Biochemical Laboratory values for this section are pertinent to healthy adult athletes/active persons. If the athlete/active person has a chronic disease, the laboratory results recommended for review may not be complete. Refer to the specific chronic disease for further recommended laboratory values (for example, an insulin-dependent patient should be assessed using values and norms for diabetes mellitus type 1). & Gen inical Laboratory Test Laboratory ena Normal Ranges * LDL Cholesterol level @ Optimal <100 @ Near optimal: 100-129 @ Borderline high: 130-159 o High: 160-189 © Very High: >190 Total Cholesterol o Desirable: <200 @ Borderline high: 200-239 @ High: = 240 « HDL Cholesterol @ Low: < 40 @ High: = 60 * Triglyceride level Normal: <150 Borderline high: 150-199 High: 200-499 Very high: 2500 Lipid Panel eoog (NHLBI ATP III 2001) « Hemoglobin ALC: 26.5% is the criteria for diagnosis of diabetes (Diabetes Care 2011) ® Glycemic control: hemoglobin A1C: <7% (American + Preprandial plasma: <76-130 mg/dL (5.0-7.2 mmol/L) * Postprandial plasma: <180 mg/dL (<10 mmol/L) (American Diabetes Association 2011) Fasting Blood GlucoseMicronutrient Status: Iron, Vitamin D, Vitamin B-12 Normal Ranges Athlete Deficiency/Overload * Glucose levels, lipid panel, and albumin recommendations Laboratory Value Normal Ranges Athlete Deficiency/Overload ‘Iron deficiency Normal iron status levels: Hemoglobi © Males: 140-180 g/L © Females: 120-160 g/L Hematocrit: + Males: 0,39-0.49 + Females: 0.33-0.43 ‘Serum ferritin: * Males: 3-300 mcg/L. © Females: 10-160 meg/L * Males: 14-32 mcmol/L * Females: 10-29 mcmol/L. ‘Serum Transferrin: 1.7-3.7 g/t. ‘Stage 1: Depleted iron stores: ‘* Stainable iron in the bone marrow is absent. © Total iron binding capacity is >400 meg/dL. ‘* Serum ferritin is <12 mea/dL. Note: Cut-offs are more conservative for athletes at sea-level and altitude. arly functional iron deficiency: © Transferrin saturation is <16%. © Serum transferrin receptor is >8.5 ma/L. ‘Stage 3: Iron deficiency anemia ‘¢ Hemoglobin is <130 g/L in males and <120 g/L in females. + Normal mean cell volume range is 86- 98 fl (Beard 2000). ‘Serum Transferrin: 1.7-3.7 9/L Total iron-binding capacity: 45-82 memol/L TSE OTT Iron overload or hemochromatosis ‘* Plasma ferritin is >200 mcg/L in males. (20-44 yrs) and >150 meg/L in females (20-44 yrs). + Plasma iron is ~175 mcg/L. ‘© Transferrin saturation Is > 60% (Burtis1999). Vitamin D 2 Seru! 5(OH)D: 32.0 to 100.0 ng/mL Recommendation for athletes: ‘+ Achieve a serum 25(0H)D concentration of 232 ng/mL and preferably >40ng/mL (Larson- Meyer 2010) Note: The Institute of Medicine determined a 25(GH)D concentration of 20 ng per millliter of blood to be sufficient for good bone health for practically all Individuals (IOM 2011). Lower-than-normal levels suggest a vitamin D deficiency. This condition can result from: Lack of exposure to sunlight Lack of adequate vitamin D in the diet Liver and kidney diseases Malabsorption Use of certain medicines, including phenytoin, phenobarbital, and rifampin Use of sunscreens with SPF 8 or higher decreases vitamin D production by 95% © Clothing that impairs Vitamin D formation in skin eee .Vitamin B-12 Males: 2.4 ug . Confusion or change in mental status in severe or advanced cases Diarrhea Fatigue Loss of appetite Numbness and tingling of hands and feet Pallor Shortness of breath Sore mouth and tongue Weakness Note that folic acid supplementation to correct megaloblastic anemia can mask a Vitamin B-12 deficiency Females: 2.4 ug ete eens 1 Iron is critical to the oxygen delivery system, and endurance athletes, especially those whose sport includes running, may be at increased risk for iron deficiency (Beard 2000). Endurance sports may also precipitate iron deficiency caused by hemolysis, the rupturing of red blood cells and muscle cells that causes a release of hemoglobin and hematuria, or the presence of hemoglobin or myoglobin in the urine (Jones 1997). A periodic determination of iron status may be warranted in these populations. 2 The Tolerable Upper Level of Intake for Vitamin D is set at 4,000 1U/day for individuals age 9-50 years and older (IOM 2011). Electrolytes Electrolytes, Sweat Rate, Osmolality, Urine Specific Gravity Laboratory —_| Normal Ranges Athlete Deficiency /Overload ‘Value Electrolytes Plasma Plasma ‘© Sodium: 136-145 mmol/L. * Sodium: <135 mmol/L © Potassium: 3.5-45.1 mmol/L © Hyponatremia © Calcium: 2.15-2.5 mmol/L. ‘© Magnesium: 0.66-1.07 mmol/L © Chloride: 98-107 mmol/L Sweat ‘© Sodium: 40-80 mmol/L ‘© Potassium: 4.4 -15.6 mmol/L. © Calcium: 3-4 mmol/L * 0-1 mmol/L © 0-3 mmol/L © Magnesium: 1-4 mmol/L ‘* <0.2 mmol/L © 0-1.5 mmol/L. ‘© Chloride: 5-35 mmol/L ‘Sweat rate - ‘A. Record body weight befere exercise (Ib/2.2 = ka) B. Record body weight after exercise (Ib/2.2 = ka) C. Change in body weight, A = B D. Record drink volume consumed during exercise (oz X 30 = mL)‘© Sodium: 40-80 mmo//L ‘+ Potassium: 4.4 -15.6 mmol/L. * Calcium: 3-4 mmol/L © 0-1 mmoyL © 0-3 mmoyL ‘© Magnesium: 1-4 mmol/L ‘+ <0.2 mmol/L + 0-1.5 mmol/L ‘* Chloride: 5-35 mmol/L ‘Sweat rate A. Record body weight before exercise (1b/2.2 = kg) B. Record body weight after exercise (lb/2.2 = kg) C. Change in body weight, A = 8 D. Record drink volume consumed during exercise (oz X 30 = mL) E. Record urine volume excreted before post-exercise weighing (oz X 30 = mL) F. Determine sweat loss (C + D - E, oz X 30 = mL) G. Record exercise time, min or hrs H. Calculate sweat rate = F/G in ml/min or mL/hr (Murray 1996) ‘Osmolality + Plasma: < 290 mOsmol * Urine: <700 mOsmol Urine Specific Gravity Urine-specific gravity determines the density of urine with relationship to the density of plasma. It can be used to ‘* Normal range is 1.002-1.030 g/mL ‘+ Hypohydration © >1.020 g/mL (Osterberg 2009, Maughan 2008) ‘© Copyright 2012 Academy of Nutrition and Dietetics, All Rights Reserved. Web2