101
|
Feinman RD, Volek JS. Low carbohydrate diets improve atherogenic dyslipidemia even in the absence of weight loss. Nutr Metab (Lond) 2006; 3:24. [PMID: 16790045 PMCID: PMC1488852 DOI: 10.1186/1743-7075-3-24] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2006] [Accepted: 06/21/2006] [Indexed: 12/02/2022] Open
Abstract
Because of its effect on insulin, carbohydrate restriction is one of the obvious dietary choices for weight reduction and diabetes. Such interventions generally lead to higher levels of dietary fat than official recommendations and have long been criticized because of potential effects on cardiovascular risk although many literature reports have shown that they are actually protective even in the absence of weight loss. A recent report of Krauss et al. (AJCN, 2006) separates the effects of weight loss and carbohydrate restriction. They clearly confirm that carbohydrate restriction leads to an improvement in atherogenic lipid states in the absence of weight loss or in the presence of higher saturated fat. In distinction, low fat diets seem to require weight loss for effective improvement in atherogenic dyslipidemia.
Collapse
Affiliation(s)
- Richard D Feinman
- Department of Biochemistry, SUNY Downstate Medical Center, Brooklyn, NY 11203, USA
| | - Jeff S Volek
- Human Performance Laboratory, Department of Kinesiology, University of Connecticut, Storrs, CT 06269-1110, USA
| |
Collapse
|
102
|
Ruaño G, Windemuth A, Kocherla M, Holford T, Fernandez ML, Forsythe CE, Wood RJ, Kraemer WJ, Volek JS. Physiogenomic analysis of weight loss induced by dietary carbohydrate restriction. Nutr Metab (Lond) 2006; 3:20. [PMID: 16700901 PMCID: PMC1479825 DOI: 10.1186/1743-7075-3-20] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2006] [Accepted: 05/15/2006] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Diets that restrict carbohydrate (CHO) have proven to be a successful dietary treatment of obesity for many people, but the degree of weight loss varies across individuals. The extent to which genetic factors associate with the magnitude of weight loss induced by CHO restriction is unknown. We examined associations among polymorphisms in candidate genes and weight loss in order to understand the physiological factors influencing body weight responses to CHO restriction. METHODS We screened for genetic associations with weight loss in 86 healthy adults who were instructed to restrict CHO to a level that induced a small level of ketosis (CHO approximately 10% of total energy). A total of 27 single nucleotide polymorphisms (SNPs) were selected from 15 candidate genes involved in fat digestion/metabolism, intracellular glucose metabolism, lipoprotein remodeling, and appetite regulation. Multiple linear regression was used to rank the SNPs according to probability of association, and the most significant associations were analyzed in greater detail. RESULTS Mean weight loss was 6.4 kg. SNPs in the gastric lipase (LIPF), hepatic glycogen synthase (GYS2), cholesteryl ester transfer protein (CETP) and galanin (GAL) genes were significantly associated with weight loss. CONCLUSION A strong association between weight loss induced by dietary CHO restriction and variability in genes regulating fat digestion, hepatic glucose metabolism, intravascular lipoprotein remodeling, and appetite were detected. These discoveries could provide clues to important physiologic adaptations underlying the body mass response to CHO restriction.
Collapse
Affiliation(s)
| | | | | | - Theodore Holford
- Department of Biostatistics, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Maria Luz Fernandez
- Department of Nutritional Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - Cassandra E Forsythe
- Human Performance Laboratory, Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA
| | - Richard J Wood
- Department of Nutritional Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - William J Kraemer
- Human Performance Laboratory, Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA
| | - Jeff S Volek
- Human Performance Laboratory, Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA
| |
Collapse
|
103
|
Wood RJ, Volek JS, Davis SR, Dell'Ova C, Fernandez ML. Effects of a carbohydrate-restricted diet on emerging plasma markers for cardiovascular disease. Nutr Metab (Lond) 2006; 3:19. [PMID: 16674818 PMCID: PMC1481590 DOI: 10.1186/1743-7075-3-19] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2006] [Accepted: 05/04/2006] [Indexed: 12/01/2022] Open
Abstract
Background Increasing evidence supports carbohydrate restricted diets (CRD) for weight loss and improvement in traditional markers for cardiovascular disease (CVD); less is known regarding emerging CVD risk factors. We previously reported that a weight loss intervention based on a CRD (% carbohydrate:fat:protein = 13:60:27) led to a mean weight loss of 7.5 kg and a 20% reduction of abdominal fat in 29 overweight men. This group showed reduction in plasma LDL-cholesterol and triglycerides and elevations in HDL-cholesterol as well as reductions in large and medium VLDL particles and increases in LDL particle size. In this study we report on the effect of this intervention with and without fiber supplementation on plasma homocysteine, lipoprotein (a) [Lp(a)], C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-α). Methods Twenty nine overweight men [body mass index (BMI) 25–35 kg/m2] aged 20–69 years consumed an ad libitum CRD (% carbohydrate:fat:protein = 13:60:27) including a standard multivitamin every other day for 12 wk. Subjects were matched by age and BMI and randomly assigned to consume 3 g/d of either a soluble fiber supplement (n = 14) or placebo (n = 15). Results There were no group or interaction (fiber × time) main effects, but significant time effects were observed for several variables. Energy intake was spontaneously reduced (-30.5%). This was accompanied by an increase in protein intake (96.2 ± 29.8 g/d to 107.3 ± 29.7 g/d) and methionine intake (2.25 ± 0.7 g/d, to 2.71 ± 0.78 g/d; P < 0.001). Trans fatty acid intake was significantly reduced (-38.6%) while dietary folate was unchanged, as was plasma homocysteine. Bodyweight (-7.5 ± 2.5 kg) was reduced as was plasma Lp(a) (-11.3%). Changes in plasma Lp(a) correlated with reductions in LDL-cholesterol (r = .436, P < 0.05) and fat loss (r = .385, P < 0,05). At wk 12, both CRP (-8.1%) and TNF-α (-9.3%) were reduced (P < 0.05) independently of weight loss. IL-6 concentrations were unchanged. Conclusion A diet based on restricting carbohydrates leads to spontaneous caloric reduction and subsequent improvement in emerging markers of CVD in overweight/obese men who are otherwise healthy.
Collapse
Affiliation(s)
- Richard J Wood
- Department of Nutritional Sciences, University of Connecticut, Storrs, CT, USA
| | - Jeff S Volek
- Human Performance Laboratory, Department of Kinesiology, University of Connecticut, Storrs, CT, USA
| | - Steven R Davis
- Department of Nutritional Sciences, University of Connecticut, Storrs, CT, USA
| | - Carly Dell'Ova
- Department of Nutritional Sciences, University of Connecticut, Storrs, CT, USA
| | - Maria Luz Fernandez
- Department of Nutritional Sciences, University of Connecticut, Storrs, CT, USA
| |
Collapse
|
104
|
Fernandez ML, Volek JS. Guinea pigs: a suitable animal model to study lipoprotein metabolism, atherosclerosis and inflammation. Nutr Metab (Lond) 2006; 3:17. [PMID: 16566831 PMCID: PMC1435897 DOI: 10.1186/1743-7075-3-17] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2006] [Accepted: 03/27/2006] [Indexed: 02/08/2023] Open
Abstract
Numerous animal models have been used to study diet effects on cholesterol and lipoprotein metabolism. However, most of those models differ from humans in the plasma distribution of cholesterol and in the processing of lipoproteins in the plasma compartment. Although transgenic or knock-out mice have been used to study a specific pathway involved in cholesterol metabolism, these data are of limited use because other metabolic pathways and responses to interventions may differ from the human condition. Carbohydrate restricted diets have been shown to reduce plasma triglycerides, increase HDL cholesterol and promote the formation of larger, less atherogenic LDL. However, the mechanisms behind these responses and the relation to atherosclerotic events in the aorta have not been explored in detail due to the lack of an appropriate animal model. Guinea pigs carry the majority of the cholesterol in LDL and possess cholesterol ester transfer protein and lipoprotein lipase activities, which results in reverse cholesterol transport and delipidation cascades equivalent to the human situation. Further, carbohydrate restriction has been shown to alter the distribution of LDL subfractions, to decrease cholesterol accumulation in aortas and to decrease aortic cytokine expression. It is the purpose of this review to discuss the use of guinea pigs as useful models to evaluate diet effects on lipoprotein metabolism, atherosclerosis and inflammation with an emphasis on carbohydrate restricted diets.
Collapse
Affiliation(s)
- Maria Luz Fernandez
- Department of Nutritional Sciences University of Connecticut, Storrs, CT 06269, USA
| | - Jeff S Volek
- Department of Kinesiology University of Connecticut, Storrs CT 06269, USA
| |
Collapse
|
105
|
Abstract
PURPOSE OF REVIEW The use of low-carbohydrate diets in weight loss is an area of great controversy. In recent years, a significant amount of research has been conducted to evaluate the efficacy of these diets. This review aims to discuss mechanisms of action for weight loss; to assess impact on metabolic parameters including insulin sensitivity and cardiovascular risk parameters and to evaluate the data regarding safety and effectiveness for weight loss. RECENT FINDINGS Most studies demonstrate that subjects following low carbohydrate diets lose more weight over the first 3-6 months than subjects consuming control diets. This weight loss is not sustained, however, at 1 year. Carbohydrate controlled diets may be associated with increased insulin sensitivity and improved glycemic control. High carbohydrate, low fat diets appear to have a more favorable impact on total and LDL cholesterol, whereas low carbohydrate diets have been shown to significantly decrease triglyceride and increase HDL cholesterol levels in short-term studies. SUMMARY Low carbohydrate diets may be effective in helping people to lose weight. More long-term studies need to be performed, however, to better evaluate efficacy, safety, and impact on metabolic profile.
Collapse
Affiliation(s)
- Courtney A Noble
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | |
Collapse
|
106
|
Torres-Gonzalez M, Volek JS, Sharman M, Contois JH, Fernandez ML. Dietary carbohydrate and cholesterol influence the number of particles and distributions of lipoprotein subfractions in guinea pigs. J Nutr Biochem 2006; 17:773-9. [PMID: 16563725 DOI: 10.1016/j.jnutbio.2006.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2005] [Revised: 01/05/2006] [Accepted: 01/06/2006] [Indexed: 11/24/2022]
Abstract
Guinea pigs (n=10/group) were fed one of three diets: a high carbohydrate (CHO) (42% energy), low cholesterol (0.04%) diet (LChHC), a diet with the same amount of CHO but with 0.25% cholesterol (HChHC) or a diet with 11% of energy from CHO and 0.25% cholesterol (HChLC) for 12 weeks. VLDL- and LDL cholesterol (LDL-C) were higher in the HChLC and HChHC groups than in the LChHC group (P<.0001). Lipoprotein subclasses and size were analyzed by nuclear magnetic resonance. Dietary cholesterol (HChHC and HChLC groups) resulted in larger VLDL particles (71.1+/-6.9, 78.9+/-3.33 nm, respectively) than those in the LChHC group (44.3+/-10.8 nm). In addition, there were higher concentrations of the large VLDL (>60 nm) and the medium VLDL (>35 nm) in the high cholesterol groups (P<.01). Similarly, the concentration of the medium (>8.2 nm) and small HDL (>7.2 nm) was higher in the HChHC and HChLC groups (P<.001). In contrast, CHO restriction affected the concentrations of LDL subfractions. The number of total LDL particles was lower in the HChLC (291.3+/-85.0 nmol/L) than in the HChHC group (467.6+/-113.1 nmol/L), indicating that the cholesterol in LDL was distributed in less particles in the former group. The concentrations of medium LDL (>19.8 nm) (98.4+/-90.8) and small LDL (>18 nm) (29.3+/-24.9 nmol/L) were lower in the HChLC group than in the HChHC group (261.8+/-105.8 and 64.9+/-27.9 nmol/L, respectively). These results indicate that dietary cholesterol increased the atherogenicity of both VLDL and HDL while CHO restriction increased the number of large LDL and decreased the concentrations of the more atherogenic smaller LDL subfractions.
Collapse
|
107
|
Wood RJ, Volek JS, Liu Y, Shachter NS, Contois JH, Fernandez ML. Carbohydrate restriction alters lipoprotein metabolism by modifying VLDL, LDL, and HDL subfraction distribution and size in overweight men. J Nutr 2006; 136:384-9. [PMID: 16424116 DOI: 10.1093/jn/136.2.384] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
To determine the effects of carbohydrate restriction (CR) with and without soluble fiber on lipoprotein metabolism, 29 men participated in a 12-wk weight loss intervention. Subjects were matched by age and BMI and randomly assigned to consume 3 g/d of either a soluble fiber supplement (n=14) or placebo (n=15) with a macronutrient energy distribution of approximately 10% carbohydrate, approximately 65% fat, and approximately 25% protein. Because the groups did not differ in any of the variables measured, all data were pooled and comparisons were made between baseline and 12 wk. After 12 wk, subjects had a mean weight loss of 7.5 kg (P<0.001), and abdominal fat was reduced by 20% (P<0.001). Plasma LDL cholesterol and triglycerides (TG) were significantly reduced by 8.9 and 38.6%, respectively. Similarly, apolipoproteins C-I (-13.8%), C-III (-21.2%) and E (-12.5%) were significantly lower after the intervention. In contrast plasma HDL-cholesterol concentrations were increased by 12% (P<0.05). Changes in plasma TG were positively correlated with reductions in large (r=0.615, P<0.01) and medium VLDL particles (r=0.432, P<0.05) and negatively correlated with LDL diameter (r=-0.489, P<0.01). Changes in trunk fat were positively correlated with medium VLDL (r=0.474, P<0.0) and small LDL (r=0.405, P<0.05) and negatively correlated with large HDL (r=-0.556, P<0.01). We conclude that weight loss induced by CR favorably alters the secretion and processing of plasma lipoproteins, rendering VLDL, LDL, and HDL particles associated with decreased risk for atherosclerosis and coronary heart disease.
Collapse
MESH Headings
- Adult
- Aged
- Apolipoproteins B/blood
- Body Weight/drug effects
- Cholesterol, LDL/blood
- Cholesterol, LDL/chemistry
- Cholesterol, LDL/metabolism
- Diet, Carbohydrate-Restricted
- Dietary Carbohydrates/pharmacology
- Humans
- Lipoproteins, HDL/blood
- Lipoproteins, HDL/chemistry
- Lipoproteins, HDL/metabolism
- Lipoproteins, VLDL/blood
- Lipoproteins, VLDL/chemistry
- Lipoproteins, VLDL/metabolism
- Male
- Middle Aged
- Overweight/physiology
- Particle Size
- Time Factors
- Triglycerides/blood
Collapse
Affiliation(s)
- Richard J Wood
- Department of Nutritional Sciences, University of Connecticut, Storrs, CT 06269, USA
| | | | | | | | | | | |
Collapse
|
108
|
Noakes M, Foster PR, Keogh JB, James AP, Mamo JC, Clifton PM. Comparison of isocaloric very low carbohydrate/high saturated fat and high carbohydrate/low saturated fat diets on body composition and cardiovascular risk. Nutr Metab (Lond) 2006; 3:7. [PMID: 16403234 PMCID: PMC1368980 DOI: 10.1186/1743-7075-3-7] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2005] [Accepted: 01/11/2006] [Indexed: 11/13/2022] Open
Abstract
Background It is speculated that high saturated fat very low carbohydrate diets (VLCARB) have adverse effects on cardiovascular risk but evidence for this in controlled studies is lacking. The objective of this study was to compare, under isocaloric conditions, the effects of a VLCARB to 2 low saturated fat high carbohydrate diets on body composition and cardiovascular risk. Methods Eighty three subjects, 48 ± 8 y, total cholesterol 5.9 ± 1.0 mmol/L, BMI 33 ± 3 kg/m2 were randomly allocated to one of 3 isocaloric weight loss diets (6 MJ) for 8 weeks and on the same diets in energy balance for 4 weeks: Very Low Fat (VLF) (CHO:Fat:Protein; %SF = 70:10:20; 3%), High Unsaturated Fat (HUF) = (50:30:20; 6%), VLCARB (4:61:35; 20%) Results Percent fat mass loss was not different between diets VLCARB -4.5 ± 0.5, VLF-4.0 ± 0.5, HUF -4.4 ± 0.6 kg). Lean mass loss was 32-31% on VLCARB and VLF compared to HUF (21%) (P < 0.05). LDL-C increased significantly only on VLCARB by 7% (p < 0.001 compared with the other diets) but apoB was unchanged on this diet and HDL-C increased relative to the other 2 diets. Triacylglycerol was lowered by 0.73 ± 0.12 mmol/L on VLCARB compared to -0.15 ± 0.07 mmol/L on HUF and -0.06 ± 0.13 mmol/L on VLF (P < 0.001). Plasma homocysteine increased 6.6% only on VLCARB (P = 0.026). VLCARB lowered fasting insulin 33% compared to a 19% fall on HUF and no change on VLF (P < 0.001). The VLCARB meal also provoked significantly lower post prandial glucose and insulin responses than the VLF and HUF meals. All diets decreased fasting glucose, blood pressure and CRP (P < 0.05). Conclusion Isocaloric VLCARB results in similar fat loss than diets low in saturated fat, but are more effective in improving triacylglycerols, HDL-C, fasting and post prandial glucose and insulin concentrations. VLCARB may be useful in the short-term management of subjects with insulin resistance and hypertriacylglycerolemia.
Collapse
Affiliation(s)
- Manny Noakes
- CSIRO Health Sciences and Nutrition, Adelaide, Australia
| | - Paul R Foster
- CSIRO Health Sciences and Nutrition, Adelaide, Australia
| | | | | | | | | |
Collapse
|
109
|
Volek JS, Feinman RD. Carbohydrate restriction improves the features of Metabolic Syndrome. Metabolic Syndrome may be defined by the response to carbohydrate restriction. Nutr Metab (Lond) 2005; 2:31. [PMID: 16288655 PMCID: PMC1323303 DOI: 10.1186/1743-7075-2-31] [Citation(s) in RCA: 152] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2005] [Accepted: 11/16/2005] [Indexed: 12/20/2022] Open
Abstract
Metabolic Syndrome (MetS) represents a constellation of markers that indicates a predisposition to diabetes, cardiovascular disease and other pathologic states. The definition and treatment are a matter of current debate and there is not general agreement on a precise definition or, to some extent, whether the designation provides more information than the individual components. We consider here five indicators that are central to most definitions and we provide evidence from the literature that these are precisely the symptoms that respond to reduction in dietary carbohydrate (CHO). Carbohydrate restriction is one of several strategies for reducing body mass but even in the absence of weight loss or in comparison with low fat alternatives, CHO restriction is effective at ameliorating high fasting glucose and insulin, high plasma triglycerides (TAG), low HDL and high blood pressure. In addition, low fat, high CHO diets have long been known to raise TAG, lower HDL and, in the absence of weight loss, may worsen glycemic control. Thus, whereas there are numerous strategies for weight loss, a patient with high BMI and high TAG is likely to benefit most from a regimen that reduces CHO intake. Reviewing the literature, benefits of CHO restriction are seen in normal or overweight individuals, in normal patients who meet the criteria for MetS or in patients with frank diabetes. Moreover, in low fat studies that ameliorate LDL and total cholesterol, controls may do better on the symptoms of MetS. On this basis, we feel that MetS is a meaningful, useful phenomenon and may, in fact, be operationally defined as the set of markers that responds to CHO restriction. Insofar as this is an accurate characterization it is likely the result of the effect of dietary CHO on insulin metabolism. Glucose is the major insulin secretagogue and insulin resistance has been tied to the hyperinsulinemic state or the effect of such a state on lipid metabolism. The conclusion is probably not surprising but has not been explicitly stated before. The known effects of CHO-induced hypertriglyceridemia, the HDL-lowering effect of low fat, high CHO interventions and the obvious improvement in glucose and insulin from CHO restriction should have made this evident. In addition, recent studies suggest that a subset of MetS, the ratio of TAG/HDL, is a good marker for insulin resistance and risk of CVD, and this indicator is reliably reduced by CHO restriction and exacerbated by high CHO intake. Inability to make this connection in the past has probably been due to the fact that individual responses have been studied in isolation as well as to the emphasis of traditional therapeutic approaches on low fat rather than low CHO. We emphasize that MetS is not a disease but a collection of markers. Individual physicians must decide whether high LDL, or other risk factors are more important than the features of MetS in any individual case but if MetS is to be considered it should be recognized that reducing CHO will bring improvement. Response of symptoms to CHO restriction might thus provide a new experimental criterion for MetS in the face of on-going controversy about a useful definition. As a guide to future research, the idea that control of insulin metabolism by CHO intake is, to a first approximation, the underlying mechanism in MetS is a testable hypothesis.
Collapse
Affiliation(s)
- Jeff S Volek
- Human Performance Laboratory, Department of Kinesiology, University of Connecticut, Storrs, CT 06269-1110 USA
| | - Richard D Feinman
- Department of Biochemistry, SUNY Downstate Medical Center, Brooklyn, NY 11203 USA
| |
Collapse
|
110
|
Feinman RD. When is a high fat diet not a high fat diet? Nutr Metab (Lond) 2005; 2:27. [PMID: 16229741 PMCID: PMC1283748 DOI: 10.1186/1743-7075-2-27] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2005] [Accepted: 10/17/2005] [Indexed: 11/17/2022] Open
Affiliation(s)
- Richard D Feinman
- Department of Biochemistry, State University of New York Downstate Medical Center, Brooklyn, NY 11203 USA
| |
Collapse
|
111
|
Volek JS, Forsythe CE. The case for not restricting saturated fat on a low carbohydrate diet. Nutr Metab (Lond) 2005; 2:21. [PMID: 16135250 PMCID: PMC1208952 DOI: 10.1186/1743-7075-2-21] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2005] [Accepted: 08/31/2005] [Indexed: 11/10/2022] Open
Affiliation(s)
- Jeff S Volek
- Human Performance Laboratory, Department of Kinesiology, University of Connecticut, Storrs, CT, USA
| | - Cassandra E Forsythe
- Human Performance Laboratory, Department of Kinesiology, University of Connecticut, Storrs, CT, USA
| |
Collapse
|