When Size Goes Inside: Visceromegaly in Bodybuilders Is Not Attributed to High-Protein Intake but More Likely Associated with the Use of Appearance- and Performance-Enhancing Drugs.

BACKGROUND

Bodybuilders use progressive resistance exercise training and high-protein-intake diets to develop muscular physiques. Some also use appearance- and performance-enhancing drugs (APED) to further enhance their physique. It has been speculated that a high-protein intake and APED use may induce visceral organ hypertrophy. Therefore, the primary objective of this study was to assess visceral organ volumes in natural and APED-using male bodybuilders and to compare these with recreationally active males (CON).

METHODS

Magnetic resonance imaging (MRI) was applied to assess skeletal muscle and visceral organ volume in 15 CON (age: 29 ± 6 y), 15 competitive male natural bodybuilders (BB-NAT; age: 30 ± 5 y), and 15 competitive male APED-using bodybuilders (BB-USE; age: 31 ± 4 y). In addition, dual-energy X-ray absorptiometry (DXA) was performed to assess total body lean mass. All participants reported their habitual food intake (via 7-d food diary) and, if applicable, their use of APED.

RESULTS

Habitual protein intake was much higher in the bodybuilders (BB-NAT: 2.5 ± 0.6 g/kg body mass (BM)/d; BB-USE: 2.9 ± 0.4 g/kg BM/d) compared with CON (1.4 ± 0.3 g/kg BM/d; P < 0.001), with no differences between both bodybuilder groups ( P = 0.109). Total lean BM was significantly different across all groups and was greater in BB-USE (87.8 ± 8.0 kg) versus BB-NAT (72.7 ± 6.4 kg) versus CON (62.8 ± 4.8 kg; P < 0.001). Muscle volumes were also different between groups, with average thigh muscle volumes of 7.1 ± 1.0, 5.8 ± 0.7, and 4.5 ± 0.4 L in BB-USE, BB-NAT, and CON, respectively ( P < 0.001). All visceral organ volumes were greater in BB-USE compared with BB-NAT and CON ( P < 0.05), with no differences between BB-NAT and CON ( P > 0.05). Heart volume averaged 1.20 ± 0.15, 0.89 ± 0.14, and 0.83 ± 0.15 L in BB-USE, BB-NAT, and CON, respectively. Liver volume averaged 2.57 ± 0.39, 1.82 ± 0.20, and 1.79 ± 0.21 L, respectively.

CONCLUSIONS

Despite higher habitual protein intake and greater lean BM, natural bodybuilders do not show greater visceral organ volumes compared to age-matched controls. Bodybuilders using APED show substantially greater lean mass, muscle mass, as well as greater visceral organ volumes, compared with natural bodybuilders or age-matched controls. We conclude that visceromegaly in bodybuilders cannot be attributed to a high-protein intake but is secondary to the use of APED.