Nutrition and Athletic Performance

Effects of short-term pre-competition weight loss on certain physiological parameters and strength change in elite boxers

BACKGROUND

Athletes in certain sports aim to gain an advantage by competing in a lower body mass class instead of competing in their own body mass class. This study aims to reveal certain physiologic and strength changes in elite male boxers who lost body mass rapidly before the competition.

METHODS

30 thirty boxers who were aged between 19-24 years and having a mean age of 7.4 years participated in the study. To evaluate the effect of short-term dietary intake interventions on body composition and muscle strength before the competition, boxers were divided into three groups: control (C), exercise+diet1 (E+D1) and exercise+diet2 (E+D2) groups. The dietary habits of the participants were controlled and they participated in the training program. The data of the study consisted of variables such as body mass, height, regional muscle mass, body fat percentage, biceps and femur bicondylar circumference measurements before the competitions. Isometric strength measurements of knee extensors and flexors and shoulder internal and external rotators were also recorded.

RESULTS

Physiologic parameters such as body mass change, BMI level, body fat percentage and leg muscle ratios of E+D2 were significantly decreased compared to C and E+D1 groups. Furthermore, submaximal and maximal strength production in knee extensors and flexors as well as shoulder internal and external rotators were significantly decreased in E+D2 compared to C and E+D1 groups.

CONCLUSION

The tendency to lose body mass quickly in a short of time may give the desired results in terms of BMI, body mass and fat percentage, but it may cause strength losses in boxers during the competition period.

Changes in the concentration of bone turnover markers in men after maximum intensity exercise

Background

Physical activity is an important factor in modelling the remodelling and metabolism of bone tissue. The aim of the study was to evaluate the changes in indices demonstrating bone turnover in men under the influence of maximum-intensity exercise.

Methods

The study involved 33 men aged 20-25, divided into two groups: experimental (n = 15) and control (n = 18). People training medium- and long-distance running were assigned to the experimental group, and non-training individuals to the control. Selected somatic, physiological and biochemical indices were measured. The level of aerobic fitness was determined using a progressively increasing graded test (treadmill test for subjective fatigue). Blood samples for determinations were taken before the test and 60 minutes after its completion. The concentration of selected bone turnover markers was assessed: bone fraction of alkaline phosphatase (b-ALP), osteoclacin (OC), N-terminal cross-linked telopeptide of the alpha chain of type I collagen (NTx1), N-terminal propeptide of type I progolagen (PINP), osteoprotegerin (OPG). In addition, the concentration of 25(OH)D3 prior to the stress test was determined. Additionally, pre and post exercise, the concentration of lactates in the capillary blood was determined.

Results

When comparing the two groups, significant statistical differences were found for the mean level of: 25(OH)D3 (p = 0.025), b-ALP (p < 0.001), OC (p = 0.004) and PINP (p = 0.029) prior to the test. On the other hand, within individual groups, between the values pre and post the stress test, there were statistically significant differences for the average level of: b-ALP (p < 0.001), NTx1 (p < 0.001), OPG (p = 0.001) and PINP (p = 0.002).

Conclusion

A single-session maximum physical effort can become an effective tool to initiate positive changes in bone turnover markers.

Effects of Hardaliye, a Fermented Grape Drink, on Oxidative Stress, Lipid Profile, and Blood Pressure in Young Soccer Players: A Randomized Controlled Trial

OBJECTIVE

Hardaliye, a traditional fermented grape juice, can prevent imbalances in the antioxidant defense systems of soccer players. Hardaliye is mainly produced through the fermentation of grapes, sour cherry leaves, and mustard seeds and is consumed as a drink. This study was aimed at investigating the effects of hardaliye consumption on oxidative stress parameters, lipid profile, and blood pressure in young elite soccer players.

METHODS

In this single-blind, randomized, placebo-controlled, parallel-design study, while the participants in one of the groups consumed 250 mL/d of hardaliye drink (Hardaliye Group), the participants in the other group consumed placebo drink (Placebo Group) for 28 days. Three-day food record and blood samples were taken from the soccer players and their blood pressure was measured.

RESULTS

Nutrient intakes in both groups were similar at the beginning and end of the study (p > 0.05). Dietary carbohydrates and vitamin A, E, and C intakes were below the recommended levels in both groups. Hardaliye consumption significantly increased the serum total antioxidant capacity level but significantly decreased serum total oxidation status, oxidative stress index, malondialdehyde, and nitric oxide levels compared to the Placebo Group (p < 0.05). Lipid parameters and diastolic blood pressure levels were not significantly different between the groups (p > 0.05). Hardaliye consumption significantly decreased systolic blood pressure compared to that in the Placebo Group (p < 0.05).

CONCLUSION

Hardaliye consumption in young elite soccer players showed antioxidative effects and decreased systolic blood pressure but did not affect their lipid profiles.

Optimizing Concussion Care Seeking: Connecting Care-Seeking Behaviors and Neurophysiological States Through Blood Biomarkers

BACKGROUND

Timely and appropriate medical care after concussion presents a difficult public health problem. Concussion identification and treatment rely heavily on self-report, but more than half of concussions go unreported or are reported after a delay. If incomplete self-report increases exposure to harm, blood biomarkers may objectively indicate this neurobiological dysfunction.

PURPOSE/HYPOTHESIS

The purpose of this study was to compare postconcussion biomarker levels between individuals with different previous concussion diagnosis statuses and care-seeking statuses. It was hypothesized that individuals with undiagnosed concussions and poorer care seeking would show altered biomarker profiles.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

Blood samples were collected from 287 military academy cadets and collegiate athletes diagnosed with concussion in the Advanced Research Core of the Concussion Assessment, Research and Education Consortium. The authors extracted each participant's self-reported previous concussion diagnosis status (no history, all diagnosed, ≥1 undiagnosed) and whether they had delayed or immediate symptom onset, symptom reporting, and removal from activity after the incident concussion. The authors compared the following blood biomarkers associated with neural injury between previous concussion diagnosis status groups and care-seeking groups: glial fibrillary acidic protein, ubiquitin c-terminal hydrolase-L1 (UCH-L1), neurofilament light chain (NF-L), and tau protein, captured at baseline, 24 to 48 hours, asymptomatic, and 7 days after unrestricted return to activity using tests of parallel profiles.

RESULTS

The undiagnosed previous concussion group (n = 21) had higher levels of NF-L at 24- to 48-hour and asymptomatic time points relative to all diagnosed (n = 72) or no previous concussion (n = 194) groups. For those with delayed removal from activity (n = 127), UCH-L1 was lower at 7 days after return to activity than that for athletes immediately removed from activity (n = 131). No other biomarker differences were observed.

CONCLUSION

Individuals with previous undiagnosed concussions or delayed removal from activity showed some different biomarker levels after concussion and after clinical recovery, despite a lack of baseline differences. This may indicate that poorer care seeking can create neurobiological differences in the concussed brain.

Effect of a plant-based diet on oxidative stress biomarkers in male footballers

Proper nutrition plays a vital role in modulating oxidative status. There is an increasing popularity of plant-based dietary patterns among athletes. Therefore, the present study aimed to determine the plant-based diet index (PDI) score among male footballers and their non-athlete controls, as well as its relationship with oxidative biomarkers by evaluating the urinary excretion of F2alpha-isoprostane (F2a-IP) and 8-hydroxy-2'-deoxyguanosine (8-OHdG). A group of footballers (n = 45) and a healthy non-athlete group (n = 45) were selected. The two groups were matched based on body mass index (BMI) and age. The mean (standard deviation (SD)) age of the subjects was 22.88 (2.41) years, and their BMI was 22.08 (1.35) kg/m2. Anthropometric indices were evaluated, and fasting morning urine samples were analyzed to measure oxidative biomarkers. The PDI, unhealthy plant-based diet index (uPDI), and healthy plant-based diet index (hPDI) were calculated using valid food frequency questionnaire data. Generalized estimating equation models were used for all analyses. Compared to the non-athlete group, the PDI score was significantly greater in the footballer group (β = 9.8; P < 0.001), while the differences between the two groups in uPDI and hPDI scores were not significant. Overall, footballers consumed more plant-based foods. By examining the relationship between dietary indices and oxidative biomarkers, only a negative association was observed between PDI score and F2a-IP level (β = -1.25; P = 0.03). Based on the results, footballers were more adherent to a plant-based diet than non-athletes. In addition, it seems that following plant-based diets (the higher PDI) may exert beneficial effects on lowering F2a-IP levels due to improving the body's antioxidant status.

Nutritional knowledge, attitude, and practice of professional athletes in an Iranian population (a cross-sectional study)

BACKGROUND

Proper nutrition is vital in promoting community health, yet insufficient knowledge and improper dietary practices can lead to deficiencies and diseases. Professional athletes depend on optimal nutrition for their performance and recovery, but a lack of understanding can impede their potential. The nutritional status of athletes impacts their overall health and sports performance. Inadequate sports nutrition knowledge may result in suboptimal practices, reducing strength, power, endurance, and immunity. Additionally, disordered attitudes can lead to dietary imbalances and an increased risk of injury. This study, conducted in Qazvin, Iran, examined athletes' nutritional knowledge, attitudes, and practices. By addressing these factors, there is potential to enhance dietary behaviors and ultimately improve athletes' performance.

METHODS

The study employed a descriptive-analytical, cross-sectional design to investigate the nutritional knowledge, attitude, and practice (KAP) of professional athletes in Qazvin, Iran. A total of 320 purposefully selected professional athletes (68.13% male, 31.87% female) from various sports fields participated in the research. The data collection tool consisted of demographic questions and a KAP questionnaire, including 27 nutritional knowledge questions, 16 nutritional attitude questions, and 14 nutritional performance questions. The quota sampling method was used to estimate sample sizes. Data analysis was carried out by SPSS v.26 using one sample t-test, one-way ANOVA, and Pearson's correlation coefficient test.

RESULTS

The results showed that nutritional knowledge (the mean value was 79.594 ± 7.015 - the optimal knowledge level = 84) and attitude (the mean value was 23.347 ± 5.300 - the optimal attitude level = 26) for athletes are low, but their nutritional practice (the mean value was 21.788 ± 3.450 - the optimal performance level = 24) was moderate. Also, professional athletes' nutritional knowledge, attitude, and practice were lower than normal (p < 0.05). Significant positive correlations were among knowledge, attitude, and practice (p < 0.05). However, there were no significant differences in nutritional knowledge, attitude, and practice among the subjects of different age groups, genders, and sports types (p > 0.05).

CONCLUSION

This study showed that the nutritional knowledge, attitude, and practice of professional Iranian athletes in Qazvin province were low; therefore, the implementation of more theoretical and applied nutrition education, such as using knowledge assessment tools and interventions, irrespective of their age, sport's field, and gender, is compelling.

Does Co-Supplementation with Beetroot Juice and Other Nutritional Supplements Positively Impact Sports Performance?: A Systematic Review

In the pursuit of enhanced athletic prowess in different disciplines, athletes constantly look for strategies to increase their physical performance, encompassing technical skills and dietary components, which inevitably, in most cases, include the incorporation of sports supplements. In recent years, there has been an increase in the number of athletes using ergogenic aids. In this context, scientific evidence must play a prominent role in either endorsing or warning against the use of these products, ensuring the preservation of health while promoting the theoretically established positive benefits. In this vein, beetroot juice (BJ) stands out as a key supplement as an ergogenic aid to improve sports performance, given its demonstrated influence on both aerobic and anaerobic exercise. However, despite widespread global demand, there remains a lack of understanding regarding the potential synergistic effects of combining BJ with other supplements. Consequently, our study aims to determine whether the combination of BJ with another nutritional supplement can enhance its beneficial effects and, therefore, optimize physical performance in humans. A comprehensive literature search was conducted in two major databases-Web of Science and PubMed-from 1 January 2018 to 29 January 2023, using specific keywords. After the exclusion criteria, six articles were selected for analysis. Therefore, our study shows that the effectiveness of combining BJ with another supplement mainly depends on the duration of the chronic intervention, which is where the greatest benefits have been observed.

Reference values for body composition and physical fitness of young Brazilian elite soccer players

Objective: a) to verify whether body composition and physical fitness should be analyzed by chronological age and/or maturity stage in young Brazilian soccer players and b) to propose reference values for the evaluation of body composition and physical fitness by maturity stage in elite soccer players. Methods: A descriptive-correlational study was carried out in 206 young Brazilian soccer players (11-16 years old). The sample selection was non-probabilistic by convenience. Weight and standing height were evaluated. Body composition (BC) was assessed by dual X-ray absorptiometry (DXA). BC indicators [(percent fat (%F), Fat-free mass (FFM), Fat mass (FM) and Bone mass (BM)] were extracted. For physical fitness (PF), we applied the Flexibility (cm) sit and reach tests, explosive strength tests [Counter Movement Jump CMJ (cm) and horizontal jump HJ (cm)], speed [Speed 10, 20, 30 and 40 m (seconds)] and Yo-Yo endurance level I test. Percentiles were constructed for BC and PF using the LMS method [L (Lambda; skewness), M (Mu; median) and S (Sigma; coefficient of variation)]. Results: The explanatory power between chronological age (CA) with BC was: FM (R2 = 0.03%), FFM (R 2 = 0.66%) and BM (R 2 = 0.62%), while between maturity status (MS) with BC were: FM (R 2 = 0.04%), FFM (R 2 = 0.71%) and BM (R 2 = 0.66). The explanatory power between the CA with the physical fitness tests ranged from: (R 2 = 0.22-0.62%). While between MS with physical fitness the values ranged from: (R 2 = 0.23-0.64%). Percentiles per MS (P3, P5, P10, P15, P25, P50, P75, P85, P90, P95 and P97) were proposed for both BC and PF. Conclusion: The results of the study have shown that the evaluation of BC and PF of young soccer players should be performed by controlling for MS rather than for CA. The inclusion of a non-invasive method to control MS by means of percentiles during puberty may contribute to the development of retention and exclusion of young soccer players, thus, they may have a better chance of achieving sporting success.

Gastrointestinal cell injury and perceived symptoms after running the Boston Marathon

Gastrointestinal (GI) disturbances are a prevalent cause of marathon related complaints, and in extreme cases can promote life-threatening conditions such as exertional heat stroke. Our aim was to study intestinal cell injury [via intestinal fatty acid binding protein (I-FABP)] and perceived GI distress symptoms among marathon runners. We also examined potential risk factors (e.g., inadequate sleep) that could exacerbate GI disturbances in healthy, trained endurance runners. This was a parallel mixed-methods study design. 2019 Boston Marathon participants were recruited via email and subjects completed surveys before the race describing demographics and training history. Participants completed a GI questionnaire to assess presence and severity of symptoms, a survey regarding risk factors (e.g., recent illness, medications) that could promote GI disturbances, and provided a urine sample at three time points (immediately pre-race, post-race, and 24-h post-race). Due to weather, blood samples were only collected immediately and 24-h post-race. A total of 40 runners (males: n = 19, age = 44.9 ± 10.8 years; females: n = 21, age = 44.8 ± 10.6 years) completed this study. I-FABP significantly decreased from post-race (3367.5 ± 2633.5 pg/mL) to 24-h post-race (1657.3 ± 950.7 pg/mL, t (39) = -4.228, p < .001, d = -.669). There was a significant difference in overall GI symptom scores across the three time points (F (2, 39) = 41.37, p < .001). The highest average score occurred post-race (.84 ± .68), compared to pre-race (.09 ± .12) and 24-h post-race (.44 ± .28). Post-race I-FABP (r = .31, p = .048) and post-race urine specific gravity (r = .33, p = .041) were significantly correlated with post-race GI symptom scores. Our study provides further support to the individualized nature of GI disturbances, with participants experiencing a wide range of risk factors that can influence the extent of GI damage and perceived symptoms during and after exercise.

Motivational Profile as a Predictor of Physical Activity Among US Adults During the Early Months of the COVID-19 Pandemic: A Daily Diary Study

This study used a daily diary approach to examine associations between day-level physical activity (PA) behavior, PA-specific motivational profile, and days since the COVID-19 national emergency declaration during the early months (April-June 2020) of the pandemic. A total of 468 US adults (Mage = 34.8 y, 79% female) participated in a 28-day smartphone-based daily diary study assessing PA. A baseline survey assessed PA and motivation for PA using the Behavioral Regulation in Exercise Questionnaire. Multilevel linear regression models examined the main effects and interactions of motivational profile and time (days since the US March 13, 2020, COVID-19 national emergency declaration) on daily PA minutes. Latent profile analysis identified 4 distinct motivational profiles for PA among this sample: profile 1: high amotivation (n = 100, 21%); profile 2: low controlled motivation (n = 55, 12%); profile 3: high external regulation (n = 47, 10%); and profile 4: moderate autonomous motivation (n = 266, 57%). After controlling for baseline PA, there were significant interactions between profile and time on daily PA (-0.21, P < .01). Profile 2 showed greater decreases in daily PA minutes over time than profile 1 (b = -0.29, P < .01). Profiles 3 and 4 did not indicate significant decreases in PA compared with profile 1 (b = 0.14, P = .31 and b = -0.16, P = .05, respectively). Contrary to previous research, individuals with lower controlled or moderate autonomous motivation demonstrated the largest decreases in PA over time, whereas individuals with higher amotivation or external regulation demonstrated smaller decreases over time. These findings suggest that external motivation may have provided short-term protection against declines in PA observed during early months of the COVID-19 pandemic.

Dietary assessment of 101 para-athletes from team and individual sports

Assessing the usual food intake of para-athletes enables knowledge and description of nutrient intakes, providing insight into the potential nutritional status of para-athletes and may help tailor dietary intake to their specific training needs. This study aimed to evaluate the usual intake of macronutrients and food groups and meal food patterns of athletes with a disability. We also compared dietary intake data between team and individual sport para-athletes. One hundred and one athletes with a disability from 13 Paralympic disciplines living in Brasília, Federal District, Brazil were included. Food intake was estimated from two or four non-consecutive 24-h food recalls in which para-athletes reported all food, beverages, and supplements consumed in the previous 24-h. Dietary intake analysis was performed by implementing the National Cancer Institute (NCI) method to calculate the macronutrient and food group usual intake. Macronutrient intakes were compared to Acceptable Macronutrient Distribution Ranges for the general population and food group intakes were compared to the 2008 Brazilian National Dietary Guidelines. Para-athletes consumed a low-carbohydrate, adequate protein, high-fat diet. There was no significant difference in macronutrient intake distribution between team sport and individual sport para-athletes. Most para-athletes had three main meals during the day. The prevalence of inadequate fruit servings in the middle and highest energy intake tertiles was significantly higher in team sport para-athletes (92.5% and 98.4%) than in individual sport para-athletes (90.8% and 65.5%), respectively. The prevalence of inadequate vegetable servings was significantly higher between team and individual para-athletes for the middle energy intake tertiles. Para-athletes generally consumed an imbalanced diet, which is a cause for concern given their additional physiological demands and specific training needs.

Performance-related physiological changes induced by one year of endurance training in young athletes

Introduction

Although maximal oxygen uptake (VO₂max) is generally recognized as the single best indicator of aerobic fitness in youth, interpretation of this parameter and the extent to which it can be improved by training remain controversial, as does the relative importance of VO₂max for performance in comparison to other factors such as power production. Here, we examined the influence of endurance training on the VO₂max, muscle power and sports-related performance of cross-country skiers attending a school specializing in sports, as well as potential relationships between any changes observed to one another and/or to perceived stress scale (Cohen) and certain blood parameters.

Methods

On two separate occasions, prior to the competition season and separated by one year of endurance training, the 12 participants (5 males, 7 females, 17 ± 1 years) carried out tests for VO₂max on a treadmill, explosive power utilizing countermovement jumps (CMJ) and ski-specific maximal double pole performance (DPP) employing roller skis on a treadmill. Blood levels of ferritin (Fer), vitamin D (VitD) and hemoglobin (Hg) were monitored, and stress assessed with a questionnaire.

Results

DPP improved by 10 ± 8% (P < 0.001), but no other significant changes were observed. There were no significant correlations between the changes in DPP and any other variable.

Discussion

Whereas one year of endurance training improved the cross-country ski-specific performance of young athletes significantly, the increase in their maximal oxygen uptake was minimal. Since DPP was not correlated with VO₂max, jumping power or the levels of certain blood parameters, the improvement observed probably reflected better upper-body performance.

α-Ketoglutarate stimulates cell growth through the improvement of glucose and glutamine metabolism in C2C12 cell culture

Introduction

Cellular adaptation to physical training and energy metabolism play an important role during physical exercise. This study sought to investigate the effects of α-KG on cell growth and energy metabolism in C2C12 cell culture.

Methods

C2C12 cells were cultured in media pretreated without (control) or with α-KG at different concentrations, and cells and media were harvested every 24 h for 8 days. From cell counts, specific cell growth rate (SGR) and doubling time were calculated. The content of glucose, glutamine, lactate, and ammonia in media was determined, and the specific consumption rate (SCR) or production rate (SPR) was calculated. Additionally, cell colony-forming efficiency (CFE) was determined.

Results

The control cells showed a CFE at 50%, a typical cell growth curve in the first 5 days with a mean SGR at 0.86/day, and a mean cell count doubling time at 19.4 h. In the group with α-KG at 100 mM, the cells underwent rapid cell death, and thus no further analysis was made. The treatment with α-KG at lower concentrations (0.1 mM and 1.0 mM) led to a higher CFE at 68 and 55%, respectively, whereas those in groups with higher α-KG concentration decreased (10 and 6% for 20 mM and 30 mM α-KG, respectively). The mean SGR was 0.95/day, 0.94/day, 0.77/day, 0.71/day, and 0.65/day for groups treated with α-KG at 0.1, 1.0, 10.0, 20.0, and 30.0 mM, respectively, and the corresponding cell count doubling time was 17.6, 17.8, 20.9, 24.6, and 24.7 h, respectively. In comparison with that of the control group, the mean glucose SCR decreased in all the groups treated with α-KG, while the mean glutamine SCR remained unchanged; the mean lactate SPR increased in the groups treated with α-KG ≥ 20.0 mM. Finally, the mean SPR of ammonia was lower in all α-KG groups than that in the control.

Discussion and conclusion

The treatment with α-KG at lower concentrations increased cell growth whereas at higher concentrations decreased cell growth, and α-KG reduced glucose consumption and ammonia production. Therefore, α-KG stimulates cell growth in a dose-dependent manner, which is likely through the improvement of glucose and glutamine metabolism in a C2C12 culture setting.

Enzymatically modified isoquercitrin in soy protein temporarily enhanced the plasma amino-acid concentrations, antioxidant index, and plasma hormone levels: a randomized, double-blind cross-over trial

This study investigated the effects of a dietary protein supplement containing enzymatically modified isoquercitrin (EMIQ) on plasma amino-acid levels in healthy people. A randomized double-blind cross-over trial (UMIN000044791) was conducted with a sample of nine healthy individuals. These participants ingested soy protein with or without 42 mg EMIQ for 7 days after performing mild exercise. Plasma amino-acid levels were measured before ingestion and at 15, 30, 45, 60, 90, 120, 180, and 240 min after ingestion on the last day. The concentrations of total amino acids at 0 and 120 min and easily oxidized amino acids at 120 min were significantly higher in the plasma of individuals who consumed 42 mg EMIQ. Oxidative stress levels were lower and plasma testosterone levels were higher in participants who ingested soy protein with 42 mg EMIQ than in those who did not. These results suggest that daily ingestion of soy protein with 42 mg EMIQ can be useful for effective protein absorption.

A Review of the Health-Promoting Properties of Spirulina with a Focus on athletes' Performance and Recovery

Spirulina species are photosynthetic and filamentous bacteria, commonly called 'blue-green microalgae'. Spirulina has a high nutrient content. It contains 60-70% protein with all essential amino acids present, and is rich in several vitamins, minerals, and bioactive compounds. Spirulina is also rich in essential fatty acids, and antioxidants. This rich nutritional content provides to Spirulina several health benefits including antioxidant, anti-inflammatory, immunomodulation, and insulin-sensitizing properties as well as positive effects in various diseases which could be also interesting for athletes. This paper mainly aims to review the interest and effects of Spirulina supplementation in athletes at rest, and in relation to exercise/training. Spirulina's biochemical composition, health properties/effects in humans, and effects in athletes including nutritional status, body composition, physical performance and intense exercise-related disorders were discussed in this review. Literature data showed that Spirulina seems to have positive effects on body composition especially in overweight and obese subjects which could not be the case in other pathologies and athletes. Spirulina appears to be also effective in improving aerobic fitness especially in untrained and moderately trained subjects. Results reported in the literature suggest that Spirulina may improve strength and power performance despite the minor or no significant effects in highly trained subjects. Most studies have shown that Spirulina improves antioxidant status, prevents and accelerates the recovery of exercise-induced lipid peroxidation, muscle damage and inflammation in trained and untrained subjects. Taken together, the results from these studies are encouraging and may demonstrate the potential benefits of Spirulina supplementation in athletes despite methodological differences.

Clinical Considerations and Practical Advice for People Living With Type 2 Diabetes Who Undertake Regular Exercise or Aim to Exercise Competitively

This article provides practical tips for advising people with type 2 diabetes on how to engage in regular exercise safely and effectively. Its focus is on individuals who wish to exceed the minimum physical activity recommendation of 150 minutes/week of moderate-intensity exercise or even compete in their chosen sport. Health care professionals who work with such individuals must have a basic understanding of glucose metabolism during exercise, nutritional requirements, blood glucose management, medications, and sport-related considerations. This article reviews three key aspects of individualized care for physically active people with type 2 diabetes: 1) initial medical assessment and pre-exercise screenings, 2) glucose monitoring and nutritional considerations, and 3) the combined glycemic effects of exercise and medications.

Food Provision at the Olympic Games in the New Millennium: A Meta-narrative Review

BACKGROUND AND OBJECTIVE

The objective of this meta-narrative review was to identify, organise and map the literature on food provision and nutrition support at the summer and winter Olympic and Paralympic Games (OPG)  and similar major competition events over the past 21 years. This builds on a comprehensive update of a previous historical review of the evolution of food provision at the summer Olympic Games up until 2000 and considers contemporary issues such as the global pandemic and sustainability goals.

METHODS

A range of sources included primary research and review articles, edited book chapters, theses, conference papers or abstracts, International Olympic Committee reports, Organising Committees' food vision and post-Games reports, independent professional reports, and media and periodicals including magazines and trade journals. The search strategy included four steps: a database search that complied with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews criteria, a search of the Olympic Studies Centre, a review of reference lists for unpublished sources, and a Google search for additional media reports. The researchers followed an iterative process where emerging narratives were discussed, recorded and refined as data were extracted.

RESULTS

The data from 229 records were extracted into a spreadsheet and grouped according to the type of evidence and specific event, then presented chronologically to give a perspective on the development of food provision and nutrition support. Eleven narratives emerged from the data extraction: 'description of meals, menus and food', 'vision of the food provision', 'food safety', 'catering company involvement', 'sponsorship or contracts with food companies', 'athlete perspective', 'stakeholder perspective', 'athlete food intake,' 'nutrition input in food provision', 'food environment' and 'sustainability'.

CONCLUSION

Results suggest that athletes' dining expectations, organising committee budgets, expert input and current global trends have led to food delivery changes. The OPG food environment has the capacity to positively influence the dietary choices of athletes and teams, while evolving to meet contemporary global challenges such as COVID-19 and sustainability targets.

Change to a Plant-Based Diet Has No Effect on Strength Performance in Trained Persons in the First 8 Weeks-A 16-Week Controlled Pilot Study

Over the past few years, the number of people who have avoided animal products has been rising steadily. A plant-based diet is associated with a healthier lifestyle and has positive effects on various diseases. More and more healthy active people and performance-orientated athletes are giving up animal products for various reasons, such as for an improved performance or faster regeneration. However, the data in this context are limited. This study aimed to obtain initial findings on the influence of a diet change to veganism on the performance of strength-trained individuals. For this study, a total of 15 omnivorous individuals were recruited. They documented their dietary food intakes over 16 weeks. Every four weeks, the strength performance was tested via a leg press and bench press. In the first 8 weeks, the participants maintained their omnivorous diet, followed by 8 weeks of a vegan dietary phase. In total, 10 subjects participated successfully, and their data were part of the statistical analyses. There was no difference in the absolute and relative strength performance for the leg and bench press after changing to a vegan diet. For the total calorie intake and carbohydrates, only a small treatment effect, but no time effect, was observed. However, for the protein intake, a time and group effect were detected. In addition, the relative protein intake decreased significantly and was lower than the current recommendations for athletes. The results demonstrate that a change to a vegan diet has no beneficial nor negative effect on the strength performance when the total calorie intake and carbohydrate content are covered in the first 8 weeks.

Nutritional intake of sport undergraduates in Sabaragamuwa University of Sri Lanka

BACKGROUND

Nutritional intake plays an important role in determining energy availability which is vital to health, wellbeing, and sports performance in an active population. This research assessed the sports undergraduates' nutritional intake compared to the Dietary Guidelines for Americans and nutrition goals provided by WHO.

METHODS

This study is a quantitative, cross-sectional descriptive study. One hundred and one (n = 101) sports undergraduates aged between 20 to 23 years were recruited and the nutrient intake was assessed using the three-day food diary method and quantified the macro and micronutrients by the food composition database. One sample t-test was performed to compare the mean nutrient intakes with the lowest recommendation values.

RESULTS

Though most undergraduates were able to meet the dietary requirements in carbohydrates, they were deficient in their protein intake and exceeded in fats intake. Further, both male and female students were deficient in their daily energy intake (1723 kcal, 1607 kcal) and dietary fiber intake (8 g, 11 g). The saturated fat intake was met by all students while 20% of males and 21% of females exceeded the recommendations (< 10%). The micronutrient intake of vitamins such as C, B1, B2, B9, and B12 and minerals such as Calcium, Magnesium, and Potassium, were significantly below the recommendations (p < 0.05) except for vitamin B3 niacin.

CONCLUSIONS

Providing a nutritionally valuable meal is essentially required to maintain both physical and mental fitness. Our results revealed that the Sri Lankan sport science undergraduates do not have an adequate daily dietary intake of energy, proteins, calcium, magnesium, potassium, and vitamins such as C, B1, B2, B9, and B12.

L-Glutamine is better for treatment than prevention in exhaustive exercise

Introduction: Glutamine is known as the richest nonessential amino acid in the human body. The intake of glutamine is not only beneficial to nutrition but also reported to enhance inflammation reducing bioactivity in exercise. Although studies have demonstrated that glutamine is beneficial for exercise, the optimal intake timing remains unclear. This study examined whether the effects of glutamine on tissue damage and physiology differ between intake timings. Methods: Rats were divided into without L-glutamine supplementation (vehicle), with L-glutamine before exhaustive exercise (prevention), and with L-glutamine after exhaustive exercise (treatment) groups. Exhaustive exercise was induced by treadmill running and L-glutamine was given by oral feeding. The exhaustive exercise began at a speed of 10 miles/min and increased in increments of 1 mile/min, to a maximum running speed of 15 miles/min with no incline. The blood samples were collected before exhaustive exercise, 12 h and 24 h after exercise to compare the creatine kinase isozyme MM (CK-MM), red blood cell count and platelet count. The animals were euthanized on 24 h after exercise, and tissue samples were collected for pathological examination and scored the severity of organ injury from 0 to 4. Results: The CK-MM was elevated gradually after exercise in the vehicle group; however, CK-MM was decreased after L-glutamine supplementation in the treatment group. The treatment group had higher red blood cell count and platelet count than the vehicle and prevention group after exercise. In addition, the treatment group had less tissue injury in the cardiac muscles, and kidneys than prevention group. Conclusion: The therapeutic effect of L-glutamine after exhaustive exercise was more effective than preventive before exercise.

Energy and Macronutrients Intake in Indoor Sport Team Athletes: Systematic Review

Indoor team sports are characterized by matches that are shorter in duration and with frequent substitution (high-intensity intermittent). The main goal of teams is to best cover athletes' physiological demands, while meeting their dietary intake needs is critical. The aim of this study is to conduct a systematic review of the dietary intake of indoor team sports athletes and to analyze whether they comply with nutritional recommendations. A search of PubMed-MEDLINE, Web of Science, and Scopus databases from 2008 to July 2022 was conducted and 2727 documents were identified. The studies focused on adult professional or semi-professional volleyball, basketball, handball, or futsal athletes. Two independent researchers screened and extracted the data, with 20 documents included after they met the inclusion criteria. Most of the athletes, both men and women, did not meet the official recommendations based on under-consumption (energy and carbohydrates) or over-consumption (fats). In relation to protein, 28.6% of studies met the recommendations, with 50% of those who did not meet it being due to under-consumption. Although there are references on athletes' dietary intakes, there are no references considering sexes or types of sport. More adapted recommendations are needed in order to more precisely evaluate athletes' intake to know if they meet their real nutritional requirements.

One Long Versus 2 Short Sessions? Physiological and Perceptual Responses to Low-Intensity Training at Self-Selected Speeds in Cross-Country Skiers

PURPOSE

To compare self-selected speeds and corresponding physiological responses and perceived training stress between 1 long session versus 2 shorter sessions of low-intensity training (LIT) in 1 day among cross-country skiers.

METHODS

Thirteen national-level skiers performed 2 different LIT types during classical roller-skiing matched for the same distance in a counterbalanced order. The training consisted of either 1 long (approximately 3 h) session (1LIT) or 2 shorter (approximately 1.5 h each) sessions (2LIT) with 7 hours of recovery in between. Speed, heart rate, rating of perceived exertion, and blood lactate concentrations were measured, and perceived training stress (1-10) was assessed after sessions.

RESULTS

2LIT was performed at mean (SD) 1.9% (2.0%) higher speeds versus 1LIT (P ≤ .01). Higher speeds were also found in the second versus first session of 2LIT and the second versus first part of 1LIT (1.9% [3.2%] and 3.2% [3.6%], respectively, both P ≤ .01). There were no significant differences between LIT types in heart rate, although rating of perceived exertion increased in the second versus first part of 1LIT (0.9 [0.8] point, P ≤ .01). Blood lactate concentration was reduced in the second versus first session/part of both LIT types (approximately 0.16 [0.20] mmol·L-1, P ≤ .05). There were no differences in perceived training stress between LIT types 7 and 23 hours after training, although higher perceived muscular exertion (2.0 [1.1] points, P ≤ .01) was found directly after 1LIT.

CONCLUSIONS

Compared with a distance-matched long session, skiers perform 2LIT at slightly higher self-selected speeds with the same physiological responses elicited, although minor differences in perceived training stress were observed.

Fitness Soccer Athletes Training at the University of Limpopo, South Africa: Are the Macronutrients Intake and Anthropometric Status of These Athletes Optimal?

BACKGROUND

Dietary practices of the University of Limpopo soccer team athletes have been reported. However, the practices of those engaging in soccer for general fitness from different non-competitive teams remain unknown. To respond to this gap, the researchers investigated the energy, macronutrient intake, and BMI status and further correlated the two variables of the fitness non-competitive soccer athletes registered at the University of Limpopo in South Africa.

METHOD

A quantitative study design was undertaken to conveniently sample 60 out of 90 fitness soccer athletes from the four non-competitive soccer teams at the University of Limpopo sports grounds. Ethics approval was obtained from the University of Limpopo Research and Ethics Committee, and permission was given by the university sports management and team coaches. Athletes signed the informed consent form before participating in the study. Data were collected at the soccer fields during the afternoons before the start of training. Macronutrient intake data were collected using multiple (two) 24-h recall questionnaires on different days, which were validated by the food frequency questionnaire. Weight and height were measured using a digital scale (Seca 813 electronic flat scale) and stadiometer (Seca 213 portable stadiometer) for BMI calculations, respectively. The average energy and macronutrient intakes were calculated through the SAMRC FoodFinder software (3.0). The nutrient averages, together with the BMI results, were loaded into SPSS (26.0) for further analysis. Descriptive statistics were used to report the energy, macronutrient intake, and BMI statuses of athletes using percentages, means, and standard deviations (±SD). A one-way ANOVA test was used to determine the association between the latter variables. A p-value of ≤ 0.05 was the criterion used to correlate the variables.

RESULTS

All (100%) athletes were males, most of whom played soccer for 2-3 years while at the university. Almost half (48%) of athletes consumed energy (39.6 kcal/kg) below the recommendations. About 92% and 53% of athletes consumed carbohydrates (5.0 g/kg) and fat (1.2 g/kg) below the recommended values; while 43% consumed protein (1.4 g/kg) optimally. The majority (>80%) had a normal BMI (21.6 ± 2.6 kg/m²) status. However, there were no relationships between the energy (p = 0.383), CHO (p = 0.261), protein (p = 0.543), and fat (p = 0179) intake and the BMI status of athletes.

CONCLUSION

The macronutrient intake of fitness soccer athletes at the University of Limpopo is, on the whole, suboptimal. However, the athletes had normal body weights. There was no association between both the energy and macronutrient intake and the anthropometric (BMI) status of soccer athletes.

Dietary Intake of Recreational Endurance Runners Associated with Race Distance-Results from the NURMI Study (Step 2)

While the popularity of distance running is growing worldwide, endurance runners’ dietary challenges associated with their prolonged training and racing activities have not yet been fully understood. The present investigation was conducted with the aim of examining the association between race distance and dietary intake of distance runners. A total of 317 runners initially participated, and after data clearance, 211 endurance runners (57% females) were finally considered the study sample. Runners were assigned to three race distance groups: 10-km (n = 74), half-marathon (n = 83), and marathon/ultra-marathon (n = 54). An online survey was used to collect data; dietary intake was monitored using a comprehensive food frequency questionnaire, including 53 food groups categorized in 14 basic and three umbrella clusters. There was no significant difference (p > 0.05) between race distance groups in consumption of most food clusters except for “fruits and vegetables” and “total of protein”, with a predominance of 10-km runners compared to half-marathoners and (ultra-)marathoners (p ≤ 0.05). Age was a significant predictor for the consumption of only five (out of 17) food clusters (p ≤ 0.05), including “fruit and vegetables”, “unprocessed meat”, “processed meat”, “eggs”, and “plant protein”. Future investigations with a larger sample size and more differentiated (sub)groups may help provide comparable data to develop a better understanding of the dietary behaviors among shorter versus longer distance runners.

Effects of ergo-nutritional strategies on recovery in combat sports disciplines

Introduction

In order to improve the recovery process in combat sports disciplines, ergo-nutritional strategies could be an effective option in training and competition. Some of these ergo-nutritional aids could improve performance but literature references are scarce, with controversial results regarding actual recovery effects. This systematic review aimed to examine which ergo-nutritional methods are most effective for assisting in the recovery process in combat sports, and to determine the appropriate training stimuli. This systematic review was carried out following the Preferred Reporting Items for Systematic Review (PRISMA) guidelines. A computerized search was performed in PubMed, Web of Science, the Cochrane Collaboration Database, Evidence Database, Evidence Based Medicine Search review, National Guidelines, EM-BASE, Scopus and Google Scholar system (from 1995 to April 30, 2021). The PICOS model was used to define inclusion and exclusion criteria. Out of 123 studies initially found, 18 met the eligibility criteria and were included in the review. Data from 367 athletes from different disciplines were examined. The evidence was grouped in 4 areas: oxidative stress, muscle and energy recovery, muscle repair, and metabolic acidosis. Evidence showed that vitamins, minerals, and some natural ergo-nutritional products are effective as antioxidants. Carbohydrates and protein determine the recovery effect. Sodium bicarbonate has a role as primary acidosis metabolic delayer. Accordingly, ergo-nutritional aids can help in the recovery process. Considering the effects outlined in the literature, more studies are needed to provide firm evidence.

Effect of Different Carbohydrate Intakes within 24 Hours after Glycogen Depletion on Muscle Glycogen Recovery in Japanese Endurance Athletes

Daily muscle glycogen recovery after training is important for athletes. Few studies have reported a continuous change in muscle glycogen for 24 h. We aimed to investigate the changes in carbohydrate intake amount on muscle glycogen recovery for 24 h after exercise using 13C-magnetic resonance spectroscopy (13C-MRS). In this randomized crossover study, eight male participants underwent prolonged high-intensity exercise, and then consumed one of the three carbohydrate meals (5 g/kg body mass (BM)/d, 7 g/kg BM/d, or 10 g/kg BM/d). Glycogen content of thigh muscle was measured using 13C-MRS before, immediately after, and 4 h, 12 h and 24 h after exercise. Muscle glycogen concentration decreased to 29.9 ± 15.9% by exercise. Muscle glycogen recovery 4−12 h after exercise for the 5 g/kg group was significantly lower compared to those for 7 g/kg and 10 g/kg groups (p < 0.05). Muscle glycogen concentration after 24 h recovered to the pre-exercise levels for 7 g/kg and 10 g/kg groups; however, there was a significant difference for the 5 g/kg group (p < 0.05). These results suggest that carbohydrate intake of 5 g/kg BM/d is insufficient for Japanese athletes to recover muscle glycogen stores 24 h after completing a long-term high-intensity exercise.

Effects of Sodium Intake on Health and Performance in Endurance and Ultra-Endurance Sports

The majority of reviews on sports nutrition issues focus on macronutrients, often omitting or paying less attention to substances such as sodium. Through the literature, it is clear that there are no reviews that focus entirely on the effects of sodium and in particular on endurance sports. Sodium intake, both at high and low doses, has been found to be associated with health and performance issues in athletes. Besides, there have been theories that an electrolyte imbalance, specifically sodium, contributes to the development of muscle cramps (EAMC) and hyponatremia (EAH). For this reason, it is necessary to create this systematic review, in order to report extensively on the role of sodium consumption in the population and more specifically in endurance and ultra-endurance athletes, the relationship between the amount consumed and the occurrence of pathological disorders, the usefulness of simultaneous hydration and whether a disturbance of this substance leads to EAH and EAMC. As a method of data collection, this study focused on exploring literature from 2000–2021. The search was conducted through the research engines PubMed and Scopus. In order to reduce the health and performance effects in endurance athletes, simultaneous emphasis should be placed on both sodium and fluid intake.

Maltodextrin-Based Carbohydrate Oral Rinsing and Exercise Performance: Systematic Review and Meta-Analysis

Background

Carbohydrates are an important fuel for optimal exercise performance during moderate- and high-intensity exercise; however, carbohydrate ingestion during high-intensity exercise may cause gastrointestinal upset. A carbohydrate oral rinse is an alternative method to improve exercise performance in moderate- to high-intensity exercise with a duration of 30–75 min. This is the first systematic review and meta-analysis to comprehensively examine the isolated effect of maltodextrin-based rinsing on exercise performance.

Objective

The objective of this review was to establish the effect of a maltodextrin-based carbohydrate oral rinse on exercise performance across various modes of exercise. Furthermore, a secondary objective was to determine the effects of moderators [(1) participant characteristics; (2) oral rinse protocols; (3) exercise protocol (i.e. cycling, running etc.) and (4) fasting] on exercise performance while using a maltodextrin-based, carbohydrate oral rinse.

Methods

Five databases (MEDLINE, PsycINFO, Embase, SPORTDiscus and Global Health) were systematically searched for articles up to March 2021 and screened using Covidence (a systematic review management tool). A random effects robust meta-analysis and subgroup analyses were performed using Stata Statistical Software: Release 16.

Results

Thirty-five articles met the inclusion criteria and were included in the systematic review; 34 of these articles were included in the meta-analysis. When using a conventional meta-analytic approach, overall, a carbohydrate oral rinse improved exercise performance in comparison with a placebo (SMD = 0.15, 95% CI 0.04, 0.27; p = 0.01). Furthermore, when implementing an adjusted, conservative, random effects meta-regression model using robust variance estimation, overall, compared with placebo, a carbohydrate oral rinse demonstrated evidence of improving exercise performance with a small effect size (SMD = 0.17, 95% CI − 0.01, 0.34; p = 0.051).

Conclusion

This systematic review and meta-analysis demonstrates that a maltodextrin-based carbohydrate oral rinse can improve exercise performance. When comparing the two meta-analytic approaches, although non-significant, the more robust, adjusted, random effects meta-regression model demonstrated some evidence of a maltodextrin-based carbohydrate oral rinse improving exercise performance overall.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40279-022-01658-3.

Efficacy of immune-strengthening functional drinks in top-level athletes: a questionnaire survey-based research

PURPOSE

Functional beverages are intended to support those who want to maintain optimal physical condition and improve their quality of life through the enhancement of heart health, immunity, and digestion. The purpose of this study was to investigate the performance of top-level athletes consuming immune-strengthening conditioning nutritional drinks.

METHODS

A total of 107 top-level athletes (baseball (56 players), pro volleyball (17), athletics (16), cycling (8), golf (6), and fencing (6)) participated in the experiment. They consumed an immune-enhancing functional beverage once a day for 8 weeks and responded to a survey before, during, and after drinking the beverage.

RESULTS

Three total aspect-based subfactors were drawn from 24 questions in the factor analysis: physical, satisfaction with mental stability, and activity in performance. The physical, mental stability and performance changes of athletes significantly increased in period 2 (4 weeks after intake) and period 3 (after 8 weeks of intake).

CONCLUSION

We evaluated the efficacy of a new conditioned beverage containing Lactobacillus B240 and protein in improving the performance and physiological utility of top athletes. This functional drink may gain popularity among those seeking health benefits and improved exercise performance.

Sports Nutrition: Diets, Selection Factors, Recommendations

An athlete’s diet is influenced by external and internal factors that can reduce or exacerbate exercise-induced food intolerance/allergy symptoms. This review highlights many factors that influence food choices. However, it is important to remember that these food choices are dynamic, and their effectiveness varies with the time, location, and environmental factors in which the athlete chooses the food. Therefore, before training and competition, athletes should follow the recommendations of physicians and nutritionists. It is important to study and understand the nutritional strategies and trends that athletes use before and during training or competitions. This will identify future clinical trials that can be conducted to identify specific foods that athletes can consume to minimize negative symptoms associated with their consumption and optimize training outcomes.

Gut Microbiota, Microbial Metabolites and Human Physical Performance

Trillions of microbes inhabiting the gut modulate the metabolism of the host. Cross-sectional studies have reported associations between physical performance and the gut microbiota (GM). Physical activity seems to increase GM diversity and the abundance of certain health-beneficial microbes. We reviewed the evidence from longitudinal studies on the connection between physically active lifestyle or long-term exercise interventions and the GM. We made literature searches using databases of Web of Science and PubMed Medline to collect human studies showing or not the associations between the GM and exercise. Many controversies exist in the studies. However, the longitudinal studies show that frequently, medium-intensity endurance exercise has yielded most beneficial effects on the GM, but the results vary depending on the study population and exercise protocol. In addition, the literature shows that certain microbes own the potency to increase physical activity and performance. Generally, a physically active lifestyle and exercise associate with a “healthy” GM. However, in previously sedentary subjects, the exercise-induced improvements in the GM seem to disappear unless the active lifestyle is continued. Unfortunately, several studies are not controlled for the diet. Thus, in the future, more longitudinal studies on the GM and physical performance are needed, with detailed dietary information.

Effectiveness of a lifestyle weight-loss intervention targeting inactive former elite athletes: the Champ4Life randomised controlled trial

OBJECTIVES

Many athletes struggle in managing the end of their career, often gaining weight and adopting unhealthy lifestyles. Lifestyle programmes targeting former athletes who have gained substantial fat mass (FM) postsports career are lacking. We studied the effects of the Champ4Life programme on body composition and other health-related outcomes in former elite athletes with overweight or obesity.

METHODS

Ninety-four former athletes(42.4±7.3 y, 34.0% female) were recruited and randomly assigned to either an intervention group (IG; n=49) or a control group (CG; n=45). The IG attended 12 educational sessions addressing physical activity, weight management and nutrition. They also had a nutrition appointment aimed to prescribe a moderate caloric deficit(~300-500 kcal/day). Dual-energy X-ray absorptiometry was used to assess body composition. The Short-Form Health Survey-36 questionnaire was used to measure general health-related quality of life. Blood samples were collected to assess cardiometabolic health parameters.

RESULTS

At 12 months, the IG lost more weight (estimated difference (ED)=-5.3 kg; -6.9 to -3.8), total FM (ED=-4.1 kg; -5.4 to -2.8) and abdominal FM (ED=-0.49 kg; -0.64 to -0.33) than did the CG (p's<0.001). Cardiometabolic health markers also improved significantly (p<0.05) more in the IG at 12 months (insulin (ED=-4.9 μU/mL;-8.0 to -1.8); homoeostatic model assessment (ED=-1.2; -2.1 to -0.4); total cholesterol (ED=-21.8 mg/dL; -35.4 to -8.2); low-density lipoprotein (ED=18.2 mg/dL;-29.2 to -7.1)), as did quality-of-life dimensions (physical functioning (ED=11.7; 6.5 to 16.9); physical role (ED=17.6; 2.1 to 33.0); general health (ED=19.4; 11.4 to 27.4); vitality (ED=13.3; 5.3 to 21.3) and mental health (ED=12.3; 4.1 to 20.6)).

CONCLUSIONS

The Champ4Life programme was effective in substantially reducing total and abdominal FM while preserving fat-free mass and improving health-related markers. These findings will enable evidence-based decisions when implementing lifestyle interventions targeting retired elite athletes.

TRIAL REGISTERATION NUMBER

NCT03031951.

Dietary Intake and Daily Distribution of Carbohydrate, Protein and Fat in Youth Tennis Players over a 7-Day Training and Competition Period

During a 7-day training and/or competition period, macronutrient intake and distribution was assessed using food diaries, supported by remote food photography and 24-hr multiple pass recalls of youth tennis players categorised by under 12s, under 14s and under 16+ age groups (n = 27). Total energy did not differ between age groups nor type of day (training [TD], competition day [CD]), irrespective of a significant increase in body mass reported in the older players (U16+; p < 0.05). Average intakes were consistently below 2250 kcal·day-1 (range 1965 ± 317-2232 ± 612 kcal·day-1). Carbohydrate consumption was below guidelines for all groups (≤6g·kg-1). Conversely, protein intake met or exceeded guidelines throughout, with intakes ≥2 g·kg-1 for both the U12 and U14 age groups on both days. Protein intake was ~17% higher on TDs than CDs (p < 0.05), with protein intake at lunch significantly higher on TDs than CDs (p < 0.05). No further differences were observed between breakfast, lunch or dinner between group or day. Inconsistent snacking was reported, with players consuming snacks on less than half of the days reported (46 ± 12% of TDs and 43 ± 30% of CDs). In conclusion, youth tennis players present sub-optimal nutrition practices, appearing to under fuel and under consume carbohydrate for performance, adaptation, recovery and health.

Continuous Protein Supplementation Reduces Acute Exercise-Induced Stress Markers in Athletes Performing Marathon

The aim of this study was to determine the changes in endurance performance and metabolic, hormonal, and inflammatory markers induced by endurance stress (marathon race) in a combined strategy of training and dietary protein supplementation. The study was designed as a randomised controlled trial consisting of regular endurance training without and with a daily intake of a soy protein-based supplement over a three-month period in 2 × 15 (10 males and 5 females per group) endurance-trained adults. Body composition (body mass, BMI, and fat mass) was determined, and physical fitness was measured by treadmill ergometry at baseline and after 3 months of intervention; changes in exercise-induced stress and inflammatory markers (CK, myoglobin, interleukin-6, cortisol, and leukocytes) were also determined before and after a marathon competition; eating behaviour was documented before and after intervention by a three-day diet diary. Although no significant influence on endurance performance was observed, the protein supplementation regime reduced the exercise-induced muscle stress response. Furthermore, a protein intake of ≥20% of total energy intake led to a lower-level stress reaction after the marathon race. In conclusion, supplementary protein intake may influence exercise-induced muscle stress reactions by changing cellular metabolism and inflammatory pathways.

Hydration Status in Adolescent Alpine Skiers During a Training Camp

Maintaining euhydration is important for optimal health, performance and recovery, but can be challenging for alpine skiers when training in a relatively cold but dry environment. This study aimed to evaluate hydration status, fluid loss and fluid intake in adolescent alpine skiers during a training camp. Twelve athletes aged 14.3 ± 0.9 years volunteered to participate in the study. Athletes resided at an altitude of 1600 m and trained between 1614 and 2164 m. During eight consecutive days, urine specific gravity was measured before each morning training session using a refractometer. Changes in body weight representing fluid loss and ad libitum fluid intake during each morning training session were assessed using a precision scale. Mean pre-training urine specific gravity remained stable throughout the training camp. Individual values ranged between 1.010 and 1.028 g/cm³with 50 to 83% of athletes in a hypohydrated state (urine specific gravity ≥ 1.020 g/cm³). Mean training induced fluid loss remained stable throughout the training camp (range -420 to -587 g) with individual losses up to 1197 g (-3.5%). Fluid intake was significantly lower than fluid loss during each training session. To conclude, urine specific gravity values before training indicated insufficient daily fluid intake in more than half of the athletes. Furthermore, fluid intake during training in adolescent alpine skiers was suboptimal even when drinks were provided ad libitum. Coaches and athletes should be encouraged to carefully monitor hydration status and to ensure that alpine skiers drink sufficiently during and in between training sessions.

The Effect of Polarized Training on the Athletic Performance of Male and Female Cross-Country Skiers during the General Preparation Period

This study aimed to analyze the effect of 12 weeks of polarized training on body composition, cardiorespiratory function, and upper-body power of male and female cross-country skiers during the general preparation period. A total of 16 national cross-country skiers (8 male and 8 female; 8 national cross-country skiers and 8 national biathlon athletes) participated. Polarization training was conducted for 12 weeks from May to July in 2019 during the general preparation period for cross-country skiers. The low-weight, high-repetition method was used for strength training. The effect of the polarized training on body composition, maximum oxygen intake (VO₂max), respiratory exchange rate, all-out time, and ski ergometer exercise time was assessed. There was no change in weight, BMI, and muscle mass in male and female cross-country skiers following the 12 weeks of polarized training (p > 0.05). Male body fat percentage (pre 18.1%, post 12.7%) and female body fat percentage (pre 29.1%, post 21.4%) showed a significant decrease (p < 0.05). After training, VO₂max increased by 7.72% in male athletes (pre 71.05 mL/kg/min, post 77.0 mL/kg/min) and 6.32% in female athletes (pre 60.26 mL/kg/min, post 64.33 mL/kg/min). Treadmill exercise time increased by 5.39% for male athletes (pre 1038 s, post 1064 s) and 2.23% for female athletes (pre 855 s, post 874 s). However, there was no significant difference between male and female athletes (p > 0.05). The 50% recovery time from the maximum heart rate to the target heart rate decreased by 64.52% in males (pre 168.8 s, post 102.6 s) and 6.48% in females (pre 135 s, post 129.6 s). Significant differences were found only in male athletes (p < 0.05). The double-pole 500 m exercise duration for the ski ergometer significantly decreased after the training for both sexes (p < 0.05). In this study, the 12 weeks of polarized training improved the body composition and athletic performance of all cross-country skiers. Interestingly, in this study, we confirmed that polarized training had a better effect on cardiorespiratory function in male cross-country skiers than in female cross-country skiers. Conversely, we found that the outcomes of the ski ergometer exercise factors were more effective in female athletes than in male athletes. Therefore, we insist that when applying a polarized training program to athletes, it should be planned in detail by sex, exercise amount, intensity, and type of training.

Food Choice Decisions of Collegiate Division I Athletes: A Qualitative Exploratory Study

Limited research has examined athletes’ food and health beliefs and decisions and the congruence of these decisions with recommendations from nutrition professionals. This study aimed to improve understanding of athletes’ food-related beliefs and practices to enable nutrition professionals to more effectively enhance performance while protecting athletes’ health. Division I college athletes (n = 14, 64% female) from a variety of sports were recruited to participate in 20-min semi-structured phone interviews about food and nutrition-related behaviors and cognitions. Data were content analyzed to identify themes and trends. Prominent factors influencing athletes’ food choices were potential benefits to health and performance, availability of foods, and recommendations from sports dietitians. Foods commonly consumed by athletes, including fruits, vegetables, and lean protein, were generally healthy and aligned with sports nutrition recommendations. Athletes avoided energy-dense nutrient-poor foods, such as fast food and fried foods, with the goal of improving performance. Some athletes took supplements (i.e., multivitamin, iron, protein) on the premise that they would improve health and enhance performance or recovery. While athletes’ nutrition behaviors are generally congruent with current recommendations, findings highlighted misconceptions held by athletes related to the benefits of some supplements and the belief that packaged/processed foods were inherently less healthy than other options. Nutrition misconceptions held by athletes and incongruities between athletes’ nutrition knowledge and behaviors suggest that dietitians should aim to dispel misconceptions held by athletes and provide additional guidance and information to support athletes’ current healthful behaviors to ensure these behaviors extend beyond their college athletic career.

[Cardiovascular Risks Associated with the use of Performance-Enhancing Stimulants]

The number of people involved in regular exercise and sports is increasing. Not infrequently, this is associated with intake of sports biologically active food supplements (BAS) and stimulators of physical ability. Data has been reported on the frequency of use of physical ability stimulators among professional athletes and on the use of the most popular food supplements among young people. Special attention is paid to the effect of such use on the cardiovascular system of athletes. This review describes negative cardiac effects and clinical cases of death of athletes due to the use of such supplements and stimulators.

Association between Mobile Phone Addiction Index and Sugar-Sweetened Food Intake in Medical College Students Stratified by Sex from Shanghai, China

This study’s objective was to depict sugar-sweetened food (SSF) consumption in medical college students stratified by sex from Shanghai, China, and to explore the association between the Mobile Phone Addiction Index (MPAI) and SSF intake. The data were obtained from 1121 medical college students from the Fudan University, Shanghai, China, who took an online questionnaire investigation in December 2020. Data included demographics, the MPAI, the Nutrition Literacy Assessment Questionnaire (NLAQ), total and food expenditure per month, the International Physical Activity Questionnaire (IPAQ), and a food frequency questionnaire (carbonated beverages (CB), other sugar-based beverages (OSBB), sugar/chocolate). We evaluated the association between the MPAI and three types of SSF intake according to multivariate logistic regression analysis stratified by sex. The mean CB, OSBB, and sugar/chocolate intakes were, respectively, 65.66 mL/d, 74.20 mL/d, and 4.96 g/d in men and 30.42 mL/d, 71.48 mL/d, and 4.99 g/d in women. The MPAI was positively associated with SSF intake, regardless of sex. In men, the CB and OSBB odds ratios (ORs) were, respectively, 1.023 (95% CI: 1.004–1.042), 1.019 (95% CI: 1.001–1.038); and in women, the CB, OSBB, and sugar/chocolate ORs were, respectively, 1.026 (95% CI: 1.013–1.039), 1.020 (95% CI: 1.007–1.033), and 1.019 (95% CI: 1.006–1.032). Age, NLAQ, total expenditure, food expenditure, and total physical activity also were related to SSF intake. Age and the application capacity of the NLAQ were negatively associated with SSF intake, whereas comprehension capacity of the NLAQ, total and food expenditure, and total physical activity were positively associated with SSF intake. This study confirmed that SSF intake is widespread among medical college students from Shanghai, China, even if they have relatively high nutrition health literacy. From a public health perspective, it is necessary to reduce SSF intake in medical college students by decreasing the MPAI, controlling the total and food expenditure per month in high-consumption areas, and improving the application ability of the NLAQ. Further studies are needed to explore the MPAI and other potential factors that may influence SSF intake of college students by expanding the sample size of college students throughout China, and the causal association between them.

The Influence of Sport Nutrition Knowledge on Body Composition and Perceptions of Dietary Requirements in Collegiate Athletes

Sport nutrition knowledge has been shown to influence dietary habits of athletes. The purpose of the current study was to examine relationships between sport nutrition knowledge and body composition and examine potential predictors of body weight goals in collegiate athletes. Participants included National Collegiate Athletic Association Division III women (n = 42, height: 169.9 ± 6.9 cm; body mass: 67.1 ± 8.6 kg; fat-free mass: 51.3 ± 6.6 kg; body fat percent: 24.2 ± 5.3%) and men (n = 25, height: 180.8 ± 7.2 cm; body mass: 89.2 ± 20.5 kg; fat-free mass: 75.9 ± 12.2 kg; body fat percent: 13.5 ± 8.9%) athletes. Body composition was assessed via air displacement plethysmography. Athletes completed a validated questionnaire designed to assess sport nutrition knowledge and were asked questions about their perceived dietary energy and macronutrient requirements, as well as their body weight goal (i.e., lose, maintain, gain weight). Athletes answered 47.98 ± 11.29% of questions correctly on the nutrition questionnaire with no differences observed between sexes (men: 49.52 ± 11.76% vs. women: 47.03 ± 11.04%; p = 0.40). An inverse relationship between sport nutrition knowledge scores and body fat percentage (BF%) (r = −0.330; p = 0.008), and fat mass (r = −0.268; p = 0.032) was observed for all athletes. Fat mass (β = 0.224), BF% (β = 0.217), and body mass index (BMI) (β = 0.421) were all significant (p < 0.05) predictors of body weight goal in women. All athletes significantly (p < 0.001) underestimated daily energy (−1360 ± 610.2 kcal/day), carbohydrate (−301.6 ± 149.2 grams/day [g/day]), and fat (−41.4 ± 34.5 g/day) requirements. Division III collegiate athletes have a low level of sport nutrition knowledge, which was associated with a higher BF%. Women athletes with a higher body weight, BF% and BMI were more likely to select weight loss as a body weight goal. Athletes also significantly underestimated their energy and carbohydrate requirements based upon the demands of their sport, independent of sex.

Bioaccessibility and Bioavailability of Minerals in Relation to a Healthy Gut Microbiome

Adequate amounts of a wide range of micronutrients are needed by body tissues to maintain health. Dietary intake must be sufficient to meet these micronutrient requirements. Mineral deficiency does not seem to be the result of a physically active life or of athletic training but is more likely to arise from disturbances in the quality and quantity of ingested food. The lack of some minerals in the body appears to be symbolic of the modern era reflecting either the excessive intake of empty calories or a negative energy balance from drastic weight-loss diets. Several animal studies provide convincing evidence for an association between dietary micronutrient availability and microbial composition in the gut. However, the influence of human gut microbiota on the bioaccessibility and bioavailability of trace elements in human food has rarely been studied. Bacteria play a role by effecting mineral bioavailability and bioaccessibility, which are further increased through the fermentation of cereals and the soaking and germination of crops. Moreover, probiotics have a positive effect on iron, calcium, selenium, and zinc in relation to gut microbiome composition and metabolism. The current literature reveals the beneficial effects of bacteria on mineral bioaccessibility and bioavailability in supporting both the human gut microbiome and overall health. This review focuses on interactions between the gut microbiota and several minerals in sport nutrition, as related to a physically active lifestyle.

Habitual Dietary Status and Stress Fracture Risk Among Japanese Female Collegiate Athletes

OBJECTIVES

The aim of the present study was to identify the habitual dietary intake and stress fractures history among sport types and to determine the factors related to the risk of stress fractures among Japanese female collegiate athletes.

METHODS

This study involved 589 Japanese female collegiate athletes. We investigated habitual dietary intake (food frequency questionnaire), eating attitude (EAT-26), demographics, training status, participation in sports events, history of injury in their career, and menstrual status using a self-reported questionnaire. A multivariate logistic regression analysis was conducted to determine the risk factors associated with stress fractures.

RESULTS

Thirty percent of the total participants had a history of stress fractures, although most participants had no risk of eating disorders. Most Japanese female collegiate athletes consumed less than the dietary reference intake levels for the general Japanese female population aged 18-29 years and the athletes' dietary guideline for key bone-health nutrients such as calcium and vitamin D. The multivariate logistic regression analysis revealed body mass index (BMI; OR, 0.91; 95% CI, 0.82-0.99) and energy intake (EI; OR, 0.99; 95% CI, 0.99-0.99) as significant and independent factors in the history of stress fractures among Japanese female collegiate athletes (p = 0.047 and p = 0.039, respectively).

CONCLUSIONS

Japanese female collegiate athletes failed to meet energy and nutrient recommendations; BMI and EI were significantly associated with stress fractures, a diet that includes an appropriate amount of energy is essential.

Contribution of Solid Food to Achieve Individual Nutritional Requirement during a Continuous 438 km Mountain Ultramarathon in Female Athlete

Background: Races and competitions over 100 miles have recently increased. Limited information exists about the effect of multiday continuous endurance exercise on blood glucose control and appropriate intake of food and drink in a female athlete. The present study aimed to examine the variation of blood glucose control and its relationship with nutritional intake and running performance in a professional female athlete during a 155.7 h ultramarathon race with little sleep. Methods: We divided the mountain course of 438 km into 33 segments by timing gates and continuously monitored the participant’s glucose profile throughout the ultramarathon. The running speed in each segment was standardized to the scheduled required time-based on three trial runs. Concurrently, the accompanying runners recorded the participant’s food and drink intake. Nutrient, energy, and water intake were then calculated. Results: Throughout the ultramarathon of 155.7 h, including 16.0 h of rest and sleep, diurnal variation had almost disappeared with the overall increase in blood glucose levels (25–30 mg/dL) compared with that during resting (p < 0.0001). Plasma total protein and triglyceride levels were decreased after the ultramarathon. The intake of protein and fat directly or indirectly contributed to maintaining blood glucose levels and running speed as substrates for gluconeogenesis or as alternative sources of energy when the carbohydrate intake was at a lower recommended limit. The higher amounts of nutrient intakes from solid foods correlated with a higher running pace compared with those from liquids and gels to supply carbohydrates, protein, and fat. Conclusion: Carbohydrate, protein, and fat intake from solid foods contributed to maintaining a fast pace with a steady, mild rise in blood glucose levels compared with liquids and gels when female runner completed a multiday continuous ultramarathon with little sleep.

Riboflavin in Neurological Diseases: A Narrative Review

Riboflavin is classified as one of the water-soluble B vitamins. It is part of the functional group of flavin mononucleotide (FMN) and flavin adenine dinucleotide (FAD) cofactors and is required for numerous flavoprotein-catalysed reactions. Riboflavin has important antioxidant properties, essential for correct cell functioning. It is required for the conversion of oxidised glutathione to the reduced form and for the mitochondrial respiratory chain as complexes I and II contain flavoprotein reductases and electron transferring flavoproteins. Riboflavin deficiency has been demonstrated to impair the oxidative state of the body, especially in relation to lipid peroxidation status, in both animal and human studies. In the nervous system, riboflavin is essential for the synthesis of myelin and its deficiency can determine the disruption of myelin lamellae. The inherited condition of restricted riboflavin absorption and utilisation, reported in about 10-15% of world population, warrants further investigation in relation to its association with the main neurodegenerative diseases. Several successful trials testing riboflavin for migraine prevention were performed, and this drug is currently classified as a Level B medication for migraine according to the American Academy of Neurology evidence-based rating, with evidence supporting its efficacy. Brown-Vialetto-Van Laere syndrome and Fazio-Londe diseases are now renamed as "riboflavin transporter deficiency" because these are autosomal recessive diseases caused by mutations of SLC52A2 and SLC52A3 genes that encode riboflavin transporters. High doses of riboflavin represent the mainstay of the therapy of these diseases and high doses of riboflavin should be rapidly started as soon as the diagnosis is suspected and continued lifelong. Remarkably, some mitochondrial diseases respond to supplementation with riboflavin. These include multiple acyl-CoA-dehydrogenase deficiency (which is caused by ETFDH gene mutations in the majority of the cases, or mutations in the ETFA and ETFB genes in a minority), mutations of ACAD9 gene, mutations of AIFM1 gene, mutations of the NDUFV1 and NDUFV2 genes. Therapeutic riboflavin administration has been tried in other neurological diseases, including stroke, multiple sclerosis, Friedreich's ataxia and Parkinson's disease. Unfortunately, the design of these clinical trials was not uniform, not allowing to accurately assess the real effects of this molecule on the disease course. In this review we analyse the properties of riboflavin and its possible effects on the pathogenesis of different neurological diseases, and we will review the current indications of this vitamin as a therapeutic intervention in neurology.

Sex differences and considerations for female specific nutritional strategies: a narrative review

Although there is a plethora of information available regarding the impact of nutrition on exercise performance, many recommendations are based on male needs due to the dominance of male participation in the nutrition and exercise science literature. Female participation in sport and exercise is prevalent, making it vital for guidelines to address the sex-specific nutritional needs. Female hormonal levels, such as estrogen and progesterone, fluctuate throughout the mensural cycle and lifecycle requiring more attention for effective nutritional considerations. Sex-specific nutritional recommendations and guidelines for the active female and female athlete have been lacking to date and warrant further consideration. This review provides a practical overview of key physiological and nutritional considerations for the active female. Available literature regarding sex-specific nutrition and dietary supplement guidelines for women has been synthesized, offering evidenced-based practical information that can be incorporated into the daily lives of women to improve performance, body composition, and overall health.

Mediterranean Diet Adherence, Body Composition and Performance in Beach Handball Players: A Cross Sectional Study

Background: Beach handball (BH) is a sport in which sporting performance is influenced, together with team interaction, by individual performance in terms of strength. Body composition is one of the main factors for sports performance and eating habits can condition this variable. The Mediterranean diet (MD) can significantly reduce the risk of mortality or cardiovascular disease. In addition, the Spanish Ministry of Agriculture, Food and Environment carries out different campaigns to promote it among young athletes, establishing it as a suitable diet for sports. Objectives: The main aims of the study are to assess body composition, physical activity and adherence to the MD of beach handball players. It also aims to evaluate age group differences in male and female players, as well as studying the possible relationship between MD, body composition and performance variables. Methods: A total of 59 Spanish BH players were recruited in the national championship of BH in the province of Alicante. Thirty-eight male (14 junior; 17.0 ± 0.1 years and 24 seniors; 25.5 ± 4.7 years) and twenty-one female (7 junior; 16.1 ± 1.46 years and 14 seniors; 23.2 ± 2.0 years) BH players participated in this study. The questionnaire to evaluate eating habits was Mediterranean diet adherence (KIDMED). Body composition was measured with electrical bioimpedance. Strength was evaluated by means of a maximum isometric handgrip test of the dominant hand with handgrip and height of jump by counter-jump on contact platform. In the statistical analysis, descriptions and correlations between the study variables were made. Results: In females, when the adherence to the MD is lower, the weight is higher, the lean body mass is lower and worse results are observed in performance tests. As for males, there are differences in weight and lean body mass according to category. Conclusions: Adequate eating habits are related to the weight of beach handball athletes. In addition, specifically with junior players, it has been observed that adherence to the MD correlates with weight.

Comparing eating disorder characteristics and treatment in self-identified competitive athletes and non-athletes from the National Eating Disorders Association online screening tool

OBJECTIVE

We compared eating disorder (ED) characteristics and treatment seeking behaviors between self-identified competitive athletes and non-athletes in a large, community-based sample.

METHOD

During the 2018 National Eating Disorders Awareness Week, 23,920 respondents, 14.7% of whom identified as competitive athletes, completed the National Eating Disorders Association online screen. Data were collected on demographics, disordered eating behaviors, probable ED diagnosis/risk, treatment history, and intent to seek treatment.

RESULTS

The sample was predominantly White (81.8%), female (90.3%), and between 13 and 24 years (82.6%). Over 86% met criteria for an ED/subthreshold ED, and of those, only 2.5% were in treatment. Suicidal ideation was reported in over half of the sample. Athletes reported a significantly greater likelihood of engaging in and more frequent excessive exercise episodes than non-athletes. Athletes also reported a significantly lower likelihood of engaging in and less frequent binge-eating episodes compared with non-athletes. Athletes were more likely to screen positive for an ED/subthreshold ED than non-athletes, but percentages across all probable ED diagnoses were similar. No significant differences between athletes and non-athletes emerged on treatment history or intention to seek treatment post-screen (less than 30%).

DISCUSSION

Although the distribution of probable ED diagnoses was similar in athletes and non-athletes, symptom profiles related to disordered eating behavior engagement and frequency may differ. Athletes may be less likely to seek treatment due to stigma, accessibility, and sport-specific barriers. Future work should directly connect survey respondents to tailored treatment tools and increase motivation to seek treatment.

Low Energy Availability with and without a High-Protein Diet Suppresses Bone Formation and Increases Bone Resorption in Men: A Randomized Controlled Pilot Study

Suppression of insulin-like growth factor 1 (IGF-1) and leptin secondary to low energy availability (LEA) may contribute to adverse effects on bone health. Whether a high-protein diet attenuates these effects has not been tested. Seven men completed three five-day conditions operationally defined as LEA (15 kcal kg fat-free mass (FFM)⁻¹·day⁻¹) with low protein (LEA-LP; 0.8 g protein·kg body weight (BW)⁻¹), LEA with high protein (LEA-HP; 1.7 g protein·kg BW⁻¹) and control (CON; 40 kcal·kg FFM⁻¹·day⁻¹, 1.7 g protein·kg BW⁻¹). In all conditions, participants expended 15 kcal·kg FFM⁻¹·day⁻¹ during supervised cycling sessions. Serum samples were analyzed for markers of bone turnover, IGF-1 and leptin. The decrease in leptin during LEA-LP (−65.6 ± 4.3%) and LEA-HP (−54.3 ± 16.7%) was greater than during CON (−25.4 ± 11.4%; p = 0.02). Decreases in P1NP (p = 0.04) and increases in CTX-I (p = 0.04) were greater in LEA than in CON, suggesting that LEA shifted bone turnover in favour of bone resorption. No differences were found between LEA-LP and LEA-HP. Thus, five days of LEA disrupted bone turnover, but these changes were not attenuated by a high-protein diet.

Goals in Nutrition Science 2020-2025

Five years ago, with the editorial board of Frontiers in Nutrition, we took a leap of faith to outline the Goals for Nutrition Science - the way we see it (1). Now, in 2020, we can put ourselves to the test and take a look back. Without a doubt we got it right with several of the key directions. To name a few, Sustainable Development Goals (SDGs) for Food and Nutrition are part of the global public agenda, and the SDGs contribute to the structuring of international science and research. Nutritional Science has become a critical element in strengthening work on the SDGs, and the development of appropriate methodologies is built on the groundwork of acquiring and analyzing big datasets. Investigation of the Human Microbiome is providing novel insight on the interrelationship between nutrition, the immune system and disease. Finally, with an advanced definition of the gut-brain-axis we are getting a glimpse into the potential for Nutrition and Brain Health. Various milestones have been achieved, and any look into the future will have to consider the lessons learned from Covid-19 and the sobering awareness about the frailty of our food systems in ensuring global food security. With a view into the coming 5 years from 2020 to 2025, the editorial board has taken a slightly different approach as compared to the previous Goals article. A mind map has been created to outline the key topics in nutrition science. Not surprisingly, when looking ahead, the majority of scientific investigation required will be in the areas of health and sustainability. Johannes le Coutre, Field Chief Editor, Frontiers in Nutrition.

Recommended Musculoskeletal and Sports Medicine Curriculum for Internal Medicine Residency Training

ABSTRACT

Patients present to primary care physicians with musculoskeletal complaints more often than they do for upper respiratory infections, hypertension, or diabetes. Despite this, instruction in musculoskeletal medicine for internal medicine residents represents less than 1% of their total didactic and clinical education time. We recognize the immense breadth of knowledge and skill required to train residents in the practice of internal medicine. This curriculum guideline defines a recommended training strategy, and supplies relevant resources, to improve musculoskeletal education among internal medicine residents to optimize patient care. This curriculum guideline was created by internists who are sports medicine specialists. Sports medicine physicians promote overall health and well-being while providing expertise in acute and chronic musculoskeletal conditions, as well as how disease affects exercise and using exercise as medicine for people with chronic disease.