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Derman W, Badenhorst M, Eken M, Gomez-Ezeiza J, Fitzpatrick J, Gleeson M, Kunorozva L, Mjosund K, Mountjoy M, Sewry N, Schwellnus M. Risk factors associated with acute respiratory illnesses in athletes: a systematic review by a subgroup of the IOC consensus on ‘acute respiratory illness in the athlete’. Br J Sports Med 2022; 56:639-650. [DOI: 10.1136/bjsports-2021-104795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2022] [Indexed: 12/18/2022]
Abstract
ObjectiveTo review risk factors associated with acute respiratory illness (ARill) in athletes, including non-infectious ARill and suspected or confirmed acute respiratory infections (ARinf).DesignSystematic review.Data sourcesElectronic databases: PubMed-Medline, EbscoHost and Web of Science.Eligibility criteriaOriginal research articles published between January 1990 and July 2020 in English were searched for prospective and retrospective full text studies that reported quantitative data on risk factors associated with ARill/ARinf in athletes, at any level of performance (elite/non-elite), aged 15–65 years.Results48 studies (n=19 390 athletes) were included in the study. Risk factors associated with ARill/ARinf were: increased training monotony, endurance training programmes, lack of tapering, training during winter or at altitude, international travel and vitamin D deficits. Low tear-(SIgA) and salivary-(IgA) were immune biomarkers associated with ARill/ARinf.ConclusionsModifiable training and environmental risk factors could be considered by sports coaches and athletes to reduce the risk of ARill/ARinf. Clinicians working with athletes can consider assessing and treating specific nutritional deficiencies such as vitamin D. More research regarding the role and clinical application of measuring immune biomarkers in athletes at high risk of ARill/ARinf is warranted.PROSPERO registration numberCRD42020160928.
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Derman W, Badenhorst M, Eken MM, Ezeiza-Gomez J, Fitzpatrick J, Gleeson M, Kunorozva L, Mjosund K, Mountjoy M, Sewry N, Schwellnus M. Incidence of acute respiratory illnesses in athletes: a systematic review and meta-analysis by a subgroup of the IOC consensus on 'acute respiratory illness in the athlete'. Br J Sports Med 2022; 56:630-638. [PMID: 35260411 DOI: 10.1136/bjsports-2021-104737] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To determine the incidence of acute respiratory illness (ARill) in athletes and by method of diagnosis, anatomical classification, ages, levels of performance and seasons. DESIGN Systematic review and meta-analysis. DATA SOURCES Electronic databases: PubMed-Medline, EbscoHost and Web of Science. ELIGIBILITY CRITERIA Original research articles published between January 1990 and July 2020 in English reporting the incidence of ARill in athletes, at any level of performance (elite/non-elite), aged 15-65 years. RESULTS Across all 124 studies (n=1 28 360 athletes), the incidence of ARill, estimated by dividing the number of cases by the total number of athlete days, was 4.7 (95% CI 3.9 to 5.7) per 1000 athlete days. In studies reporting acute respiratory infections (ARinf; suspected and confirmed) the incidence was 4.9 (95% CI 4.0 to 6.0), which was similar in studies reporting undiagnosed ARill (3.7; 95% CI 2.1 to 6.7). Incidences of 5.9 (95% CI 4.8 to 7.2) and 2.8 (95% CI 1.8 to 4.5) were found for studies reporting upper ARinf and general ARinf (upper or lower), respectively. The incidence of ARinf was similar across the different methods to diagnose ARinf. A higher incidence of ARinf was found in non-elite (8.7; 95% CI 6.1 to 12.5) vs elite athletes (4.2; 95% CI 3.3 to 5.3). SUMMARY/CONCLUSIONS These findings suggest: (1) the incidence of ARill equates to approximately 4.7 per athlete per year; (2) the incidence of upper ARinf was significantly higher than general (upper/lower) ARinf; (3) elite athletes have a lower incidence of ARinf than non-elite athletes; (4) if pathogen identification is not available, physicians can confidently use validated questionnaires and checklists to screen athletes for suspected ARinf. For future studies, we recommend that a clear diagnosis of ARill is reported. PROSPERO REGISTRATION NUMBER CRD42020160472.
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Affiliation(s)
- Wayne Derman
- Institute of Sport and Exercise Medicine, Department of Sport Science, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa .,International Olympic Committee Research Centre, Pretoria, South Africa
| | - Marelise Badenhorst
- Institute of Sport and Exercise Medicine, Department of Sport Science, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.,Sports Performance Research Institute New Zealand (SPRINZ), Auckland University of Technology, Auckland, New Zealand
| | - Maaike Maria Eken
- Institute of Sport and Exercise Medicine, Department of Sport Science, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Josu Ezeiza-Gomez
- Institute of Sport and Exercise Medicine, Department of Sport Science, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.,International Olympic Committee Research Centre, Pretoria, South Africa
| | - Jane Fitzpatrick
- Centre for Health and Exercise Sports Medicine, Faculty of Medicine Dentistry and Health Science, University of Melbourne, Parkville, Victoria, Australia
| | - Maree Gleeson
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Lovemore Kunorozva
- Institute of Sport and Exercise Medicine, Department of Sport Science, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Katja Mjosund
- Paavo Nurmi Centre, Sport and Exercise Medicine Unit, University of Turku, Turku, Finland
| | - Margo Mountjoy
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Nicola Sewry
- International Olympic Committee Research Centre, Pretoria, South Africa.,Sport, Exercise Medicine and Lifestyle Institute, University of Pretoria, Faculty of Health Sciences, Pretoria, South Africa
| | - Martin Schwellnus
- International Olympic Committee Research Centre, Pretoria, South Africa.,Sport, Exercise Medicine and Lifestyle Institute, University of Pretoria, Faculty of Health Sciences, Pretoria, South Africa
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Prevalence and novel risk factors for vitamin D insufficiency in elite athletes: systematic review and meta-analysis. Eur J Nutr 2022; 61:3857-3871. [PMID: 35882673 PMCID: PMC9596536 DOI: 10.1007/s00394-022-02967-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 07/18/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE Vitamin D insufficiency may be common among elite athletes, but prevalence is unclear, and some potentially important risk factors are uncertain. The present study aimed to (a) estimate the prevalence of vitamin D insufficiency in elite athletes, and (b) examine differences in prevalence between the sexes, and between adults and adolescents, from recent studies which used a contemporary definition of insufficiency. METHODS Four databases (Web of Science, SPORTDiscus, PubMed, and Sports Medicine and Education Index) were searched for studies in elite athletes. Literature selection, data extraction, and risk of bias assessment were conducted independently by two researchers. Vitamin D insufficiency was defined as 25(OH)D < 50 nmol/L. Meta-analysis was conducted, using R software x64 4.0.2, to provide estimates of prevalence of insufficiency for adults and adolescents, and to examine between-sex differences in risk of insufficiency. RESULTS From the initial 943 literature search hits, 51 studies were eligible with 5456 participants, 33 studies in adults (12/33 in winter and spring), 15 studies in adolescents (6/15 in winter and spring) and 3 studies with age of study participants not given. Prevalence of vitamin D insufficiency from meta-analysis was 30% (95% CI 22-39%) in adults and prevalence was higher, though not significantly so, at 39% (95% CI 25-55%) in adolescents. Differences in the prevalence of insufficiency between the sexes for the eight studies which provided within-study comparisons was not significant (RR = 1.0; 95% CI 0.79-1.26). Evidence quality was moderate. CONCLUSIONS Prevalence of vitamin D insufficiency (≤ 50 nmol/L) in elite athletes is high, suggesting a need for greater attention to prevention and treatment. Prevalence estimates in the present study are conservative due to a relative lack of studies in winter. While there was no evidence of higher risk among women than men in the present study, there was less evidence on women.
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Cicchella A, Stefanelli C, Massaro M. Upper Respiratory Tract Infections in Sport and the Immune System Response. A Review. BIOLOGY 2021; 10:biology10050362. [PMID: 33922542 PMCID: PMC8146667 DOI: 10.3390/biology10050362] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/12/2021] [Accepted: 04/20/2021] [Indexed: 02/07/2023]
Abstract
Simple Summary This review aims at clarifying the relationships of heavy training with the upper respiratory tract infections (URTI), a topic which has reach the public awareness with the recent outbreaks of Covid 19. The URTIs are quite common in several sport activities among athletes who undergo heavy training. Causes of URTI are still poorly understood, because can be related with innate and genetic susceptibility and with several environmental factors connected with training load and nutrition. The time course of the inflammation process affecting URTI after training, has been also reviewed. After a survey of the possible physiological and psychological causes (stressors), including a survey of the main markers of inflammation currently found in scientific literature (mainly catecholamines), we provided evidence of the ingestion of carbohydrates, C, D, and E vitamins, probiotics and even certain fat, in reducing URTI in athletes. Possible countermeasures to URTI can be a correct nutrition, sleep hygiene, a proper organization of training loads, and the use of technique to reduce stress in professional athletes. There is a lack of studies investigating social factors (isolation) albeit with Covid 19 this gap has been partially fill. The results can be useful also for non-athletes. Abstract Immunity is the consequence of a complex interaction between organs and the environment. It is mediated the interaction of several genes, receptors, molecules, hormones, cytokines, antibodies, antigens, and inflammatory mediators which in turn relate and influence the psychological health. The immune system response of heavily trained athletes resembles an even more complex conditions being theorized to follow a J or S shape dynamics at times. High training loads modify the immune response elevating the biological markers of immunity and the body susceptibility to infections. Heavy training and/or training in a cold environment increase the athletes’ risk to develop Upper Respiratory Tract Infections (URTIs). Therefore, athletes, who are considered healthier than the normal population, are in fact more prone to infections of the respiratory tract, due to lowering of the immune system in the time frames subsequent heavy training sessions. In this revision we will review the behavioral intervention, including nutritional approaches, useful to minimize the “open window” effect on infection and how to cope with stressors and boost the immune system in athletes.
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Affiliation(s)
- Antonio Cicchella
- Department for Quality of Life Studies, University of Bologna, 40127 Bologna, Italy;
- Correspondence: ; Tel.: +39-051-2088772
| | - Claudio Stefanelli
- Department for Quality of Life Studies, University of Bologna, 40127 Bologna, Italy;
| | - Marika Massaro
- Institute of Clinical Physiology, National Research Council (CNR), 73047 Lecce, Italy;
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Pham H, Rahman A, Majidi A, Waterhouse M, Neale RE. Acute Respiratory Tract Infection and 25-Hydroxyvitamin D Concentration: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3020. [PMID: 31438516 PMCID: PMC6747229 DOI: 10.3390/ijerph16173020] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 08/15/2019] [Accepted: 08/19/2019] [Indexed: 12/31/2022]
Abstract
Observational studies and randomised controlled studies suggest that vitamin D plays a role in the prevention of acute respiratory tract infection (ARTI); however, findings are inconsistent and the optimal serum 25-hydroxyvitamin D (25(OH)D) concentration remains unclear. To review the link between 25(OH)D concentration and ARTI, we searched PubMed and EMBASE databases to identify observational studies reporting the association between 25(OH)D concentration and risk or severity of ARTI. We used random-effects meta-analysis to pool findings across studies. Twenty-four studies were included in the review, 14 were included in the meta-analysis of ARTI risk and five in the meta-analysis of severity. Serum 25(OH)D concentration was inversely associated with risk and severity of ARTI; pooled odds ratios (95% confidence interval) were 1.83 (1.42-2.37) and 2.46 (1.65-3.66), respectively, comparing the lowest with the highest 25(OH)D category. For each 10 nmol/L decrease in 25(OH)D concentration, the odds of ARTI increased by 1.02 (0.97-1.07). This was a non-linear trend, with the sharpest increase in risk of ARTI occurring at 25(OH)D concentration < 37.5 nmol/L. In conclusion, there is an inverse non-linear association between 25(OH)D concentration and ARTI.
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Affiliation(s)
- Hai Pham
- Population Health Department, QIMR Berghofer Medical Research Institute, Herston, QL 4006, Australia.
- School of Public Health, The University of Queensland, Herston, QL 4006, Australia.
| | - Aninda Rahman
- Population Health Department, QIMR Berghofer Medical Research Institute, Herston, QL 4006, Australia
- School of Public Health, The University of Queensland, Herston, QL 4006, Australia
| | - Azam Majidi
- Population Health Department, QIMR Berghofer Medical Research Institute, Herston, QL 4006, Australia
- School of Public Health, The University of Queensland, Herston, QL 4006, Australia
| | - Mary Waterhouse
- Population Health Department, QIMR Berghofer Medical Research Institute, Herston, QL 4006, Australia
| | - Rachel E Neale
- Population Health Department, QIMR Berghofer Medical Research Institute, Herston, QL 4006, Australia
- School of Public Health, The University of Queensland, Herston, QL 4006, Australia
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