Presence of Metabolic Syndrome in Football Linemen

Transcription

1 Joual of Athletic Taiig 2008;43(6): g by the Natioal Athletic Taies Associatio, Ic oigial eseach esece of Metabolic Sydome i Football Lieme Jackie L. Buell, hd, RD/LD, LAT, ATC*; Doug Callad, MS, LAT, ATC*; Fioa Haks, MS, LAT, ATCÀ; Buce Johsto, MS, LAT, ATCÀ; Bejami este, MS, LAT, ATC`; Robet Sweeey, MS, LAT, ATC*; Robet Thoe, MEd, LAT, ATC` *The Ohio State Uivesity, Columbus, OH; 3The Uivesity of Fidlay, Fidlay, OH; 4Capital Uivesity, Columbus, OH. M Johsto is ow at the Uivesity of Ciciati, Ciciati, OH. Cotext: Metabolic sydome is a clusteig of symptoms associated with abdomial obesity that demostates a high isk fo cadiovascula disease ad type II diabetes mellitus. Objective: To evaluate football lieme i Natioal Collegiate Athletic Associatio Divisios I, II, ad III schools fo the pesece of metabolic sydome accodig to the Ameica Heat Associatio/Natioal Heat, Lug, ad Blood Istitute citeia as well as to documet othe elated biomakes. Desig: Coss-sectioal desciptive study. Settig: Thee uivesity locatios o the fist full day of football camp i ealy moig. atiets o Othe aticipats: Of 76 football lieme, wee able to povide blood samples. Mai Outcome Measue(s): Height, mass, blood pessue, uppe-body skifolds, ad waist cicumfeece wee measued at vaious statios. Two small veous samples of blood wee collected ad aalyzed i a hospital laboatoy fo fastig isuli, glucose, high-desity lipopotei, total cholesteol, tiglyceides, C-eactive potei, ad glycosylated hemoglobi. The last statio was a vebal family histoy fo cadiovascula disease ad diabetes; also, athletes filled out a utitio attitudes questioaie. Results: Of the athletes, 34 wee idetified as havig metabolic sydome accodig to measues of blood pessue, waist cicumfeece, fastig glucose, high-desity lipopotei, ad tiglyceides. The mea total cholesteol-to-high-desity lipopotei cholesteol atio fo the goup was 4.95, with 32 paticipats displayig values highe tha 5.0. Twelve volutees had total cholesteol levels geate tha 200 mmol/l, 15 had high levels of C-eactive potei, ad 9 had slightly elevated levels of glycosylated hemoglobi. Coclusios: Although athletes might be assumed to be potected fom isks of cadiovascula disease, we foud a high icidece of metabolic sydome ad othe associated advese biomakes fo heat disease i collegiate football lieme. Ealy sceeig, awaeess, ad itevetio may have favoable effects o the oveall health outcomes of football lieme. Key Wods: obesity, football playes, dyslipidemia, hypetesio, isuli, C-eactive potei N N N Key oits Football lieme with abdomial adiposity exhibited the clusteig of symptoms associated with highe isks of diabetes ad cadiovascula disease (metabolic sydome). Athletes with a waist cicumfeece equal to o geate tha 40 i ( cm) should be evaluated fo othe isk factos (fastig blood glucose, blood cholesteol, ad tiglyceide levels ad pehypetesive blood pessue levels) to detemie metabolic sydome status ad isks. Athletes with metabolic sydome should be couseled about the associated isks ad educated about lifestyle choices that may educe these isks. Recet authos1 4 have demostated that football lieme ae obese accodig to body mass idex (BMI) measues. It may be temptig to discout these epots because of the iappopiate applicatio of BMI i athletes, but football lieme may ot be as healthy as we pesume them to be, ad close evaluatio of these lage athletes fo metabolic sydome is eeded. Metabolic sydome (MetSy) is typically defied as a clusteig of cliical symptoms associated with iceased abdomial adiposity ad icludes egative health coelates such as high blood pessue, dyslipidemia, isuli esistace, impaied glucose metabolism, ad possibly elevated iflammatoy ad pothombotic makes. 5 Clusteig of MetSy abomalities iceases the isk of cooay heat disease ad diabetes. 6 8 The physique of football lieme ca be cosistet with iceased body ad abdomial fat stoes, 9 which may be associated with the pesece of MetSy. Football lieme ofte seek advice fo a weight gai outie (diet ad weight taiig), with the goal of becomig lage tha thei oppoets. 10 Ideally, the iceased body weight would be iceased muscle mass, but ofte playes icease thei body size by accumulatig moe adipose tissue, specifically i the abdomial egio. I ou expeiece as athletic taies ad spots utitioists, some athletes ae idiffeet to the compositio of the weight gai; they just wat to be immovable ad moe competitive with lage oppoets. Numeous guidelies have bee published by vaious pofessioal goups fo the idetificatio of MetSy. The 608 Volume 43 N Numbe 6 N Decembe 2008

2 pupose of ou coss-sectioal, desciptive study was to idetify the icidece of MetSy accodig to the Ameica Heat Associatio ad Natioal Heat, Lug, ad Blood Istitute (AHA/NHLBI) citeia 5 i football lieme at the Natioal Collegiate Athletic Associatio (NCAA) Divisio I (DI), II (DII), ad III (DIII) levels. The most commo citeia fo MetSy iclude elevated waist cicumfeece, blood pessue, fastig blood glucose (FBG), ad tiglyceides (TG) ad depessed high-desity lipopotei (HDL) cholesteol. Makes of iflammatio ad isuli esistace may be secoday makes of MetSy ad may eflect iceased isk. Theefoe, a secoday aim of ou study was to documet fastig isuli, C-eactive potei (CR), ad glycosylated hemoglobi (HbA1c) levels i this cohot of collegiate football lieme. METHODS aticipats Offesive ad defesive lieme wee ecuited by the football athletic taiig staffs at NCAA DI, DII, ad DIII schools. The potocol was appoved by the huma subjects committee at each istitutio, ad witte ifomed coset was obtaied fom each volutee befoe paticipatio. A total of 77 athletes coseted to the study; 1 athlete withdew befoe ay data wee collected. Six paticipats wee ot willig o able to povide a blood sample, leavig who povided complete data. Data collectio visits wee completed i ealy August aticipatio i DII was excellet, with all lieme choosig to take pat ( 5 30). May lieme i DI ad DIII chose ot to paticipate: DI paticipatio was 76% (26/34), ad DIII paticipatio was 48% (21/44). We wote the potocol fo 80 paticipats, so heavy ecuitmet at the last site (DIII) was limited to those athletes willig to give a blood sample. Roste data o all opaticipats wee available fo compaiso. Lieme totaled 108 i the 3 schools, ad 76 of those (%) paticipated i the study. otocol Data wee collected by a eseach team of 8 to 12 membes at each istitutio o the fist full day of peseaso taiig camp i the ealy moig afte a oveight fast (at least 6 to 8 hous) ad befoe sigificat team taiig o testig took place. Oce volutees coseted, they poceeded though statios ogaized to measue height, mass, blood pessue, uppe-body skifolds, ad waist cicumfeece. Taied phlebotomists obtaied 2 small samples of veous blood, ad the athletes completed a shot vebal iteview to documet family histoy, estimated time spet uig ad liftig i the last week, ad cuet ijuy status. The athletes the completed a self-epot utitio attitudes questioaie. Specific Statio Methods. Height was measued to the eaest 0.1 cm usig a wall-mouted SECA stadiomete (model 210; Haove, MD). Mass was ecoded to the eaest 0.1 kg with a digital system (model BWB-800A; Taita Cop of Ameica, Aligto Heights, IL). Systolic ad diastolic blood pessues (SB ad DB) wee obtaied with a sigle measuemet, usig a exta-lage adult cuff with a stadad sphygmomaomete ad Table 1. Ameica Heat Associatio/Natioal Heat, Lug, ad Blood Istitute Citeia Defiig Metabolic Sydome a Risk Facto Blood pessue Waist cicumfeece Fastig blood glucose High-desity lipopoteis Seum tiglyceides Citeio Systolic $130 mm Hg o diastolic $85 mm Hg $102 cm (40 i) $5.6 mmol/l ($100 mg/dl),1.03 mmol/l (,40 mg/dl) $1.7 mmol/l ($150 mg/dl) a The pesece of 3 o moe isk factos idicates the pesece of metabolic sydome. stethoscope. To ehace eliability, the same eseach team membe measued blood pessue at all 3 istitutios. The skifold measuemets wee stadadized i the same mae, with 1 taied eseach team membe obtaiig all measues of ticeps, subscapula, ad chest skifolds i tiplicate fo all paticipats. These skifolds wee selected to simplify data collectio because volutees oly eeded to emove thei shits. 11 The ecoded skifolds wee late summed ad eteed ito stadad equatios specific to the age ad ethicity of the paticipat to estimate body desity ad fatess. 11 While the volutee s shit was off, waist cicumfeece was also measued by the same eseache usig the ateio supeio iliac spie as the ladmak to measue to the eaest 0.1 cm. 5 Blood was obtaied by taied phlebotomists usig a Vacutaie system (Becto Dickiso, Fakli Lakes, NJ) to daw appoximately 25 ml total i seum sepaato ad hepaiized sodium tubes with a sigle eedle stick. The seum sepaato tube was immediately cetifuged at 1300 evolutios pe miute fo 5 miutes, ad both tubes wee stoed ove ice i a coole util submitted to the hospital laboatoy fo pocessig 2 to 6 hous late. Blood measues icluded fastig isuli; FBG; cholesteol pael (icludig total [TChol], HDL, ad calculated low-desity lipopotei [LDL]; TG; CR; ad HbA1c. The fastig isuli ad CR samples wee u o a Immulite system (model 2000; Diagostic oducts Cop, Los Ageles, CA). The SYNCHRON LX System (Beckma Coulte, Fulleto, CA) was used to measue FBG, total ad HDL cholesteol, ad TGs ad LDL. Fially, the HbA1c samples wee u o the VARIANT II TURBO istumetatio (Bio-Rad Laboatoies, Hecules, CA). Afte the volutee gave the blood sample ad visited the athopometic statios, he poceeded to a iteview statio, at which he was asked about demogaphics ad occuece of obesity, diabetes, heat disease, high blood pessue, ad high cholesteol i himself, his fathe ad mothe, ad both sets of gadpaets. The statio attedat also asked the athlete to estimate weight taiig ad uig histoy fo each day of the past week ad if he had a cuet ijuy. Oce the iteview was complete, the athlete was asked to fill out a 24-item Nutitio Attitude Suvey to gauge dietay helplessess, food exploatio, meat pefeece, ad health coce. This questioaie was oigially desiged to measue attitudes gemae to cooay isk factos ad has bee validated i the lage populatio. 12 Data Aalysis ad Statistics. All data wee collated ito a Excel speadsheet (vesio 2003; Micosoft Cop, Redmod, WA), checked, ad loaded ito SSS (vesio 14.0 fo Widows; SSS Ic, Chicago, IL). The AHA/ Joual of Athletic Taiig 609

3 Table 2. Diffeeces Amog Natioal Collegiate Athletic Associatio Divisios pe 1-Way Aalysis of Vaiace (Mea 6 SD) Depedet Vaiable Divisio I Divisio II Divisio III Model Value Age, y Weight, kg a a b,.001 Height, cm a b c,.001 Waist cicumfeece, cm a a b.001 ecetage of body fat a b a.003 d Fastig blood glucose, mmol/l a a,b a,c.011 Fastig isuli, pmol/l a a b.022 d Ruig, mi i past 7 d a b b,.001 Liftig, mi i past 7 d a a b,.001 a,b,c Goups with the same supescipt have statistically simila meas; those with diffeet supescipts have diffeet meas. d Duett C statistic calculated because of uequal vaiaces. NHLBI MetSy citeia ae a modificatio of the oigial Adult Teatmet ael citeia defiig MetSy as the pesece of 3 o moe citeia listed i Table 1. To detemie the pesece of MetSy, we evaluated the citeia vaiables fo each paticipat ad summed the umbe of positive isk factos. The MetSy citeia did ot iclude evaluatio of fastig isuli, TChol:HDL atio, CR, o HbA1c. These additioal vaiables wee evaluated ad examied withi bivaiate easo coelatios to detemie the stegth ad atue of clusteig elatioships. Othe statistical methods applied icluded 1-way aalysis of vaiace with the Tukey post hoc aalysis whe vaiaces wee equal (Levee statistic,..1), ad the Duett C statistic was applied whe vaiaces wee ot assumed equal to idetify diffeeces amog DI, DII, ad DIII goups. Whe appopiate, t tests wee pefomed to idetify o cofim diffeeces betwee goups (paticipats ad opaticipats, MetSy ad o-metsy, ad offesive ad defesive lieme). RESULTS As a esult of icomplete study paticipatio at the DI ad DIII schools, the study paticipats at each istitutio wee compaed with opaticipats fo height, mass, BMI, ad class distibutio to led isight ito missed data. The DI opaticipats wee talle tha the paticipats (196.8 vesus cm, 5.026). This esulted i a lowe BMI fo the DI opaticipat goup (32.7 kg/m 2 vesus 35.8 kg/ m 2, 5.009), despite 3 of the 8 opaticipats havig BMIs geate tha 35. The compaiso fo the DIII opaticipats to DIII paticipats yielded simila esults i that the opaticipats wee talle (185.4 cm vesus cm, 5.016), with a lowe BMI (30.1 kg/m 2 vesus 32.9 kg/m 2, 5.019). Thee of 23 DIII opaticipats had a BMI slightly highe tha 35. The diffeeces i body weight ad class distibutio wee osigificat. Diffeeces amog NCAA levels wee examied with aalysis of vaiace fo all quatitative vaiables of iteest (Table 2). No diffeeces wee evidet i the ages of the volutees. The data cofim the assumptio that oveall body size iceases with NCAA level of play, as the DI playes wee talle ad heavie tha the DII athletes, who wee lage tha the DIII athletes. Waist cicumfeeces of the DIII goup wee smalle tha those of the DI ad DII goups, ad pecetage of body fat ad sum of skifolds demostated that the DII playes wee less lea tha the DI ad DIII playes. The FBG was lowe i the DIII goup tha i the DII goup, ad the DIII goup had lowe fastig isuli levels tha eithe the DI o DII goups. Accodig to the self-epot data fo miutes of uig ad liftig, the DI goup had moe miutes of uig tha the DII ad DIII goups, ad the DIII goup had fewe miutes of liftig tha the DI ad DII goups. The eollmet, positios, ethicity, ad yeas of eligibility fo each istitutio ae delieated i Table 3. Whe the MetSy citeia wee applied to the defiig vaiables, 34 of the playes who ageed to the blood sample fomally qualified fo MetSy (havig 3 o moe isk factos), ad these esults fo all divisios ae also icluded i Table 3. Waist cicumfeece without a adjustmet fo body size may be a questioable idicato i lage-famed me; theefoe, the data wee also evaluated usig pedicted body fat istead of waist cicumfeece whe a estimated body fat of moe tha 25% was substituted as a obesity idicato 11 fo the waist cicumfeece isk facto. Nie MetSy playes had a waist equal to o lage tha 102 cm with a estimated body fat pecetage of less tha 25%, but 6 of these 9 still qualified fo MetSy with 3 citeia without icludig the waist cicumfeece. Usig this body fat pecetage substitutio fo waist cicumfeece still yielded 31 playes with MetSy. Of the playes who did ot povide a blood sample, 5 of the 6 displayed isk factos fo waist Table 3. Desciptive Statistics by Natioal Collegiate Athletic Associatio Divisio ad esece of Metabolic Sydome by ositio, Ethicity, ad Yea of Eligibility Divisio a Defesive Lie ositio: Offesive Lie/ Ethicity: White/ No-White Yea of Eligibility Feshma Sophomoe Juio Seio I 26 15/11 20/ II 30 17/13 23/ III 21 14/7 20/ Metabolic sydome 34 22/12 28/ No metabolic sydome 36 18/18 28/ a Six athletes wee uwillig o uable to povide a blood sample; 1 athlete withdew befoe ay data wee collected. 610 Volume 43 N Numbe 6 N Decembe 2008

4 Table 4. Numbe of Risk Factos fo Metabolic Sydome by Natioal Collegiate Athletic Associatio Divisio No. of Risk Divisio Factos I(522) II ( 5 27) III ( 5 21) Total ( 5 ) cicumfeece ad blood pessue (2 of 5 isk factos). The diffeece i MetSy by positio did ot each statistical sigificace, but the offesive lieme had a geate waist cicumfeece (115.0 cm vesus cm,,.001) ad a ted fo highe pecetage of body fat (27.4% vesus 26.0%, 5.058) tha the defesive paticipats. Table 4 delieates the umbe of isk factos fo playes at each NCAA level. Numeous pemutatios of values fo waist cicumfeece, B, FBG, HDL, ad TG ca chaacteize MetSy. It is iteestig to examie the pattes ad heteogeeity of these combiatios (Table 5). Iceased waist cicumfeece ad low levels of HDL occued i all but 2 of the 34 playes ad elevated blood pessue i all but 5. The Iteatioal Diabetes Fedeatio citeia 6 diffe fom the AHA/NHLBI citeia i that iceased waist cicumfeece must be peset alog with 2 othe isk factos. Because each MetSy athlete i this study also had a waist lage tha 102 cm, the Iteatioal Diabetes Fedeatio ad AHA/NHLBI algoithms esult i the same outcome i this cohot. If oe disputes the eliability of the waist cicumfeece i this cohot, 9 lieme (13%) still qualified fo MetSy usig the othe 4 citeia. The 5 citeia to idetify MetSy do ot iclude iflammatio makes such as CR. Howeve, elevated CR has bee suggested to be pedictive of diabetes ad cadiovascula disease, 13 ad the theshold fo elevated CR was 3.0 mg/l. 5 Fiftee paticipats exceeded that value, ad 6 of those wee ot i the MetSy goup. Thee of the MetSy paticipats had CR values betwee 10 mg/l ad 20 mg/l, idicatig a vey high isk. 13 Notably, oe of the 15 paticipats with CR levels geate tha 3.0 mg/l epoted a cuet ijuy o the iteview potio of data collectio, ad those who did epot a cuet ijuy wee withi the acceptable CR age of 0 mg/l to 3.0 mg/l. To futhe exploe the possible effect of ecet taiig o CR, we looked at the Table 5. aticipats Combiatios of Risk Factos fo Metabolic Sydome No. of Factos Combiatio of Factos No. of aticipats 3 Waist, B, HDL 18 Waist, TG, HDL 4 Waist, FBG, HDL 1 Waist, B, FBG 1 Waist, B, TG 1 4 Waist, B, TG, HDL 3 Waist, B, FBG, HDL 5 5 Waist, B, FBG, TG, HDL 1 Abbeviatios: B, blood pessue; FBG, fastig blood glucose; HDL, HDL-cholesteol; TG, tiglyceides. self-epoted total time spet uig o liftig, which did ot appea to pedict a elevated CR level i a logistic egessio with elevated CR as the dichotomous depedet vaiable (uig 5.222, liftig 5.998). Despite the highe vaiace i the MetSy goup, the mea CR level was 3.1 mg/l, as compaed with 1.6 mg/l i the o- MetSy goup, a sigificat diffeece (t test, 5.035). I evaluatig cadiovascula disease isk factos, it is commo to iclude the atio of total cholesteol to HDL cholesteol (TChol:HDL), with a desiable atio beig less tha The mea atio fo the goup was 4.95 (age ); 32 paticipats exceeded the theshold of 5. Compaig the meas of this atio betwee the goups (with ad without MetSy) demostated diffeet atios (t test,,.001), a expected fidig give that low HDL is pat of the atio as well as a citeio of MetSy. I evaluatig fo diabetes, the HbA1c is used as a idex of ecet (past 8 10 weeks) blood glucose cotol. Fo males of this age, the HbA1c should be maitaied below 5.8%; 9 paticipats exceeded this value, although o values wee gossly out of age (age 5 4.4% 6.3%). No diffeeces wee oted betwee the mea values of isuli o HbA1c fo the goups as defied by MetSy ( ad 5.719, espectively). Of the etie goup, 12 paticipats exceeded the desiable TChol level of 200 mg/dl, with 17 havig calculated LDL values betwee 130 mg/dl ad 160 mg/dl ad 4 havig values of moe tha 160 mg/dl. The paetal histoy of heat disease ad diabetes vaiables wee collated sepaately fo each paticipat; 0 idicated eithe paet was epoted to have heat disease o diabetes, 1 idicated 1 paet diagosed, ad 2 idicated both paets diagosed. The estimated pecetage of body fat was positively coelated with paetal histoy of diabetes ( , ). Both TChol ( , ) ad calculated LDL ( , ) wee associated with paetal histoy of heat disease. Cosistet with its desig, the Nutitio Attitude Suvey was scoed fo dietay helplessess, food exploatio, meat pefeece, ad health coce. 15 The 4 scoes wee evaluated as cotiuous vaiables; thus, highe scoes idicated a geate popesity fo the chaacteistic. No diffeeces wee evidet amog NCAA divisios o betwee MetSy ad o-metsy goups. These vaiables wee evaluated alog with all othe vaiables i bivaiate coelatios fo isight ito the iteelatioships of MetSy measues i these athletes. Dietay helplessess was egatively coelated with miutes spet liftig ( , ). Food exploatio was positively coelated with miutes spet liftig ( , ). Othe egative coelatios wee meat pefeece facto ad the sum of skifolds ( , ), FBG ( , ), ad HbA1c ( , ). Seveal othe coelatios ae woth metioig: N Mass was coelated with pecetage of body fat ( ,,.001), miutes uig ( , ), miutes liftig ( , ), isuli ( , ), ad CR ( , ). N Waist cicumfeece was coelated with mass ( ,,.001), pecetage of body fat ( 5.69,,.001), isuli ( , ), FBG ( , ), HDL ( , [ted oly]), ad CR ( ,,.001). Joual of Athletic Taiig 611

5 Table 6. Bivaiate Coelatios Nutitio Attitude Suvey Meat pefeece Health coce Height Mass Waist Cicumfeece C-Reactive otei Diastolic Blood essue Sum of Skifolds ecetage of Body Fat Height Mass Waist cicumfeece C-eactive potei Systolic blood pessue Diastolic blood pessue Sum of skifolds ecetage of body fat Ruig Liftig Fastig blood glucose Total cholesteol Tiglyceides High-desity lipopoteis Cholesteol: high-desity lipopoteis Low-desity lipopoteis Nutitio Attitude Suvey Dietay helplessess Food exploatio Meat pefeece Health coce NCAA divisio Abbeviatio: NCAA, Natioal Collegiate Athletic Associatio. a Values ae easo coelatios; values ae fo 2-tailed testig; is based o 76 paticipats with data: with blood data, 69 with isuli values, ad 69 with lipid pofiles. 612 Volume 43 N Numbe 6 N Decembe 2008

6 Table 6. Exteded Ruig Liftig Fastig Blood Glucose Total Cholesteol High-Desity Lipopoteis Cholesteol: High-Desity Lipopoteis Low-Desity Lipopoteis Isuli Glycosylated Hemoglobi aetal Histoy of Heat Disease aetal Histoy of Diabetes Joual of Athletic Taiig 613

7 N Systolic ad diastolic blood pessues wee coelated ( ,,.001), ad both coelated with FBG ( , ad , , espectively). Diastolic blood pessue was also coelated with CR ( , ). N ecetage of body fat was coelated with FBG ( , ), calculated LDL ( , ), ad CR ( , ). N Tiglyceides wee egatively coelated with HDL ( , ) ad HbA1c ( , ). Ou fidigs cotiue to eifoce the multifaceted atue of the MetSy ad clusteig of isk factos. Sigificat bivaiate coelatios ae show i Table 6. DISCUSSION Authos 1 3 have calculated BMIs fom the heights ad weights povided o football ostes at the pofessioal ad high school levels to examie the pevalece of obesity accodig to a BMI geate tha 30 kg/m 2, dawig attetio to the size of these youg me. Howeve, BMI is ot a valid gauge fo athletes, ad health cae pofessioals might be iclied to discout these fidigs. A item o HealthDay News (as posted o Medlie lus) demostated moe fim evidece that football lieme may be moe poe to MetSy tha leae football playes ad the geeal populatio, with moe tha 50% of etied football lieme exhibitig the cluste of symptoms. 4 Ou pupose was to bette defie the magitude of the poblem i active collegiate lieme. hysicias, health educatos, athletic taies, spots utitioists, ad othe health cae povides ae obligated to help these athletes bette udestad the latet ifluece thei day-to-day choices may have o thei geetics ad thei cuet ad futue health. Some heavy lieme aleady exhibited MetSy, ad the laboatoy values cofim a easo fo coce about the isk of futue diabetes ad heat disease as a esult of the weight ad cetal adiposity of this goup. Epidemiologic studies i the Uited States have show a gadual icease i the icidece of obesity, MetSy, ad diabetes ove the past 10 yeas. 16 It is possible that this same ted is occuig i lieme, as evideced by compaig the fidigs of Collis et al 9 i 1999 with ous. Collis et al oted pecetages of body fat of 23.5% ad 19.6% i offesive ad defesive lieme, espectively, wheeas we showed values of 26% ad 26.3%, espectively. I examiig the esults fom a athlete s blood test ad body measuemets fo each of the isk factos fo MetSy sepaately, the pactitioe might ot pioitize a blood pessue of 132/88 mm Hg, a FBG of 106 mg/dl, o a 43- i ( cm) waist. Seekig evidece of clusteed symptoms that defie MetSy should become a stadad health cae pactice pefomed by those cliicias suppotig the athlete. Blood pessue, waist cicumfeece, ad body fatess (skifolds) ae easy ad iexpesive to assess. The blood tests fo this study cost about $57 pe paticipat ad would be a useful sceeig pael fo icomig feshme, allowig physicias ad athletic taies to scee fo MetSy to idetify athletes likely to beefit fom ealy educatio ad itevetio. The multiple coelatios i this study (Table 6) eifoce the clusteig of symptoms i metabolic sydome. 5 Itevetio studies idicate that educig abdomial adiposity is the best way to pevet disease o to iteupt the pogessio of disease, ad educig this adiposity helps educe isuli ad FBG ad pomote a moe favoable lipid pofile. The positive coelatios i this study amog body fatess, waist cicumfeece, isuli, FBG, ad CR suppot the advice that losig body mass likely atteuates the ifluece of those vaiables used to defie MetSy. 16,17 Give the pemium o body size fo football lieme, weight loss duig the competitive yeas is ot typically a acceptable solutio, but helpig these athletes with body weight issues afte the competitive yeas may be moe ealistic. Caoll ad Dudfield 16 suggested that fo each kilogam decease i body weight, visceal fat is educed by 2% to 5%. The family histoy coelatios with body fat ad elevated cholesteol epeset the geetic pedispositio haded dow to these me. Theefoe, pat of the teatmet pogam should be devoted to helpig these athletes lea how to adapt lifestyle ad utitio habits to bette modify geetic pedispositios. Teatmet of MetSy depeds o the symptoms peset 5 ad is well outlied i the Theapeutic Lifestyle Chages descibed i the Natioal Cholesteol Educatio ogam. 18,19 Helpig the athlete udestad the potetial ole cetal adiposity plays i oveall health may povide motivatio to pevet pogessio of MetSy ito diabetes o heat disease i late life by chagig body fat ad lea muscle distibutio. It may be helpful to shae the data fom McGill et al 20 ad Zieske et al, 21 who demostated clea ad pogessive cooay atey disease occuig liealy with BMI, abdomial adiposity, ad elevated CR i postmotem studies of youg people (15 34 yeas of age) who died of ocadiovascula causes. Weight loss i idividuals with MetSy has esulted i impoved glucose egulatio ad blood pessue, cofimig the impotace of such effots. 16,17 If lifestyle modificatios ae usuccessful i patiets with MetSy, team physicias may coside pescibig medicatios to cotol bodelie hypetesio ad elevated fastig isuli. 5,17 Geeal dietay guidelies to educe the isk of cadiovascula disease typically iclude weight eductio by potio cotol, selectio of utiet-dese food, limitig fats (especially satuated ad hydogeated [tas] fats), educig sodium itake if sodium sesitive, iceasig itake of fuits ad vegetables, ad emphasizig whole gais as cabohydate souces. 22 Specific dietay itevetios may iclude igestig moe omega-3 fatty acids, which may help to decease iflammatio (by deceasig cytokie levels) ad icease isuli sesitivity. 23 The Theapeutic Lifestyle Chages poposed by the Natioal Cholesteol Educatio ogam suggest that satuated fats costitute o moe tha 7% of total fat caloies, with up to 10% of caloies fom polyusatuated fats ad up to 20% of caloies fom moousatuated fats; fats should costitute 25% to 35% of daily caloies; ad cholesteol cosumptio should ot total moe tha 200 mg/d. 18,19 Additioally, diets high i simple sugas have bee implicated i elevated levels of TGs ad depessed levels of HDLs, 24 wheeas othes 25 have suggested that a diet of high glycemic idex foods may cotibute to highe levels of fastig isuli. The Theapeutic Lifestyle Chages guidelies ecommed 50% to 60% of total caloies as 614 Volume 43 N Numbe 6 N Decembe 2008

8 cabohydates ad 20 g to 30 g of fibe pe day, although the cuet Dietay Recommeded Itake fo me i this age goup is 38 g of fibe daily. 26 Based o ou kowledge of othe studies ad the atual pogessio of the disease, it seems pudet to ecommed that athletes with MetSy follow the Theapeutic Lifestyle Chages Guidelies, but moe eseach o the ifluece of diet o MetSy chaacteistics ad pefomace is eeded i this age goup ad i athletes. Football lieme ae cosideed stegth athletes: stoge is bette. They sped a sigificat amout of time i itesive weight taiig. It is o secet that may of these lage athletes detest aeobic coditioig activities. Although we did ot measue the aeobic capacity of ou paticipats, it is plausible that a elative lack of aeobic coditioig peveted the execise-associated icease i HDLs assumed as a beefit of egula execise. We also do ot kow if ealy-seaso aeobic coditioig impoves this metabolic pofile to cycle athletes i ad out of MetSy as the seaso pogesses. The pehypetesio ad low levels of HDL idetified i this goup should ecouage coachig ad stegth staffs to favo moe aeobic taiig. Impope esistace taiig techiques ad pologed static cotactios ae geeally kow to icease blood pessue; theefoe, coectig liftig techiques i MetSy athletes may help to limit peak blood pessues. The last few epetitios of ay maximal effot set should be accompaied by expeieced spottig to limit the volutay cocetic failue (isometic i atue) ad to pomote a less static cotactio while beathig popely (ie, o Valsalva maeuve). 27 It is ot possible to ascetai if the yeas of maximal-itesity stegth taiig o the static atue of the liema positio (o both) is patially esposible fo the pehypetesio values we foud i this study. The low levels of HDL i this goup of football lieme as compaed with those of Joalagadda et al 10 also deseve pompt attetio by eseaches to idetify the pobable stimulus ad elatioship to taiig outie ad diet. Give the likely metabolic diffeeces i MetSy athletes, it would be desiable to have a blood lipid pofile befoe utitioal couselig iteded to impove pefomace. I the absece of MetSy, the taditioal ecommedatio would be to place these athletes o a faily highcabohydate taiig diet ad to povide eough potei fo the icease i muscle mass stimulated by the taiig outie. 28 As was the case i the study of Cole et al, 29 may of ou athletes seemed to value meat i the diet, as idicated by the high pefeece fo meat o the Nutitio Attitude Suvey. The egative coelatios of meat pefeece with waist cicumfeece, deceased body fatess, ad appaet bette glucose hadlig (eg, FBG ad HgbA1c levels) deseve moe attetio fom the eseach commuity amid the feuds ove high-potei diets i athletes. Ou fidigs idicate that a pefeece fo meat is associated with a slightly bette MetSy pofile. It is uclea fom these data if the pefeece fo meat is equivalet to a high-potei diet o if these athletes simply coside meat impotat. Athletes with MetSy may eed diffeet utitioal guidace tha the usual high-cabohydate, adequate-potei advice fo athletes. Additioally, it would be iteestig to evaluate these lage athletes fo oalcoholic fatty live disease, as the liteatue idicates this coditio is ofte cocuet with isuli esistace, 19 implicatig high-fat ad possibly high-cabohydate diets. 30 Noalcoholic fatty live disease may help to explai the iceased CR levels associated with MetSy. 28 This does ot ecessaily mea that a high-potei, lowcabohydate diet will be advised, but cliical studies ae justified to idetify desiable macoutiet itakes fo health ad pefomace i this goup of heavy athletes. Examiig the use of dietay supplemets i these athletes is aothe pespective to coside i futue eseach. Ma huag, caffeie, ad othe stimulats may icease blood pessue. May football athletes use dietay supplemets that cotai multiple igediets (icludig stimulats) desiged to pomote muscle gowth ad icease pefomace. Athletes with hypetesio should be caefully questioed about the use of supplemets because some of these agets ca icease blood pessue. Limitatios The mai limitatio of this study is the volutee atue of huma subject eseach. May of the athletes at the DI ad DIII schools chose ot to paticipate. A few volutees chose ot to allow blood samplig. The physical activity ad diet data i this aalysis ae isufficiet to daw fim coclusios about thei ifluece o the MetSy, as the paticipats self-epoted thei estimated physical activity fo the past week, which is ot validated o ecessaily eliable. The Nutitio Attitude Suvey tool gives isight ito dietay attitudes but does ot allow fo specific compaisos egadig the ifluece of the macoutiet compositio of the diet. We caot compae the icidece of MetSy i this athlete cohot with that of the geeal populatio because the fome is biased towad lage body size tha that studied i most ivestigatios of the latte. May vaiables i this study, such as blood ad blood pessue measues, may have impoved accuacy with multiple measues. We desiged ou eseach as a field study to equie limited paticipat effot ad miimal time commitmet. Body fatess may have bee bette measued i a BOD OD (Life Measuemet Ic, Cocod, CA) o udewate tak, but this method was time pohibitive ad cost pohibitive fo this field study, as ot all istitutios had access ad some athletes would have had to tavel. CONCLUSIONS Ou fidigs should geeate sigificat doubt about the pesumed health of collegiate football lieme. Though vaious blood ad athopometic measues, we demostated that lage athletes, such as football lieme, should be sceeed fo MetSy. The cuet health of the athlete is of obvious ogoig coce i the field of spots medicie, but the futue health of the lage athlete waats moe pevetive cosideatio tha it may be eceivig. With a high pevalece of MetSy i these collegiate athletes, we should look at the pevalece i youge football lieme as well as olde lieme to examie the iitiatio ad pogessio of symptoms. The physical activity of football lieme does ot seem to cofe eough potective beefit to avoid MetSy, ceatig coce fo these athletes whe they etie fom the spot if they choose to become less active. Joual of Athletic Taiig 615

9 ACKNOWLEDGMENTS We thak the Natioal Football League Chaities fo fudig this poject. Thak you to gaduate studet Amy Vide fo settig up ad coodiatig the study, to each of the spots utitio studets who helped us collect ad check the data, ad to Tim Dulavey, ATC (The Ohio State Uivesity) fo his ecuitmet suppot. Ad fially, thak you to Babaa Loso, Diae Habash, ad Matha Beluy (ad he laboatoy goup) fo isightful commets i eview of the mauscipt. REFERENCES 1. Malia RM, Moao J, Bao M, et al. Oveweight ad obesity amog youth paticipats i Ameica football. J ediat. 2007;151 (4): Hap JB, Hecht L. Obesity i the Natioal Football League. JAMA. 2005;293: Lauso KR, Eisema JC. evalece of oveweight amog high school football lieme. JAMA. 2007;297(4): Reibeg S. Ex-NFL lieme poe to heat disease. HealthDay News. Accessed Mach 22, Gudy SM, Cleema JI, Daiels SR. Diagosis ad maagemet of the metabolic sydome: a Ameica Heat Associatio/Natioal Heat, Lug, ad Blood Istitute scietific statemet. Ciculatio. 2005;112(17): Albeti KGMM, Zimmet, Shaw J. Metabolic sydome: a ew wold-wide defiitio. A cosesus statemet fom the Iteatioal Diabetes Fedeatio. Diabet Med. 2006;23(15): Segua J, Rolda C, Gacia-Doaie JA, Ruilope LM. ediabetes ad cadiovascula isk i hypetesive patiets. Cu Hypetes Rep. 2006;8(2): Sudstom J, Vallhage E, Riseus U, et al. Risk associated with the metabolic sydome vesus the sum of its idividual compoets. Diabetes Cae. 2006;29(7): Collis MA, Millad-Staffod ML, Spalig B, et al. Evaluatio of the BODOD fo assessig body fat i collegiate football playes. Med Sci Spots Exec. 1999;31(9): Joalagadda SS, Rosebloom CA, Skie R. Dietay pactices, attitudes, ad physiological status of collegiate feshma football playes. J Stegth Cod Res. 2001;15(4): Ameica College of Spots Medicie. ACSM s Guidelies fo Execise Testig ad esciptio. 7th ed. hiladelphia, A: Lippicott Williams & Wilkis; 2006: St Jeo ST. Obesity Assessmet: Tools, Methods, Itepetatios. New Yok, NY: Chapma & Hall; 1997: Ridke M. C-Reactive potei, iflammatio, ad cadiovascula disease: cliical update. Cu Issues Cadiol. 2005;32(3): Wag TD, Che WJ, Chie KL, et al. Efficacy of cholesteol levels ad atios i pedictig futue cooay heat disease i a Chiese populatio. Am J Cadiol. 2001;88(7): Hollis JF, Camody T, Coo SL, Fey SG, Mataazzo JD. The Nutitio Attitude Suvey: associatios with dietay habits, psychological ad physical well-beig, ad cooay isk factos. Health sychol. 1986;5(4): Caoll S, Dudfield M. What is the elatioship betwee execise ad metabolic abomalities? A eview of the metabolic sydome. Spots Med. 2004;34(6): Kowle WC, Baett-Coo E, Fowle SE, et al. Diabetes evetio ogam Reseach Goup. Reductio i the icidece of type 2 diabetes with lifestyle itevetio o metfomi. New Egl J Med. 2002;346(6): Expet ael o Detectio, Evaluatio, ad Teatmet of High Blood Cholesteol i Adults. Executive Summay of the Thid Repot of the Natioal Cholesteol Educatio ogam (NCE) Expet ael o Detectio, Evaluatio, ad Teatmet of High Blood Cholesteol i Adults (Adult Teatmet ael III). JAMA. 2001;285(19): Libeopoulos EN, Mikhailidis D, Elisaf MS. Diagosis ad maagemet of the metabolic sydome i obesity. Obes Rev. 2005;6(4): McGill HC J, McMaha CA, Hedeick EE, et al. athobiological Detemiats of Atheoscleosis i Youth (DAY) Reseach Goup. Obesity acceleates the pogessio of cooay atheoscleosis i youg me. Ciculatio. 2002;105(23): Zieske AW, Tacy R, McMaha CA, et al. athobiological Detemiats of Atheoscleosis i Youth (DAY) Reseach Goup. Elevated seum C-eactive potei levels ad advaced atheoscleosis i youth. Ateioscle Thomb Vasc Biol. 2005;25(6): Melaso J. actical dietay appoaches to educig isk of cadiovascula disease. Am J Lifestyle Med. 2007;1(2): Feadez-Real JM, Boch M, Vedell J, Ricat W. Isuli esistace, iflammatio, ad seum fatty acid compositio. Diabetes Cae. 2003;26(5): Howad BV, Wylie-Rosett J. Suga ad cadiovascula disease: a statemet fo healthcae pofessioals fom the Committee o Nutitio of the Coucil o Nutitio, hysical Activity, ad Metabolism of the Ameica Heat Associatio. Ciculatio. 2002;106(4): Sahyou NR, Adeso AL, Kaaya AM, et al. Dietay glycemic idex ad load, measues of glucose metabolism, ad body fat distibutio i olde adults. Am J Cli Nut. 2005;82(3): Food ad Nutitio Boad. Dietay Refeece Itakes fo Eegy, Cabohydate, Fibe, Fat, Fatty Acids, Cholesteol, otei, ad Amio Acids (Macoutiets). Washigto, DC: Natioal Academies ess; 2005: Ameica College of Spots Medicie. ACSM s Resouce Maual fo Guidelies fo Execise Testig ad esciptio. 5th ed. Baltimoe, MD: Lippicott Williams & Wilkis; 2006: Dufod M. Spots Nutitio: A actice Maual fo ofessioals. 4th ed. Washigto, DC: Ameica Dietetic Associatio; 2006: Cole CR, Slavatea GF, Davis JE J, et al. Evaluatio of dietay pactices of Natioal Collegiate Athletic Associatio Divisio I football playes. J Stegth Cod Res. 2005;19(3): Utzscheide KM, Kah SE. Review: the ole of isuli esistace i oalcoholic fatty live disease. J Cli Edociol Metab. 2006;91(12): Jackie L. Buell, hd, RD/LD, LAT, ATC, cotibuted to coceptio ad desig; acquisitio ad aalysis ad itepetatio of the data; ad daftig, citical evisio, ad fial appoval of the aticle. Doug Callad, MS, LAT, ATC, ad Fioa Haks, MS, LAT, ATC, cotibuted to coceptio ad desig, acquisitio of the data, ad daftig, citical evisio, ad fial appoval of the aticle. Buce Johsto, MS, LAT, ATC, ad Bejami este, MS, LAT, ATC, cotibuted to coceptio ad desig, acquisitio of the data, ad citical evisio ad fial appoval of the aticle. Robet Sweeey, MS, LAT, ATC, cotibuted to coceptio ad desig, acquisitio of the data, ad daftig ad fial appoval of the aticle. Robet Thoe, MEd, LAT, ATC, cotibuted to coceptio ad desig, acquisitio of the data, ad citical evisio ad fial appoval of the aticle. Addess coespodece to Jackie L. Buell, hd, RD/LD, LAT, ATC, The Ohio State Uivesity, 1787 Neil Aveue, Campbell Hall 325, Columbus, OH Addess to buell.7@osu.edu. 616 Volume 43 N Numbe 6 N Decembe 2008