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.