Nutritional and metabolic characteristics of Paralympic athletes with spinal cord injury

BACKGROUND: Common consequences of spinal cord injury in athletes include reduced basal metabolic rate, loss of muscle mass, impaired thermoregulation, and the development of chronic subclinical inflammation. Evidence-based recommendations for nutritional support in this group of athletes are currently lacking. AIM: This work aimed to characterize the plasma proteomic and metabolomic profiles of athletes from the Russian national wheelchair basketball team with spinal cord injury in order to develop personalized nutritional support recommendations. METHODS: Mass spectrometry analysis of blood plasma was performed in nine athletes from the Russian national wheelchair basketball team (mean age 37.9 ± 5.8 years, spinal cord injury at Th3–L1). A total of 61 proteins were identified and 40 endogenous metabolites were quantitatively measured. RESULTS: Activation of the acute-phase response was revealed (an increase in the levels of ITIH4, SERPINA3, AHSG, and ORM2 proteins by 2.3–9.6-fold), as well as a fivefold increase in apolipoprotein C-III concentration (57.78 ± 30.39 μM). Marked reductions were detected in glucogenic amino acids (alanine, serine, threonine decreased by 84%–96%), urea cycle components (arginine, ornithine decreased by 78%–88%), and Krebs cycle substrates (citrate and lactate decreased by 89%–99%). A sixfold increase in d-hydroxylysine concentration (54.022 ± 13.599 μM) indicates intensive collagen catabolism. CONCLUSION: Wheelchair basketball players exhibit a specific metabolic phenotype characterized by deficiency of amino acids involved in energy metabolism, dyslipidemia, and activation of inflammatory processes. To correct these alterations, personalized nutritional support is recommended, including increased protein intake to 2.0–2.2 g/kg, additional supplementation with L-citrulline (6–8 g/day), taurine (2–3 g/day), collagen synthesis substrates, and omega-3 polyunsaturated fatty acids (3–4 g/day).