic index (GI) not only among diabetic patients but also healthy people. The purpose of this study is to validate the estimated glycemic load model (eGL) developed in 2018. This study measured the glycemic load (GL) of 24 fast foods in the market in 20 subjects. Then, the transportability of the model was assessed, followed by an assessment of model calibration and discrimination based on model performance. The transportability assessment showed that the subjects at the time of model development are different from the subjects of this validation study. Therefore, the model can be described as transportable. As for the model's performance, the calibration assessment found an x2 value of 11.607 and a p-value of 0.160, which indicates that the prediction model fits the observations. The discrimination assessment found a discrimination accuracy exceeding 0.5 (57.1%), which confirms that the performance and stability of the prediction model can be discriminated across all classifications. The correlation coefficient between GLs and eGLs measured from the 24 fast foods was statistically significant at 0.712 (p < 0.01), indicating a strong positive linear relationship. The explanatory powers of GL and eGL was high at 50.7%. The findings of this study suggest that this prediction model will greatly contribute to healthy food choices because it allows for predicting blood glucose responses solely based on the nutrient content labeled on the fast foods.

Production of trimethylamine-N-oxide (TMAO), a biomarker of CVD risk, is dependent on intestinal microbiota, but little is known of dietary conditions promoting changes in gut microbial communities. Resistant starches (RS) alter the human microbiota. We sought to determine whether diets varying in RS and carbohydrate (CHO) content affect plasma TMAO levels. We also assessed postprandial glucose and insulin responses and plasma lipid changes to diets high and low in RS. In a cross-over trial, fifty-two men and women consumed a 2-week baseline diet (41 percentage of energy (%E) CHO, 40 % fat, 19 % protein), followed by 2-week high- and low-RS diets separated by 2-week washouts. RS diets were assigned at random within the context of higher (51-53 %E) v. lower CHO (39-40 %E) intake. Measurements were obtained in the fasting state and, for glucose and insulin, during a meal test matching the composition of the assigned diet. With lower CHO intake, plasma TMAO, carnitine, betaine and γ-butyrobetaine concentrations were higher after the high- v. low-RS diet (P

The preoperative use of carbohydrate loading (CHO) is recommended in patients undergoing abdominal surgery, even if the advantages remain debatable. The aim was to evaluate the CHO benefits in patients undergoing abdominal surgery. A systematic search of randomized clinical trials was made. A frequentist random-effects network meta-analysis was carried out, reporting the surface under the cumulative ranking (SUCRA). The primary endpoint regarded the morbidity rate. The secondary endpoints were aspiration/regurgitation rates, the length of stay (LOS), the rate of postoperative nausea and vomiting (PONV), the changes (Δ) in insulin sensitivity or resistance, and the postoperative C- reactive protein (CRP) values. CHO loading and water administration had a similar probability of being the approach with a lower morbidity rate (SUCRA = 62.4% and 64.7%). CHO and clear water also had a similar chance of avoiding the PONV (SUCRA of 80.8% and 77%). The aspiration regurgitation rate was not relevant in non-fasting patients (0.06%). CHO administration was associated with the shorter hospitalization (SUCRA 86.9%), with the best metabolic profile (SUCRA values for insulin resistance and sensitivity were 81.1% and 76%). CHO enriched was the best approach for postoperative CRP values. Preoperative fasting was the worst approach for morbidity, PONV, insulin resistance and sensitivity, and CRP (SUCRA values of 32.1%, 21.7%, 10.2%, 3.2%, and 2.0%). Both preoperative CHO loading and clear water use were superior to the fasting about morbidity. CHO drinks use could provide specific advantages, reduce the PONV rate, and improve carbohydrate homeostasis, inflammatory pathway, and hospitalization. [ABSTRACT FROM AUTHOR]

Background: Insulin resistance (IR) is one of the independent determinants influencing the length of hospital stay (LOHS) and postoperative complications in colorectal procedures. Preoperative oral carbohydrate loading (OCL) has emerged as a prospective countermeasure for IR. This study aimed to investigate the effects of preoperative carbohydrate loading on postoperative IR, inflammatory parameters, and clinical outcomes in patients undergoing elective colorectal surgery., Methods: This was an open-label, parallel arm, superiority randomized controlled trial conducted over 2 years. Participants were assigned to conventional fasting and oral OCL groups. IR, insulin sensitivity, Glasgow Prognostic Score (GPS), and interleukin 6 levels were analyzed on the day of surgery and on the first postoperative day (POD-1) and third POD (POD-3). Clinical parameters, such as thirst, hunger, dry mouth, anxiety, weakness, pain, nausea, and vomiting, were compared in the perioperative period. In addition, surgical clinical outcomes, such as intestinal recovery, time to independent ambulation, postoperative morbidity, and LOHS, were studied., Results: A total of 72 participants were included, with 36 in each group. In the OCL group, there was a statistically significant decrease in postoperative IR on the day of surgery, POD-1, and POD-3 (P = .0336). Similarly, inflammatory parameters and the GPS were found to be significantly lower in the OCL group (P < .001). Clinical parameters, such as thirst, hunger, and dry mouth, were significantly lower in the intervention group (P =.00), with a shortened LOHS., Conclusion: This study demonstrated that preoperative carbohydrate loading is associated with reduced IR and inflammatory markers, shortened hospital stays, and improved overall clinical outcomes in elective colorectal surgery., (Copyright © 2024 Society for Surgery of the Alimentary Tract. Published by Elsevier Inc. All rights reserved.)

Purpose: To better understand the carbohydrate (CHO) requirement of Australian Football (AF) match play by quantifying muscle glycogen utilization during an in-season AF match. Methods: After a 24-h CHO-loading protocol of 8 and 2 g/kg in the prematch meal, 2 elite male forward players had biopsies sampled from m. vastus lateralis before and after participation in a South Australian Football League game. Player A (87.2 kg) consumed water only during match play, whereas player B (87.6 kg) consumed 88 g CHO via CHO gels. External load was quantified using global positioning system technology. Results: Player A completed more minutes on the ground (115 vs 98 min) and covered greater total distance (12.2 vs 11.2 km) than player B, although with similar high-speed running (837 vs 1070 m) and sprinting (135 vs 138 m). Muscle glycogen decreased by 66% in player A (pre: 656 mmol/kg dry weight [dw], post: 223 mmol/kg dw) and 24% in player B (pre: 544 mmol/kg dw, post: 416 mmol/kg dw). Conclusion: Prematch CHO loading elevated muscle glycogen concentrations (ie, >500 mmol/kg dw), the magnitude of which appears sufficient to meet the metabolic demands of elite AF match play. The glycogen cost of AF match play may be greater than in soccer and rugby, and CHO feeding may also spare muscle glycogen use. Further studies using larger sample sizes are now required to quantify the interindividual variability of glycogen cost of match play (including muscle and fiber-type-specific responses), as well examining potential metabolic and ergogenic effects of CHO feeding. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: The purpose of this case study was to implement an evidence-based dietary approach to peaking for a bodybuilding competition and monitor its impact on body composition, muscle thickness (MT), intra-to-extra-cellular fluid shifts, subcutaneous thickness (ST), and hydration status. Secondarily, to document any adverse events of this peak week approach in a small, controlled setting. Methods Dietary practices were recorded, and laboratory testing was conducted throughout peak week, including competition morning. Assessments included: dual-energy X-ray absorptiometry (DEXA) for body composition, B-mode ultrasound for MT and ST, bioimpedance spectroscopy (BIS) for total body water (TBW)/intracellular water (ICW)/extracellular water (ECW), and raw BIS data (i.e., resistance, reactance, and phase angle), urine specific gravity (USG) for hydration status, and subjective fullness. Sequential dietary manipulations were made (i.e., CHO depletion/fat loading, CHO/water loading, and a refinement phase) with specific physiological goals. This was reflected in changes observed across all assessments throughout the peak week. Results: From the carbohydrate-depleted state (three days out) to competition day, we observed increases in lean body mass, MT, TBW (primarily ICW), and subjective fullness. Kendall’s Tau B revealed a strong relationship between carbohydrate intake and ∑MT (τ = 0.733, p = 0.056). Additionally, novel ST data demonstrated a 10% reduction for the summation of all seven sites, with some drastic changes in specific regions (e.g., −43% for triceps ST) from three days out to competition day. Conclusions: These data suggest that the prototypical goals of bodybuilders’ peak week (i.e., increasing muscle fullness, decreasing subcutaneous thickness) to enhance their aesthetics/muscularity presented can be achieved with a drug-free protocol involving dietary manipulations.

Purpose: Preoperative oral carbohydrate loading is a component of enhanced recovery after surgery protocols. The aim of this study is to investigate the effects of preoperative oral carbohydrate loading on postoperative clinical outcomes in spinal surgery patients., Design: This is a prospective case-control study., Methods: This study was conducted with patients who underwent spinal surgery from October 1, 2020 to October 1, 2021 in a neurosurgery clinic of an education and research hospital. The intervention group (n = 46) ingested 800 mL oral carbohydrate drinks at least 8 hours before surgery. The postoperative clinical outcomes were nausea, vomiting, antiemetic and analgesic drug medication, inflammation, and bleeding. The first flatus and defecation time, oral intake time, mobilization time, and length of stay in hospital were assessed postoperatively. Adverse events were monitored up to 24 hours postoperatively. The control group (n = 46) underwent routine fasting protocols., Findings: Lower rates of vomiting and bleeding during and after surgery and earlier defecation time and first mobilization time were determined in the intervention group, and the difference compared with the control group was statistically significant., Conclusions: Preoperative oral carbohydrate loading is a nonpharmacological intervention that has a positive effect on postoperative clinical outcomes in patients who underwent spinal surgery and should be included in the enhanced recovery after surgery protocol., Competing Interests: Declaration of Competing Interest None to report., (Copyright © 2024 The American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.)

The present study analyzed the effects from day-before to day-of bodybuilding competition on intracellular water (ICW), extracellular water (ECW), total body water (TBW), and bioimpedance analysis (BIA) parameters (resistance, R; reactance, Xc; and derived scores) in bodybuilding athletes. We assessed anthropometry and BIA (foot-to-hand; tetrapolar; 50 kHz) in 11 male bodybuilders (29 ± 4 year-old; 81 ± 8 kg; 172 ± 7 cm; 27 ± 2 kg/m2) both on the pre-competition day and on the contest day. Results revealed significant increases in ICW (31.6 ± 2.9 to 33.1 ± 2.8 L), with concomitant decreases in ECW (19.8 ± 1.8 to 17.2 ± 1.4 L) and TBW (51.4 ± 4.6 to 50.3 ± 4.2 L) from the day-before competition to contest day, which resulted in relatively large increases in the ICW/ECW ratio (1.60 ± 0.03 to 1.92 ± 0.01 L). Moreover, significant increases in R (391 ± 34 to 413 ± 33 ohm), Xc (64 ± 7 to 70 ± 6 ohm), and phase angle (9.3 ± 0.6 to 9.6 ± 0.7 degree) were observed between time periods. The phase angle scores reported on show-day of 9.6 and 11.2 appear to be the highest group mean and individual values observed in the literature to date. In conclusion, the strategies carried out on the final day of peak-week bodybuilding preparation lead to changes in BIA parameters and body water, with fluids shifting from the extra- to the intracellular compartment.

The aim of the study was to investigate the pre- and during-race nutritional intake of cyclists competing in a 210-km 1-day ultraendurance cycle race. Forty-five endurancetrained male cyclists participated in this dietary survey and completed a 3-day dietary record. Mean reported carbohydrate (CHO) intake over the 3 days before the race (5.6 ± 1.7 g/kg) was below the recommended guidelines of 7-10 g/kg. Although 57% of participants indicated that they CHO loaded 1-3 days before the race, only 23% of these participants achieved CHO intakes of ≥7 g/kg over the 3-day period before the race, demonstrating a discrepancy between perceived and actual intakes of CHO. Most participants indicated the use of CHO supplements before (84%) and during (98%) the race and achieved a CHO intake of 63 ± 23 g/hr during the race. Although most cyclists failed to meet recommended prerace CHO intakes, most achieved the recommended CHO intakes during the race. [ABSTRACT FROM AUTHOR]

We assessed our institutional practice of individualized insulin dosing for patients with type 2 diabetes receiving preoperative carbohydrate loading (CHO-L) within an enhanced recovery after surgery (ERAS®) protocol. Patients enrolled in an ERAS® protocol with concomitant type 2 diabetes received rapid acting insulin (Novolog®[insulin aspart]) prior to 50 g CHO-L on the day of surgery. Following CHO-L and the administration of insulin, no hypoglycemic episodes occurred with preoperative POC glucose values between 6.8 and 12.3 mmol/L (123 and 221 mg/dL). Our experience demonstrates that administering rapid acting insulin prior to CHO-L in patients with type 2 diabetes is feasible and targets the potentially negative influence CHO-L may impose on preoperative glycemia in this population. Important considerations of this approach are highlighted and an insulin dosing algorithm designed for non-specialty providers is suggested., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

The purpose of this project was to implement carbohydrate loading in patients undergoing thoracic surgery in an effort to decrease postoperative pain, nausea, and length of stay as a part of an enhanced recovery after surgery protocol. This quality-improvement project used a preintervention and postintervention design. Carbohydrate loading was given to 50 patients before undergoing thoracic surgery. Chart review was performed for 47 patients who received standard preoperative instructions in the preintervention group as historical control. Patients who received carbohydrate loading had a decreased use of opioids in the first 4 hours after surgery (P =.028) and decreased use of antiemetic medication in the first 24 hours after surgery compared with the preintervention group (P =.066). Patients who were instructed to consume carbohydrate loading complied 87% of the time. Carbohydrate loading can decrease postoperative nausea and pain in patients undergoing thoracic surgery. [ABSTRACT FROM AUTHOR]

Objectives: To determine if a 4 d period of high carbohydrate intake can supercompensate muscle glycogen and exercise work capacity on back-to-back occasions.Design: Seven trained cyclists (6 male, VO2peak: 57 ± 4 mL kg-1 min-1) completed a 9-d experimental period, consisting of three intermittent exhaustive cycling trials on days 1 (trial 1), 5 (trial 2) and 9 (trial 3). Following trial 1 cyclists were fed a high carbohydrate diet (˜10 g kg-1 day-1) for eight days to assess their capacity to repeatedly supercompensate muscle glycogen with 4 d recovery.Methods: A resting muscle biopsy was obtained prior to each trial consisting of 2 min work intervals (90-60% peak power output) interspersed with 2 min recovery (40% peak power output) repeated until exhaustion. Each 72-h period between trial days included two days of low volume cycling and a rest day. Resting muscle glycogen and total work completed was determined for each trial day.Results: Baseline muscle glycogen on day 1 (583.6 ± 111.0 mmol kg-1 dry mass) was supercompensated on day 5 (835.1 ± 112.8 mmol kg-1 dry mass; p = 0.04, d = 2.25) and again on day 9 (848.3 ± 111.4 mmol kg-1 dry mass; p = 0.01, d = 2.38). Total cycling work capacity increased from trial 1 to trial 2 (+8.7 ± 5.4 kJ kg-1; p = 0.01; d = 1.41); a large effect was observed in trial 3 compared to trial 1 (+6.4 ± 6.8 kJ kg-1; p = 0.10; d = 1.10).Conclusions: A 4 d high carbohydrate feeding strategy is sufficient to repeatedly supercompensate muscle glycogen content following exhaustive exercise and results in enhanced work capacity. [ABSTRACT FROM AUTHOR]

Standardizing a dual x-ray absorptiometry (DXA) protocol is thought to provide a reliable measurement of body composition. Purpose: We investigated the effects of manipulating muscle glycogen and creatine content independently and additively on DXA estimates of lean mass. Method: Eighteen well-trained male cyclists undertook a parallel group application of creatine loading (n = 9) (20 g⋅d-1 for 5 d loading; 3 g⋅d-1 maintenance) or placebo (n = 9) with crossover application of glycogen loading (12 v 6 g⋅kg-1 BM per day for 48 h) as part of a larger study involving a glycogen-depleting exercise protocol. Body composition, total body water, muscle glycogen and creatine content were assessed via DXA, bioelectrical impedance spectroscopy and standard biopsy techniques. Changes in the mean were assessed using the following effect-size scale: >0.2 small, >0.6, moderate, >1.2 large and compared with the threshold for the smallest worthwhile effect of the treatment. Results: Glycogen loading, both with and without creatine loading, resulted in substantial increases in estimates of lean body mass (mean ± SD; 3.0% ± 0.7% and 2.0% ± 0.9%) and leg lean mass (3.1% ± 1.8% and 2.6% ± 1.0%) respectively. A substantial decrease in leg lean mass was observed after the glycogen depleting condition (-1.4% ± 1.6%). Total body water showed substantial increases after glycogen loading (2.3% ± 2.3%), creatine loading (1.4% ± 1.9%) and the combined treatment (2.3% ± 1.1%). Conclusions: Changes in muscle metabolites and water content alter DXA estimates of lean mass during periods in which minimal change in muscle protein mass is likely. This information needs to be considered in interpreting the results of DXA-derived estimates of body composition in athletes. [ABSTRACT FROM AUTHOR]

Since the pioneering studies conducted in the 1960s in which glycogen status was investigated using the muscle biopsy technique, sports scientists have developed a sophisticated appreciation of the role of glycogen in cellular adaptation and exercise performance, as well as sites of storage of this important metabolic fuel. While sports nutrition guidelines have evolved during the past decade to incorporate sport-specific and periodized manipulation of carbohydrate (CHO) availability, athletes attempt to maximize muscle glycogen synthesis between important workouts or competitive events so that fuel stores closely match the demands of the prescribed exercise. Therefore, it is important to understand the factors that enhance or impair this biphasic process. In the early postexercise period (0-4 h), glycogen depletion provides a strong drive for its own resynthesis, with the provision of CHO (~1 g/kg body mass) optimizing this process. During the later phase of recovery (4-24 h), CHO intake should meet the anticipated fuel needs of the training/competition, with the type, form, and pattern of intake being less important than total intake. Dietary strategies that can enhance glycogen synthesis from suboptimal amounts of CHO or energy intake are of practical interest to many athletes; in this scenario, the coingestion of protein with CHO can assist glycogen storage. Future research should identify other factors that enhance the rate of synthesis of glycogen storage in a limited time frame, improve glycogen storage from a limited CHO intake, or increase muscle glycogen supercompensation. [ABSTRACT FROM AUTHOR]

Background: Guidelines for fasting in elderly patients with acute hip fracture are the same as for other trauma patients, and longer than for elective patients. The reason is assumed stress-induced delayed gastric emptying with possible risk of pulmonary aspiration. Prolonged fasting in elderly patients may have serious negative metabolic consequences. The aim of our study was to investigate whether the preoperative gastric emptying was delayed in elderly women scheduled for surgery due to acute hip fracture. Methods: In a prospective study gastric emptying of 400 ml 12.6% carbohydrate rich drink was investigated in nine elderly women, age 77-97, with acute hip fracture. The emptying time was assessed by the paracetamol absorption technique, and lag phase and gastric half-emptying time was compared with two gender-matched reference groups: ten elective hip replacement patients, age 45-71 and ten healthy volunteers, age 28-55. Results: The mean gastric half-emptying time in the elderly study group was 53 ± 5 (39-82) minutes with an expected gastric emptying profile. The reference groups had a mean half-emptying time of 58 ± 4 (41-106) and 59 ± 5 (33-72) minutes, indicating normal gastric emptying time in elderly with hip fracture. Conclusion: This pilot study in women with an acute hip fracture shows no evidence of delayed gastric emptying after an orally taken carbohydrate-rich beverage during the pre-operative fasting period. This implies no increased risk of pulmonary aspiration in these patients. Therefore, we advocate oral pre-operative management with carbohydrate- rich beverage in order to mitigate fasting-induced additive stress in the elderly with hip fracture. Trial registration: ClinicalTrials.gov NCT02753010. Registered 17 April 2016, retrospectively. [ABSTRACT FROM AUTHOR]