Metabolic syndrome outcomes and insulin resistance among former elite middle-aged combat sports athletes with a history of rapid weight loss: A case–control study

Nemanja Maksimovic; Marko Manojlovic; Tatjana Trivic; Yerlan Seisenbekov; Nemanja Lakicevic; Antonino Bianco; Patrik Drid

doi:10.2478/bhk-2026-0022

.blurhash-client-img { display: none !important; }

Metabolic syndrome outcomes and insulin resistance among former elite middle-aged combat sports athletes with a history of rapid weight loss: A case–control study

Biomedical Human Kinetics

Volume 18 (2026): Issue 1 (January 2026)

By: Nemanja Maksimovic , Marko Manojlovic , Tatjana Trivic , Yerlan Seisenbekov , Nemanja Lakicevic , Antonino Bianco and Patrik Drid

Open Access

|Sep 2026

Abstract

Study aim

The objective of this study was to determine metabolic syndrome (MS) outcomes and insulin resistance (IR) among retired combat sports athletes (CSA) who practiced rapid weight loss (RWL) compared with the control group (CG).

Material and methods

The present case–control study included 56 male former elite middle-aged CSA, as well as 52 respondents in the CG who did not practice RWL during their careers. The MS outcomes referred to the waist circumference, fasting glucose, systolic blood pressure, diastolic blood pressure, triglycerides, and high-density lipoprotein cholesterol. The levels of fasting insulin and blood glucose were determined before and following the oral glucose tolerance test.

Results

Former CSA had significantly higher values of systolic blood pressure (r = −0.42, p < 0.001), diastolic blood pressure (r = −0.42, p < 0.001), triglycerides (r = −0.28, p = 0.004), and total cholesterol (r = −0.25, p = 0.011) compared with the matched CG. The statistically significant differences regarding the fasting insulin (p = 0.026) and fasting glucose (p = 0.023) were revealed at the final measurement in favor of the former CSA. The odds of having an MS (68 vs. 19%, respectively, odds ratio = 9.49 [95% confidence interval 3.76, 23.95], p < 0.001) were substantially greater among athletes with a history of RWL relative to the CG.

Conclusion

The findings of the current study demonstrated that the MS outcomes and IR were more pronounced among former elite middle-aged CSA with a history of RWL compared with the matched male controls.

References

Altowerqi, Z. M., & Zainuddin, Z. A. B. (2021). Comparison of metabolic syndrome, uric acid and leisure time physical activity between former athletes and non-athlees. Journal of Pharmaceutical Research International, 32(48), 85–95. https://doi.org/10.9734/jpri/2020/v32i4831128
Open DOI Search in Google Scholar Back to article
Altowerqi, Z. M., Zainuddin, Z. A. B., Hashim, A. H. B. M., & Almarwaey, A. O. (2020). Are former athletes protected against obesity after retirement? Indian Journal of Public Health Research & Development, 11(2), 1995–2000. https://doi.org/10.37506/v11/i2/2020/ijphrd/195123
Open DOI Search in Google Scholar Back to article
Artioli, G. G., Gualano, B., Franchini, E., Scagliusi, F. B., Takesian, M., Fuchs, M., & Lancha, A. H. (2010). Prevalence, magnitude, and methods of rapid weight loss among judo competitors. Medicine and Science in Sports and Exercise, 42(3), 436–442. https://doi.org/10.1249/MSS.0b013e3181ba8055
Open DOI Search in Google Scholar Back to article
Bartoli, E., Fra, G. P., & Carnevale Schianca, G. P. (2011). The oral glucose tolerance test (OGTT) revisited. European Journal of Internal Medicine, 22(1), 8–12. https://doi.org/10.1016/j.ejim.2010.07.008
Open DOI Search in Google Scholar Back to article
Batista, C., & Soares, J. M. (2013). Are former elite athletes more protected against metabolic syndrome? Journal of Cardiology, 61(6), 440–445. https://doi.org/10.1016/j.jjcc.2013.01.011
Open DOI Search in Google Scholar Back to article
Batty, G. D., Bell, S., Kujala, U. M., Sarna, S. J., & Kaprio, J. (2024). Health characteristics and health behaviours in male former contact sports participants: Comparison with general population controls in a Finnish cohort study. Journal of Epidemiology and Community Health, 79(5), 354–358. https://doi.org/10.1136/jech-2024-222931
Open DOI Search in Google Scholar Back to article
Bonora, E. (2006). The metabolic syndrome and cardiovascular disease. Annals of Medicine, 38(1), 64–80. https://doi.org/10.1080/07853890500401234
Open DOI Search in Google Scholar Back to article
Chang, A. Y., FitzGerald, S. J., Cannaday, J., Zhang, S., Patel, A., Palmer, M. D., Reddy, G. P., Ordovas, K. G., Stillman, A. E., Janowitz, W., Radford, N. B., Roberts, A. J., & Levine, B. D. (2009). Cardiovascular risk factors and coronary atherosclerosis in retired National Football League players. The American Journal of Cardiology, 104(6), 805–811. https://doi.org/10.1016/j.amjcard.2009.05.008
Open DOI Search in Google Scholar Back to article
Chen, H., Cohen, P., & Chen, S. (2010). How big is a big odds ratio? Interpreting the magnitudes of odds ratios in epidemiological studies. Communications in Statistics—Simulation and Computation, 39(4), 860–864.
Search in Google Scholar Back to article
Chen, Y. L., Huang, C. Y., Lee, S. D., Chou, S. W., Hsieh, P. S., Hsieh, C. C., Huang, Y. G., & Kuo, C. H. (2009). Discipline-specific insulin sensitivity in athletes. Nutrition, 25(11–12), 1137–1142.
Search in Google Scholar Back to article
Cohen, J. (1992). A power primer. Psychological Bulletin, 112(1), 155–159. https://doi.org/10.1037//0033-2909.112.1.155
Open DOI Search in Google Scholar Back to article
Drid, P., Figlioli, F., Lakicevic, N., Gentile, A., Stajer, V., Raskovic, B., Vojvodic, N., Roklicer, R., Trivic, T., Tabakov, S., Eliseev, S., & Bianco, A. (2021). Patterns of rapid weight loss in elite sambo athletes. BMC Sports Science, Medicine & Rehabilitation, 13(1), 39. https://doi.org/10.1186/s13102-021-00267-3
Open DOI Search in Google Scholar Back to article
Emami, M., Behforouz, A., Jarahi, L., Zarifian, A., Rashidlamir, A., Rashed, M. M., Khaleghzade, H., Ghaneifar, Z., Safarian, M., Azimi-Nezhad, M., Nikroo, H., & Nematy, M. (2018). The risk of developing obesity, insulin resistance, and metabolic syndrome in former power-sports athletes—does sports career termination increase the risk. Indian Journal of Endocrinology and Metabolism, 22(4), 515–519. https://doi.org/10.4103/ijem.IJEM_83_18
Open DOI Search in Google Scholar Back to article
Galassi, A., Reynolds, K., & He, J. (2006). Metabolic syndrome and risk of cardiovascular disease: A meta-analysis. The American Journal of Medicine, 119(10), 812–819. https://doi.org/10.1016/j.amjmed.2006.02.031
Open DOI Search in Google Scholar Back to article
Gastaldelli, A. (2022). Measuring and estimating insulin resistance in clinical and research settings. Obesity, 30(8), 1549–1563. https://doi.org/10.1002/oby.23503
Open DOI Search in Google Scholar Back to article
Gonzalez-Chávez, A., Chávez-Fernández, J. A., Elizondo-Argueta, S., González-Tapia, A., León-Pedroza, J. I., & Ochoa, C. (2018). Metabolic syndrome and cardiovascular disease: A health challenge. Archives of Medical Research, 49(8), 516–521. https://doi.org/10.1016/j.arcmed.2018.10.003
Open DOI Search in Google Scholar Back to article
Grundy, S. M., Cleeman, J. I., Daniels, S. R., Donato, K. A., Eckel, R. H., Franklin, B. A., Gordon, D. J., Krauss, R. M., Savage, P. J., Smith, S. C., Spertus, J. A., & Costa, F. (2005). Diagnosis and management of the metabolic syndrome: An american heart association/national heart, lung, and blood institute scientific statement. Circulation, 112(17), 2735–2752. https://doi.org/10.1161/CIRCULATIONAHA.105.169404
Open DOI Search in Google Scholar Back to article
Hirode, G., & Wong, R. J. (2020). Trends in the prevalence of metabolic syndrome in the United States, 2011-2016. JAMA, 323(24), 2526–2528. https://doi.org/10.1001/jama.2020.4501
Open DOI Search in Google Scholar Back to article
Kassi, E., Pervanidou, P., Kaltsas, G., & Chrousos, G. (2011). Metabolic syndrome: Definitions and controversies. BMC Medicine, 9(1), 48. https://doi.org/10.1186/1741-7015-9-48
Open DOI Search in Google Scholar Back to article
Khodaee, M., Olewinski, L., Shadgan, B., & Kiningham, R. R. (2015). Rapid weight loss in sports with weight classes. Current Sports Medicine Reports, 14(6), 435–441. https://doi.org/10.1249/JSR.0000000000000206
Open DOI Search in Google Scholar Back to article
Laine, M. K., Eriksson, J. G., Kujala, U. M., Kaprio, J., Loo, B. M., Sundvall, J., Bäckmand, H. M., Peltonen, M., Jula, A., & Sarna, S. (2016). Former male elite athletes have better metabolic health in late life than their controls. Scandinavian Journal of Medicine & Science in Sports, 26(3), 284–290. https://doi.org/10.1111/sms.12442
Open DOI Search in Google Scholar Back to article
Lakicevic, N., Paoli, A., Roklicer, R., Trivic, T., Korovljev, D., Ostojic, S. M., Proia, P., Bianco, A., & Drid, P. (2021). Effects of rapid weight loss on kidney function in combat sport athletes. Medicina, 57(6), 551. https://doi.org/10.3390/medicina57060551
Open DOI Search in Google Scholar Back to article
Lebron, M. A., Stout, J. R., & Fukuda, D. H. (2024). Physiological perturbations in combat sports: Weight cycling and metabolic function-a narrative review. Metabolites, 14(2), 83. https://doi.org/10.3390/metabo14020083
Open DOI Search in Google Scholar Back to article
Lukic-Sarkanovic, M., Roklicer, R., Trivic, T., Manojlovic, M., Gilic, B., Milovancev, A., Rossi, C., Bianco, A., Carraro, A., Cvjeticanin, M., & Drid, P. (2024). Acute muscle damage as a metabolic response to rapid weight loss in wrestlers. Biomedical Human Kinetics, 16(1), 99–105. https://doi.org/10.2478/bhk-2024-0010
Open DOI Search in Google Scholar Back to article
Majerczak, J., Grandys, M., Frołow, M., Szkutnik, Z., Zakrzewska, A., Niżankowski, R., Duda, K., Chlopicki, S., & Zoladz, J. A. (2019). Age-dependent impairment in endothelial function and arterial stiffness in former high class male athletes is no different to that in men with no history of physical training. Journal of the American Heart Association, 8(18), e012670. https://doi.org/10.1161/JAHA.119.012670
Open DOI Search in Google Scholar Back to article
Maksimovic, N., Cvjeticanin, O., Rossi, C., Manojlovic, M., Roklicer, R., Bianco, A., Carraro, A., Sekulic, D., Milovancev, A., Trivic, T., & Drid, P. (2024). Prevalence of metabolic syndrome and its association with rapid weight loss among former elite combat sports athletes in Serbia. BMC Public Health, 24(1), 245. https://doi.org/10.1186/s12889-024-17763-z
Open DOI Search in Google Scholar Back to article
Milanović, Z., Pantelić, S., Trajković, N., Jorgić, B., Sporiš, G., & Bratić, M. (2014). Reliability of the serbian version of the International Physical Activity Questionnaire for older adults. Clinical Interventions in Aging, 9, 581–587. https://doi.org/10.2147/CIA.S57379
Open DOI Search in Google Scholar Back to article
Miller, M. A., Croft, L. B., Belanger, A. R., Romero-Corral, A., Somers, V. K., Roberts, A. J., & Goldman, M. E. (2008). Prevalence of metabolic syndrome in retired National Football League players. The American Journal of Cardiology, 101(9), 1281–1284. https://doi.org/10.1016/j.amjcard.2007.12.029
Open DOI Search in Google Scholar Back to article
Milovančev, A., Ilić, A., Miljković, T., Petrović, M., Stojšić Milosavljević, A., Roklicer, R., Trivic, T., Manojlovic, M., Rossi, C., Bianco, A., & Drid, P. (2024). Cardiac biomarkers alterations in rapid weight loss and high-intensity training in judo athletes: A crossover pilot study. The Journal of Sports Medicine and Physical Fitness, 64(11), 1224–1233. https://doi.org/10.23736/S0022-4707.24.15992-0
Open DOI Search in Google Scholar Back to article
Minh, H. V., Tien, H. A., Sinh, C. T., Thang, D. C., Chen, C. H., Tay, J. C., Siddique, S., Wang, T. D., Sogunuru, G. P., Chia, Y. C., & Kario, K. (2021). Assessment of preferred methods to measure insulin resistance in Asian patients with hypertension. The Journal of Clinical Hypertension, 23(3), 529–537. https://doi.org/10.1111/jch.14155
Open DOI Search in Google Scholar Back to article
Panayiotoglou, A., Grammatikopoulou, M. G., Maraki, M. I., Chourdakis, M., Gkiouras, K., Theodoridis, X., Papadopoulou, S. K., Famisis, K., & Hassapidou, M. N. (2017). Metabolic syndrome in retired soccer players: A pilot study. Obesity Medicine, 8, 15–22. https://doi.org/10.1016/j.obmed.2017.09.004
Open DOI Search in Google Scholar Back to article
Pihl, E., Zilmer, K., Kullisaar, T., Kairane, C., Pulges, A., & Zilmer, M. (2003). High-sensitive C-reactive protein level and oxidative stress-related status in former athletes in relation to traditional cardiovascular risk factors. Atherosclerosis, 171(2), 321–326. https://doi.org/10.1016/j.atherosclerosis.2003.08.015
Open DOI Search in Google Scholar Back to article
Reaven, G. M. (2011). Relationships among insulin resistance, type 2 diabetes, essential hypertension, and cardiovascular disease: Similarities and differences. Journal of Clinical Hypertension, 13(4), 238–243. https://doi.org/10.1111/j.1751-7176.2011.00439.x
Open DOI Search in Google Scholar Back to article
Roklicer, R., Lakicevic, N., Stajer, V., Trivic, T., Bianco, A., Mani, D., Milosevic, Z., Maksimovic, N., Paoli, A., & Drid, P. (2020). The effects of rapid weight loss on skeletal muscle in judo athletes. Journal of Translational Medicine, 18(1), 142. https://doi.org/10.1186/s12967-020-02315-x
Open DOI Search in Google Scholar Back to article
Roklicer, R., Rossi, C., Bianco, A., Stajer, V., Ranisavljev, M., Todorovic, N., Manojlovic, M., Gilic, B., Trivic, T., & Drid, P. (2022). Prevalence of rapid weight loss in Olympic style wrestlers. Journal of the International Society of Sports Nutrition, 19(1), 593–602. https://doi.org/10.1080/15502783.2022.2119095
Open DOI Search in Google Scholar Back to article
Sisk, M., Medawar, N., McClure, M., Cooke, B., Cannon, R., Kufner, D., D’Almeida, S., Jardaly, A., Asif, I., Momaya, A., & Ponce, B. (2024). Cardiovascular disease in retired NFL players: A systematic review. The Physician and Sportsmedicine, 52(5), 444–451. https://doi.org/10.1080/00913847.2024.2315929
Open DOI Search in Google Scholar Back to article
Štangar, M., Štangar, A., Shtyrba, V., Cigić, B., & Benedik, E. (2022). Rapid weight loss among elite-level judo athletes: Methods and nutrition in relation to competition performance. Journal of the International Society of Sports Nutrition, 19(1), 380–396. https://doi.org/10.1080/15502783.2022.2099231
Open DOI Search in Google Scholar Back to article
Street, J. H., Boos, Z. P., Fial, A., Lennon, S. L., Smith, C. S., Creasy, S. A., Hunter, S. K., Farquhar, W. B., & Capin, J. J. (2023). Long-term function, body composition and cardiometabolic health in midlife former athletes: A scoping review. BMJ Open Sport & Exercise Medicine, 9(4), e001605. https://doi.org/10.1136/bmjsem-2023-001605
Open DOI Search in Google Scholar Back to article
Sung, Y. C., Liao, Y. H., Chen, C. Y., Chen, Y. L., & Chou, C. C. (2017). Acute changes in blood lipid profiles and metabolic risk factors in collegiate elite taekwondo athletes after short-term de-training: A prospective insight for athletic health management. Lipids in Health and Disease, 16(1), 143. https://doi.org/10.1186/s12944-017-0534-2
Open DOI Search in Google Scholar Back to article
Thornton, J., Rosen, C., Davenport, M., Mountjoy, M. L., Dorian, P., Gouttebarge, V., Breau, B., Pila, E., Reilly, K., Yuan, J., Mok, K., Di Ciacca, S., Speechley, M., & Crossley, K. (2023). Beyond the medals: A cross-sectional study exploring retired elite female athletes’ health. BMJ Open Sport & Exercise Medicine, 9(1), e001479. https://doi.org/10.1136/bmjsem-2022-001479
Open DOI Search in Google Scholar Back to article
Trivic, T., Roklicer, R., Zenic, N., Modric, T., Milovancev, A., Lukic-Sarkanovic, M., Maksimovic, N., Bianco, A., Carraro, A., & Drid, P. (2023). Rapid weight loss can increase the risk of acute kidney injury in wrestlers. BMJ Open Sport & Exercise Medicine, 9(2), e001617. https://doi.org/10.1136/bmjsem-2023-001617
Open DOI Search in Google Scholar Back to article
Unt, E., Zilmer, K., Mägi, A., Kullisaar, T., Kairane, C., & Zilmer, M. (2008). Homocysteine status in former top-level male athletes: Possible effect of physical activity and physical fitness. Scandinavian Journal of Medicine & Science in Sports, 18(3), 360–366. https://doi.org/10.1111/j.1600-0838.2007.00674.x
Open DOI Search in Google Scholar Back to article
World Health Organization. (2000). Obesity: Preventing and managing the global epidemic: Report of a WHO consultation.
Search in Google Scholar Back to article
Zhong, Y., Song, Y., Artioli, G. G., Gee, T. I., French, D. N., Zheng, H., Lyu, M., & Li, Y. (2024). The practice of weight loss in combat sports athletes: A systematic review. Nutrients, 16(7), 1050. https://doi.org/10.3390/nu16071050
Open DOI Search in Google Scholar Back to article

Articles in this issue

DOI: https://doi.org/10.2478/bhk-2026-0022 | Journal eISSN: 2080-2234 | Journal ISSN: 2080-2234

Journal RSS Feed

Language: English

Page range: 247 - 257

Submitted on: Jun 2, 2026

Accepted on: Jun 29, 2026

Published on: Sep 4, 2026

Published by: University of Physical Education in Warsaw

In partnership with: Paradigm Publishing Services

Keywords:

Fasting insulin,

Martial arts,

Oral glucose tolerance test,

Retired athletes,

Weight cycling

Related subjects:

Medicine,

Basic medical science,

Basic medical science, other,

Sports and recreation,

Physical education,

Sports and recreation, other

© 2026 Nemanja Maksimovic, Marko Manojlovic, Tatjana Trivic, Yerlan Seisenbekov, Nemanja Lakicevic, Antonino Bianco, Patrik Drid, published by University of Physical Education in Warsaw
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Volume 18 (2026): Issue 1 (January 2026)