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The impact of tangeretin combined with whey protein on exercise-induced bronchoconstriction in professional athletes: a placebo-controlled trial.

  • 2024-10-18
  • Journal of the International Society of Sports Nutrition 21(1)
    • Zhi Cao
    • Can Zhao
    • Shiwei Mo
    • Bing-Hong Gao
    • Meng Liu

Study Design

Type
Randomized Controlled Trial (RCT)
Population
30 professional athletes with EIB, consisting of 14 females and 16 males
Methods
placebo-controlled, double-blind, paired, randomized trial design; tangeretin combined with whey protein intervention vs placebo; exercise challenge tests and VO2max tests; blood and serum measurements
Blinding
Double-blind
Duration
4 weeks
Funding
Unclear

Background

Exercise-induced bronchoconstriction (EIB) is highly prevalent in athletes. The objective of this study was to assess the therapeutic efficacy of daily tangeretin combined with whey protein supplementation over a period of 4 weeks in professional athletes with EIB.

Methods

Using a placebo-controlled, double-blind, paired, randomized trial design, a cohort of 30 professional athletes with EIB, consisting of 14 females and 16 males, was divided into two groups: the tangeretin combined with whey protein intervention group (TIG), and the placebo control group (PCG). Both the TIG and PCG underwent exercise challenge tests (ECT) and VO2max tests before (ECT1, V1) and after (ECT2, V2) the intervention. Blood (eosinophils, neutrophils, and basophils) and serum (interleukin-5, IL-5; interleukin-8, IL-8; Clara cell secretory protein-16, CC16; immunoglobulin E, IgE) levels were measured early in the morning of ECT1 and ECT2, respectively. Lung function was assessed immediately before and post-ECT immediately.

Results

Tangeretin combined with whey protein use for 4 weeks attenuated the decrease in forced expiratory volume in 1 s (FEV1) post trials (∆FEV1(ECT1-ECT2): mean (SD) TIG -7.51(6.9)% vs. PCG -2.33(11.49)%, p = 0.013). Tangeretin also substantially attenuated IL-5 concentration (∆IL-5(T1-T5): Tangeretin -19.4% vs Placebo + 8.37%, p = 0.022); IL-8 concentration (∆IL-8(T1-T5): Tangeretin -17.28% vs Placebo + 6.1%, p = 0.012); CC16 concentration (∆CC16(T1-T5): Tangeretin -11.77% vs Placebo + 24.19%); and IgE concentration in the serum (∆IgE(T1-T5): Tangeretin -24.1% vs Placebo -3.9%), and significantly decreased neutrophil count (∆N(T1-T5): Tangeretin -11.34% vs Placebo + 0.3%) and eosinophil count in blood (∆N(T1-T5): Tangeretin -38.5% vs Placebo + 4.35%). Compared with V1, VO2max (p = 0.042) and TLim (p = 0.05) of V2 were significantly increased in the TIG, and there was no significant change in the PCG. Meanwhile, six athletes in the TIG and 0 athletes in the PCG became EIB-negative at ECT2; the overall negative conversion rate of EIB was 40.00% in TCG. Additionally, the number of cough symptoms decreased from 9 to 3 and dyspnea from 4 to 2 in the TIG.

Conclusion

After high-intensity exercise, athletes with EIB achieved significant improvements in lung function and blood inflammatory factors by combining tangeretin and whey protein supplementation. EIB athletes also showed longer exercise endurance and VO2max at 4 weeks after TI. In addition, some patient symptoms disappeared after combination supplementation. The effect of this treatment on professional athletes with EIB was beneficial.

Research Insights

  • Tangerine→Improved Exercise Duration

    Compared with V1, VO2max (p = 0.042) and TLim (p = 0.05) of V2 were significantly increased in the TIG

    Effect
    Beneficial
    Effect size
    Small
    Dose
    not specified
  • Tangerine→Improved Exercise Time to Exhaustion

    Compared with V1, VO2max (p = 0.042) and TLim (p = 0.05) of V2 were significantly increased in the TIG, and there was no significant change in the PCG.

    Effect
    Beneficial
    Effect size
    Small
    Dose
    not specified
  • Tangerine→Improved Maximal Oxygen Consumption

    Compared with V1, VO2max (p = 0.042) and TLim (p = 0.05) of V2 were significantly increased in the TIG, and there was no significant change in the PCG.

    Effect
    Beneficial
    Effect size
    Small
    Dose
    not specified
  • Tangerine→Improved VO2max

    Compared with V1, VO2max (p = 0.042) and TLim (p = 0.05) of V2 were significantly increased in the TIG, and there was no significant change in the PCG.

    Effect
    Beneficial
    Effect size
    Small
    Dose
    not specified
  • Tangerine→Increased Immunoglobulin Levels

    IgE concentration in the serum (∆IgE(T1-T5): Tangeretin -24.1% vs Placebo -3.9%),

    Effect
    Beneficial
    Effect size
    Moderate
    Dose
    not specified
  • Tangerine→Increased Interleukin 8 Levels

    IL-8 concentration (∆IL-8(T1-T5): Tangeretin -17.28% vs Placebo + 6.1%, p = 0.012);

    Effect
    Beneficial
    Effect size
    Small
    Dose
    not specified
  • Tangerine→Reduced Basophil Count

    Blood (eosinophils, neutrophils, and basophils) ... were measured ... significantly decreased neutrophil count ... and eosinophil count ... (no significant change reported for basophils in the abstract, implying null).

    Effect
    Neutral
    Effect size
    Small
    Dose
    not specified
  • Tangerine→Reduced Clara Cell Secretory Protein-16 Level

    CC16 concentration (∆CC16(T1-T5): Tangeretin -11.77% vs Placebo + 24.19%);

    Effect
    Beneficial
    Effect size
    Small
    Dose
    not specified
  • Tangerine→Reduced Cough Frequency

    the number of cough symptoms decreased from 9 to 3 and dyspnea from 4 to 2 in the TIG.

    Effect
    Beneficial
    Effect size
    Small
    Dose
    not specified
  • Tangerine→Reduced Cough Symptom

    the number of cough symptoms decreased from 9 to 3 and dyspnea from 4 to 2 in the TIG.

    Effect
    Beneficial
    Effect size
    Large
    Dose
    not specified
  • Tangerine→Reduced Dyspnea

    the number of cough symptoms decreased from 9 to 3 and dyspnea from 4 to 2 in the TIG.

    Effect
    Beneficial
    Effect size
    Small
    Dose
    not specified
  • Tangerine→Reduced Dyspnea Symptoms

    the number of cough symptoms decreased from 9 to 3 and dyspnea from 4 to 2 in the TIG.

    Effect
    Beneficial
    Effect size
    Moderate
    Dose
    not specified
  • Tangerine→Reduced Eosinophil Count

    eosinophil count in blood (∆N(T1-T5): Tangeretin -38.5% vs Placebo + 4.35%)

    Effect
    Beneficial
    Effect size
    Large
    Dose
    not specified
  • Tangerine→Reduced Exercise-Induced Bronchoconstriction

    six athletes in the TIG and 0 athletes in the PCG became EIB-negative at ECT2; the overall negative conversion rate of EIB was 40.00% in TCG.

    Effect
    Beneficial
    Effect size
    Moderate
    Dose
    not specified
  • Tangerine→Reduced Forced Expiratory Volume in 1 Second Decline

    Tangeretin combined with whey protein use for 4 weeks attenuated the decrease in forced expiratory volume in 1 s (FEV1) post trials (∆FEV1(ECT1-ECT2): mean (SD) TIG -7.51(6.9)% vs. PCG -2.33(11.49)%, p = 0.013).

    Effect
    Beneficial
    Effect size
    Large
    Dose
    not specified
  • Tangerine→Reduced Interleukin-5 Level

    Tangeretin also substantially attenuated IL-5 concentration (∆IL-5(T1-T5): Tangeretin -19.4% vs Placebo + 8.37%, p = 0.022);

    Effect
    Beneficial
    Effect size
    Small
    Dose
    not specified
  • Tangerine→Reduced Neutrophil Count

    significantly decreased neutrophil count (∆N(T1-T5): Tangeretin -11.34% vs Placebo + 0.3%)

    Effect
    Beneficial
    Effect size
    Small
    Dose
    not specified
  • Tangerine→Reversed Exercise-Induced Bronchoconstriction

    six athletes in the TIG and 0 athletes in the PCG became EIB-negative at ECT2; the overall negative conversion rate of EIB was 40.00% in TIG.

    Effect
    Beneficial
    Effect size
    Large
    Dose
    not specified
  • Whey Protein→Improved Exercise Duration

    Compared with V1, VO2max (p = 0.042) and TLim (p = 0.05) of V2 were significantly increased in the TIG

    Effect
    Beneficial
    Effect size
    Small
    Dose
    not specified
  • Whey Protein→Improved Exercise Time to Exhaustion

    Compared with V1, VO2max (p = 0.042) and TLim (p = 0.05) of V2 were significantly increased in the TIG, and there was no significant change in the PCG.

    Effect
    Beneficial
    Effect size
    Small
    Dose
    not specified
  • Whey Protein→Improved Maximal Oxygen Consumption

    Compared with V1, VO2max (p = 0.042) and TLim (p = 0.05) of V2 were significantly increased in the TIG, and there was no significant change in the PCG.

    Effect
    Beneficial
    Effect size
    Small
    Dose
    not specified
  • Whey Protein→Improved VO2max

    Compared with V1, VO2max (p = 0.042) and TLim (p = 0.05) of V2 were significantly increased in the TIG, and there was no significant change in the PCG.

    Effect
    Beneficial
    Effect size
    Small
    Dose
    not specified
  • Whey Protein→Increased Immunoglobulin Levels

    IgE concentration in the serum (∆IgE(T1-T5): Tangeretin -24.1% vs Placebo -3.9%),

    Effect
    Beneficial
    Effect size
    Moderate
    Dose
    not specified
  • Whey Protein→Increased Interleukin 8 Levels

    IL-8 concentration (∆IL-8(T1-T5): Tangeretin -17.28% vs Placebo + 6.1%, p = 0.012);

    Effect
    Beneficial
    Effect size
    Small
    Dose
    not specified
  • Whey Protein→Reduced Basophil Count

    Blood (eosinophils, neutrophils, and basophils) ... were measured ... significantly decreased neutrophil count ... and eosinophil count ... (no significant change reported for basophils in the abstract, implying null).

    Effect
    Neutral
    Effect size
    Small
    Dose
    not specified
  • Whey Protein→Reduced Clara Cell Secretory Protein-16 Level

    CC16 concentration (∆CC16(T1-T5): Tangeretin -11.77% vs Placebo + 24.19%);

    Effect
    Beneficial
    Effect size
    Small
    Dose
    not specified
  • Whey Protein→Reduced Cough Frequency

    the number of cough symptoms decreased from 9 to 3 and dyspnea from 4 to 2 in the TIG.

    Effect
    Beneficial
    Effect size
    Small
    Dose
    not specified
  • Whey Protein→Reduced Cough Symptom

    the number of cough symptoms decreased from 9 to 3 and dyspnea from 4 to 2 in the TIG.

    Effect
    Beneficial
    Effect size
    Large
    Dose
    not specified
  • Whey Protein→Reduced Dyspnea

    the number of cough symptoms decreased from 9 to 3 and dyspnea from 4 to 2 in the TIG.

    Effect
    Beneficial
    Effect size
    Small
    Dose
    not specified
  • Whey Protein→Reduced Dyspnea Symptoms

    the number of cough symptoms decreased from 9 to 3 and dyspnea from 4 to 2 in the TIG.

    Effect
    Beneficial
    Effect size
    Moderate
    Dose
    not specified
  • Whey Protein→Reduced Eosinophil Count

    eosinophil count in blood (∆N(T1-T5): Tangeretin -38.5% vs Placebo + 4.35%)

    Effect
    Beneficial
    Effect size
    Large
    Dose
    not specified
  • Whey Protein→Reduced Exercise-Induced Bronchoconstriction

    six athletes in the TIG and 0 athletes in the PCG became EIB-negative at ECT2; the overall negative conversion rate of EIB was 40.00% in TCG.

    Effect
    Beneficial
    Effect size
    Moderate
    Dose
    not specified
  • Whey Protein→Reduced Forced Expiratory Volume in 1 Second Decline

    Tangeretin combined with whey protein use for 4 weeks attenuated the decrease in forced expiratory volume in 1 s (FEV1) post trials (∆FEV1(ECT1-ECT2): mean (SD) TIG -7.51(6.9)% vs. PCG -2.33(11.49)%, p = 0.013).

    Effect
    Beneficial
    Effect size
    Large
    Dose
    not specified
  • Whey Protein→Reduced Interleukin-5 Level

    Tangeretin also substantially attenuated IL-5 concentration (∆IL-5(T1-T5): Tangeretin -19.4% vs Placebo + 8.37%, p = 0.022);

    Effect
    Beneficial
    Effect size
    Small
    Dose
    not specified
  • Whey Protein→Reduced Neutrophil Count

    significantly decreased neutrophil count (∆N(T1-T5): Tangeretin -11.34% vs Placebo + 0.3%)

    Effect
    Beneficial
    Effect size
    Small
    Dose
    not specified
  • Whey Protein→Reversed Exercise-Induced Bronchoconstriction

    six athletes in the TIG and 0 athletes in the PCG became EIB-negative at ECT2; the overall negative conversion rate of EIB was 40.00% in TIG.

    Effect
    Beneficial
    Effect size
    Large
    Dose
    not specified
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