IOC consensus statement: dietary supplements and the high-performance athlete

Sport supplementation in competitive swimmers: a systematic review with meta-analysis

BACKGROUND

Competitive swimmers have a high prevalence of sports supplement (SS) consumption. However, only a few SS are scientifically proven to be safe, effective, and legal. Therefore, before incorporating supplements to enhance performance and health in competitive swimming, it is crucial to conduct an analysis and review to assess their effects. The objective of this study was to analyze the demonstrated effects of SS, as reported in published studies, on the swimming performance of competitive swimmers.

METHODS

Following PRISMA guidelines, a systematic search was conducted across six databases for the selection of studies included in this review. Studies that analyzed the effects of sports supplementation compared to placebo were included and subjected to meta-analysis.

RESULTS

This revision included 23 studies, 16 of them (69.6%) qualified as excellent and 7 (30.4%) as good at the methodological level based on the punctuation in the PEDro scale. The systematic review included 422 swimmers (61.8% male, 38.2% female), with distances assessed ranging from 50 m to 800 m, including studies employing interval procedures. Creatine showed a significant effect (ES = -0.46; 95% CIs = -0.75 to -0.17, p = 0.002; I2 = 11%) on swimming performance, while the rest of the analyzed supplements did not show significant effects (all p > 0.05).

CONCLUSIONS

Creatine supplementation demonstrated ergogenic benefits for competitive swimmers, although the evidence supporting the use of this supplement is still limited. Sodium bicarbonate and β-alanine may enhance performance in distances with higher glycolytic demands, while caffeine is effective at dosages of 3-6 mg/kg administered 60 min before exercise. Further research is needed to confirm the potential ergogenic effects of other supplements, such as beetroot juice.

Reference Values for Hydration Biomarkers: Optimizing Athletic Performance and Recovery

The negative effects of dehydration or overhydration on exercise performance and health are widely recognized. However, the interindividual variability of fluid imbalances among athletes and across various sports is large, due to the complex interactions of physiological, environmental, and sport-specific factors. Such complexity not only makes it difficult to predict fluid needs prior to competition or training sessions, but also supports the creation of an individualized hydration plan (IHP) for each athlete. Measurements of valid, field-expedient biomarkers such as body mass change, urine concentration, and thirst enable ongoing monitoring of an athlete's hydration state and are integral components of an IHP. Unfortunately, no extensive repository of sport-relevant hydration biomarker data exists. Therefore, this narrative review presents a novel inventory of pre- and post-exercise reference values for body mass change, urine specific gravity, and subjective rating of thirst. These reference values were identified via electronic database searches that discovered field studies of competitive events, weight category sports, training sessions, and routine daily activities. We propose that comparing an athlete's real-time body mass change, urine specific gravity, and thirst rating to previously published reference values will clarify the extent of dehydration or overhydration, guide rehydration efforts, and optimize subsequent exercise performance, recovery, and health.

Nutrition for optimising immune function and recovery from injury in sports

The immune system, sports injuries, physical activity and clinical sports nutrition are closely linked. Inadequate nutrition and intense stress in athletes increase the risk of immune dysfunction, injury and disease, while injury reduces the positive effects of physical activity, creating a vicious cycle affecting health and performance. Nutritional support is key to reducing the risk of injury, speeding up recovery and shortening rehabilitation. The intake of energy, protein, carbohydrates, fats and micronutrients should be adapted to the needs following injury. Quality nutrition is preferred over the use of dietary supplements, which are limited to cases of identified deficiencies (e.g. vitamin D or iron deficiencies). Health professionals with knowledge of clinical nutrition have a key role to play in injury prevention, treatment and rehabilitation, and nutritional interventions are an indispensable part of a holistic approach to athletes' health.

The Role of Nutrition in Applied Physiology

Nutrition in applied and exercise physiology explores the relationship between nutrients and human body functions, focusing on the biochemical processes involved in the absorption, digestion, and utilization of food, nutrients, and other dietary compounds, as well as their impact on human performance [...].

Nutritional Intake and Timing of Marathon Runners: Influence of Athlete's Characteristics and Fueling Practices on Finishing Time

BACKGROUND

Endurance athletes' competitions have increased over the decades and marathon races are becoming increasingly popular. Proper nutrition is critical for optimal performance and long-term health in marathon athletes. This study aimed to investigate runners' nutritional intake, especially fluids, food, and supplements, competing in the Seville Marathon. A descriptive and cross-sectional study was carried out to obtain information on the consumption of liquids, food, and supplements. A total of 160 runners (aged 42.2 ± 7.3 years) who were primarily men (87.5%) who participated in the 2022 Seville marathon took part in the study.

RESULTS

There was no significant difference (p > 0.050) between marathon finish time (from 2 h 12 min to 5 h) or sports experience and fluid, carbohydrates (CHO), sodium, and caffeine intake pre- and post-competition. However, according to the results obtained, the athletes who met CHO intake recommendations during the competition (60-90 g/h) were more likely to finish the marathon in less than 180 min (p = 0.035).

CONCLUSIONS

The intake of CHO (35 ± 17 g/h), sodium (192 ± 150 mg/h) and caffeine (57 ± 49 mg/h) was low compared to the current recommendations during the competition. The intake of fluids (466 ± 279 mL/h) was at the lower limit of recommendations. Most athletes did not receive nutritional counselling by a sport dietitian, which may explain why athletes failed to meet specific nutrient recommendations. Future investigations with a larger sample size are warranted to assess the relationship between dietary intake and finish time.

The Translation of Policy to Person: A Qualitative Analysis of Elite Athletes' Perceptions of Pregnancy in the United Kingdom

BACKGROUND

An increasing number of female athletes are navigating an athletic career alongside pregnancy. Limited qualitative research has investigated the experiences of elite athletes in the United Kingdom (UK). This study aimed to explore the experiences of elite athletes in the UK as they navigated pregnancy, employing a socio-ecological framework to inform future research and policy recommendations on sport participation during pregnancy.

METHODS

A descriptive qualitative study design, adopting a relativist ontology and constructivist epistemology, was implemented. Semi-structured online interviews were conducted with elite athletes ≥ 18 years old, who resided in the UK, and who trained and/or competed at the highest level of their sport prior to and/or during pregnancy. Interviews were recorded, transcribed and analysed using reflexive thematic analysis.

RESULTS

Eleven athletes (mean age 31 ± 3 years) from nine team and individual sports participated in the study. Four key themes were developed: (1) From the Podium to Parenthood: Institutional versus Individual Influence on Reproductive Planning; (2) Is My Career Over? Micro Level Support versus Macro Level Doubt and Worry; (3) Athlete to Mother: Internal Conflict to Community Role Model; (4) Navigating the Bump: Individual Drive to Tackle Systemic Gaps.

CONCLUSIONS

Findings highlight the complexity female athletes face when navigating pregnancy, motherhood and elite sport. There is a need for high-quality research focusing on preconception and pregnancy-specific training and nutrition modifications for elite athletes, particularly regarding nutrient intake and supplementation. Additionally, efforts to improve the translation of evidence-based research into practical applications remain essential.

Dietary Nitrate Supplementation and Exercise Performance: An Umbrella Review of 20 Published Systematic Reviews with Meta-analyses

BACKGROUND

Dietary nitrate (NO3-) supplementation is purported to benefit exercise performance. However, previous studies have evaluated this nutritional strategy with various performance outcomes, exercise tasks, and dosing regimens, often yielding inconsistent results that limit the generalizability of the findings.

OBJECTIVE

We aimed to synthesize the available evidence regarding the effect of NO3- supplementation on 11 domains of exercise performance.

METHODS

An umbrella review was reported in accordance with the Preferred Reporting Items for Overviews of Reviews guideline. Seven databases (MEDLINE, EMBASE, Cochrane Database, CINAHL, Scopus, SPORTDiscus, and Web of Science) were searched from inception until July 2024. Systematic reviews with meta-analyses comparing NO3- supplementation and placebo-controlled conditions were included. Literature search, data extraction, and methodological quality assessment (A Measurement Tool to Assess Systematic Reviews Assessing the Methodological quality of SysTemAtic Review [AMSTAR-2]) were conducted independently by two reviewers.

RESULTS

Twenty systematic reviews with meta-analyses, representing 180 primary studies and 2672 unique participants, met the inclusion criteria. Our meta-analyses revealed mixed effects of NO3- supplementation. It improved time-to-exhaustion tasks [standardized mean difference (SMD): 0.33; 95% confidence interval (CI) 0.19-0.47] with subgroup analyses indicating more pronounced improvements when a minimum dose of 6 mmoL/day (372 mg/day) and chronic (> 3 days) supplementation protocol was implemented. Additionally, ergogenic effects of NO3- supplementation were observed for total distance covered (SMD: 0.42; 95% CI 0.09-0.76), muscular endurance (SMD: 0.48; 95% CI 0.23-0.74), peak power output (PPO; SMD: 0.25; 95% CI 0.10 to 0.39), and time to PPO (SMD: - 0.76; 95% CI - 1.18, - 0.33). However, no significant improvements were found for other performance outcomes (all p > 0.05). The AMSTAR-2 ratings of most included reviews ranged from low to critically low.

CONCLUSIONS

This novel umbrella review with a large-scale meta-analysis provides an updated synthesis of evidence on the effects of NO3- supplementation across various aspects of exercise performance. Our review also highlights significant methodological quality issues that future systematic reviews in this field should address to enhance the reliability of evidence.

CLINICAL TRIAL REGISTRATION

This study was registered in the International Prospective Register of Systematic Review (PROSPERO) database (registration number: CRD42024577461).

Reliability of a non-invasive method to calculate buffer capacity after exhaustive cycling exercise of 20 s to 12 min: a pilot study

Traditionally, buffer capacity (β) is measured on muscle biopsies by measuring changes in muscle pH in relation to exposure of standardized quantities of hydrochloric acid. This is an invasive approach requiring specific equipment and trained personnel which limits its usability in a normal training context. Assessing β using capillary blood lactate concentration (BLC) and pH values has been proposed as a more practical and cost-effective approach. The reliability of the input BLC and pH data on the calculations of β after maximal sprint and endurance exercise has not yet been investigated and was major aim of our study. Eleven subjects performed six maximal performance tests ranging from 20 s to 12 min duration over a 2-week period. All subjects were familiarized with the test conditions. For each performance test, pre and posttest BLC and pH was measured and used to calculate β using the Henderson-Hasselbach equation. As BLCpre and pHpre values showed poor reliability, β calculations were repeated using constants for BLCpre (1.23 mmol·L-1) and pHpre (7.426) chosen from the average values in the experimental data. Test-retest reliability for BLCpre (ICC: 0.12, 95% CI -0.49-0.65, n.s.) and pHpre (ICC: 0.40, 95% CI -0.22-0.79, n.s.) was poor, whereas BLCpost (ICC: 0.95, 95% CI 0.82-0.99, p < 0.05) and pHpost (ICC: 0.89, 95% CI 0.65-0.97, p < 0.05) displayed good to excellent reliability. Good reliability was observed for β calculated from the Henderson-Hasselbalch equation utilizing BLCpost and pHpost only (ICC: 0.86, 95% CI 0.55-0.96, p < 0.05). The validity of this method in comparison with gold-standard methods needs further scientific investigation.

Are knowledge, attitudes and practices about dietary supplements and nutraceuticals related with exercise practice and setting? A cross-sectional study among Italian adults

This cross-sectional study was aimed to investigate knowledge, attitudes, and practices regarding dietary supplements (DS) and nutraceuticals among athletes, gym practitioners, and individuals who did not exercise regularly. A total of 372 participants, aged 18-65, completed a questionnaire covering demographics, supplement usage, and three validated tools: the Knowledge about Dietary Supplements (KaDS), Supplements Knowledge Score (SKS), and Knowledge, Attitude, and Practice towards Nutraceuticals (KAPN). Significant differences were found in the use of vitaminised water, protein powder, glucosamines, beetroot juice, creatine, omega-3, and pre-workout supplements among the groups, with gym practitioners reporting the highest usage. Athletes scored the highest in knowledge of DS effects on health, while both athletes and gym practitioners scored higher than non-exercisers in knowledge related to sports supplements. However, all groups showed inadequate knowledge of nutraceuticals, and moderately positive attitudes towards these products. Older participants performed better in knowledge questionnaires. These findings suggest that gym practitioners, inactive and young people could benefit most from educational interventions regarding dietary supplementation.

Dietary Supplement Use in Competitive Spanish Football Players and Differences According to Sex

Objectives: This study aimed to evaluate and compare the consumption of dietary supplements (DS) in semi-professional male and professional female Spanish football players. Methods: The study involved 129 football players (92 men and 37 women) who completed a validated, self-administered questionnaire on the use of DS in athletes. Results: The results indicated that 96.12% of the sample reported taking DS, with the main reason for consumption being performance enhancement. The most commonly consumed DS were creatine monohydrate (66.77%), caffeine (56.59%), whey protein (48.06%), isotonic drinks (37.21%), vitamin D (27.91%), energy bars (27.13%), magnesium (20.93%), and vitamin C (20.16%). Additionally, significant differences were found between sexes regarding vitamin D consumption (p < 0.05; OR = 3.27 [0.36-2.00]). According to the Australian Institute of Sport DS classification, group A was the most consumed, followed by group B. Significant sex differences were found in the consumption of sports foods (p = 0.034; OR = 3.25 [0.05-2.31]) and medical supplements (p < 0.001; OR = 3.75 [0.52-2.12]). Sex differences were also found in place of purchase, source of recommendation, as well as the situation and timing of consumption (p < 0.05). Conclusions: The use of DS among Spanish football players was prevalent at 96.12%, with creatine monohydrate, caffeine, and whey protein being the most commonly consumed. Differences in consumption patterns were noted between sexes.

The race within a race: Together on the marathon starting line but miles apart in the experience

Every four years the world's best athletes come together to compete in the Olympic games, electrifying audiences with incredible feats of speed, strength, endurance and skill as personal best performances and new records are set. However, the exceptional talent that underpin such performances is incomprehensible to most casual observers who often cannot appreciate how unique these athletes are. In this regard, endurance running, specifically the marathon, a 42.195 km foot race, provides one of the few occasions in sport outside of Olympic, world and national competitions, that permits sport scientists and fans alike to directly compare differences in the physiology between recreational and elite competitors. While these individuals may all cover the same distance, on the same course, on the same day - their experience and the physiological and psychological demands placed upon them are vastly different. There is, in effect, a "race within a race". In the current review we highlight the superior physiology of the elite endurance athlete, emphasizing the gap between elite competitors and well-trained, but less genetically endowed athletes. We draw attention to a range of inconsistencies in how current sports science practices are understood, implemented, and communicated in terms of the elite and not-so-elite endurance athlete.

Cross-validation of the safe supplement screener (S3) predicting consistent third-party-tested nutritional supplement use in NCAA Division I athletes

Introduction

This cross-sectional study aimed to cross-validate an earlier developed algorithm-based screener and explore additional potential predictors for whether athletes will use third-party-tested (TPT) supplements.

Methods

To justify the initial model behind the supplement safety screener (S3) algorithm which predicts whether athletes will use TPT supplements, a cross-validation was performed using this independent dataset based on responses of a large group of collegiate NCAA DI athletes. Additionally, explorative modeling using stepwise logistic regression was used to identify new predictors for TPT supplement use to create and evaluate a new model for future use.

Results

The S3 algorithm was applied to the responses from n = 662 athletes using supplements (age: 20 ± 1.5 years, 50% female, from >24 sports) confirming that the algorithm identifies consistent and inconsistent TPT users (χ2 (1) = 15.95, p < 0.001), with a moderate area under the curve (AUC, 0.67) and a moderate specificity (68%), but low sensitivity (51%). Explorative modeling identified two new variables: TPT logo recognition, and having at least one name, image, likeness (NIL) deal that may help to predict TPT supplement use.

Discussion

Strong relationships between risk groupings and product use outcomes toward TPT supplement use were identified for the athletes screened. The S3 screener showed high sensitivity for identifying student-athletes inconsistently using TPT supplements, but a low specificity, lacking the ability to place less risky athletes into low-risk quadrants. The exploratory modeling, identifying TPT logo recognition and having a NIL deal, further strengthens our knowledge on predictors for consistent TPT supplement use.

Ameliorating role of co-administration of granulocyte colony stimulating factor and sodium bicarbonate on the skeletal muscle of a rat model of chronic kidney disease (A histological and immunohistochemical study)

Over half million individuals suffer from chronic kidney disease (CKD) worldwide. In addition to raising the possibility of cardiovascular diseases, skeletal myopathy remains a challenging complication that is highly correlated with mortality and a lower quality of life. Granulocyte-colony stimulating factor (G-CSF) is an active cytokine for mobilization of immunological and hematopoietic stem cells that can replace exogenous stem cell infusions. So, it is seen as a less expensive and noninvasive tool for regenerative medicine. Sixty three rats were divided into 4 groups: I control, II CKD induced, IIIa, IIIb treated and IV recovery groups. After induction of CKD in all rats, group II were sacrificed after 4 weeks. Rats of group IIIa received NaHCO3. Group IIIb rats were injected subcutaneously by G-CSF as 100 µg/kg/day for 5 successive days in addition to NaHCO3 as group IIIa. Group IV rats were housed for 4 weeks without treatment. Serum urea, creatinine, tissue MDA& TNF-α were assessed. Renal and gastrocnemius muscle sections were evaluated for histological structure, CD34 and myogenin immune expression, morphometric and statistical analyses. The CKD group revealed a significant increase in MDA and TNF-α. Furthermore, features of renal injury, muscle degenerative changes, increased collagen and decreased CD34 and myogenin expression were observed. Alterations were partially attenuated by NaHCO3, while GCSF remarkably improved most parameters. The current results indicated that co-administration of GCSF and NaHCO3 could ameliorate CKD myopathy via attenuating oxidative stress, immunomodulation, pro-angiogenic ability, myocyte regeneration. In addition to the reduction of mitochondrial stress and maintenance of cellular homeostasis.

Advantages of different dietary supplements for elite combat sports athletes: a systematic review and Bayesian network meta-analysis

With an increasing number of studies delving into the impact of dietary supplements on combat sports performance, researchers are actively seeking a more efficient dietary supplement for use in these sports. Nonetheless, controversies persist. Hence, we undertook a systematic review and Bayesian network meta-analysis to discern the most effective dietary supplements in combat sports by synthesizing the available evidence. We conducted a comprehensive search across PubMed, Web of Science, Cochrane, Embase, and SPORTDiscus, covering the period from their establishment to November 2, 2023. Our aim was to identify randomized controlled trials that evaluated the benefits of various dietary supplements for elite combat sports athletes. The risk of bias in these trials was assessed using the revised Cochrane Risk of Bias Tool for Randomized Trials. Subsequently, we employed Bayesian network meta-analysis through R software and Stata 15.0. During the analysis, we performed subgroup analysis based on the type of combat, distinguishing between striking and grappling disciplines. The analysis is based on 67 randomized controlled trials that meet all the inclusion criteria, involving 1026 elite combat sports athletes randomly assigned to 26 different dietary supplements or placebos. Results from the 50 trials included in the network meta-analysis indicate that compared to a placebo, sodium bicarbonate combined with caffeine (SMD: 2.3, 95% CrI: 1.5, 3.2), caffeine (SMD: 0.72, 95% CrI: 0.53, 0.93), beta-alanine (SMD: 0.58, 95% CrI: 0.079, 1.1), and sodium bicarbonate (SMD: 0.54, 95% CrI: 0.30, 0.81) was associated with a statistically significant increase in blood lactate concentrations. Compared to placebo, caffeine (SMD: 0.27, 95% CrI: 0.12, 0.41) was associated with a statistically significant increase in the final heart rate. Compared to placebo, creatine combined with sodium bicarbonate (SMD: 2.2, 95% CrI: 1.5, 3.1), creatine (SMD: 1.0, 95% CrI: 0.38, 1.6), and sodium bicarbonate (SMD: 0.42, 95% CrI: 0.18, 0.66) was associated with a statistically significant increase in mean power. Compared to placebo, creatine combined with sodium bicarbonate (SMD: 1.6, 95% CrI: 0.85, 2.3), creatine (SMD: 1.1, 95% CrI: 0.45, 1.7), and sodium bicarbonate (SMD: 0.35, 95% CrI: 0.11, 0.57) was associated with a statistically significant increase in peak power. Compared to placebo, caffeine (SMD: 1.4, 95% CrI: 0.19, 2.7) was associated with a statistically significant increase in the number of kicks. Compared to placebo, caffeine (SMD: 0.35, 95% CrI: 0.081, 0.61) was associated with a statistically significant increase in the number of throws. This study suggests that a range of dietary supplements, including caffeine, sodium bicarbonate, sodium bicarbonate combined with caffeine, creatine, creatine combined with sodium bicarbonate, and beta-alanine can improve the athletic performance of elite combat sports athletes.

Enhancement of Interferon-γ Secretion by Lepidium meyenii Extract Supplementation After Exhaustive Endurance Exercise in Healthy Men: A Double-blind, Placebo-controlled Trial

Aim: To investigate the effects of 12-week Lepidium Meyenii extract supplementation on immune responses and inflammatory cytokines after exhaustive endurance exercise (EEE), emphasizing its novel focus on peripheral blood mononuclear cells (PBMCs) cytokine secretion and the implications of interferon-γ (IFN-γ) as a marker for immune modulation. Methods: Twenty healthy men were recruited and assigned into maca and placebo groups using a matched-pair design based on their maximal oxygen consumption (V̇O2max). All participants consumed 2.25 g of maca or placebo twice per day for 12 weeks, and they then performed EEE. Researchers collected blood samples before exercise, immediately after exercise, and at 2, 4, and 24 hours post-exercise to analyze immune functions and inflammatory markers. Results: No significant differences were observed in the variables between the two groups before supplementation. However, interferon-γ levels from peripheral blood mononuclear cells were significantly higher in the maca group than in the placebo group immediately and at 24 hours after exercise. Regarding the main time effect, the number of lymphocytes in all participants was significantly lower at 2 and 4 hours after exercise than before supplementation. The CD4+/CD8+ ratio in the groups was significantly lower immediately after exercise than before supplementation, and the ratio retuned to baseline levels at 2 hours after exercise. Conclusion: A 60-minute EEE session induces the open window phenomenon, characterized by immune suppression. Moreover, 12-week maca supplementation had positive effects only on interferon-γ levels from peripheral blood mononuclear cells.

Association Between Dietary Supplement Use and Academic Achievement Among University Students in the Kingdom of Saudi Arabia: A Cross-Sectional Study

Background Dietary supplements are commonly utilized worldwide, including in the Kingdom of Saudi Arabia (KSA), primarily to improve memory, focus, wakefulness, learning, and academic achievement. Nevertheless, there is still uncertainty regarding their efficacy and safety, particularly concerning academic performance. This study examines the prevalence of dietary supplement use among students in KSA and how this affects their academic performance. Methodology The current study was a cross-sectional study conducted in KSA between 2022 and 2024 on a sample size of 513 students aged ≥18 years, as calculated by Epi Info software (Centers for Disease Control and Prevention, Atlanta, United States). A self-administered online questionnaire was designed, tested for validity and reliability, and then propagated via social media. It included four parts assessing the socio-demographic, past medical and medication history, academic information, and dietary supplement use. Results The results showed that 360 (70.2%) participants used dietary supplements, while most of them, 141 (39.2%), used a combination of supplements. Users who reported taking supplements every day were 266 (73.9% of supplement users), and the supplement-related adverse effects occurred in about 147 (41% of supplement users). The most commonly reported side effects were headaches, sleeplessness, and irritability. No discernible influence of any of the reported dietary supplements on academic achievement was identified, despite the high prevalence of supplement usage and the related negative effects. A high percentage of the participants had incorrect knowledge about dietary supplements - 262 (51.1%) had a false belief that supplements can improve their achievement and 238 (46.4%) considered them completely safe with no risks of adverse effects. Conclusions Nutritional supplement intake was highly prevalent among KSA students; however, no positive association was identified between academic achievement and any of the used supplements (caffeine, creatine, curcumin, omega-3 fatty acids, Ginkgo biloba, or multivitamins). False knowledge was common among the studied group about the effects of supplements on academic achievement and their safety.

A Comprehensive Insight into Apoptosis: Molecular Mechanisms, Signaling Pathways, and Modulating Therapeutics

Apoptosis, or programmed cell death, is a fundamental biological process essential for maintaining tissue homeostasis. Dysregulation of apoptosis is implicated in a variety of diseases, including cancer, neurodegenerative disorders, and autoimmune conditions. This review provides an in-depth insight into the molecular mechanisms and signaling pathways that regulate apoptosis, highlighting both intrinsic and extrinsic pathways. Additionally, the review explains the tumor microenvironment's influence on apoptosis and its implications for cancer therapy resistance. Understanding the complex interplay between apoptotic signaling and cellular responses is crucial for developing targeted therapies that can effectively manage diseases associated with apoptosis dysregulation. The effects of conventional therapeutics and alternative substances with natural sources such as herbal compounds, alongside vitamins, minerals, and trace elements on cellular homeostasis and disease pathogenesis have been thoroughly investigated. Moreover, recent advances in therapeutic strategies aimed at modulating apoptosis are discussed, with a focus on novel interventions such as nutrition bio shield dietary supplement. These emerging approaches offer potential benefits beyond conventional treatments by selectively targeting apoptotic pathways to inhibit cancer progression and metastasis. By integrating insights from recent studies, this review aims to enhance our understanding of apoptosis and guide future research in developing innovative therapeutic approaches.

Nutritional Strategies for Enhancing Performance and Training Adaptation in Weightlifters

Weightlifting demands explosive power and neuromuscular coordination in brief, repeated intervals. These physiological demands underscore the critical role of nutrition, not only in optimizing performance during competitions but also in supporting athletes' rigorous training adaptations and ensuring effective recovery between sessions. As weightlifters strive to enhance their performance, well-structured nutritional strategies are indispensable. In this comprehensive review, we explored how weightlifters can optimize their performance through targeted nutritional strategies, including carbohydrate intake for glycogen replenishment and proteins for muscle growth and recovery. Additionally, the roles of key supplements, such as creatine, beta-alanine, and branch-chained amino acids in enhancing strength, delaying fatigue, and supporting muscle repair were discussed. A comprehensive literature review was conducted using PubMed, Google Scholar, and Web of Science to gather studies on nutritional strategies for weightlifting performance and training adaptation. The review focused on English-language articles relevant to weightlifters, including studies on powerlifting, while excluding those involving non-human subjects. Weightlifting requires explosive power, and proper nutrition is vital for performance and recovery, emphasizing the role of carbohydrate, protein, and fat intake. Nutrient timing and personalized strategies, informed by genetic and metabolomic analyses, enhance recovery and performance, while supplements like creatine, caffeine, and beta-alanine can significantly improve results when used correctly. Sustainable nutritional strategies are essential for enhancing weightlifter performance, emphasizing a balanced approach over extreme diets or excessive supplements. Further research is needed to refine these strategies based on individual athlete characteristics, ensuring consistent top-level performance throughout competitive seasons.

[Relationship between consumption of sports supplements and addiction to sport in road and mountain runners]

Introduction

Introduction: sports nutrition and supplementation (SD) are commonly used by road and mountain runners to achieve their goals and increased performance. However, sometimes sports practice can become an obsession and/or addiction, although the literature on the use of DS and sports addiction (SD) is scarce. Objective: to describe and analyse the relationship between SD use and AD in asphalt and mountain runners in the Canary Islands. Methodology: a cross-sectional observational study in a sample of 613 adult athletes, using a self-administered online questionnaire that assessed SD use and AD, disseminated by federations, sports clubs, race organisers and social networks. Results: 75.7 % of participants reported taking some form of SD and being younger was associated with a higher likelihood of taking SD. On the total SD scale (SAS-15) the mean was 9.19 (SD = 3.24), above the midpoint of the theoretical range (0-15). Among participants taking and not taking DS, there is higher AD in those taking versus those not; and among those taking DS, AD is significantly higher in those taking weight management recoverers and supplements. Conclusions: the sample had indicators of WD and, for the most part, were consuming some form of DS. In addition, there is a significant relationship between the use of DS and WD in road and mountain runners, with the level of WD being a predictor of DS consumption.

Enhancing Performance in Young Athletes: A Systematic Review of Acute Supplementation Effects

BACKGROUND/OBJECTIVES

The increasing popularity of acute supplementation among young athletes is concerning, given the limited scientific evidence to guide recommendations specific to this group. Therefore, the aim of this systematic review was to synthesize the available scientific evidence on the acute effects of supplementation in young athletes to understand the impact on physical and cognitive performance.

METHODS

Following pre-registration on INPLASY (INPLASY202310017) and according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, systematic searches of three electronic databases (Web of Science, PubMed, and Scopus) were conducted by independent researchers from inception until July 2024. Only original studies in English that examined the acute effects of supplementation on young athletes' physical and/or cognitive performance, specifically when taken on the same day as exercise (before or during), were included. The risk of bias was individually assessed for each study using the revised Cochrane risk of bias tool for randomized trials (RoB 2.0).

RESULTS

A total of 16 studies were included in the review. A range of ages, participants, sports, and methodological approaches were involved in the studies included in the current review. The studies mainly used carbohydrates, beetroot juice, and sodium citrate, with carbohydrates being the most used acute supplementation. Carbohydrate supplementation enhanced endurance capacity and increased blood glucose, but mixed results were found for anaerobic performance. Mixed results were found for beetroot juice, with one study finding increases in power production. One study used sodium citrate supplementation, with improvements in technical performance observed.

CONCLUSIONS

Since this review identified only three substances meeting our eligibility criteria, further research is needed to confirm the acute effects of supplements in young athletes and to better understand their benefits and limitations. Carbohydrate supplementation shows strong evidence for enhancing endurance performance, particularly during prolonged activities, while sodium citrate appears to support the preservation of skill performance. In contrast, the effects of beetroot juice are less consistent. Additional research is required to confirm the acute effects of supplements like beetroot juice in young athletes.

What Do We Know About the Energy Status and Diets of Pre-Professional and Professional Dancers: A Scoping Review

BACKGROUND/OBJECTIVES

Dancers require adequate nutrition support for growth and development during the pre-professional stage, as well as to fuel classes and rehearsals and to enhance performance for both pre-professional and professional dancers. The aim of this study is to understand the energy status and diet of pre-professional and professional dancers in the genres of ballet, contemporary, musical theatre, and opera.

METHODS

Electronic databases (n = 9) and grey literature were searched for primary studies with no time limit. Screening and data extraction were completed by two reviewers.

RESULTS

Twelve studies were included for pre-professional (n = 7) and professional (n = 5) dancers. The genres identified were ballet (n = 11) and contemporary (n = 1), with no studies on musical theatre or opera. Studies on pre-professional ballet and contemporary dancers indicated a negative energy balance and low energy availability. Pre-professional ballet dancers had lower energy intakes than professional dancers. Professional dancers had lower BMI and body fat percentages. Macronutrients were mostly reported using the acceptable macronutrient distribution range for carbohydrates (38-56%E), protein (12-17%E), and total fat (26-42%E). Iron and calcium were the main micronutrients of concern.

CONCLUSIONS

Accredited sports dietitians are recommended to support pre-professional and professional dancers to optimize their diet for health and performance. Further investigation is needed to quantify and assess dancers' dietary intake using sports nutrition guidelines for reference.

Salidroside and exercise performance in healthy active young adults - an exploratory, randomized, double-blind, placebo-controlled study

BACKGROUND

Rhodiola rosea extract is purported to improve physical performance and support resilience to stress. Salidroside is considered to be one of the main constituents responsible for the ergogenic actions of R. rosea. However, R. rosea extract contains relatively little salidroside and cultivation of R. rosea is challenging as it is mainly found in high-altitude, cold regions. Additionally, the R. rosea plant is subject to conservation concerns because of its growing popularity. The purpose of this exploratory study was to evaluate the short-term effects of pure, biosynthetic salidroside supplementation on exercise performance, mood state, and markers of inflammation and muscle damage in healthy active young adults.

METHODS

Fifty participants (30 M, 20F; 21 ± 4 yrs; 173 ± 8 cm; 74 ± 13 kg) were randomly assigned to either salidroside (60 mg/day for 16 days) or placebo supplementation and underwent peak oxygen uptake (VO2 peak), intermittent time-to-exhaustion (TTE), and local muscular endurance assessments, along with mood state evaluations using the Profile of Mood States (POMS). Blood samples were analyzed for erythropoietin, myoglobin, creatine kinase-MM, and C-reactive protein.

RESULTS

Salidroside supplementation enhanced overall percent predicted oxygen uptake during high-intensity intermittent exercise (p < 0.01). An increase in serum myoglobin was observed 24 hours following exercise in the placebo group (p = 0.02) compared with baseline whereas no statistically significant increase was observed for the salidroside group indicating reduced exercise-induced muscle damage. Placebo group experienced a decrease in number of intervals performed during the TTE test (p = 0.03), and a decrease in friendliness (p < 0.01) and an increase in fatigue-inertia (p < 0.01) as reported by POMS. The salidroside group exhibited stable mood states and maintained performance levels during the time-to-exhaustion test.

CONCLUSION

Salidroside supplementation may enhance oxygen utilization and mitigate exercise-induced muscle damage and fatigue, warranting further research on its long-term effects and potential as an adaptogen for active individuals.

Exploring the ergogenic potential of carbohydrate-caffeine combined mouth rinse on exercise and cognitive performance: a systematic review

Carbohydrate (CHO) and caffeine (CAF) mouth rinsing have been independently reported to benefit sport performance. The proposed mechanisms by which mouth rinsing CHO exerts an influence are reported to be different from those for mouth rinsing CAF. However, the potential ergogenic effects of combining CHO and CAF in a single mouth rinse solution, are unclear. This study aimed to review the available evidence of CHO-CAF combined mouth rinse on exercise and cognitive performance in human participants. A systematic literature search was conducted using five databases until April 2024, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) recommendations. Among the nine randomized crossover studies included, only one study showed significant improvements in lower-body muscular endurance with CHO-CAF mouth rinse (effect size (ES): 0.48; p < 0.05), while two studies reported non-statistically significant improvements in repeated sprint performance compared to other mouth rinse and placebo conditions (ES: 0.20-0.81; p = 0.07-0.18). However, for other performance measures, including repeated jumps, upper-body strength and endurance, endurance cycling, and intermittent recovery run, most evidence (five studies) did not demonstrate significant ergogenic effects. Notably, of the two studies that examined cognitive performance, both reported significant improvements with CHO-CAF mouth rinse compared with the placebo condition (ES: 0.45-3.45; p < 0.05). Overall, a synergistic influence of CHO-CAF mouth rinse on physical exercise performance is not evident, but preliminary evidence suggests potential benefits on cognitive performance. Future studies are required to address various methodological issues identified in this review, while practitioners and athletes should exercise caution when considering this novel nutritional strategy.

Nutrition and Golf Performance: A Systematic Scoping Review

BACKGROUND

Golf is played both recreationally and professionally by approximately 66.6 million people worldwide. Despite the potential for nutrition to influence golf performance, research in this area is somewhat limited.

OBJECTIVE

To identify the existing literature regarding nutrition and golf and where the current research gaps lie.

DESIGN

Scoping review. Online databases were used to retrieve data from 2003 to the present day.

DATA SOURCES

A three-step search strategy identified relevant primary and secondary articles as well as grey literature. Published and unpublished articles in the English language, identified by searching electronic databases (ProQuest Central, Web of Science, Scopus, SPORTDiscus and PubMed) and reference searching.

REVIEW METHODS

Relevant identified studies were screened for final inclusion. Data were extracted using a standardised tool to create a descriptive analysis and a thematic summary. In summary, studies were included if they focused on nutrition, hydration, energy requirements, supplements, or body composition in relation to golf.

RESULTS AND DISCUSSION

Our initial search found 3616 relevant articles. Eighty-two of these articles were included for the scoping review. Nutrition has the potential to impact golf performance in areas including the maintenance of energy levels, cognitive function, and body composition. Currently, there is limited research available discussing the effects of nutrition interventions related specifically to golf performance.

CONCLUSION

This scoping review highlights that more work is needed to provide golfers and practitioners with golf-specific nutrition research. The key areas for future golf-specific nutrition research include nutrition on cognitive performance, body composition, energy requirements, supplementation, and the potential role of nutrition for the travelling golfer. Systematic reviews could also be used to identify future priorities for nutrition and golf research.

Nutritional approaches applied to recovery of skeletal muscle injury immobilization: a review of nutrition aid for sport trauma

Skeletal muscle (SM) injuries are a very common occurrence among athletes during training and/or competitive periods, resulting in time loss and absence from sports. Of several existing interventions to improve SM recovery, the nutritional approach has emerged as integral part to improve the physiological response and maintain the body composition to promote a rapid and safe return to play. Growing evidence supports that the physiological response to SM injuries results in a number of changes, suggesting the relevance of a personalized nutritional approach, according to the degree of immobilization, SM mass loss, strength and function. Therefore, we aimed to review the current evidence of the nutritional approach applied to SM injuries recovery in athletes, highlighting energy intake, use the main nutrients and elements for the SM recovery, such as proteins, carbohydrates, vitamins and omega-3 fatty acids. Currently, evidence from injured athletes is scarce, and so specific guidelines cannot be established, calling from greater research into nutritional interventions in SM injury recovery in athletes.

Collegiate Student-Athletes' Use and Knowledge of Third-Party-Tested Nutritional Supplements: An Exploratory Study

CONTEXT

Nutritional supplement use in athletes is common, accompanied by potential doping risk.

OBJECTIVE

To determine athletes' nutritional supplement and third-party-tested (TPT) supplement use, supplement knowledge, and factors influencing their behavior.

DESIGN

Cross-sectional study.

SETTING

National Collegiate Athletic Association Division I athletic departments.

PATIENTS OR OTHER PARTICIPANTS

Student-athletes (n = 410, 53% female, age = 21.4 ± 1.6 years).

MAIN OUTCOME MEASURE(S)

Survey questions addressed topics including nutritional supplement knowledge and use, TPT supplement knowledge and use, and logo recognition, and data were stratified for sex differences.

RESULTS

Athletes (91%) reported the use of supplements, but the total number of supplements used was lower in female (median = 7; interquartile range, 4-11) than in male (median = 9; interquartile range, 4-12) athletes, with U = 17 960 and P = .01. A total of 48% (n = 191, out of 402 responses) reported purchasing supplements outside of their athletic department, with significantly fewer female (40%, n = 84) than male (56%, n = 107) athletes reporting this behavior (χ2 = 11.20, P < .001). No association between TPT logo recognition and TPT use was seen (χ2 = 0.238, P = .63). Of all athletes using supplements, 38% (n = 140) reported "consistent TPT use," whereas female athletes (36%, n = 70) reported this less often than male athletes (41%, n = 70, χ2 = 0.952, P < .32). No sex differences were seen for receiving nutritional counseling (89%, P = .37) or low nutritional supplement knowledge (<50%, P = .38); however, males had 2.5 times greater odds at recognizing a TPT organization logo than females (odds ratio = 2.45; 95% CI, 1.58-3.79).

CONCLUSIONS

Most athletes use nutritional supplements. Female athletes report slightly fewer supplements than male athletes, while also less frequently purchasing them outside their athletic department, potentially explaining the lower TPT logo recognition in female athletes.

Use of Sport Supplements and Doping Substances by Athletes: Prevalence and Relationships

Background: The use of sport supplements may represent a risk factor for the use of doping in sports. To explore this putative risk, the current study examined the frequency of sport supplement use and associations between the use of sport supplements and the use of doping substances and methods in athletes. Methods: The participants (n = 345; 56% male, 22 ± 5 years, 18-43 years) completed measures of sport supplement use, sport supplement beliefs, doping likelihood, and doping use. Based on the Australian Institute of Sport's "Sports Supplement Framework", the participants were asked whether they used 23 sport supplements from four categories (sport foods, medical supplements, performance supplements, other). They were also asked whether they used six classes of doping substances and methods (alphabodies, stimulants, steroids, erythropoietin, growth hormone, blood doping). Results: Sport supplements were used by 96% of the athletes, whereas doping substances were used by 4% of the athletes. Moreover, athletes who used more sport supplements also used more doping substances. The use of sport supplements was related to the use of doping substances both directly and indirectly via sport supplement beliefs and doping likelihood. Conclusions: Consumption of sport supplements is common, whereas doping is rare, and, moreover, the belief that sport supplements help optimize performance in competitive sport confers an increased risk for doping.

Caffeine intake is nonlinearly associated with muscle mass in young and middle-aged US adults

BACKGROUND

Recent studies have indicated that coffee consumption is inversely correlated with sarcopenia in the elderly population. Data regarding the association between caffeine intake and muscle mass in young adults are scarce.

OBJECTIVE

We aimed to investigate how dietary caffeine correlates with muscle mass and sarcopenia in the young and middle-aged people.

METHODS

We performed a cross-sectional study utilizing data from NHANES. Muscle mass was evaluated using DXA and caffeine intake was derived from 24-h dietary recalls. Multivariable regression analysis was adopted to explore association between caffeine and sarcopenia. Restricted cubic spline analysis was conducted to investigate dose-response effect of dietary caffeine on muscle mass. Mediation effect of high-sensitivity C reactive protein was examined by mediation analysis.

RESULTS

A total of 9116 adults aged from 20 to 59 years old were included. Higher ingestion of caffeine was not associated with sarcopenia. Association between dietary caffeine and muscle mass was found to be W-shaped in males and U-shaped in young females, wherein mediation effect of hs-CRP was not discovered.

CONCLUSIONS

Caffeine consumption is associated with muscle mass in a nonlinear pattern. ASMI peaks at a daily caffeine intake of 1.23 mg/kg in young adults, while 0.64-1.49 mg/kg is recommended for middle-aged men.

Fitness and Dietary Supplements: A Cross-Sectional Study on Food Practices and Nutrivigilance

Background/Objectives: The use of dietary supplements (DSs) has become common among fitness enthusiasts, aiming to enhance performance, recovery, and overall well-being. Methods: A cross-sectional study was conducted in the city of Beni Mellal from April to July 2024, assessed dietary practices, motivations for supplement use, and associated adverse effects among 420 survey participants. Results: The majority of dietary supplement users were aged 25-64 and had higher education levels. Colopathy (67.38%) was the most common eating disorder, followed by digestive (59.46%), inflammatory, and rheumatic diseases (53.50%). Dietary supplementation prevalence was 88.1%, with proteins (60.81%), medicinal plants (45.13%), and vitamins (42.70%) being the most consumed. Key motivations included supporting muscle, bone, and joint strength (musculoskeletal) (83.78%) and enhancing heart and lung function for cardiorespiratory health (82.43%). However, 28% of protein users experienced adverse effects, such as myalgia, gastralgia, palpitations, and insomnia. Multivariate linear regression indicated a significant negative association of creatine with effectiveness (β = -0.485, p = 0.001). Conclusions: Overall, while the benefits of dietary and sports practices are evident, the adverse effects associated with protein supplements highlight the necessity for enhanced nutrivigilance and nutritional education to ensure safe supplements.

Caffeine Enhances Some Aspects of Physical Performance in Well-Trained Hammer and Discus Throwers

BACKGROUND

Caffeine is a widely recognized ergogenic aid for enhancing exercise performance. However, its effect on throwing performance has been less studied, yielding contradictory results.

OBJECTIVES

The main aim of the study was to analyze the potential ergogenic effects of a moderate dose of caffeine (3 mg·kg-1 body mass) on vertical jump performance and throwing distance during a simulated competition in trained discus and hammer throwers.

METHODS

In a randomized, counterbalanced, and repeated measures design, 14 well-trained throwers (9 hammer throwers and 5 discus throwers; age 24.8 ± 6.3 years old, training 14.9 ± 5.0 h per week, competing experience 10.5 ± 6.1 years) performed a countermovement jump (CMJ) test, a modified throw, and a complete throw after the ingestion of 3 mg·kg⁻¹ body mass of caffeine or a placebo. Each participant performed three maximal-effort valid modified throws of his/her respective event (i.e., hammer or discus throw), plus three maximal-effort valid official throws (up to five tries, respectively, in case any attempt was called as foul). Throwing distance was measured according to World Athletics regulations using a metal tape, while release speed was assessed with a radar device. After the performance measurements, participants completed a form about side effects prevalence.

RESULTS

Caffeine, compared to placebo, increased throw distance (3.0 ± 5.1%, p = 0.048) and speed release (5.7 ± 8.7%, p = 0.03) for the complete throw, and distance (3.6 ± 4.4%, p = 0.01) and speed release (4.8 ± 7.4 %, p = 0.01) for the modified throw. Caffeine ingestion did not significantly improve jump height (1.1 ± 4.3%, p = 0.28), although it improved force and power on braking and the propulsive phases of the CMJ (p < 0.05). Caffeine only increased the prevalence of activeness (p < 0.05).

CONCLUSIONS

An acute moderate dose of caffeine enhanced hammer and discus throw performance in well-trained throwers during a simulated competitive setting, with minimal adverse side effects.

Nutrition, hydration and supplementation considerations for mountaineers in high-altitude conditions: a narrative review

Staying and climbing in high mountains (>2,500 m) involves changes in diet due to poor access to fresh food, lack of appetite, food poisoning, environmental conditions and physiological changes. The purpose of this review is to summarize the current knowledge on the principles of nutrition, hydration and supplementation in high-altitude conditions and to propose practical recommendations/solutions based on scientific literature data. Databases such as Pubmed, Scopus, ScienceDirect and Google Scholar were searched to find studies published from 2000 to 2023 considering articles that were randomized, double-blind, placebo-controlled trials, narrative review articles, systematic reviews and meta-analyses. The manuscript provides recommendations for energy supply, dietary macronutrients and micronutrients, hydration, as well as supplementation recommendations and practical tips for mountaineers. In view of the difficulties of being in high mountains and practicing alpine climbing, as described in the review, it is important to increase athletes' awareness of nutrition and supplementation in order to improve well-being, physical performance and increase the chance of achieving a mountain goal, and to provide the appropriate dietary care necessary to educate mountaineers and personalize recommendations to the needs of the individual.

β-Hydroxy β-Methyl Butyric Acid (HMB) and Its Potential Doping Relevance: A Pilot Study on Its Urinary Excretion Profile

β-hydroxy β-methyl butyric acid (HMB), either as the free acid or in the form of its calcium salt, is a component of several dietary supplements marketed to enhance sports performance, due to its role in protein synthesis. In this pilot study, we investigated the urinary excretion profile of HMB, an endogenous metabolite of the essential amino acid leucine. The endogenous reference ranges of HMB, in human urine samples, were monitored by collecting samples from 20 volunteers. Data obtained were compared with those from controlled excretion studies, following the intake of a 3-g oral dose of HMB. Urine samples were analyzed through a targeted procedure employing a conventional GC-MS system operating in SIM mode. Our results show that the excreted urinary concentration of HMB significantly exceeds the range of endogenous concentrations for at least 24 h, making possible to detect its exogenous origin.

The Efficacy of Nutritional Strategies and Ergogenic Aids on Acute Responses and Chronic Adaptations to Exertional-Heat Exposure: A Narrative Review

Global warming is attributed to an increased frequency of high ambient temperatures and humidity, elevating the prevalence of high-temperature-related illness and death. Evidence over recent decades highlights that tailored nutritional strategies are essential to improve performance and optimise health during acute and chronic exertional-heat exposure. Therefore, the purpose of this review is to discuss the efficacy of various nutritional strategies and ergogenic aids on responses during and following acute and chronic exertional-heat exposure. An outline is provided surrounding the application of various nutritional practices (e.g., carbohydrate loading, fluid replacement strategies) and ergogenic aids (e.g., caffeine, creatine, nitrate, tyrosine) to improve physiological, cognitive, and recovery responses to acute exertional-heat exposure. Additionally, this review will evaluate if the magnitude and time course of chronic heat adaptations can be modified with tailored supplementation practices. This review highlights that there is robust evidence for the use of certain ergogenic aids and nutritional strategies to improve performance and health outcomes during exertional-heat exposure. However, equivocal findings across studies appear dependent on factors such as exercise testing modality, duration, and intensity; outcome measures in relation to the ergogenic aid's proposed mechanism of action; and sex-specific responses. Collectively, this review provides evidence-based recommendations and highlights areas for future research that have the potential to assist with prescribing specific nutritional strategies and ergogenic aids in populations frequently exercising in the heat. Future research is required to establish dose-, sex-, and exercise-modality-specific responses to various nutritional practices and ergogenic aid use for acute and chronic exertional-heat exposure.

Youth and Adolescent Athlete Musculoskeletal Health: Dietary and Nutritional Strategies to Optimise Injury Prevention and Support Recovery

Background: Despite the well-documented benefits of exercise and sports participation, young athletes are particularly vulnerable to musculoskeletal injuries. This is especially true during periods of rapid growth, sports specialisation, and high training loads. While injuries are an inevitable aspect of sports participation, the risk can be minimised by promoting the development of strong, resilient tissues through proper nutrition and injury prevention strategies. Moreover, targeted nutrition strategies can accelerate recovery and rehabilitation, allowing for a quicker return to sports participation. Methods: This narrative review synthesises scientific evidence with practical insights to offer comprehensive dietary recommendations aimed at strengthening tissues and supporting the healing process during recovery and rehabilitation. The selection of all sources cited and synthesised in this narrative review were agreed upon by contributing author consensus, experts in sports nutrition (R.A., H.V., B.D.) and exercise and sports medicine (M.H.). Results: Key topics include factors that contribute to injury susceptibility, general dietary recommendations for growth and development, sports nutrition guidelines, and nutrition considerations during injury and rehabilitation. This review also addresses external factors that may lead to suboptimal nutrition, such as food literacy and eating disorders. Conclusions: By highlighting these factors, this article aims to equip coaches, nutritionists, dietitians, athletic trainers, physical therapists, parents/guardians, sporting organisations, and schools with essential knowledge to implement effective nutritional strategies for injury prevention, recovery, and rehabilitation, ultimately enhancing long-term health and athletic performance.

Evidence-based sports supplements: A redox analysis

Despite the overwhelming number of sports supplements on the market, only seven are currently recognized as effective. Biological functions are largely regulated through redox reactions, yet no comprehensive analysis of the redox properties of these supplements has been compiled. Here, we analyze the redox characteristics of these seven supplements: bicarbonates, beta-alanine, caffeine, creatine, nitrates, carbohydrates, and proteins. Our findings suggest that all sports supplements exhibit some degree of redox activity. However, the precise physiological implications of these redox properties remain unclear. Future research, employing unconventional perspectives and methodologies, will reveal new redox pixels of the exercise physiology and sports nutrition picture.

Review of Exercise Interventions to Improve Clinical Outcomes in Nondialysis CKD

Exercise interventions in chronic kidney disease (CKD) have received growing interest, with over 30 meta-analyses published in the past 5 years. The potential benefits of exercise training in CKD range from slowing disease progression to improving comorbidities and quality of life. Nevertheless, there is a lack of large, randomized control trials in diverse populations, particularly regarding exercise in nondialysis-dependent CKD (NDD). When exercise interventions are implemented, they often lack fundamental features of exercise training such as progressive overload, personalization, and specificity. Furthermore, the physiology of exercise and CKD-specific barriers appear poorly understood. This review explores the potential benefits of exercise training in NDD, draws lessons from previous interventions and other fields, and provides several basic tools that may help improve interventions in research and practice.

Sodium bicarbonate improved CrossFit® Benchmark Fran, but not subsequent 500 m rowing performance

The aim of this study was to evaluate the influence of sodium bicarbonate (SB) supplementation on physical performance, neuromuscular and metabolic responses during CrossFit® exercise. Seventeen Advanced CrossFit®-trained athletes completed the randomized, double-blind, placebo-controlled crossover protocol consisting of four visits, including two familiarization sessions and two experimental trials separated by a 7-day washout period. Participants supplemented 0.3 g/kg body mass (BM) of SB or placebo 120-min prior to performing the CrossFit® benchmark Fran followed by 500 m of rowing. SB improved time to complete Fran compared to PLA (291.2 ± 71.1 vs. 303.3 ± 77.8 s, p = 0.047), but not 500 m rowing (112.1 s ± 7.9 vs. 113.2 s ± 8.9 s, p = 0.26). No substantial side-effects were reported during the trials. This study showed that SB improved CrossFit® benchmark Fran performance, but not subsequent 500-m rowing. These data suggest that SB might be an interesting supplementation strategy for CrossFit® athletes.

Short-Term Cocoa Supplementation Influences Microbiota Composition and Serum Markers of Lipid Metabolism in Elite Male Soccer Players

OBJECTIVES

Dietary strategies to improve arachidonic acid:eicosapentaenoic acid (AA:EPA) ratios are of interest due to potential reductions in inflammation and oxidative stress following exercise. The aim of this study was to investigate the impact of a novel dietary intervention, that is, the ingestion of 30 g of dark chocolate, on blood lipid profiles and gut microbiota composition in elite male soccer players.

METHODS

Professional male soccer players were randomly assigned to the experimental group (DC) provided with 30 g of dark chocolate or to the control group (WC), provided with 30 g of white chocolate, for 30 days. Before and after intervention, blood, fecal sample, and anthropometry data were collected. For each outcome, two-way repeated-measure analysis of variance was used to identify differences between baseline and endpoint (Week 4), considering treatment (dark chocolate, white chocolate) as intersubjects' factors. Metagenomic analysis was performed following the general guidelines, which relies on the bioBakery computational environment.

RESULTS

DC group showed increased plasma polyphenols (from 154.7 ± 18.6 μg gallic acid equivalents/ml to 185.11 ± 57.6 μg gallic acid equivalents/ml, Δ pre vs. post = +30.41 ± 21.50) and significant improvements in lipid profiles: total cholesterol (Δ -32.47 ± 17.18 mg/dl DC vs. Δ -2.84 ± 6.25 mg/dl WC, Time × Treatment interaction p < .001), triglycerides (Δ -6.32 ± 4.96 mg/dl DC vs. Δ -0.42 ± 6.47 mg/dl WC, Time × Treatment interaction p < .001), low-density lipoprotein (Δ -18.42 ± 17.13 mg/dl vs. Δ -2.05 ± 5.19 mg/dl WC, Time × Treatment interaction p < .001), AA/EPA ratio (Δ -5.26 ± 2.35; -54.1% DC vs. Δ -0.47 ± 0.73, -6.41% WC, Time × Treatment interaction p < .001) compared with WC group. In addition, 4 weeks of intervention showed a significant increase in high-density lipoprotein concentration in DC group (Δ + 3.26 ± 4.49 mg/dl DC vs. Δ -0.79 ± 5.12 mg/dl WC). Microbial communities in the DC group maintained a slightly higher microbial stability over time (exhibiting lower within-subject community dissimilarity).

CONCLUSION

Ingesting 30 g of dark chocolate over 4 weeks positively improved AA:EPA ratio and maintained gut microbial stability. Dark chocolate ingestion represents an effective nutritional strategy to improve blood lipid profiles in professional soccer players. What Are the Findings? Ingesting 30 g of dark chocolate for 4 weeks positively influences blood lipid AA: EPA ratio while maintaining gut microbial stability. What This Study Adds? Dietary intake of specific foods such as dark chocolate represents an alternative strategy to support the health and recovery of elite soccer players. What Impact Might This Have on Clinical Practice in the Future? From a clinical and translational perspective, dark chocolate ingestion positively modulates favorable blood lipid profiles and polyunsaturated fatty acid metabolism while maintaining gut microbial stability. Dark chocolate ingestion may be considered as an effective nutritional strategy in elite sport environments during periods of high-intensity training and congested competitions. Further research is required to determine functional outcomes associated with the observed improvements in blood lipid profiles.

Health-Related Quality of Life in Rugby Athletes: The Role of Dietary Supplements and Their Consumption

This study investigates dietary supplement use among rugby players and their general health, focusing on prevalence and underlying motivations. Involving 92 athletes, it examines the relationship between supplement usage, motivations, and health outcomes using the 36-item Short Form Health Survey and a 24-item ad hoc questionnaire. Findings reveal a high frequency of supplement usage, motivated by desires to enhance performance, appearance, and mood. Significant differences in health-related quality of life are found between users and non-users, particularly in mental health, social functioning, and emotional stability. Motivations like performance enhancement and body shape manipulation were linked to altered health perceptions, indicating the psychosocial impacts of supplementation. This study emphasizes the need to consider the holistic effects of supplements on athlete well-being, advocating for a balanced approach prioritizing both physical and mental health. It calls for increased awareness among athletes, coaches, and sports professionals about the potential risks and benefits of supplement use and the importance of informed decision-making. Additionally, it highlights the need for further research to understand the mechanisms of supplement use and its impact on athlete health, aiming to enhance sports science and promote overall athlete well-being in competitive environments.

Analysis of combinatory effects of free weight resistance training and a high-protein diet on body composition and strength capacity in postmenopausal women - A 12-week randomized controlled trial

BACKGROUND

Menopause has a significant impact on the endocrine system of middle-aged women, resulting in a loss of skeletal muscle mass (SMM), changes in fat mass (FM) and a reduction in strength capacity. Resistance training (RT) and a high-protein diet (HPD) are effective methods for maintaining or increasing SMM. This study aims to determine the effects of HPD and RT on body composition, muscle thickness and strength capacity in postmenopausal women.

METHODS

In total 55 healthy postmenopausal women (age: 58.2 ± 5.6 years, weight 69.1 ± 9.6 kg, height 166.5 ± 6.5 cm) successfully participated in the study. The women were randomly assigned to either group: training + protein (2.5 g/kg fat-free mass (FFM)) (n = 15; TP); only training (n = 12; T); only protein (2.5 g/kg FFM) (n = 14; CP) or control (n = 14; C). TP and T performed RT for 12 weeks with three training sessions and five exercises each. CP and C were prohibited from training during the period. The main parameters analysed for body composition were FFM, SMM, FM, muscle thickness of the M. rectus femoris, M. biceps femoris, M. triceps brachii and M. biceps brachii muscles. Strength was tested using a dynamometer for grip strength and 1-RM in the squat (BBS) and deadlift (DL).

RESULTS

The SMM significantly increased by RT (TP: (Δ+1.4 ± 0.9 kg; p < 0.05; d = 0.4; T: Δ+1.2 ± 1.3kg; p < 0.05; d = 0.3) and FM could be reduced only in T: (Δ-2.4 ± 2.9 kg; p < 0.05; d = 0.3). In muscle thickness a significant increase in the M. biceps brachii in both training groups (TP: (Δ+0.4 ± 0.3 cm; p < 0.05; d = 1.6; T: (Δ+0.3 ± 0.3 cm; p < 0.05; d = 0.9) and in M. biceps femoris only in TP (Δ+0.3 ± 0.4 cm; p < 0.05; d = 0.9) were observed. HPD without training does not affect body composition, A significant increase in grip strength (TP: Δ+4.7 ± 2.4 kg; (p < 0.05; d = 1.5; T: (Δ+3.6 ± 3.0 kg; p < 0.05; d = 0.8), in BBS (TP: (Δ+30.0 ± 14.2 kg; p < 0.05; d = 1.5; T: (Δ+34.0 ± 12.0 kg; p < 0.05; d = 2.4) and in DL (TP: (Δ+20.8 ± 10.3 kg; p < 0.05; d = 1.6; T: (Δ+22.1 ± 7.6 kg; p < 0.05; d = 2.0) was observed in both training groups. The CP also recorded a significant increase in the BBS (Δ+7.5 ± 5.4 kg; p < 0.05; d = 0.4) and in DL (Δ+5.5 ± 7.7 kg; p < 0.05; d = 0.5). No significant differences were detected for TP and T for any of the parameters.

CONCLUSION

The results indicate that RT enhances body composition and strength capacity in postmenopausal women and is a preventive strategy against muscle atrophy. Besides HPD without training has a trivial significant effect on BBS and DL. HPD with RT has no clear additive effect on body composition and strength capacity. Further studies are needed to confirm these observations.

Effects of acute creatine supplementation on cardiac and vascular responses in older men; a randomized controlled trial

BACKGROUND AND AIMS

In the recent years creatine has been shown promising results in patients with neurodegenerative diseases, myopathies and dystrophies. Cardiovascular diseases could be another pathology that can benefit from creatine supplementation, considering the influence on the risk factors associated with the development of cardiovascular diseases including reduction in chronic inflammation, and improved control of hyperglycemia and dyslipidemia The aim of the present study was to investigate the impact of short-term creatine supplementation on cardiac and vascular health in older adults.

METHODS

Males between the ages of 55-80 were randomly assigned to three groups: creatine, placebo and control. Creatine or placebo was provided for 7-day supplementation, at a dose of 20 g/day. Testing was performed at the same time of the day at baseline and on the eighth day. Vascular responses were assessed using an arterial pulse wave velocity equipment, while cardiac assessment was performed using an impedance cardiography device.

RESULTS

The placebo group was older (71.1 ± 8.2 yr) compared to creatine (61.4 ± 5.2 yr) and control (62.5 ± 7.1 yr). Cardio-ankle vascular index improved just in the creatine group (8.7 ± 0.5 to 8.2 ± 0.5, p = 0.03). While the upstroke time of the placebo and control groups did not change after 7 days, the creatine group had a nonsignificant reduction, 178.9 ± 26.5 ms to 158.4 ± 28.6 ms, p = 0.07. Similar tendency was seen with the systolic blood pressures, while the placebo and control did not change, the creatine group showed nonsignificant improvement, especially on the right, 144.0 ± 12.7 mmHg to 136.1 ± 13.4 mmHg, p = 0.08. All three groups had similar responses in stroke volume (p = 0.61), contractility index (p = 0.64) and ejection fraction (p = 0.72).

CONCLUSIONS

In older adults, acute creatine supplementation can positively affect vascular parameters of arterial stiffness and atherosclerosis. Creatine supplementation has the potential to serve as a potent adjuvant in the management of CVD for older adults.

CLINICAL TRIAL REGISTRATION

clinicaltrials.gov; ID: NCT05329480.

2024 HRS expert consensus statement on arrhythmias in the athlete: Evaluation, treatment, and return to play

Youth and adult participation in sports continues to increase, and athletes may be diagnosed with potentially arrhythmogenic cardiac conditions. This international multidisciplinary document is intended to guide electrophysiologists, sports cardiologists, and associated health care team members in the diagnosis, treatment, and management of arrhythmic conditions in the athlete with the goal of facilitating return to sport and avoiding the harm caused by restriction. Expert, disease-specific risk assessment in the context of athlete symptoms and diagnoses is emphasized throughout the document. After appropriate risk assessment, management of arrhythmias geared toward return to play when possible is addressed. Other topics include shared decision-making and emergency action planning. The goal of this document is to provide evidence-based recommendations impacting all areas in the care of athletes with arrhythmic conditions. Areas in need of further study are also discussed.

Neither an Individualised Nor a Standardised Sodium Bicarbonate Strategy Improved Performance in High-Intensity Repeated Swimming, or a Subsequent 200 m Swimming Time Trial in Highly Trained Female Swimmers

Inconsistent swimming performances are often observed following sodium bicarbonate (NaHCO3) ingestion, possibly because the time taken to reach peak blood buffering capacity is highly variable between individuals. Personalising NaHCO3 ingestion based on time-to-peak blood bicarbonate (HCO3-) could be a solution; however, this strategy is yet to be explored in swimming, or adequately compared to standardised NaHCO3 approaches. Therefore, six highly trained female swimmers ingested 0.3 g·kg BM-1 NaHCO3 in capsules to pre-determine their individual time-to-peak blood HCO3-. They then participated in three experimental trials, consisting of a 6 × 75 m repeated sprint swimming test, followed by a 200 m maximal time trial effort after 30 min active recovery. These experiments were conducted consuming a supplement at three different timings: individualised NaHCO3 (IND: 105-195 min pre-exercise); standardised NaHCO3 (STND: 150 min pre-exercise); and placebo (PLA: 90 min pre-exercise). Both NaHCO3 strategies produced similar increases in blood HCO3- prior to exercise (IND: +6.8 vs. STND: +6.1 mmol·L-1, p < 0.05 vs. PLA) and fully recovered blood HCO3- during active recovery (IND: +6.0 vs. STND: +6.3 mmol·L-1 vs. PLA, p < 0.05). However, there were no improvements in the mean 75 m swimming time (IND: 48.2 ± 4.8 vs. STND: 48.9 ± 5.8 vs. PLA: 49.1 ± 5.1 s, p = 0.302) nor 200 m maximal swimming (IND: 133.6 ± 5.0 vs. STND: 133.6 ± 4.7 vs. PLA: 133.3 ± 4.4 s, p = 0.746). Regardless of the ingestion strategy, NaHCO3 does not appear to improve exercise performance in highly trained female swimmers.

Global hotspots and trends of nutritional supplements in sport and exercise from 2000 to 2024: a bibliometric analysis

BACKGROUND

Nutritional supplements for sports and exercise (NSSE) can facilitate the exogenous replenishment of the body. This study provides the first extensive overview of NSSE research through bibliometric and visual analyses.

METHODS

We searched the Web of Science Core Collection database for literature related to "NSSE" from 1st January 2000 to 8th March 2024. A total of 1744 articles were included. CiteSpace, VOSviewer, and Bibliometrix R package software were used to analyze the data.

RESULTS

Research in the NSSE can be divided into steady growth, exponential growth, fluctuating stage, and surge stages. The United States is the most active country in this field. In recent years, the leading countries have been Croatia, Colombia, Slovenia, Chile, Egypt, China, and Thailand. The Australian Institute of Sports is the top research institution in terms of number of publications. Burke, LM from Australia published the most articles. Research in this area has primarily been published in Nutrients in Switzerland. The study population mainly consisted of men, and postmenopausal women were the main focus of the female group. Coronary heart and cardiovascular diseases continue to dominate research.

CONCLUSION

Research on the NSSE is developing rapidly, with an annual growth trend. Insulin resistance, sports nutrition, inflammation, alpha-linolenic acid, limb strength performance, female sex, and gut microbiota are the focus of the current research and trends for future research. Future research should focus on improving the scientific training system for athletes and quality of training and life for the general public.

IOC consensus statement on elite youth athletes competing at the Olympic Games: essentials to a healthy, safe and sustainable paradigm

With the pronounced ongoing growth of global youth sports, opportunities for and participation of youth athletes on the world sports stage, including the Olympic Games, are expected to escalate. Yet, adolescence is a vulnerable period of development and inherently dynamic, with non-linear and asynchronous progression of physical, physiological, psychological and social attributes. These non-concurrent changes within and between individuals are accompanied by irregular and unpredictable threats and impediments. Likewise, the evident age-based criteria and conventional path for those youth athletes deemed eligible candidates for the Olympic Games are not well or consistently defined. Furthermore, the unstructured and largely varying policies and practices across the sporting International Federations specific to youth participation underscore the need to establish a contemporary universal paradigm that would enable elite youth athletes to navigate an individualised healthy pathway to personal, athletic and sport success. First, we reviewed and summarised key challenges facing elite youth athletes and the relevant evidence fundamental to facilitating and supporting central aspects of health and well-being, while empowering safe, sustainable and positive engagement during athletic and personal advancement and competition. Second, we developed and present a modern elite youth athlete model that emphasises a child-centred, practical framework with corresponding guidelines and recommendations to protect health and well-being while safely and favourably managing international sport competition. Our proposed evidence-informed paradigm will enable and support individualised pathways for healthy, well-rounded and sustainable positive engagement while achieving sport success for youth contending or aiming to compete at world-class international sporting events.

Effect of high-dose β-Alanine supplementation on uphill cycling performance in World Tour cyclists: A randomised controlled trial

Scientists and coaches seek effective ergogenic aids for performance improvement. Cyclists commonly use β-Alanine, which may enhance post-exercise recovery and physical performance. High-dose β-Alanine supplementation's impact on World Tour cyclists during a 7-day camp remains unstudied. This study aimed to analyse the effect of a high dose of β-alanine in World Tour cyclist during a 7-day camp. A double-blinded, randomised controlled trial was conducted. 11 cyclists were included in the final analysis: β-alanine supplementation (n = 5; VO2max: 67.6±1.6 ml/kg/min) and a placebo group (n = 6; VO2max: 68.0±2.4 ml/kg/min). The duration of the supplementation protocol was seven days with four daily intakes. The subjects commenced supplementation after the physical tests (immediately following the snack) and consumed the final intake after breakfast on the day of the final test (a total of 7 days and 3 additional doses, 31 servings in total; 5g per dosage; 155g the total cumulative amount). Before and after seven days of supplementation, the cyclists performed an uphill time trial. Blood lactate, heart rate and rating of perceived exertion were measured during test. β-alanine supplementation improved the relative mean power attained during the time-trial compared with the control group (Z = -2.008; p = 0.045; Δ = 0.060), as well as the time needed to complete this trial (Z = -2.373; p = 0.018). As for physiological and metabolic variables, no significant change was found. In conclusion, the present study supports the effectiveness of one-week high dose of β-alanine during a cycling training in World Tour cyclists to improve their uphill time-trial performance. In addition, it is important to highlight the potential role of β-alanine in improving recovery power. This aspect is particularly relevant in the context of a training camp, where fatigue levels can increase alongside training intensity. Trial registration: This study was registered in ClinicalTrials.gov: (identifier: NCT04427319).

6'-Sialyllactose Alleviates Muscle Fatigue through Reduced Blood Lactate Level after Treadmill Exercise in Mice

6'-Sialyllactose (6'-SL), found in human breast milk, exhibits anti-inflammatory, immune function-enhancing, brain development-promoting, and gut health-improving effects. However, its effects on muscle fatigue remain unknown. Here, we aimed to investigate the effects of 6'-SL on blood lactate level, muscle fiber type, and oxidative phosphorylation protein complexes (OXPHOS) in muscle after exercise using C57BL/6J male mice. C57BL/6J mice were randomly assigned to control or 100 mg/kg 6'-SL. After 12 weeks of 6'-SL administration, the mice were made to perform treadmill exercise; their blood lactate and glucose levels were measured at the basal level (rest) and 0, 5, and 10 min after treadmill exercise. Results showed that 6'-SL treatment in C57BL/6J mice significantly reduced blood lactate level and improved blood glucose level. Moreover, 6'-SL increased the expression of slow-myosin heavy chain (MHC) and OXPHOS in gastrocnemius muscle. In addition, 6'-SL treatment for 12 weeks did not affect food intake, serum biomarkers of tissue injury, and lipid profiles compared with those of the controls. These findings indicate that non-toxic 6'-SL suppressed muscle fatigue during exercise by promoting protein expression of muscle fibers, especially slow-twitch muscle fibers characterized by abundant OXPHOS complexes and decreased blood lactate level. This study suggests that 6'-SL holds promise as a nutritional supplement in exercise and clinical settings, subject to further validation.

Nitrate: "the source makes the poison"

Interest in the role of dietary nitrate in human health and disease has grown exponentially in recent years. However, consensus is yet to be reached as to whether consuming nitrate from various food sources is beneficial or harmful to health. Global authorities continue to recommend an acceptable daily intake (ADI) of nitrate of 3.7 mg/kg-bw/day due to concerns over its carcinogenicity. This is despite evidence showing that nitrate consumption from vegetable sources, exceeding the ADI, is associated with decreased cancer prevalence and improvements in cardiovascular, oral, metabolic and neurocognitive health. This review examines the paradox between dietary nitrate and health and disease and highlights the key role of the dietary source and food matrix in moderating this interaction. We present mechanistic and epidemiological evidence to support the notion that consuming vegetable-derived nitrate promotes a beneficial increase in nitric oxide generation and limits toxic N-nitroso compound formation seen with high intakes of nitrate added during food processing or present in contaminated water. We demonstrate the need for a more pragmatic approach to nitrate-related nutritional research and guidelines. Ultimately, we provide an overview of our knowledge in this field to facilitate the various therapeutic applications of dietary nitrate, whilst maintaining population safety.

Exogenous Lactate Treatment Immediately after Exercise Promotes Glycogen Recovery in Type-II Muscle in Mice

Recent studies suggest that lactate intake has a positive effect on glycogen recovery after exercise. However, it is important to verify the effect of lactate supplementation alone and the timing of glycogen recovery. Therefore, in this study, we aimed to examine the effect of lactate supplementation immediately after exercise on glycogen recovery in mice liver and skeletal muscle at 1, 3, and 5 h after exercise. Mice were randomly divided into the sedentary, exercise-only, lactate, and saline-treated groups. mRNA expression and activation of glycogen synthesis and lactate transport-related factors in the liver and skeletal muscle were assessed using real-time polymerase chain reaction. Skeletal muscle glycogen concentration showed an increasing trend in the lactate group compared with that in the control group at 3 and 5 h after post-supplementation. Additionally, exogenous lactate supplementation significantly increased the expression of core glycogen synthesis enzymes, lactate transporters, and pyruvate dehydrogenase E1 alpha 1 in the skeletal muscles. Conversely, glycogen synthesis, lactate transport, and glycogen oxidation to acetyl-CoA were not significantly affected in the liver by exogenous lactate supplementation. Overall, these results suggest that post-exercise lactate supplement enables glycogen synthesis and recovery in skeletal muscles.