Evaluation of physiological and nutritional risk factors for upper respiratory illness using a zero-inflated negative binomial model

• Intensified training periods may increase incidence of upper respiratory illness (URI) in athletes (Meeusen et al., 2013,Medicine and Science in Sports and Exercise, 45(1), 186–205). Many physiological and nutritional risk factors have beenassociated with increased risk of URI (Bermon et al., 2017, Exercise Immunology Review, 23, 8–50), including reductionsin salivary IgA (sIgA), elevated cortisol, vitamin D insufficiency, iron deficiency and low energy availability (EA). However, few studies have explored the relative importance of each of thesehealth-related biomarkers in a multivariate model. Our aimwas therefore to investigate the relationship between multiplebiological risk factors for illness and incidence, duration andseverity of URIs that present during intensified training. 3815Twenty-five well-trained male cyclists and triathletes (age 30 ± 9 y, VO2peak 64 ± mL· kg−1· min−1) performed one ofthree different high-intensity interval training (HIT) programmes for three sessions per week over four weeks in November-December. The study received local ethical approval and participants provided written, informed consentto participate. Participants performed each HIT session at “isoeffort” intensity and sessions were matched for total accumulated work duration. Participants logged upper respiratorysymptoms (URS) daily using the Jackson Common Cold Scale; episodes of URI were identified retrospectively using the followinga priori criteria: weekly symptom score > 14 or selfreportedcommon cold for > 2 consecutive days (Jacksonet al., 1958, American Medical Association Archives of Internal Medicine, 101, 267–278). Before commencing the training period, VO2peak was determined using an incremental maximal cycling protocol and participants provided rested, fasted blood and saliva samples prior to the training period foranalysis of plasma 25(OH)D, ferritin, cortisol, testosterone and sIgA secretion rate. EA was calculated based on a 3-day registration of energy intake and expenditure relative to fat-free mass measured in a rested, fasted state using indirect calorimetry (Torstveit et al., 2018 February, International Journal of Sport Nutrition and Exercise Metabolism, 1–28). We used a zero-inflated negative binomial model to investigate the relationship between baseline VO2peak, health-related biomarkers and URI incidence/duration/global URS severity. Fourteen athletes(56%) reported an episode of URI during the four-week monitoring period. Higher sIgA was associated with reduced risk of URI (odds ratio = 0.90, 90% confidence interval (CI): [0.83,0.97]). Lower plasma cortisol (P = 0.02) and higher EA (P = 0.02) were associated with longer URI duration; holding cortisol constant, the incidence risk ratio (IRR) for a one-unit increase in EA was 1.04 (90% CI: [1.01, 1.07]). Participants with higher VO2peak reported higher total symptom scores during the intervention period (P = 0.03, IRR = 1.07, 90% CI: [1.01,1.13]). Several health-related biomarkers and physiological parameters may therefore be associated with risk and severityof URI, including sIgA, cortisol, EA and VO2peak.

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MEDICIN OCH HÄLSOVETENSKAP  -- Hälsovetenskap -- Idrottsvetenskap (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Health Sciences -- Sport and Fitness Sciences (hsv//eng)

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