The genetic frequencies of all the polymorphisms in the candidate genes were in Hardy-Weinberg equilibrium in all the groups presented.
The athletes had a mean age of 24.91 years (±4.97 years): elite endurance athletes 26.10 years (±4.49 years) and professional soccer players 23.46 years (±5.14 years) and the non-athlete population 27.89 years (±4.49 years).
3.1 Polygenic profile of liver metabolism
When adding the genotype scores of CYP2D6, GSTM, GSTP and GSTT polymorphisms, the mean value of the TGS in the professional athletes had a value of 69.96 a.u. (±17.38 a.u.), statistical kurtosis: -0.405 (±0.284). The value for the group of elite endurance athletes was 69.73 a.u. (±18.91 a.u.), statistical kurtosis: -0.474 (±0.381) and in professional football players it was 70.23 a.u. (±15.39 a.u.), statistical kurtosis: -0.593 (±0.419). The mean value of the TGS in non-athletes was 63.23 a.u. (±17.79 a.u.) statistical kurtosis: -0.702 (±0.435). The TGS values of the 160 non-athletes and 292 professional athletes were statistically significant (Figure 1a) and between both groups with non-athletes (Figure 1b).
TGS distribution of liver-metabolising genes in the professional athletes is shifted to the right with respect to non-athletes (p=0.022) (Figure 2a), similar between professional football players with non-athletes (p=0.010) and shows statistical trends with respect to endurance athletes (p=0.087) (Figure 2b).
ROC analysis showed significant discriminatory accuracy of TGS in the identification of professional athletes (AUC=0.605; 95% CI: 0.545–0.665; p=0.001) (sensitivity = 0.640, specificity = 0.475) (Figure 3). The corresponding TGS value at this point was 64.28 a.u. Binary logistic regression analysis showed that subjects with a higher TGS of 64.28 a.u. had an odds ratio (OR) of 1.965 (95% CI: 1.281-3.016; p=0.002) of being professional athletes, compared to those with a TGS below this value. The elite endurance athletes showed an OR at the cut-off point in comparison to the non-athlete population of 1.791 (95% CI: 1.111-2.887; p=0.017) and the professional football players, in comparison to non-athlete subjects, had an OR of 2.207 (95% CI: 1.329-3.665; p=0.001).
Genotype distribution of liver-metabolising genes in the professional athletes’ group, when compared with the non-athlete population, was statistically significant for CYP2D6 (p<0.001), showing a higher frequency in the “optimal” genotype in athletes (GG 93.20%) than the non-athlete population (GG 61.10%) (Table 1). Between both groups of professional athletes (endurance and football players), statistically significant results were found in CYP2D6 (p=0.002), which was more favourable in football players (GG 98.50%) than elite endurance athletes (88.80%), and the GSTP (p=0.014) and GSTT genotypes (p<0.049), which presented a more favourable genetic score in elite endurance athletes than football players (56.90% vs. 42.40% and 45.00% vs. 38.60% respectively). Differences between endurance athletes and non-athletes were found only in the CYP2D6 polymorphism (p<0.001), while in the professional football players and non-athlete population they were found in the CYPD2D6 (p<0.001) and GSTT (p=0.003) genes (Table 2).
3.2 Polygenic profile of iron metabolism and energy efficiency
When adding the genotype scores of HFE, AMPD1 and PGC1a polymorphisms, the mean value of the TGS in professional athletes was 49.78 a.u. (±12.06 a.u.), statistical kurtosis: 0.133 (±0.284). For the group of elite endurance athletes, it was 51.17 a.u. (±11.62 a.u.), statistical kurtosis: 0.387 (±0.381) and in the professional football players, it was 48.10 a.u. (±12.40 a.u.), statistical kurtosis: -0.116 (±0.419). The mean value of the TGS in the non-athletes was 43.34 a.u. (±11.93 a.u.) statistical kurtosis: -0.467 (±0.435). The TGS values of non-athlete subjects and professional athletes were statistically significant (Figure 4a) and between both groups with non-athletes (Figure 4b).
TGS distribution of iron metabolism and energy efficiency genes in the professional athletes is shifted to the right with respect to non-athletes (p<0.001) (Figure 5a), similar between professional football players (p=0.044) and endurance athletes (p<0.001) with respect to non-athletes (Figure 5b).
ROC analysis showed significant discriminatory accuracy of TGS in the identification of professional athletes (AUC=0.638; 95% CI: 0.580–0.695; p<0.001) (sensitivity = 0.729, specificity = 0.549) (Figure 6). The corresponding TGS value at this point was 43.75 a.u. Binary logistic regression analysis showed that subjects with a higher TGS of 43.75 a.u. had an OR of 2.213 (95% CI: 1.425-3.438; p<0.001) of being professional athletes, compared to those with a TGS below this value. The elite endurance athletes showed an OR at the cut-off point in comparison to the non-athlete population of 2.828 (95% CI: 1.690-4.731; p<0.001) and professional football players, in comparison to non-athlete subjects, had an OR of 1.699 (95% CI: 1.021-2.828; p=0.041).
Genotype distribution of iron metabolism and energy efficiency genes in the professional athlete’s group, when compared with the non-athlete population, was statistically significant for HFE c.187C>G (p=0.001), showing a higher frequency in the “optimal” genotype in athletes (GG 5.80%) than the non-athlete population (GG 0.00%) and AMPD1 CC genotype (94.20% vs. 62.10% respectively; p=0.006) (Table 3). Between both groups of professional athletes (endurance and football players), statistically significant results were found in HFE c.187C>G showing genotypes more favourable in iron absorption in endurance athletes than in professional football players (p=0.001). Differences between endurance athletes and the non-athlete population was found in the HFE c.187C>G polymorphism (p<0.001), similar in professional football players and the non-athlete population (p=0.013), presenting similar results in the AMPD1 polymorphism between endurance athletes and non-athletes (p=0.010) and professional football players and the non-athlete population (p=0.014) (Table 4).
3.3 Polygenic profile of cardiorespiratory fitness
When adding the genotype scores of ACE, NOS3, ADRA2A, ADRB2 and BDKRB2 polymorphisms, the mean value of the TGS in professional athletes had a value of 53.62 a.u. (±13.02 a.u.), statistical kurtosis: 0.061 (±0.284). That of the group of elite endurance athletes was 51.17 a.u. (±11.62 a.u.), statistical kurtosis: 0.143 (±0.381) and in professional football players it was 54.87 a.u. (±13.68 a.u.), statistical kurtosis: -0.138 (±0.419). The mean value of the TGS in non-athletes was 51.71 a.u. (±12.02 a.u.) statistical kurtosis: -0.180 (±0.437). The TGS values of non-athletes and professional athletes were not statistically significant (Figure 7a) but there were differences between professional soccer players and the non-athlete population (Figure 7b).
TGS distribution of cardiorespiratory fitness genes in professional athletes was similar with respect to non-athletes (p=0.590) (Figure 8a), similar between professional football players and endurance athletes (p=0.282) with respect to non-athletes (p=0.830) (Figure 8b).
ROC analysis in this profile did not show significant discriminatory accuracy of TGS in the identification of professional athletes (AUC=0.545; 95% CI: 0.485–0.605; p=0.152) (sensitivity = 0.493, specificity = 0.413) (Figure 9). The corresponding TGS value at this point was 53.57 a.u. Binary logistic regression analysis showed that subjects with a higher TGS of 53.57 a.u. had an OR of 1.382 (95% CI: 0.900-2.121; p=0.129) of being professional athletes, compared to those with a TGS below this value. The elite endurance athletes showed an OR at the cut-off point in comparison to the non-athlete population of 1.285 (95% CI: 0.798-2.069; p=0.303) and professional football players, in comparison to non-athlete subjects, had an OR of 1.509 (95% CI: 0.917-2.481; p=0.105).
Genotype distribution of cardiorespiratory fitness genes in the professional athletes’ group when compared with the non-athlete population was statistically significant for ACE (p=0.006), showing a higher frequency in the “non-optimal” genotype in professional athletes (DD 47.90%) than the non-athlete population (DD 38.70%), and similar in the ADRA2A c.-1291C>G GG genotype (11.50% vs. 3.30% respectively; p=0.010). However, in the ADRB2 c.79C>G polymorphism, the professional athletes showed a higher frequency in the “optimal” genotype (CC 31.50%) than the non-athlete population (16.00%) (p<0.001) (Table 5). Between both groups of professional athletes (endurance and football players), statistically significant results were found in NOS3 c.-786T>C showing a genotype more favourable in endurance athletes than in professional football players (p=0.037), However, in the polymorphisms ADRB2 c.46A>G and BDKRB2 -9/+9 more favourable genotypes were found in professional football players than in endurance athletes (p=0.034 and p<0.001 respectively). Differences between endurance athletes and non-athletes were found in the ACE I/D polymorphism (p=0.011), NOS3 c.-786T>C (p=0.005), BDKRB2 -9/+9 (p=0.003). Statistical differences were found in the ADRA2A c.-1291C>G and ADRB2 c.79C>G polymorphisms in professional football players regarding the non-athlete population (Table 6).
3.4 Polygenic profile of muscle performance
When adding the genotype scores of ACE, ACTN3, AMPD1, MLCK and CKM polymorphisms, the mean value of the TGS in professional athletes had a value of 58.31 a.u. (±11.49 a.u.), statistical kurtosis: -0.208 (±0.284). That of the group of elite endurance athletes was 57.94 a.u. (±11.82 a.u.), statistical kurtosis: -0.297 (±0.381) and in professional football players was 58.76 a.u. (±11.11 a.u.), statistical kurtosis: -0.050 (±0.419). The mean value of the TGS in non-athletes was 51.20 a.u. (±10.86 a.u.) statistical kurtosis: 0.115 (±0.435). The (differences in the TGS values between non-athletes and professional athletes were statistically significant (Figure 10a), like between both groups with non-athletes (Figure 10b).
TGS distribution of muscle performance genes in professional athletes is shifted to the right with respect to non-athletes (p<0.001) (Figure 11a), showing similar results between elite endurance athletes and professional football players with non-athletes (p<0.001) (Figure 11b).
ROC analysis in this profile did not show significant discriminatory accuracy of the TGS in the identification of professional athletes (AUC=0.672; 95% CI: 0.618–0.726; p<0.001) (sensitivity = 0.675, specificity = 0.434) (Figure 12). The corresponding TGS value at this point was 53.57 a.u. Binary logistic regression analysis showed that subjects with a higher TGS of 53.57 a.u. had an OR of 2.700 (95% CI: 1.750-4.165; p<0.001) of being professional athletes, compared to those with a TGS below this value. The elite endurance athletes showed an OR at the cut-off point in comparison to the non-athlete population of 2.485 (95% CI: 1.531-4.034; p<0.001) and professional football players, in comparison to non-athlete subjects, had an OR of 2.994 (95% CI: 1.788-5.015; p<0.001).
Genotype distribution of muscle performance polymorphisms in the professional athletes’ group when compared with the non-athlete population was statistically significant for ACE I/D (p=0.034), showing a higher frequency in the “optimal” genotype in athletes (DD 47.90%) than the non-athlete population (DD 38.70%), AMPD1 CC genotype (94.20% vs. 62.10% respectively; p=0.006) and “optimal” c.37885C>A and c.49C>T MLCK polymorphisms (p<0.001) (Table 7). Between both groups of professional athletes (endurance and football players), statistically significant results were found in MLCK polymorphisms showing genotypes more favourable in professional football players than in endurance athletes (c.37885C>A; p=0.002 and c.49C>T; p=0.001).
Differences between endurance athletes and non-athletes were found in the ACE polymorphism (p=0.001), presenting similar results in the AMPD1 polymorphism between endurance athletes, and the non-athlete population (p=0.013) and professional football players and non-athletes (p=0.014). In MLCK c.37885C>A and c.49C>T polymorphisms statistically significant differences were found between both groups of endurance athletes and professional football players and the non-athlete population (p<0.001) (Table 8).
All genetic profiles, through binary logistic regression showed different prediction values of being professional athletes, both endurance athletes and professional football players, in the genes presented, with reference to non-athletes, as shown in Table 9.