Low plasma thiamine and phosphate in male patients with Parkinson's disease is associated with mild cognitive impairment.

OBJECTIVES: Thiamine deficiency (TD) and phosphate depletion increase the risk for cognitive disturbances. This study investigates whether plasma levels of thiamine (P-THIAM), thiamine-monophosphate (P-TMP), and phosphate (P-PHOS) are associated with mild cognitive decline (MCI) in patients with Parkinson's disease (PD). DESIGN AND STUDY POPULATION: This case-control study includes baseline data from a cohort of newly diagnosed patients identified in the New Parkinsonism in Umeå study (NYPUM) (N = 75) and an age and sex matched control group (n = 24). MEASUREMENTS: Mini Nutritional Assessment (MNA-score) and concentrations of P-THIAM, P-TMP, and P-PHOS at baseline were compared between PD patients with mild cognitive impairment (PD-MCI) and PD patients with normal cognition (PD-NC). Neuropsychological assessments of MCI were performed at time of diagnosis. RESULTS: Compared to patients with NC, patients with MCI had lower levels of P-THIAM and P-TMP as well as lower scores on both the Mini Mental State Examination (MMSE) and MNA-screening test. In addition, patients with MCI were older and had more motor problems. The multiple logistic regressions adjusted for age and sex revealed that higher levels of P-THIAM and the MNA-total score were associated with a lower risk of having MCI. Higher MNA-total score and higher P-THIAM and P-PHOS concentrations decreased the risk of MCI in male patients, but not in female patients. The decreased risk of MCI with higher P-TMP levels was lost after adding age and sex to the model. Bivariate correlations between P-PHOS and P-TMP were shown for the total PD population and controls as well as for males with MCI (r = 0.533; n = 22; p = 0.011), but not for males with NC (r = 0.314; n = 19; p = 0.204). An inverse partial correlation (adjusted for age, sex and UPDRS III) was shown for P-THIAM and MNA-total (r = -0.315,p = 0.009) and -final (part II) (r = -0.395,p = 0.001) score for the PD population (n = 75). CONCLUSIONS: Higher P-THIAM and P-PHOS concentrations and higher MNA-total score were associated with a lower risk of MCI in male PD patients, findings that indicate that nutritional factors may influence cognitive function in males in the early phase of PD.

Intake of vitamin B before onset of Parkinson's disease and atypical parkinsonism and olfactory function at the time of diagnosis.

BACKGROUND/OBJECTIVES: To investigate whether vitamin-B density in the diet 2-8 years before diagnosis is associated with olfactory function at the time of diagnosis. SUBJECTS/METHODS: This prospective nested case-control study included patients with Parkinson's disease (PD), multiple system atrophy and progressive supranuclear paralysis identified between 2004 and 2009 in the county of Västerbotten in northern Sweden. The case database (NYPUM study; Newly Diagnosed Parkinson in Umeå; n=147) was cross-linked to the Northern Sweden Health and Disease Study (NSHDS). Identified patients (n=96) and controls (n=375) were matched for sex, age, year of health survey, sub-cohort and geographical area. Dietary intake was assessed by a food frequency questionnaire, and the brief smell identification test (B-SIT) was used to measure olfactory function at the time of diagnosis. RESULTS: There was no difference in vitamin-B or any other macro- or micro-nutrient densities, energy intake or body mass index (kg/m2; BMI) between patients and controls at baseline at the time of the healthcare survey. A lower thiamin and folate density, amount per 1 megajoule, was reported in patients who scored below median on B-SIT (<7) when compared with that in patients who scored ⩾7 at the time of diagnosis. After adjusting for age, sex and BMI using linear and logistic regressions, an even stronger association was found between thiamin density and olfactory function. CONCLUSIONS: A low thiamin and folate density in the reported diet, 2-8 years before PD diagnosis, was significantly associated with olfactory dysfunction at the time of PD diagnosis.

Olfactory Function, Eating Ability, and Visceral Obesity Associated with MMSE Three Years after Parkinson's Disease Diagnosis.

OBJECTIVES: This study examines whether risk factors for poor nutrition are associated with global cognitive function three years after confirmed Parkinson's disease (PD) diagnosis. DESIGN: The follow-up investigations for this prospective community-based study were conducted three years after PD diagnosis. SETTING: The study participants lived in Västerbotten County, a region in northern Sweden with 142,000 inhabitants. PARTICIPANTS: This study population consisted of 118 PD outpatients from the study of Newly Diagnosed PD in Umeå (NYPUM). MEASUREMENTS: Global cognition was assessed with the Mini Mental State Examination (MMSE) at baseline and at follow-up. Anthropometry, nutrition (Mini Nutritional Assessment, MNA, 3-day food registration, 3-FDR), olfactory function (Brief Smell Identification Test, B-SIT), and swallowing, cutting food, and salivation (single questions from the Unified Parkinson's Disease Rating Scale, UPDRS) were used as markers for nutritional status. RESULTS: The MMSE score decreased over three years (-1.06±3.38, p=0.001). Olfactory function at baseline was associated to MMSE at three years (B=0.365, p=0.004). Changes in waist/hip ratio (B=113.29, p=0.017), swallowing (B=1.18, P=0.033), and cutting food (B=-1.80, p=0.000) were associated with MMSE at follow-up. CONCLUSION: This study indicates that olfactory function, cutting food, swallowing, and visceral obesity are associated with MMSE three years after PD diagnosis.

High serum phosphate concentration as the result of smoking might underlie the lower risk of Parkinson's disease.

Epidemiological studies have found a negative association between cigarette smoking and Parkinson's disease (PD): PD patients are approximately 50% less likely to have smoked cigarettes than age- and sex-matched controls. In both women and men, the PD protection effect of smoking may be explained by higher levels of phosphate in serum (S-P) and triglycerides (S-TG) in smokers compared to non-smokers. That is, the protecting effect from smoking could be mediated by either a high S-P or high S-TG levels. I suggest that higher S-P as the result of smoking may be associated with intracellular depletion of Pi in skeletal muscle and that this depletion of Pi is associated with increased availability of phosphate for the brain. This increased phosphate availability would protect against PD, as oxidative phosphorylation in the mitochondria is a central and persistent phenomenon in the pathogenesis cascade of PD. Phosphate is necessary for energy production in the form of creatine phosphate (CP) and adenosine-tri-phosphate (ATP) in the brain and skeletal muscle. As such, hypophosphatemia increases risk of cell death. In some clinical instances, this energy depletion may pre-dispose to dopamine neuron death. Mitochondrial dysfunction is associated with the generation of oxidative stress and mediates the induction of apoptosis. Studies with NMR spectroscopy reveal that an energy deficit in brain cells is a strong mark for PD although this differed for men and women. Compared to women, men had lower serum phosphate and ATP levels in the brain (about 15% lower). In addition to sex differences, age, stress, and malnutrition may cause low serum phosphate levels, a situation that could contribute to the lack of energy available to the brain and the risk of PD. As hypophosphatemia is present in overnutrition and has an inverse relation with a high BMI, both obesity and malnutrition are considered to be presumptive risk factor for PD.

Assessment of energy intake in women with chronic obstructive pulmonary disease: a doubly labeled water method study.

OBJECTIVES: To maintain energy balance, reliable methods for assessing energy intake and expenditure should be used in patients with chronic obstructive pulmonary disease (COPD). The purpose of this study was to validate the diet history and 7-day food diary methods of assessing energy intake (EI) using total energy expenditure (TEE) with the doubly labeled water (DLW) method (TEEDLW) as the criterion method in outpatient women with COPD. METHODS: EI was assessed by diet history (EIDH) and a 7-day food diary (EIFD) in 19 women with COPD, using TEEDLW as the criterion method. The three methods were compared using intra-class correlation coefficients (ICC) and Bland-Altman analyses. The participants were classified according to their reporting status (EI/TEE) as valid-reporters 0.79-1.21, under-reporters < 0.79 or over-reporters > 1.21. RESULTS: Diet history underestimated reported EI by 28%, and 7-day food diary underestimated EI by approximately 20% compared with TEEDLW. The ICC analysis showed weak agreement between TEEDLW and EIDH (ICC=-0.01; 95%CI-0.10 to 0.17) and between TEEDLW and EIFD (ICC=0.11; 95%CI -0.16 to 0.44). The Bland-Altman plots revealed a slight systematic bias for both methods. For diet history, six women (32%) were identified as valid-reporters, and for the 7-day food diary, twelve women (63%) were identified as valid-reporters. The accuracy of reported EI was only related to BMI. CONCLUSION: The diet history and 7-day food diary methods underestimated energy intake in women with COPD compared with the DLW method. Individuals with higher BMIs are prone to underreporting. Seven-day food diaries should be used with caution in assessing EI in women with COPD.

Cardiovascular risk factors and the risk of Parkinson's disease.

BACKGROUND/OBJECTIVES: The objective of this study was to investigate whether serum triglycerides (S-TG), cholesterol, blood pressure and waist/height ratio are risk factors for Parkinson's disease (PD). SUBJECTS AND METHODS: A population-based sample within the Northern Sweden Health and Disease Study (NSHDS) was used in this study (n=101 790 subjects). Cases with PD were identified prospectively in a community-based study of idiopathic Parkinsonism in the period 2004-2009 in the county of Västerbotten in northern Sweden. The case database obtained was crosslinked to the NSHDS. Eighty-four of 147 patients with PD had visited the primary health care 2-8 years before diagnosis for participation in the NSHDS. For each case, four referents from the NSHDS population were selected, matched for sex, age, year of health survey, subcohort and geographic area. RESULTS: Cases had lower mean S-TG levels (P=0.007). After stratification for sex, the lower S-TG remained significant for men (P=0.006) but not for women (P=0.450), and these were confirmed by the conditional logistic regression for all cases, none adjusted (hazard ratio (HR): 0.65; 95% confidence interval (CI): 0.42, 0.99) and after adjusting for age, body mass index (BMI) and physical activity (HR: 0.61; 95% CI: 0.39, 0.96). Systolic blood pressure (SBP) was negatively associated with PD risk after adjustments for age, BMI and physical activity (HR: 0.98; 95% CI: 0.97-0.99). Smoking and former smoking were associated with a reduced risk for PD. CONCLUSIONS: We found lower S-TG and SBP 2-8 years before a diagnosis of PD. Smoking was confirmed to be negatively associated with PD, whereas recreational activity indicates a risk for women.

Poor nutritional status is associated with urinary tract infection among older people living in residential care facilities.

AIM: To investigate factors associated with poor nutritional status in older people living in residential care facilities. METHODS: 188 residents (136 women, 52 men) with physical and cognitive impairments participated. Mean age was 84.7 y (range 65-100). The Mini Nutritional Assessment (MNA), Barthel ADL Index, Mini Mental State Examination (MMSE), and Geriatric Depression Scale were used to evaluate nutritional status, activities of daily living, cognitive status and depressive symptoms. Medical conditions, clinical characteristics and prescribed drugs were recorded. Univariate and multivariate regressions were used to investigate associations with MNA scores. RESULTS: The mean MNA score was 20.5 ± 3.7 (range 5.5-27) and the median was 21 (interquartile range (IQR) 18.8-23.0). Fifteen per cent of participants were classified as malnourished and 66% at risk of malnutrition. Lower MNA scores were independently associated with urinary tract infection (UTI) during the preceding year (ß = - 0.21, P = 0.006), lower MMSE scores (ß = 0.16, P = 0.030), and dependent in feeding (ß = - 0.14, P = 0.040). CONCLUSION: The majority of participants were at risk of or suffering from malnutrition. Urinary tract infection during the preceding year was independently associated with poor nutritional status. Dependence in feeding was also associated with poor nutritional status as were low MMSE scores for women. Prospective observations and randomized controlled trials are necessary to gain an understanding of a causal association between malnutrition and UTI.

Effects of high-intensity exercise and protein supplement on muscle mass in ADL dependent older people with and without malnutrition: a randomized controlled trial.

BACKGROUND: Loss of muscle mass is common among old people living in institutions but trials that evaluate interventions aimed at increasing the muscle mass are lacking. Objective, participants and intervention: This randomized controlled trial was performed to evaluate the effect of a high-intensity functional exercise program and a timed protein-enriched drink on muscle mass in 177 people aged 65 to 99 with severe physical or cognitive impairments, and living in residential care facilities. DESIGN: Three-month high-intensity exercise was compared with a control activity and a protein-enriched drink was compared with a placebo drink. A bioelectrical impedance spectrometer (BIS) was used in the evaluation. The amount of muscle mass and body weight (BW) were followed-up at three and six months and analyzed in a 2 x 2 factorial ANCOVA, using the intention to treat principle, and controlling for baseline values. RESULTS: At 3-month follow-up there were no differences in muscle mass and BW between the exercise and the control group or between the protein and the placebo group. No interaction effects were seen between the exercise and nutritional intervention. Long-term negative effects on muscle mass and BW was seen in the exercise group at the 6-month follow-up. CONCLUSION: A three month high-intensity functional exercise program did not increase the amount of muscle mass and an intake of a protein-enriched drink immediately after the exercise did not induce any additional effect on muscle mass. There were negative long-term effects on muscle mass and BW, indicating that it is probably necessary to compensate for an increased energy demand when offering a high-intensity exercise program.

The feasibility of serving liquid yoghurt supplemented with probiotic bacteria, Lactobacillus rhamnosus LB 21, and Lactococcus lactis L1A--a pilot study among old people with dementia in a residential care facility.

BACKGROUND: Constipation and body weight loss are prevalent among old people. Treatment with different species of lactic acid bacteria has been suggested for various forms of gastrointestinal disorders. OBJECTIVE, PARTICIPANTS AND INTERVENTION: This pilot study was performed to assess the feasibility of administering and consuming a drinkable yoghurt containing Lactobacillus rhamnosus LB 21 and Lactococcus L1A, and to evaluate the influence on bowel movements and body weight in 15 people with dementia, aged 65-95 years in residential care facility. DESIGN: A drinkable yoghurt (Verum Drickyoghurt) with added bacteria was served daily for 6 months in conjunction with ordinary food intake. Body weight, bowel movement frequency and consistency, food and fluid intake and time spent in various activities were recorded for two weeks pre-intervention, and 3 times during the follow-up period. RESULT: This study showed that the yoghurt was easy to serve, with few side effects for the participants and that the various recording forms and diaries were easy for the staff to complete. The extra intake of yoghurt did not have any detectable beneficial effect on bowel movements. The overnight fast was almost 15 hours per day. Body weight decreased by 0.65 kg/month (95% confidence interval. 0.27-0.97). CONCLUSIONS: The present study design was feasible in this group of old people with dementia. The absence of any detectable effect of the supplement on constipation, but rather a considerable loss in body weight, indicate that further research is needed in a large randomised controlled trial, if associations between dementia, constipation and energy balance are to be understood.

Prediction of all-cause mortality in a patient population with hypertension and type 2 DM by using traditional risk factors and serum-phosphate,-calcium and-magnesium.

The aim of this study is to investigate whether the prediction of all-cause mortality from traditional risk factors is improved by adding electrolytes (serum-phosphate (S-P), serum-calcium (S-Ca) and serum-magnesium (S-Mg)) in a Cox regression. The study uses an 18-year follow-up of patients (n=2504) referred by physicians in primary health care and hospitals to the Vindeln Patient Education (VPE) Center, mainly with a diagnosis of hypertension (HT), type 2 diabetes mellitus (DM) and/or obesity. Cox regression, with the latest registered value and baseline values for risk factors, was used to study all-cause mortality in men and women. 221 out of 1096 men and 157 out of 1408 women died during the 18-year follow-up (20% and 11% respectively). The Cox regression analysis reveals that high blood glucose (B-Glu) and low S-Mg were significantly associated with increased all-cause mortality in the whole patient population as well as in men and women separately. Among women, type 2 DM and systolic blood pressure (SBP) and among men, high S-Ca, S-P, S-urate and body mass index (BMI) were the main predictors of all-cause mortality. There is significantly improved prediction of all-cause mortality with electrolytes added to the traditional risk factors. High B-Glu and low S-Mg in both men and women, and high S-Ca and S-P in men, are significantly associated with all-cause mortality. The metabolic disturbance in this high-risk group of patients can be more fully understood if ionic imbalance is included in the prediction of mortatlity.

Phosphate depletion is the link between growth, stress and diet in the aetiology of MS.

Predisposition to multiple sclerosis (MS) can originate in adolescence, when nutrient requirement is high and not satisfied and because of too little food intake and/or a poor diet. Growth per se increases the need for phosphate, an often neglected mineral in clinical conditions. The combination of marginal nutrition (either under- or malnutrition) with a negative phosphate balance, physical exertion, infections or other types of stress during puberty can disturb metabolism and result in demyelinization. Phosphate depletion (PD) can lead to neurological complications, which have been characterized in experimental and clinical studies. Hypophosphataemia, whether acute or chronic, induced by stress from accident, surgery or burns, by infection and/or undernutrition, is therefore an important etiological factor. Low SP levels have been reported in MS patients and the hypothesis that PD causes MS is presented here.

Hypophosphataemia in the metabolic syndrome. Gender differences in body weight and blood glucose.

OBJECTIVE: We examined gender differences in the clustering of risk factors, especially regarding the possible role of serum phosphate (S-P) in obese patients who participated in a 4 week education programme to reduce their excess risk of cardiovascular disease (CVD). RESULTS: Significantly higher body mass index (BMI) and concentrations of S-P and high density lipids (S-HDL) in serum were found in women (n=1272) than in men (n=993). In women, BMI was inversely correlated with S-P at the time of admission. Also in women (but not in men), changes in BMI and S-P over 1 or 1-1/2 y were inversely correlated. In men (but not in women), S-P level was inversely correlated with age, systolic blood pressure (SBP), diastolic blood pressure (DBP) and blood glucose at the time of admission. In women, S-P increased and DBP decreased, in addition to weight decrease over both 6 months and 1(1/2) y or 1 y. In women (but not in men), significantly higher age, S-P, S-chol, S-TG, S-urate, SBP and DBP values were found with the highest vs the lowest decile of S-Ca. CONCLUSION: We conclude that higher S-P and S-Ca levels may contribute to the difference in metabolic disturbances occurring in obesity, seen in women vs men.

Hypophosphataemia: cause of the disturbed metabolism in the metabolic syndrome.

The clustering of risk factors for cardiovascular disease (CVD) and non-insulin-dependent diabetes mellitus (NIDDM) in obese patients may be attributable to a disturbed metabolism caused by hypophosphataemia. A low serum phosphate (S-P) level may be a limiting factor for glucose metabolism and may account for hyperglycaemia, with an increased risk of NIDDM and hypertension and consequent increased risk of stroke. Low S-HDL levels, known to exist in the metabolic syndrome, as well as high serum triglycerides may also have been the results of phosphate depletion. The hypothesis presents a new serious disturbance which accounts for the dyslipidaemia, hyperglycaemia and the hypertension in metabolic syndrome. The proposed causal relationship between low S-P and the clustering of risk factors is based on results from a cross-sectional study of obese patients, where low S-P was associated with high body mass index (BMI), high blood glucose (B-glu), high systolic blood pressure (SBP), high diastolic blood pressure (DBP), but low serum high density lipoprotein (S-HDL) and serum magnesium (S-Mg) levels. Knowledge from experimental and clinical studies on hypophosphataemia and/or phosphate depletion are referred to when discussing the hypothesis.

[Diet in Parkinson disease]. / Kost vid Parkinsons sjukdom.

The interest in a protein redistribution diet, also called daytime protein restriction diet, has increased among patients with Parkinson's disease. Since certain amino acids compete with L-dopa in the intestine and at the blood-brain barrier, daytime protein restriction may improve fluctuations in motor ability. However, this diet can contribute to weight loss, nutrient deficiencies and cause cognitive disabilities if the diet is not correctly observed. Further studies are needed to clarify how medication with L-dopa in combination with different diets (relative contributions of protein, fat and carbohydrate) may affect motor fluctuations, nutritional status and cognitive ability.

High prevalence of hypophosphataemia amongst patients with infectious diseases. A retrospective study.

OBJECTIVES: To describe the prevalence of hypophosphataemia amongst all patients treated during 1993 for infectious diseases. The associations between serum C-reactive protein, serum albumin and white blood cells in blood were studied amongst hypophosphataemic patients. Comparisons were made according to the severity of infection. DESIGN: A retrospective study of the prevalence of hypophosphataemia, and a case-control study amongst a subgroup of patients. SETTING: The Department of Infectious Diseases, University Hospital, Umeå, Sweden. SUBJECTS: For the prevalence study all 967 patients (449 women and 518 men) treated during 1993 were included. In the case-control study, 108 cases, with serum phosphate < or =0.64 mmol L(-1), 216 age-and sex-matched controls with serum phosphate >0.82 mmol L(-1) (men) and >0.86 mmol L(-1) (women), respectively, were included. RESULTS: In 402 of 967 patients (42%) at least one serum phosphate value was below the reference level. Hypophosphataemia was found in 573 of 1966 blood samples (29%). Severe hypophosphataemia (<0.30 mmol L(-1)) was seen in 1.2% of the patients (0.9% of blood samples). The prevalence of hypophosphataemia was higher amongst women than amongst men. In the case-control study, the serum C-reactive protein and the number of white blood cells was higher amongst the cases compared with the controls (124 vs. 94 mg L(-1) and 11.4 vs. 9.3 cells/L x10(9), respectively). The multiple logistic regression showed a 4-fold higher risk of having low serum phosphate in patients with severe infection, compared with mild infections. None of the other variables (albumin, days of hospital stay or white blood cells in blood) increased the risk for hypophosphataemia. CONCLUSIONS: The high prevalence of low serum phosphate levels and the increased risk of having low levels in severe infections shown in this study needs further attention.

The nutrient density of present-day and traditional diets and their health aspects: the Sami- and lumberjack families living in rural areas of Northern Sweden.

In a rural area of Northern Sweden, the food consumption of 22 Swedish Sami families and 32 lumberjack families was recorded. Repeated 24-hour recalls were obtained from September 1990 to April 1991. The traditional Sami diet was calculated from interviews with old Sami people living today and from information from the literature. The nutrient density was well above recommended levels for most nutrients except for folate and fiber, in the Sami and lumberjack diets. Sami diet was just below NNR for calcium density and the lumberjacks' diet for selenium density. The present-day diets of Sami families contain less protein than in the past. In lumberjack families today, the intake of energy and fat is less than in the past while protein content has been kept constant over time. Different aspects of these dietary changes and possible health effects are discussed and compared with food consumption in Iceland and Finland in the past.

Hypophosphatemia induced by dietary aluminium hydroxide supplementation in growing pigs: effects on erythrocytes, myocardium, skeletal muscle and liver.

Three groups of pigs were studied during and after 10 weeks of treatment with either Al(OH)3 (Al[OH]3-group, n = 8) to induce hypophosphatemia. AlPO4 (AlPO4-group, n = 8, aluminium control without hypophosphatemia) or no addition to the feed (control group, n = 8). Blood samples were taken at the start of the experiment and after 3, 6 and 10 weeks and were analyzed for phosphate, calcium and 2,3-diphosphoglycerate (2,3-DPG). Samples from myocardium, skeletal muscle and liver were obtained in connection with exsanguination and analyzed for glycogen, adenosine-tri-phosphate (ATP), creatine phosphate (CP), glucose-6-phosphate (G-6-P) and lactate. The Al(OH)3-group became hypophosphatemic and hypercalcemic with low levels of 2,3-DPG in erythrocytes within 3 weeks and showed a retarded growth rate. After 10 weeks the Al(OH)3-group had low levels of ATP in myocardium as compared with the control-group and low levels of G-6-P as compared with the AlPO4-group. No disturbances on electro-cardiograms registered at rest could be documented. G-6-P concentration was low in the biceps muscle in the Al(OH)3-group as compared with the AlPO4-group and in the liver low G-6-P concentration was seen in addition to high lactate concentration. The fibre type composition in M. Longissimus did not differ between groups, but the Al(OH)3-group had, due to retardation in growth, smaller mean fibre-areas than pigs in the AlPO4-group.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of hypophosphatemia on muscle metabolism after exercise in pigs.

Five Swedish Landrace pigs with a mean weight of 51 +/- 5 kg performed an exercise test on a treadmill at a speed of 1.8 m/s and a duration of 10 min. Hypophosphatemia was then induced in these pigs by addition of aluminium hydroxide (liquid antacid) to the normal feed. After 3 weeks, the exercise test was repeated when the mean weight of the pigs was 65 +/- 9 kg. Five other Swedish Landrace pigs with a mean weight of 72 +/- 4 kg performed a similar exercise test. Muscle biopsies from M. biceps and blood samples were taken from all pigs 3-5 days before and immediately after each exercise test. Hypophosphatemic pigs had significantly lower serum phosphate and higher aluminium levels than normophosphatemic pigs. In all pigs, glycogen content in muscle decreased significantly (-108 to -135 mmol/kg muscle) with exercise while no changes were seen in adenosine triphosphate, creatine phosphate or inorganic phosphate concentrations. In normophosphatemic pigs, glucose-6-phosphate and lactate concentrations increased significantly during exercise by 2-4 mmol/kg and 12.8-14.4 mmol/kg, respectively. However, in hypophosphatemic pigs, glucose-6-phosphate concentrations decreased significantly during exercise by 4.4 mmol/kg and lactate levels were unchanged. These results indicate that low serum inorganic phosphate levels influence muscle metabolism and glycolysis in connection with physical exercise.