Cardiovascular Risk Factors and Haematological Indexes of Inflammation in Paralympic Athletes with Different Motor Impairments

Abstract

Haematological indexes of both inflammation and platelet activation have been suggested as predictive markers of cardiovascular disease (CVD), which has high prevalence in Paralympic athletes (PA). Different mechanisms could play a role in increasing CVD risk in PA with spinal cord injury (PA-SCI), lower limb amputation (PA-LLA), or upper limb impairment (PA-ULI). We compared, in 4 groups of PA competing in power, intermittent (mixed metabolism), and endurance sports, Framingham Risk Score (FRS), metabolic syndrome criteria (MetS-C), inflammation (INFLA) Score, 5 haematological indexes of platelet activation (mean platelet volume (MPV), platelet distribution width (PDW), and the ratios between MPV and platelet (MPVPR), between MPV and lymphocyte (MPVLR), and between PDW and lymphocyte (PDWLR)) and the endogenous antioxidants uric acid (UA) and bilirubin (BR). A retrospective chart review of PA from preparticipation examinations' records (London 2012 and Sochi 2014 Paralympics) was performed. We included 25 PA-SCI (13 with high and 12 with low lesion, PA-SCI-H and PA-SCI-L), 15 PA-LLA, and 10 PA-ULI. FRS and INFLA Score did not differ among groups, but PA-SCI-H had lower HDL, compared to PA-SCI-L and PA-ULI. PA-LLA had more MetS diagnostic criteria with significant higher glucose levels than other groups. PA-SCI-H had significantly lower lymphocytes' count compared to PA-LLA and higher MPV, PDW, MPVPR, MPVLR, and PDWLR. SCI-H had lower BR, haemoglobin, haematocrit, proteins, and creatinine. No interaction was found between the 3 kinds of sitting sports and the 2 groups of health conditions (PA-SCI and PA-LLA). In conclusion, PA-LLA had a higher cardiometabolic risk, whereas PA-SCI-H had a higher platelet-derived cardiovascular risk. Further larger studies are needed to investigate the relationship between indexes of inflammation/oxidation and dietary habit, body composition, and physical fitness/performance in PA with motor impairments.

Aerobic fitness is a potential crucial factor in protecting paralympic athletes with locomotor impairments from atherosclerotic cardiovascular risk

“…However, a high prevalence of ACVD-risk factors was even found both in a group of brazilian paralympic athletes (67 with physical and 12 with visual impairment), including 11 with SCI, 6 with lower limb deficiency, 27 with poliomyelitis sequelae, and 21 with cerebral palsy [33], and in 50 elite italian paralympic athletes competing in summer and winter games including athletes with SCI, lower limb amputation (n = 15), and upper limb impairments (n = 10) [34]. Also in the present study, the prevalence of ACVDrisk factors was considerably high, having about 2/3 of the sample at least 1 ACVD-risk factor, while 28% had 2 or more ACVD-risk factors, confirming that the prevalence of modifiable ACVD-risk factor in paralympic athletes with locomotor impairment is relevant, as already stated [33,34]. The comparison between paralympic athletes with SCI and those with other Health Conditions did not find any significant difference in both absolute values and prevalence of the modifiable ACVD-risk factors.…”

“…At our best knowledge, however, the relationship between aerobic fitness and cardiovascular risk reduction is debated in individuals with SCI with low cardiovascular fitness [27][28][29] and it has been only suggested but not demonstrated in Paralympic Athletes [30], even though sport has been repeatedly considered and used as one of the most effective ways to improve cardiovascular fitness and provide health benefits in people with SCI [31], lower limb amputation [32], and other health conditions [30]. Nevertheless, a Brazilian study [33] and a recent Italian study [34] found in different cohorts of Paralympic Athletes a high prevalence of ACVD-risk factors. In spite of a demonstrated increased energy expenditure [35,36] and its direct impact on VO 2peak [35], some paralympic athletes are still at high risk of developing ACVD.…”

Protein Considerations for Athletes With a Spinal Cord Injury

“…Skeletal muscle atrophy and increased sedentary time increase the risk of glucose intolerance, potentially leading to insulin resistance (17). Osteoporosis, oxidative stress, chronic systemic inflammation, reduced cardiovascular efficiency, dyslipidemia, and cardiovascular disease (CVD) risk are also elevated with a SCI (17). While physical activity can positively impact the aforementioned health concerns, CVD risk remains elevated in Paralympic athletes with a SCI (18).…”

“…While physical activity can positively impact the aforementioned health concerns, CVD risk remains elevated in Paralympic athletes with a SCI (18). A more recent assessment comparing Paralympic athletes with an amputation vs. a SCI found that PARA-SCI with a high lesion SCI had a higher plateletderived cardiovascular risk as compared with those with an amputation, which the authors attributed to malnutrition (17).…”

Dietary Antioxidants: Micronutrients and Antinutrients in Physiology and Pathology

“…Although, among celiac individuals, chocolate consumers had a higher lymphocyte-to-monocyte ratio [11] and a lower neutrophil-to-lymphocyte ratio [12], two hematological indexes of inflammation [13], while no differences were observed between chocolate consumers and non-consumers in red blood cell count, mean corpuscular volume, and hemoglobin values [11], a nutrition or health claim should not be made if it is inconsistent with generally accepted nutrition and health principles or if it encourages or condones excessive consumption of any food or disparages good dietary practice [1]. The COMMISSION REGULATION (EU) No 488/2014 (amending Regulation (EC) No 1881/2006) as regards maximum levels of cadmium in foodstuffs reported the following: "Chocolate and cocoa powder sold to the final consumer can contain high levels of cadmium and are an important source of human exposure.…”