Prevalence of Metabolic Syndrome and Its Components among Chinese Professional Athletes of Strength Sports with Different Body Weight Categories

Background

There is an increasing concern on cardiometabolic health in young professional athletes at heavy-weight class.

Objective

Our cross-sectional survey aimed to evaluate the prevalence of metabolic syndrome and clustering of metabolic risk factors in a population of young and active professional athletes of strength sports in China.

Methods

From July 2006 to December 2008, a total of 131 male and 130 female athletes of strength sports were enrolled. We used two criteria provided by the Chinese Diabetes Society (2004) and the National Cholesterol Education Program''s Adult Treatment Panel III (2002) to define the metabolic syndrome and its individual components, respectively.

Results

Regardless of their similar ages (mean: 21 years) and exercise levels, athletes in the heaviest-weight-class with unlimited maximum body weight (UBW) boundaries (mean weight and BMI: 130 kg and 38 kg/m² for men, 110 kg and 37 kg/m² for women) had significantly higher prevalence of metabolic syndrome than did those in all other body-weight-class with limited body weight (LBW) boundaries (mean weight and BMI: 105 kg and 32 kg/m² for men, 70 kg and 26 kg/m² for women). Prevalence of metabolic syndrome using CDS criteria (UBW vs. LBW: 89% vs. 18% for men, 47% vs. 0% for women) and its individual components, including central obesity, hypertension, hypertriglyceridemia, low high-density lipoprotein-cholesterol levels, and impaired fasting glucose, were all significantly higher in athletes at the heaviest weight group with UBW than all other weight groups with LBW.

Conclusions

Our study suggests that professional athletes of strength sports at the heaviest-weight-class are at a significant increased risk of cardiometabolic disease compared with those at all other weight categories. The findings support the importance of developing and implementing the strategy of early screening, awareness, and interventions for weight-related health among young athletes.     

The power-duration product--evaluation of a new reference system for cardiopulmonary exercise testing.

The aim of this study was to assess the discriminatory power of the new reference system, power-duration product (PDP), for the analysis of haemodynamic and metabolic variables derived from cardiopulmonary exercise tests. The PDP was calculated as the cumulative index of the product of power (W) times the duration (minutes) of each individual exercise step. The study comprised 30 healthy male volunteers, who were classified into three groups with respect to their regular physical activity: 10 untrained medical students (students), 10 sprinters and long-jumpers (athletes) and 10 endurance athletes performing triathlon (triathletes). Twenty metabolic and haemodynamic variables were recorded throughout exhaustion-limited cycling ergometry. The data were analysed with respect to five reference systems (heart rate, relative and absolute oxygen consumption/body surface area, power, and PDP). A total of 14 differences between modified time courses of haemodynamic and metabolic variables in the three groups of volunteers were observed by reference to PDP, 12 by reference to relative oxygen consumption/body surface area, 11 by reference to heart rate, 8 by reference to absolute oxygen consumption/body surface area, and 7 by reference to power. When using PDP as the reference, the time courses of 8 parameters differed significantly between students and triathletes, 5 between students and athletes, and 1 between athletes and triathletes. In addition to its discriminatory superiority for the comparison of different groups characterized by different cardiopulmonary training and endurance, it was found that PDP permitted a better characterization of the individually performed exercise than the consideration of power per se.     

Metabolic changes during a field experiment in a world-class windsurfing athlete: a trial with multivariate analyses

Physical exercise affects hematological equilibrium and metabolism. This study evaluated the biochemical and hematological responses of a male world-class athlete in sailing who is ranked among the top athletes on the official ISAF ranking list of windsurfing, class RS:X. The results describe the metabolic adaptations of this athlete in response to exercise in two training situations: the first when the athlete was using the usual training and dietary protocol, and the second following training and nutritional interventions based on a careful analysis of his diet and metabolic changes measured in a simulated competition. The intervention protocol for this study consisted of a 3-month facility-based program using neuromuscular training (NT), aerobic training (AT), and nutritional changes to promote anabolism and correct micronutrient malnutrition. Nutritional and training intervention produced an increase in the plasma availability of branched-chain amino acids (BCAAs), aromatic amino acids (AAAs), alanine, glutamate, and glutamine during exercise. Both training and nutritional interventions reduced ammonemia, uricemia, and uremia. In addition, we are able to correct a significant drop in potassium levels during races by correct supplementation. Due to the uniqueness of this experiment, these results may not apply to other windsurfers, but we nonetheless had the opportunity to characterize the metabolic adaptations of this athlete. We also proposed the importance of in-field metabolic analyses to the understanding, support, and training of world-class elite athletes.     

Aerobic power as a factor in women's response to work in hot environments.

Twelve young women, athletes (n = 6) and nonathletes (n = 6), walked on a treadmill at loads equivalent to approximately 30% Vo2 max for two 50-min periods in three environments: 1) 28 degrees C, 45% rh, 2) 35 degrees C, 65% rh, and 3) 48 degrees C, 10% rh. There were no differences between groups in rectal temperature, heart rate, evaporative heat loss, or mean skin temperature at 28 or 35 degrees C or during the first work period in the 48 degrees C environment. However, a significantly lower cardiac output (Q) and stroke volume (SV) observed for nonathletes by the 46th min of work at 48 degrees C may explain why no nonathletes were able to complete a 2nd h of work while four of six athletes successfully finished the period. It appears that in conditions of severe heat stress (48 degrees C) athletes were able to maintain a cardiac output sufficient to meet the metabolic requirements and the large increase in peripheral blood flow for a longer period of time than nonathletes.     

Contribution of postexercise increment in glucose storage to variations in glucose-induced thermogenesis in endurance athletes

The present study was undertaken to evaluate the contribution of an increment in glucose storage to the reduced glucose-induced thermogenesis (GIT) characterizing endurance-trained individuals. For that purpose, glucose storage and GIT were determined during an oral glucose tolerance test (OGTT) in eight elite endurance athletes exercising between 6 and 16 h/week. Their values were compared with those obtained in five nontrained subjects submitted to two OGTT, i.e., before and 16 h after they had performed a 90-min vigorous exercise. As expected, endurance athletes exhibited a reduced GIT and a greater glucose storage during the OGTT in comparison to the preexercise values of nontrained subjects. Once the latter subjects had performed the 90-min exercise, their glucose storage during the OGTT was similar to the level found in athletes. This adaptation was accompanied by a significant reduction in GIT, which corresponded to 47% of the difference observed between trained and nontrained subjects when both groups maintained their usual life habits. Unlike GIT, resting metabolic rate (RMR) was found to be higher in athletes than in nontrained individuals. When subdividing the athletes into two subgroups on the basis of the duration of their weekly training, it was found that RMR was mainly elevated in those performing the higher amount of exercise. These results demonstrate that the reduced GIT characterizing endurance-trained individuals is partly explained by an increase in glucose storage during an OGTT. As further discussed, this reduced GIT is likely an indirect consequence of modifications of other energy-requiring energy processes rather than a direct result of the postexercise increment in glucose storage.     

Metabolic states in athletes during alternate intense muscular activity

The dynamics of metabolic states in athletes during alternate intense muscular activity was studied. In a laboratory, highly trained athletes (cyclists and speed skaters) performed tests on a bicycle ergometer at the level of the critical power and maximal oxygen consumption. In two additional series of experiments, each of the subjects performed tests at the level of critical power with initial acceleration of 28% of the maximal duration of the 45- and 108-s exercises. During the exercise when the subjects worked at critical power, a succession of metabolic phases was observed: the initial lag period, rapid exponential growth to the level of critical power, subsequent maintenance of the critical power, and, finally, functional disorders of aerobic metabolism, along with increasing local fatigue. We found that a short (no more than 10 s) initial acceleration at the level of power equal to the 45-s maximal exercise is the most efficient for performance at the level of critical power maintenance; this acceleration stimulates the development of aerobic metabolism and does not lead to depletion of anaerobic resources or considerable local exhaustion at the end of the performance.     

Blood Rheology, Sex Hormones, and Cortisol in Athletes

The interrelations of blood rheology, plasma proteins and lipids, and steroid hormones (total testosterone, estradiol, and cortisol) were studied in athletes (N = 14). Blood (BV), plasma (PV), and erythrocyte suspension (ESV) viscosities; fibrinogen; total cholesterol (Ch); low density lipoprotein (LDL) Ch; and plasminogen activity were lower in the athletes than in control subjects (N = 10). The specific peripheral vascular resistance (SPVR) to BV ratio and PWC₁₇₀ were lower in the athletes. All these parameters correlated with decreased estradiol. Discriminant analysis indicated PWC₁₇₀, estradiol, and ESV to be the main parameters discriminating the groups. Decreased estradiol seemed to be associated with an increased physical activity in the athletes, as evident from its correlation with PWC₁₇₀ and differences in the body composition (a correlation with the body mass index). No significant difference was found in total Ch and cortisol. However, in the combined sample, decreased testosterone was associated with decreased BV, which was explained by direct correlations of the hormone with hematocrit (Ht) and PV through relationships with Ch and triglycerides (TG). Increased cortisol correlated with the higher plasma fluidity in the athletes as a result of inverse correlations of the hormone with TG and the increased suspension stability of the blood. Training-induced changes in hormonal and metabolic parameters were assumed to play an important role in the regulation of blood fluidity in athletes.     

Size and blood flow of central and peripheral arteries in highly trained able-bodied and disabled athletes.

In a cross-sectional study, central and peripheral arteries were investigated noninvasively in high-performance athletes and in untrained subjects. The diastolic inner vessel diameter (D) of the thoracic and abdominal aorta, the subclavian artery (Sub), and common femoral artery (Fem) were determined by duplex sonography in 18 able-bodied professional tennis players, 34 able-bodied elite road cyclist athletes, 26 athletes with paraplegia, 17 below-knee amputated athletes, and 30 able-bodied, untrained subjects. The vessel cross-sectional areas (CSA) were set in relation to body surface area (BSA), and the cross-section index (CS-index = CSA/BSA) was calculated. Volumetric blood flow was determined in Sub and Fem via a pulsed-wave Doppler system and was set in relation to heart rate to calculate the stroke flow. A significantly increased D of Sub was found in the racket arm of able-bodied tennis players compared with the opposite arm (19%). Fem of able-bodied road cyclist athletes and of the intact limb in below-knee amputated athletes showed similar increases. D of Fem was lower in athletes with paraplegia (37%) and in below-knee amputated athletes proximal to the lesion (21%) compared with able-bodied, untrained subjects; CS-indexes were reduced 57 and 31%, respectively. Athletes with paraplegia demonstrated a larger D (19%) and a larger CS-index in Sub (54%) than able-bodied, untrained subjects. No significant differences in D and CS-indexes of the thoracic and abdominal aorta were found between any of the groups. The changes measured in Sub and Fem were associated with corresponding alterations in blood flow and stroke flow in all groups. The study suggests that the size and blood flow volume of the proximal limb arteries are adjusted to the metabolic needs of the corresponding extremity musculature and underscore the impact of exercise training or disuse on the structure and the function of the arterial system.     

Effects of 3-day bed rest on physiological responses to graded exercise in athletes and sedentary men.

To test the hypotheses that short-term bed-rest (BR) deconditioning influences metabolic, cardiorespiratory, and neurohormonal responses to exercise and that these effects depend on the subjects' training status, 12 sedentary men and 10 endurance- and 10 strength-trained athletes were submitted to 3-day BR. Before and after BR they performed incremental exercise test until volitional exhaustion. Respiratory gas exchange and heart rate (HR) were recorded continuously, and stroke volume (SV) was measured at submaximal loads. Blood was taken for lactate concentration ([LA]), epinephrine concentration ([Epi]), norepinephrine concentration ([NE]), plasma renin activity (PRA), human growth hormone concentration ([hGH]), testosterone, and cortisol determination. Reduction of peak oxygen uptake (VO(2 peak)) after BR was greater in the endurance athletes than in the remaining groups (17 vs. 10%). Decrements in VO(2 peak) correlated positively with the initial values (r = 0.73, P < 0.001). Resting and exercise respiratory exchange ratios were increased in athletes. Cardiac output was unchanged by BR in all groups, but exercise HR was increased and SV diminished in the sedentary subjects. The submaximal [LA] and [LA] thresholds were decreased in the endurance athletes from 71 to 60% VO(2 peak) (P < 0.001); they also had an earlier increase in [NE], an attenuated increase in [hGH], and accentuated PRA and cortisol elevations during exercise. These effects were insignificant in the remaining subjects. In conclusion, reduction of exercise performance and modifications in neurohormonal response to exercise after BR depend on the previous level and mode of physical training, being the most pronounced in the endurance athletes.     

IS GNB3 C825T POLYMORPHISM ASSOCIATED WITH ELITE STATUS OF POLISH ATHLETES?

The GNB3 gene encodes the beta 3 subunit of heterotrimeric G-proteins that are key components of intracellular signal transduction between G protein-coupled receptors (GPCR) and intracellular effectors and might be considered as a potential candidate gene for physical performance.

Objectives

The aim of this study was to compare frequency distribution of the common C to T polymorphism at position 825 (C825T) of the GNB3 gene between athletes and nonathletic controls of the Polish population as well as to compare the genotype distribution and allele frequency of C825T variants within a group of athletes, i.e. between athletes of sports of different metabolic demands and competitive levels.

Methods

The study was performed in a group of 223 Polish athletes of the highest nationally competitive standard (123 endurance-oriented athletes and 100 strength/ power athletes). Control samples were prepared from 354 unrelated, sedentary volunteers.

Results

The χ² test revealed no statistical differences between the endurance-oriented athletes and the control group or between sprint/strength athletes and the control group across the GNB3 825C/T genotypes. There were no male-female genotype or allele frequency differences in controls or in either strength/power or endurance-oriented athletes. No statistically significant differences in either allele frequencies or genotype distribution were noted between the top-elite, elite or sub-elite of endurance-oriented and strength/power athletes and the control group.

Conclusions

No association between elite status of Polish athletes and the GNB3 C825T polymorphic site has been found.     

Intramyocellular lipid content in type 2 diabetes patients compared with overweight sedentary men and highly trained endurance athletes

Recent evidence suggests that intramyocellular lipid (IMCL) accretion is associated with obesity and the development of insulin resistance and/or type 2 diabetes. However, trained endurance athletes are markedly insulin sensitive, despite an elevated mixed muscle lipid content. In an effort to explain this metabolic paradox, we compared muscle fiber type-specific IMCL storage between populations known to have elevated IMCL deposits. Immunofluorescence microscopy was performed on muscle biopsies obtained from eight highly trained endurance athletes, eight type 2 diabetes patients, and eight overweight, sedentary men after an overnight fast. Mixed muscle lipid content was substantially greater in the endurance athletes (4.0 +/- 0.4% area lipid stained) compared with the diabetes patients and the overweight men (2.3 +/- 0.4 and 2.2 +/- 0.5%, respectively). More than 40% of the greater mixed muscle lipid content was attributed to a higher proportion type I muscle fibers (62 +/- 8 vs. 38 +/- 3 and 33 +/- 7%, respectively), which contained 2.8 +/- 0.3-fold more lipid than the type II fibers. The remaining difference was explained by a significantly greater IMCL content in the type I muscle fibers of the trained athletes. Differences in IMCL content between groups or fiber types were accounted for by differences in lipid droplet density, not lipid droplet size. IMCL distribution showed an exponential increase in lipid content from the central region toward the sarcolemma, which was similar between groups and fiber types. In conclusion, IMCL contents can be substantially greater in trained endurance athletes compared with overweight and/or type 2 diabetes patients. Because structural characteristics and intramyocellular distribution of lipid aggregates seem to be similar between groups, we conclude that elevated IMCL deposits are unlikely to be directly responsible for inducing insulin resistance.     

Assessment of association of estrogen receptor-α gene polymorphism with physical activity and bone metabolism

Genetic and environmental factors have long been suspected to influence on athletic performance and bone metabolism. We have therefore investigated a population-based association study of Korean elite athletes relative to the general population with PvuII polymorphism of the ER-α gene. In addition, interactions between the ER-a genotype distribution and variation of biochemical parameters for bone metabolism during short-duration aerobic performance development were analyzed in a Korean middle-aged women population. The ER-a gene locus was found to be deviation from Hardy-Weinberg equilibrium (p<0.05), but not in the female athlete group. The most common ER-α genotype wasPp in elite athletes (44/72) and controls (74/109), with higher than expected number of heterozygotes (p<0.05). No statistically significant difference in the distribution of ER-a genotype frequency was observed between the elite athletes and control groups. In contrast, almost all biochemical markers studied here appeared to be significantly higher levels after 12-week exercise training compared with baseline in both groups of Korean women, although there was no genotype effect on the change of levels of the bone metabolic parameters. Thus, our data imply that regularly exercise training may affect bone metabolism, but the genetic marker of ER-a gene polymorphism may not be valuable indicator for the development of elite athletes and physical therapy educational program.     

CK and LD isozymes in human single muscle fibers in trained athletes

Individual human muscle fibers from the vastus lateralis were isolated from age-matched endurance-trained and strength-trained athletes and untrained controls. Slow- (ST) and fast-twitch (FT) fibers were assayed for total creatine kinase (CK), CK-MB, total lactate dehydrogenase (LD), the LD isozyme that predominates in the heart muscle of most vertebrates (LD1), and citrate synthase (CS). Regardless of training of the athletes, both CK-MB and CS were higher in ST than in FT fibers. Also, irrespective of fiber type, CK-MB and CS were greatest in the endurance-trained group. A positive correlation existed between CK-MB and CS, relating oxidative capacity of individual fibers with CK-MB. Total CK varied little among the fiber types, trained groups, or controls. Total LD in FT fibers was greater than in ST fibers in all groups, with only ST fibers from the endurance-trained group containing substantial amounts of LD1. These findings suggest that specific training, endurance exercise, causes a favorable metabolic adaptation of CK and LD isozymes at the individual fiber level, allowing for the muscle to cope with increased energy demands during prolonged exercise.     

Effect of Chronic Athletic Activity on Brown Fat in Young Women

BackgroundThe effect of chronic exercise activity on brown adipose tissue (BAT) is not clear, with some studies showing positive and others showing negative associations. Chronic exercise is associated with increased resting energy expenditure (REE) secondary to increased lean mass and a probable increase in BAT. Many athletes are in a state of relative energy deficit suggested by lower fat mass and hypothalamic amenorrhea. States of severe energy deficit such as anorexia nervosa are associated with reduced BAT. There are no data regarding the impact of chronic exercise activity on BAT volume or activity in young women and it is unclear whether relative energy deficiency modifies the effects of exercise on BAT.PurposeWe assessed cold induced BAT volume and activity in young female athletes compared with non-athletes, and further evaluated associations of BAT with measures of REE, body composition and menstrual status.MethodsThe protocol was approved by our Institutional Review Board. Written informed consent was obtained from all participants prior to study initiation. This was a cross-sectional study of 24 women (16 athletes and8 non-athletes) between 18–25 years of age. Athletes were either oligo-amenorrheic (n = 8) or eumenorrheic (n = 8).We used PET/CT scans to determine cold induced BAT activity, VMAX Encore 29 metabolic cart to obtain measures of REE, and DXA for body composition.ResultsAthletes and non-athletes did not differ for age or BMI. Compared with non-athletes, athletes had lower percent body fat (p = 0.002), higher percent lean mass (p = 0.01) and trended higher in REE (p = 0.09). BAT volume and activity in athletes trended lower than in non-athletes (p = 0.06; p = 0.07, respectively). We found negative associations of BAT activity with duration of amenorrhea (r = -0.46, p = 0.02).BAT volume correlated inversely with lean mass (r = -0.46, p = 0.02), and positively with percent body fat, irisin and thyroid hormones.ConclusionsOur study shows a trend for lower BAT in young female athletes compared with non-athletes, and shows associations of brown fat with menstrual status and body composition. Brown fat may undergo adaptive reductions with increasing energy deficit.     

Training-induced adaptation in purine metabolism in high-level sprinters vs. triathletes

The aim of this study was to assess the effect of training loads on metabolic response of purine derivatives in highly trained sprinters (10 men, age range 20-29 yr) in a 1-yr cycle, compared with endurance-training mode in triathletes (10 men, age range 21-28 yr). A four-time measurement of respiratory parameters, plasma hypoxanthine (Hx) concentration, and erythrocyte hypoxanthine-guanine phosphoribosyl transferase (HGPRT) activity was administered in four characteristic training phases (general, specific, competition, and transition). A considerably lower postexercise plasma concentration of Hx in sprinters (8.1-18.0 μmol/l) than in triathletes (14.1-24.9 μmol/l) was demonstrated in all training phases. In both groups, a significant decrease in plasma Hx concentration in the competition phase and a considerable increase in the transition phase were observed. It was found that the resting erythrocyte HGPRT activity increased in the competition period and declined in the transition phase. Sprinters showed higher HGPRT activity (58.5-71.8 nmol IMP·mg Hb(-1)·h(-1)) than triathletes (55.8-66.6 nmol IMP·mg Hb(-1)·h(-1)) in all examinations. The results suggest a more effective use of anaerobic metabolic energy sources induced by sprint training characterized by higher amount of exercise in the anaerobic lactacid and the nonlactacid zone. The changes in plasma Hx concentration and erythrocyte HGPRT activity might serve as sensitive metabolic indicators in the training control, especially in sprint-trained athletes. These parameters may provide information about the energetic status of the muscles in highly trained athletes in which no significant adaptation changes are detected by means of commonly acknowledged biochemical and physiological parameters.     

Elite athletes’ genetic predisposition for altered risk of complex metabolic traits

Background

Genetic variants may predispose humans to elevated risk of common metabolic morbidities such as obesity and Type 2 Diabetes (T2D). Some of these variants have also been shown to influence elite athletic performance and the response to exercise training. We compared the genotype distribution of five genetic Single Nucleotide Polymorphisms (SNPs) known to be associated with obesity and obesity co-morbidities (IGF2BP2 rs4402960, LPL rs320, LPL rs328, KCJN rs5219, and MTHFR rs1801133) between athletes (all male, n = 461; endurance athletes n = 254, sprint/power athletes n = 207), and controls (all male, n = 544) in Polish and Russian samples. We also examined the association between these SNPs and the athletes’ competition level (‘elite’ and ‘national’ level). Genotypes were analysed by Single-Base Extension and Real-Time PCR. Multinomial logistic regression analyses were conducted to assess the association between genotypes and athletic status/competition level.

Results

IGF2BP2 rs4402960 and LPL rs320 were significantly associated with athletic status; sprint/power athletes were twice more likely to have the IGF2BP2 rs4402960 risk (T) allele compared to endurance athletes (OR = 2.11, 95% CI = 1.03-4.30, P <0.041), and non-athletic controls were significantly less likely to have the T allele compared to sprint/power athletes (OR = 0.62, 95% CI =0.43-0.89, P <0.0009). The control group was significantly more likely to have the LPL rs320 risk (G) allele compared to endurance athletes (OR = 1.26, 95% CI = 1.05-1.52, P <0.013). Hence, endurance athletes were the “protected” group being significantly (p < 0.05) less likely to have the risk allele compared to sprint/power athletes (IGF2BP2 rs4402960) and significantly (p < 0.05) less likely to have the risk allele compared to controls (LPL rs320). The other 3 SNPs did not show significant differences between the study groups.

Conclusions

Male endurance athletes are less likely to have the metabolic risk alleles of IGF2BP2 rs4402960 and LPL rs320, compared to sprint/power athletes and controls, respectively. These results suggest that some SNPs across the human genome have a dual effect and may predispose endurance athletes to reduced risk of developing metabolic morbidities, whereas sprint/power athletes might be predisposed to elevated risk.     

Association between Myocardial Triglyceride Content and Cardiac Function in Healthy Subjects and Endurance Athletes

Ectopic fat accumulation plays important roles in various metabolic disorders and cardiovascular diseases. Recent studies reported that myocardial triglyceride (TG) content measured by proton magnetic resonance spectroscopy (¹H-MRS) is associated with aging, diabetes mellitus, and cardiac dysfunction. However, myocardial TG content in athletes has not yet been investigated. We performed ¹H-MRS and cardiac magnetic resonance imaging in 10 male endurance athletes and 15 healthy male controls. Serum markers and other clinical parameters including arterial stiffness were measured. Cardiopulmonary exercise testing was also performed. There were no significant differences in clinical characteristics including age, anthropometric parameters, blood test results, or arterial stiffness between the two groups. Peak oxygen uptakes, end–diastolic volume (EDV), end–systolic volume (ESV), left ventricular (LV) mass, peak ejection rates and peak filling rates were significantly higher in the athlete group than in the control group (all P<0.02). Myocardial TG content was significantly lower in the athlete group than in the control group (0.60±0.20 vs. 0.89±0.41%, P<0.05). Myocardial TG content was negatively correlated with EDV (r = −0.47), ESV (r = −0.64), LV mass (r = −0.44), and epicardial fat volume (r = 0.47) (all P<0.05). In conclusion, lower levels of myocardial TG content were observed in endurance athletes and were associated with morphological changes related to physiological LV alteration in athletes, suggesting that metabolic imaging for measurement of myocardial TG content by ¹H-MRS may be a useful technique for noninvasively assessing the “athlete’s heart”.