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Staśkiewicz-Bartecka W, Kardas M, Zydek G, Zając A, Chycki J. Changes in Body Composition and Nutritional Periodization during the Training Macrocycle in Football-A Narrative Review. Nutrients 2024; 16:1332. [PMID: 38732581 PMCID: PMC11085159 DOI: 10.3390/nu16091332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 04/23/2024] [Accepted: 04/27/2024] [Indexed: 05/13/2024] Open
Abstract
Nutrition periodization in football training is an important determinant of adaptation to cyclic training loads. Personalizing an athlete's diet is crucial to ensure optimal performance and body composition, depending on the phase of training. The purpose of this review is to answer the question of how the body composition of football players changes over the training macrocycle and how dietary recommendations should be tailored to specific training periods. The review of scientific evidence was conducted based on the available literature, typing in phrases related to training and nutrition periodization using the PubMed and Google Scholar database methodology tools. A literature search resulted in the selection of 346 sources directly related to the topic of the study, and then those with the highest scientific value were selected. There is a need to adjust energy and nutrient intake according to the different training phases in a football player's preparation cycle. During the preparatory phase, it is recommended to increase protein and energy intake to support anabolic processes and muscle mass development. During the competitive period, due to the intensity of matches and training, the importance of carbohydrates for glycogen replenishment and recovery is emphasized. The transition phase requires the regulation of caloric intake to prevent adverse changes in body composition. Hydration has been identified as a key element in each phase of training. Cooperation between coaches, nutritionists, and players is essential to optimize sports performance and rapid recovery, and the authors recommend continuous adaptation and nutritional optimization as an integral part of football training.
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Affiliation(s)
- Wiktoria Staśkiewicz-Bartecka
- Department of Food Technology and Quality Evaluation, Department of Dietetics, Faculty of Public Health in Bytom, Medical University of Silesia in Katowice, ul. Jordana 19, 41-808 Zabrze, Poland;
| | - Marek Kardas
- Department of Food Technology and Quality Evaluation, Department of Dietetics, Faculty of Public Health in Bytom, Medical University of Silesia in Katowice, ul. Jordana 19, 41-808 Zabrze, Poland;
| | - Grzegorz Zydek
- Department of Sport Nutrition, Jerzy Kukuczka Academy of Physical Education in Katowice, ul. Mikołowska 72A, 40-065 Katowice, Poland;
| | - Adam Zając
- Department of Sports Training, Institute of Sport Sciences, Jerzy Kukuczka Academy of Physical Education in Katowice, ul. Mikołowska 72A, 40-065 Katowice, Poland; (A.Z.); (J.C.)
| | - Jakub Chycki
- Department of Sports Training, Institute of Sport Sciences, Jerzy Kukuczka Academy of Physical Education in Katowice, ul. Mikołowska 72A, 40-065 Katowice, Poland; (A.Z.); (J.C.)
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Dziedzic A, Maciak K, Bliźniewska-Kowalska K, Gałecka M, Kobierecka W, Saluk J. The Power of Psychobiotics in Depression: A Modern Approach through the Microbiota-Gut-Brain Axis: A Literature Review. Nutrients 2024; 16:1054. [PMID: 38613087 PMCID: PMC11013390 DOI: 10.3390/nu16071054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024] Open
Abstract
The microbiota-gut-brain (MGB) axis is a complex communication network linking the gut, microbiota, and brain, influencing various aspects of health and disease. Dysbiosis, a disturbance in the gut microbiome equilibrium, can significantly impact the MGB axis, leading to alterations in microbial composition and function. Emerging evidence highlights the connection between microbiota alterations and neurological and psychiatric disorders, including depression. This review explores the potential of psychobiotics in managing depressive disorders, emphasizing their role in restoring microbial balance and influencing the MGB axis. Psychobiotics exhibit positive effects on the intestinal barrier, immune response, cortisol levels, and the hypothalamic-pituitary-adrenal (HPA) axis. Studies suggest that probiotics may serve as an adjunct therapy for depression, especially in treatment-resistant cases. This review discusses key findings from studies on psychobiotics interventions, emphasizing their impact on the gut-brain axis and mental health. The increasing acceptance of the expanded concept of the MGB axis underscores the importance of microorganisms in mental well-being. As our understanding of the microbiome's role in health and disease grows, probiotics emerge as promising agents for addressing mental health issues, providing new avenues for therapeutic interventions in depressive disorders.
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Affiliation(s)
- Angela Dziedzic
- University of Lodz, Faculty of Biology and Environmental Protection, Department of General Biochemistry, Pomorska 141/143, 90-236 Lodz, Poland; (K.M.); (W.K.); (J.S.)
| | - Karina Maciak
- University of Lodz, Faculty of Biology and Environmental Protection, Department of General Biochemistry, Pomorska 141/143, 90-236 Lodz, Poland; (K.M.); (W.K.); (J.S.)
| | | | - Małgorzata Gałecka
- Department of Psychotherapy, Medical University of Lodz, Aleksandrowska 159, 91-229 Lodz, Poland;
| | - Weronika Kobierecka
- University of Lodz, Faculty of Biology and Environmental Protection, Department of General Biochemistry, Pomorska 141/143, 90-236 Lodz, Poland; (K.M.); (W.K.); (J.S.)
| | - Joanna Saluk
- University of Lodz, Faculty of Biology and Environmental Protection, Department of General Biochemistry, Pomorska 141/143, 90-236 Lodz, Poland; (K.M.); (W.K.); (J.S.)
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Merkouris E, Mavroudi T, Miliotas D, Tsiptsios D, Serdari A, Christidi F, Doskas TK, Mueller C, Tsamakis K. Probiotics' Effects in the Treatment of Anxiety and Depression: A Comprehensive Review of 2014-2023 Clinical Trials. Microorganisms 2024; 12:411. [PMID: 38399815 PMCID: PMC10893170 DOI: 10.3390/microorganisms12020411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/11/2024] [Accepted: 02/17/2024] [Indexed: 02/25/2024] Open
Abstract
Changes in the gut microbiome can affect cognitive and psychological functions via the microbiota-gut-brain (MGB) axis. Probiotic supplements are thought to have largely positive effects on mental health when taken in sufficient amounts; however, despite extensive research having been conducted, there is a lack of consistent findings on the effects of probiotics on anxiety and depression and the associated microbiome alterations. The aim of our study is to systematically review the most recent literature of the last 10 years in order to clarify whether probiotics could actually improve depression and anxiety symptoms. Our results indicate that the majority of the most recent literature suggests a beneficial role of probiotics in the treatment of depression and anxiety, despite the existence of a substantial number of less positive findings. Given probiotics' potential to offer novel, personalized treatment options for mood disorders, further, better targeted research in psychiatric populations is needed to address concerns about the exact mechanisms of probiotics, dosing, timing of treatment, and possible differences in outcomes depending on the severity of anxiety and depression.
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Affiliation(s)
- Ermis Merkouris
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupoli, Greece; (E.M.); (T.M.); (D.M.); (D.T.); (F.C.)
| | - Theodora Mavroudi
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupoli, Greece; (E.M.); (T.M.); (D.M.); (D.T.); (F.C.)
| | - Daniil Miliotas
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupoli, Greece; (E.M.); (T.M.); (D.M.); (D.T.); (F.C.)
| | - Dimitrios Tsiptsios
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupoli, Greece; (E.M.); (T.M.); (D.M.); (D.T.); (F.C.)
- 3rd Neurology Department, Aristotle University, 54124 Thessaloniki, Greece
| | - Aspasia Serdari
- Department of Child and Adolescent Psychiatry, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | - Foteini Christidi
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupoli, Greece; (E.M.); (T.M.); (D.M.); (D.T.); (F.C.)
| | | | - Christoph Mueller
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London SE5 8AB, UK;
- Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London SE5 8AF, UK
| | - Konstantinos Tsamakis
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London SE5 8AB, UK;
- Institute of Medical and Biomedical Education, St George’s, University of London, London SW17 0RE, UK
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Mohr AE, Pyne DB, Leite GSF, Akins D, Pugh J. A systematic scoping review of study methodology for randomized controlled trials investigating probiotics in athletic and physically active populations. JOURNAL OF SPORT AND HEALTH SCIENCE 2024; 13:61-71. [PMID: 36539062 PMCID: PMC10818115 DOI: 10.1016/j.jshs.2022.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/25/2022] [Accepted: 11/23/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The purported ergogenic and health effects of probiotics have been a topic of great intrigue among researchers, practitioners, and the lay public alike. There has also been an increased research focus within the realm of sports science and exercise medicine on the athletic gut microbiota. However, compared to other ergogenic aids and dietary supplements, probiotics present unique study challenges. The objectives of this systematic scoping review were to identify and characterize study methodologies of randomized controlled trials investigating supplementation with probiotics in athletes and physically active individuals. METHODS Four databases (MEDLINE, CINAHL, Cochrane CENTRAL, and Cochrane Database of Systematic Reviews) were searched for randomized controlled studies involving healthy athletes or physically active individuals. An intervention with probiotics and inclusion of a control and/or placebo group were essential. Only peer-reviewed articles in English were considered, and there were no date restrictions. Results were extracted and presented in tabular form to detail study protocols, characteristics, and outcomes. Bias in randomized controlled trials was determined with the RoB 2.0 tool. RESULTS A total of 45 studies were included in the review, with 35 using a parallel group design and 10 using a cross-over design. Approximately half the studies used a single probiotic and the other half a multi-strain preparation. The probiotic dose ranged from 2 × 108 to 1 × 1011 colony forming units daily, and the length of intervention was between 7 and 150 days. Fewer than half the studies directly assessed gastrointestinal symptoms, gut permeability, or the gut microbiota. The sex ratio of participants was heavily weighted toward males, and only 3 studies exclusively investigated females. Low-level adverse events were reported in only 2 studies, although the methodology of reporting varied widely. The risk of bias was generally low, although details on randomization were lacking in some studies. CONCLUSION There is a substantial body of research on the effects of probiotic supplementation in healthy athletes and physically active individuals. Considerable heterogeneity in probiotic selection and dosage as well as outcome measures has made clinical and mechanistic interpretation challenging for both health care practitioners and researchers. Attention to issues of randomization of participants, treatments and interventions, selection of outcomes, demographics, and reporting of adverse events will facilitate more trustworthy interpretation of probiotic study results and inform evidence-based guidelines.
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Affiliation(s)
- Alex E Mohr
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA.
| | - David B Pyne
- Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT 2617, Australia
| | - Geovana Silva Fogaça Leite
- Laboratory of Functional Fermented Food, Faculty of Pharmaceutical Sciences, University of São Paulo, São Paulo 05508-030, Brazil
| | - Deborah Akins
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA
| | - Jamie Pugh
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 3AF, UK
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Youssef HAI, Vitaglione P, Ferracane R, Abuqwider J, Mauriello G. Evaluation of GABA Production by Alginate-Microencapsulated Fresh and Freeze-Dried Bacteria Enriched with Monosodium Glutamate during Storage in Chocolate Milk. Microorganisms 2023; 11:2648. [PMID: 38004660 PMCID: PMC10673371 DOI: 10.3390/microorganisms11112648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 11/26/2023] Open
Abstract
Two strains of γ-aminobutyric acid (GABA) producing bacteria, L. brevis Y1 and L. plantarum LM2, were microencapsulated in sodium alginate with two concentrations (1% and 2%) of monosodium glutamate (MSG) by using vibrating technology. The mix of both species was microencapsulated both in fresh and freeze-dried form. After 0, 1, 2, and 4 weeks of storage at 4 °C in quarter strength Ringer's solution, the microcapsules were subjected to cell viable counting and sub-cultured in MRS at 37° for 24 h. The MRS cultures were analyzed for the GABA content. The amount of GABA produced per CFU of MRS inoculum was then calculated. Only the 4-week-old microcapsules were used to inoculate a chocolate milk drink with the aim of obtaining a functionalized drink containing viable probiotic cells and GABA after a 1-week incubation at 4 °C. Therefore, the GABA production in chocolate milk per CFU of the probiotic culture after the incubation time was calculated. Results of the GABA analysis by liquid chromatography mass spectrometry of the MRS sub-cultures showed no significant difference (p > 0.05) in GABA yield between 1% and 2% MSG for the microcapsules containing fresh cells. On the contrary, a significant difference (p < 0.05) in productivity along the storage was registered. Microcapsules containing freeze-dried cells showed significant differences (p < 0.05) in GABA yield between 1% and 2% MSG only after 2 and 4 weeks of storage. A significant difference (p < 0.05) in GABA yield between the storage time was found only for the trials with 2% MSG for freeze-dried cells. The synthesis of GABA in chocolate milk significantly decreased (p < 0.05) only for fresh cells when comparing 2% with 1% MSG. In conclusion, a 1-month storage of microcapsules containing both culture forms, fresh and freeze-dried, did not affect GABA production.
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Affiliation(s)
- Hebat Allah Ibrahim Youssef
- Microbiology Department, Faculty of Science, Ain Shams University, El-Khalyfa El-Mamoun St. Abbasya, Cairo 11566, Egypt
- Department of Agricultural Sciences, University of Naples Federico II, Via Università 100, 80055 Portici, Italy
| | - Paola Vitaglione
- Department of Agricultural Sciences, University of Naples Federico II, Via Università 100, 80055 Portici, Italy
| | - Rosalia Ferracane
- Department of Agricultural Sciences, University of Naples Federico II, Via Università 100, 80055 Portici, Italy
| | - Jumana Abuqwider
- Department of Agricultural Sciences, University of Naples Federico II, Via Università 100, 80055 Portici, Italy
| | - Gianluigi Mauriello
- Department of Agricultural Sciences, University of Naples Federico II, Via Università 100, 80055 Portici, Italy
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Przewłócka K, Folwarski M, Kaczmarczyk M, Skonieczna-Żydecka K, Palma J, Bytowska ZK, Kujach S, Kaczor JJ. Combined probiotics with vitamin D 3 supplementation improved aerobic performance and gut microbiome composition in mixed martial arts athletes. Front Nutr 2023; 10:1256226. [PMID: 37885441 PMCID: PMC10599147 DOI: 10.3389/fnut.2023.1256226] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
Introduction Mixed Martial Arts (MMA) is characterized as an interval sport in which the training program focuses on enhancing both aerobic and anaerobic capacities. Therefore, strategies targeting the intestinal microbiome may be beneficial for MMA athletes. Moreover, vitamin D supplementation may amplify the positive effects of certain bacterial strains. We previously demonstrated that the combined of probiotics and vitamin D3 supplementation improved the lactate utilization ratio, total work, and average power achieved during anaerobic tests in MMA. Therefore, this study aimed to investigate whether combined probiotic and vitamin D3 ingestion can modify the composition of the gut microbiome and epithelial cell permeability, influence the inflammatory response, and ultimately enhance aerobic capacity. Methods A 4-week clinical trial was conducted with 23 male MMA athletes randomly assigned to either the probiotic + vitamin D3 (PRO + VIT D) group or the vitamin D3 group (VIT D). The trial employed a double-blind, placebo-controlled design and involved measurements of serum inflammatory markers, gut microbiome composition, epithelial cell permeability, and aerobic performance. Results After 4-week of supplementation, we found a significantly lower concentration of calprotectin in the PRO + VIT D group (34.79 ± 24.38 mmol/L) compared to the value before (69.50 ± 46.91) supplementation (p = 0.030), augmentation of beta diversity after the intervention in the PRO + VIT D group (p = 0.0005) and an extended time to exhaustion to 559.00 ± 68.99; compared to the value before (496.30 ± 89.98; p = 0.023) after combined probiotic and vitamin D3 supplementation in MMA athletes. No effect was observed in the VIT D group. Conclusion Our results indicate that combined treatment of probiotics and vitamin D3 may cause alterations in alpha and beta diversity and the composition of the gut microbiota in MMA athletes. We observed an improvement in epithelial cell permeability and an extended time to exhaustion during exercise in MMA athletes following a 4-week combined probiotic and vitamin D3 treatment.
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Affiliation(s)
- Katarzyna Przewłócka
- Department of Bioenergetics and Exercise Physiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Marcin Folwarski
- Department of Clinical Nutrition and Dietetics, Medical University of Gdańsk, Gdańsk, Poland
| | - Mariusz Kaczmarczyk
- Department of Clinical and Molecular Biochemistry, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | | | - Joanna Palma
- Department of Biochemical Research, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Zofia Kinga Bytowska
- Department of Bioenergetics and Exercise Physiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Sylwester Kujach
- Department of Physiology, Gdansk University of Physical Education and Sport, Gdańsk, Poland
- Department of Neurophysiology, Neuropsychology and Neuroinformatics, Medical University of Gdańsk, Gdańsk, Poland
| | - Jan Jacek Kaczor
- Department of Bioenergetics and Exercise Physiology, Medical University of Gdańsk, Gdańsk, Poland
- Department of Animal and Human Physiology, University of Gdańsk, Gdańsk, Poland
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Cichońska P, Kowalska E, Ziarno M. The Survival of Psychobiotics in Fermented Food and the Gastrointestinal Tract: A Review. Microorganisms 2023; 11:microorganisms11040996. [PMID: 37110420 PMCID: PMC10142889 DOI: 10.3390/microorganisms11040996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 04/04/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
In recent years, scientists have been particularly interested in the gut-brain axis, as well as the impact of probiotics on the nervous system. This has led to the creation of the concept of psychobiotics. The present review describes the mechanisms of action of psychobiotics, their use in food products, and their viability and survival during gastrointestinal passage. Fermented foods have a high potential of delivering probiotic strains, including psychobiotic ones. However, it is important that the micro-organisms remain viable in concentrations ranging from about 106 to 109 CFU/mL during processing, storage, and digestion. Reports indicate that a wide variety of dairy and plant-based products can be effective carriers for psychobiotics. Nonetheless, bacterial viability is closely related to the type of food matrix and the micro-organism strain. Studies conducted in laboratory conditions have shown promising results in terms of the therapeutic properties and viability of probiotics. Because human research in this field is still limited, it is necessary to broaden our understanding of the survival of probiotic strains in the human digestive tract, their resistance to gastric and pancreatic enzymes, and their ability to colonize the microbiota.
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Affiliation(s)
- Patrycja Cichońska
- Department of Food Technology and Assessment, Institute of Food Science, Warsaw University of Life Sciences-SGGW (WULS-SGGW), Nowoursynowska 159c St., 02-776 Warsaw, Poland
| | - Ewa Kowalska
- Department of Food Technology and Assessment, Institute of Food Science, Warsaw University of Life Sciences-SGGW (WULS-SGGW), Nowoursynowska 159c St., 02-776 Warsaw, Poland
| | - Małgorzata Ziarno
- Department of Food Technology and Assessment, Institute of Food Science, Warsaw University of Life Sciences-SGGW (WULS-SGGW), Nowoursynowska 159c St., 02-776 Warsaw, Poland
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Gervasi T, Mandalari G. The Interplay Between Gut Microbiota and Central Nervous System. Curr Pharm Des 2023; 29:3274-3281. [PMID: 38062662 DOI: 10.2174/0113816128264312231101110307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 09/14/2023] [Indexed: 01/26/2024]
Abstract
This review highlights the relationships between gastrointestinal microorganisms and the brain. The gut microbiota communicates with the central nervous system through nervous, endocrine, and immune signalling mechanisms. Our brain can modulate the gut microbiota structure and function through the autonomic nervous system, and possibly through neurotransmitters which directly act on bacterial gene expression. In this context, oxidative stress is one the main factors involved in the dysregulation of the gut-brain axis and consequently in neurodegenerative disorders. Several factors influence the susceptibility to oxidative stress by altering the antioxidant status or free oxygen radical generation. Amongst these, of interest is alcohol, a commonly used substance which can negatively influence the central nervous system and gut microbiota, with a key role in the development of neurodegenerative disorder. The role of "psychobiotics" as a novel contrast strategy for preventing and treating disorders caused due to alcohol use and abuse has been investigated.
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Affiliation(s)
- Teresa Gervasi
- Department of Biomedical and Dental Science and Morphofunctional Imaging, University of Messina, Messina 98166, Italy
| | - Giuseppina Mandalari
- Department of Chemical, Biological, Pharmaceutical and Environmental Science, University of Messina, Messina 98166, Italy
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Sun Y, Li J, Xu Z, Liu Y, Hou L, Huang Z. Exploring relationship between emotion and probiotics with knowledge graphs. Health Inf Sci Syst 2022; 10:27. [PMID: 36101548 PMCID: PMC9464290 DOI: 10.1007/s13755-022-00179-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/02/2022] [Indexed: 10/14/2022] Open
Abstract
Purpose Researchers have identified gut microbiota that interact with brain regions associated with emotion and mood. Literature reviews of those associations rely on rigorous systematic approaches and labor-intensive investments. Here we explore how knowledge graph, a large scale semantic network consisting of entities and concepts as well as the semantic relationships among them, is incorporated into the emotion-probiotic relationship exploration work. Method We propose an end-to-end emotion-probiotics relationship exploration method with an integrated medical knowledge graph, which incorporates the text mining output of knowledge graph, concept reasoning and evidence classification. Specifically, a knowledge graph for probiotics is built based on a text-mining analysis of PubMed, and further used to retrieve triples of relationships with reasoning logistics. Then specific relationships are annotated and evidence levels are retrieved to form a new evidence-based emotion-probiotic knowledge graph. Results Based on the probiotics knowledge graph with 40,442,404 triples, totally 1453 PubMed articles were annotated in both the title level and abstract level, and the evidence levels were incorporated to the visualization of the explored emotion-probiotic relationships. Finally, we got 4131 evidenced emotion-probiotic associations. Conclusions The evidence-based emotion-probiotic knowledge graph construction work demonstrates an effective reasoning based pipeline of relationship exploration. The annotated relationship associations are supposed be used to help researchers generate scientific hypotheses or create their own semantic graphs for their research interests.
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Affiliation(s)
- Yueping Sun
- Institute of Medical Information, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, 100020 China
| | - Jiao Li
- Institute of Medical Information, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, 100020 China
| | - Zidu Xu
- Institute of Medical Information, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, 100020 China
| | - Yan Liu
- Institute of Medical Information, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, 100020 China
| | - Li Hou
- Institute of Medical Information, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, 100020 China
| | - Zhisheng Huang
- Knowledge Representation and Reasoning (KR\&R) Group, Computer Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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10
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Han S, Li Y, Song R, Gao H, Zhang W. Effect of Probiotics Supplementation on Heart Rate: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Front Nutr 2022; 9:829703. [PMID: 35392286 PMCID: PMC8982511 DOI: 10.3389/fnut.2022.829703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background and Aims Probiotics consumption lowers the risk of cardiovascular disease, but whether it affects heart rate (HR) remains controversial. Therefore, our study aimed to assess the chronotropic effects of probiotics on heartbeat via a meta-analysis of randomized clinical trials. Methods Relevant studies were identified by searching PubMed, Cochrane library, and Clinical Trials databases up to October 2021. Either a fixed-effects or a random-effects model was used to calculate the pooled effect sizes and 95% confidence intervals (CIs). Results This meta-analysis included 13 studies involving 16 interventional trial arms and 931 participants according to inclusion criteria. The overall pooled estimate showed that probiotics supplementation had a slight, but no significant reduction of 0.28 bpm (95% CI: −1.17, 0.60) on HR. Relatively high heterogeneity was observed among included trials (I2 = 80.8%, P heterogeneity < 0.001). Subgroup analysis displayed that probiotics supplementation significantly reduced HR by 2.94 bpm (95% CI: −5.06, −0.82) among participants with baseline HR ≥ 75 bpm, by 1.17 bpm (95% CI: −2.34, −0.00) with probiotics dose ≥1 × 1010 CFU/day, and by 1.43 bpm (95% CI: −2.69, −0.17) with multiple-strain intervention. Meta-regression analysis showed that baseline HR was a major potential effect modifier of probiotics supplementation on lowering HR. Conclusion Hitherto, the overall evidence in the literature was insufficient to support the notion that probiotics supplementation has a class effect on HR reduction. However, in subgroup analysis, probiotics reduced HR significantly in those who had higher baseline HR, received a higher dose or multiple strains of probiotics.
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Affiliation(s)
- Shufen Han
- School of Public Health, Hangzhou Normal University, Hangzhou, China
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, Suzhou, China
- *Correspondence: Shufen Han ;
| | - Yuezhen Li
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, Suzhou, China
| | - Ruijuan Song
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, Suzhou, China
| | - Hui Gao
- Prefecture Center for Disease Control and Prevention, Jiaxing, China
| | - Weiguo Zhang
- Independent Researcher, Irving, TX, United States
- Weiguo Zhang
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Mohr AE, Pugh J, O'Sullivan O, Black K, Townsend JR, Pyne DB, Wardenaar FC, West NP, Whisner CM, McFarland LV. Best Practices for Probiotic Research in Athletic and Physically Active Populations: Guidance for Future Randomized Controlled Trials. Front Nutr 2022; 9:809983. [PMID: 35350412 PMCID: PMC8957944 DOI: 10.3389/fnut.2022.809983] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/26/2022] [Indexed: 12/12/2022] Open
Abstract
Probiotic supplementation, traditionally used for the prevention or treatment of a variety of disease indications, is now recognized in a variety of population groups including athletes and those physically active for improving general health and performance. However, experimental and clinical trials with probiotics commonly suffer from design flaws and different outcome measures, making comparison and synthesis of conclusions difficult. Here we review current randomized controlled trials (RCTs) using probiotics for performance improvement, prevention of common illnesses, or general health, in a specific target population (athletes and those physically active). Future RCTs should address the key elements of (1) properly defining and characterizing a probiotic intervention, (2) study design factors, (3) study population characteristics, and (4) outcome measures, that will allow valid conclusions to be drawn. Careful evaluation and implementation of these elements should yield improved trials, which will better facilitate the generation of evidence-based probiotic supplementation recommendations for athletes and physically active individuals.
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Affiliation(s)
- Alex E. Mohr
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
- *Correspondence: Alex E. Mohr
| | - Jamie Pugh
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Orla O'Sullivan
- Teagasc Food Research Centre, Moorepark, Ireland
- APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Katherine Black
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Jeremy R. Townsend
- Exercise and Nutrition Science Graduate Program, Lipscomb University, Nashville, TN, United States
| | - David B. Pyne
- Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT, Australia
| | - Floris C. Wardenaar
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - Nicholas P. West
- School of Medical Science and Menzies Health Institute of QLD, Griffith Health, Griffith University, Southport, QLD, Australia
| | - Corrie M. Whisner
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - Lynne V. McFarland
- Department of Medicinal Chemistry, University of Washington, Seattle, WA, United States
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12
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Li X, Chen LM, Kumar G, Zhang SJ, Zhong QH, Zhang HY, Gui G, Wu LL, Fan HZ, Sheng JW. Therapeutic Interventions of Gut-Brain Axis as Novel Strategies for Treatment of Alcohol Use Disorder Associated Cognitive and Mood Dysfunction. Front Neurosci 2022; 16:820106. [PMID: 35185459 PMCID: PMC8847450 DOI: 10.3389/fnins.2022.820106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/10/2022] [Indexed: 11/25/2022] Open
Abstract
Alcohol use disorders (AUD) is characterized by persistent or intermittent alcohol cravings and compulsive drinking. The functional changes in the central nervous system (CNS) after alcohol consumption are alcohol-associated cognitive impairment and mood disorders, which are major health issues reported in AUDs. Studies have shown that transferring the intestinal microbiota from AUDs patients to germ-free animals causes learning and memory dysfunction, depression and anxiety-like behavior, indicating the vital role of intestinal microbiota in development of neuropsychiatric disorders in AUD. Intestinal flora composition of AUD patients are significantly different from normal people, suggesting that intestinal flora imbalance orchestrate the development of neuropsychiatric disorders in AUD. Studies suggests that gut microbiome links bidirectional signaling network of the enteric nervous system (ENS) to central nervous system (CNS), forming gut-microbe-brain axis (brain-gut axis). In this review, we discussed pathogenesis and possible treatment of AUD-induced cognitive deficits, anxiety, and depression disorders. Further, we described the mechanism of intestinal flora imbalance and dysfunction of hippocampus-amygdala-frontal cortex (gut-limbic circuit system dysfunction). Therefore, we postulate therapeutic interventions of gut-brain axis as novel strategies for treatment of AUD-induced neuropsychiatric disorders.
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Affiliation(s)
- Xin Li
- Department of Gastroenterology, The People’s Hospital of Zhangshu City, Jiangxi, China
| | - Le-Mei Chen
- Department of Pharmacy, Guangdong Provincial People’s Hospital Ganzhou Hospital, Ganzhou Municipal Hospital, Jiangxi, China
| | - Gajendra Kumar
- Department of Neuroscience, City University of Hong Kong, Kowloon Tong, Hong Kong SAR, China
| | - Shan-Jin Zhang
- Department of Gastroenterology, The People’s Hospital of Yichun City, Jiangxi, China
| | - Quan-hai Zhong
- School of Chemistry and Bioengineering, Yichun University, Jiangxi, China
| | - Hong-Yan Zhang
- School of Chemistry and Bioengineering, Yichun University, Jiangxi, China
| | - Guan Gui
- Department of Gastroenterology, The People’s Hospital of Yichun City, Jiangxi, China
| | - Lv-Le Wu
- Department of Gastroenterology, The People’s Hospital of Yichun City, Jiangxi, China
| | - Hui-Zhen Fan
- Department of Gastroenterology, The People’s Hospital of Yichun City, Jiangxi, China
- School of Chemistry and Bioengineering, Yichun University, Jiangxi, China
- *Correspondence: Hui-Zhen Fan,
| | - Jian-Wen Sheng
- Department of Gastroenterology, The People’s Hospital of Yichun City, Jiangxi, China
- Jian-Wen Sheng,
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13
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Basso M, Johnstone N, Knytl P, Nauta A, Groeneveld A, Cohen Kadosh K. A Systematic Review of Psychobiotic Interventions in Children and Adolescents to Enhance Cognitive Functioning and Emotional Behavior. Nutrients 2022; 14:nu14030614. [PMID: 35276975 PMCID: PMC8840038 DOI: 10.3390/nu14030614] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/17/2022] [Accepted: 01/21/2022] [Indexed: 02/05/2023] Open
Abstract
This systematic review brings together human psychobiotic interventions in children and adolescents (aged 6-25 years) to evaluate the efficacy of pre- and probiotic supplements on stress, anxiety, and cognitive outcomes. Psychobiotic interventions in animal studies highlighted sensitivity to effects during development and maturation in multiple domains from emotion to cognitive processing. Several translational psychobiotic interventions in humans have been carried out to assess effects on emotion and cognition during childhood and into adulthood. The findings illustrate that there are limited consistent psychobiotic effects in developing human populations, and this is proposed to be due to heterogeneity in the trials conducted. Consequentially, it is recommended that three specific factors are considered in future psychobiotic trials: (1) Specificity of population studied (e.g., patients, developmental age), (2) specificity of intervention, and (3) homogeneity in outcome measures.
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Affiliation(s)
- Melissa Basso
- Department of Psychological Sciences, School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK; (M.B.); (P.K.)
| | - Nicola Johnstone
- Department of Psychological Sciences, School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK; (M.B.); (P.K.)
- Correspondence: (N.J.); (K.C.K.); Tel.: +44-(0)-1483-68-3968 (K.C.K.)
| | - Paul Knytl
- Department of Psychological Sciences, School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK; (M.B.); (P.K.)
| | - Arjen Nauta
- FrieslandCampina, 3818 LE Amersfoort, The Netherlands; (A.N.); (A.G.)
| | - Andre Groeneveld
- FrieslandCampina, 3818 LE Amersfoort, The Netherlands; (A.N.); (A.G.)
| | - Kathrin Cohen Kadosh
- Department of Psychological Sciences, School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK; (M.B.); (P.K.)
- Correspondence: (N.J.); (K.C.K.); Tel.: +44-(0)-1483-68-3968 (K.C.K.)
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14
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Le Morvan de Sequeira C, Hengstberger C, Enck P, Mack I. Effect of Probiotics on Psychiatric Symptoms and Central Nervous System Functions in Human Health and Disease: A Systematic Review and Meta-Analysis. Nutrients 2022; 14:nu14030621. [PMID: 35276981 PMCID: PMC8839125 DOI: 10.3390/nu14030621] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/25/2022] [Accepted: 01/25/2022] [Indexed: 12/01/2022] Open
Abstract
Background: The gut microbiota impacts on central nervous system (CNS) function via the microbiota–gut–brain axis. Thus, therapeutics targeting the gut microbiota such as probiotics have the potential for improving mental health. This meta-analysis synthesizes the evidence regarding the impacts of probiotics on psychological well-being, psychiatric symptoms and CNS functioning. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were applied for executing this review using the databases PubMed, Web of Science and Cochrane Library. The data were summarized at qualitative and quantitative level. Results: Fifty-four randomized placebo-controlled studies were included, of which 30 were eligible for meta-analysis. If investigated, the probiotics mostly exerted effects on CNS function. Most probiotics did not affect mood, stress, anxiety, depression and psychiatric distress when compared to placebo at the qualitative level. At quantitative level, depression and psychiatric distress improved slightly in the probiotic condition (depression: mean difference −0.37 (95% CI: −0.55, −0.20); p ≤ 0.0001; psychiatric distress: mean difference −0.33 (95% CI: −0.53, −0.13); p = 0.001). Conclusions: To date it is unclear to which extent and in which specific areas next generation probiotics selected and developed for their ability to improve psychiatric condition and potentially other CNS functions are promising.
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15
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Verification of Lactobacillus brevis tolerance to simulated gastric juice and the potential effects of postbiotic gamma-aminobutyric acid in streptozotocin-induced diabetic mice. FOOD SCIENCE AND HUMAN WELLNESS 2022. [DOI: 10.1016/j.fshw.2021.07.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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16
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Oliver LS, Sullivan JP, Russell S, Peake JM, Nicholson M, McNulty C, Kelly VG. Effects of Nutritional Interventions on Accuracy and Reaction Time with Relevance to Mental Fatigue in Sporting, Military, and Aerospace Populations: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:307. [PMID: 35010566 PMCID: PMC8744602 DOI: 10.3390/ijerph19010307] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 01/10/2023]
Abstract
Background: Research in sport, military, and aerospace populations has shown that mental fatigue may impair cognitive performance. The effect of nutritional interventions that may mitigate such negative effects has been investigated. This systematic review and meta-analysis aimed to quantify the effects of nutritional interventions on cognitive domains often measured in mental fatigue research. Methods: A systematic search for articles was conducted using key terms relevant to mental fatigue in sport, military, and aerospace populations. Two reviewers screened 11,495 abstracts and 125 full texts. A meta-analysis was conducted whereby effect sizes were calculated using subgroups for nutritional intervention and cognitive domains. Results: Fourteen studies were included in the meta-analysis. The consumption of energy drinks was found to have a small positive effect on reaction time, whilst the use of beta-alanine, carbohydrate, and caffeine had no effect. Carbohydrate and caffeine use had no effect on accuracy. Conclusions: The results of this meta-analysis suggest that consuming energy drinks may improve reaction time. The lack of effect observed for other nutritional interventions is likely due to differences in the type, timing, dosage, and form of administration. More rigorous randomized controlled trials related to the effect of nutrition interventions before, during, and after induced mental fatigue are required.
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Affiliation(s)
- Liam S. Oliver
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD 4059, Australia; (L.S.O.); (J.M.P.); (M.N.); (C.M.)
| | | | - Suzanna Russell
- School of Behavioural and Health Sciences, Australian Catholic University, Brisbane, QLD 4014, Australia;
| | - Jonathan M. Peake
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD 4059, Australia; (L.S.O.); (J.M.P.); (M.N.); (C.M.)
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Mitchell Nicholson
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD 4059, Australia; (L.S.O.); (J.M.P.); (M.N.); (C.M.)
| | - Craig McNulty
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD 4059, Australia; (L.S.O.); (J.M.P.); (M.N.); (C.M.)
| | - Vincent G. Kelly
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD 4059, Australia; (L.S.O.); (J.M.P.); (M.N.); (C.M.)
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD 4059, Australia
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17
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Salleh RM, Kuan G, Aziz MNA, Rahim MRA, Rahayu T, Sulaiman S, Kusuma DWY, Adikari A, Razam MSM, Radhakrishnan AK, Appukutty M. Effects of Probiotics on Anxiety, Stress, Mood and Fitness of Badminton Players. Nutrients 2021; 13:nu13061783. [PMID: 34073684 PMCID: PMC8225117 DOI: 10.3390/nu13061783] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/07/2021] [Accepted: 05/20/2021] [Indexed: 12/17/2022] Open
Abstract
Background: Reports of probiotic consumption on athletes’ performance are debatable due to their equivocal results. There is a need for more evidence on the effects of probiotic intake on psychological state and fitness level. Thus, this study determined the effects of daily probiotic consumption on competitive anxiety, perceived stress and mood among university badminton players, besides their fitness like aerobic capacity, strength, speed, leg power and agility. Methods: Thirty university badminton players aged from 19 to 22 years old were randomly divided equally into two groups, where the probiotic group (PG; n = 15) received a drink that contained Lactobacillus casei Shirota (3 × 1010 CFU) and placebo group (CG; n = 15) a placebo drink for six weeks. Anxiety, stress and mood levels were determined using the CSAI-2R, PSS and BRUMS questionnaires, respectively. Fitness levels were measured using by subjecting the players to 20-m shuttle runs (aerobic capacity), handgrips (muscular strength), vertical jumps (leg power), 40-m dash (speed) and T-test (agility). The Student’s t-test (p < 0.05) was used to determine the differences between PG and CG players. Results: After six weeks, the anxiety and stress levels of PG players significantly decreased by 16% (p < 0.001) and 20% (p < 0.001), respectively, but there were no significant changes detected in CG players. Supplementation of probiotics also improved aerobic capacity in PG players by 5.9% (p < 0.001) but did not influence the speed, strength, leg power and agility. Conclusions: Probiotics supplementation showed improved aerobic capacity and relieve anxiety and stress. However, further studies need to be carried out to determine the mechanisms through which probiotic intake produces these effects.
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Affiliation(s)
- Razali Mohamed Salleh
- Sports Science Programme, Faculty of Sports Science and Recreation, Universiti Teknologi MARA, Shah Alam 40450, Malaysia; (R.M.S.); (M.N.A.A.); (M.R.A.R.); (A.M.G.C.P.A.); (M.S.M.R.)
| | - Garry Kuan
- Exercise and Sports Science Programme, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian Kelantan 16150, Malaysia
- Department of Life Sciences, Brunel University, London UB8 3PH, UK
- Correspondence: (G.K.); (M.A.)
| | - Mohd Noorazlan Ab Aziz
- Sports Science Programme, Faculty of Sports Science and Recreation, Universiti Teknologi MARA, Shah Alam 40450, Malaysia; (R.M.S.); (M.N.A.A.); (M.R.A.R.); (A.M.G.C.P.A.); (M.S.M.R.)
| | - Mohamad Rahizam Abd Rahim
- Sports Science Programme, Faculty of Sports Science and Recreation, Universiti Teknologi MARA, Shah Alam 40450, Malaysia; (R.M.S.); (M.N.A.A.); (M.R.A.R.); (A.M.G.C.P.A.); (M.S.M.R.)
| | - Tandiyo Rahayu
- Faculty of Sports Science, Universitas Negeri Semarang, Semarang 50229, Indonesia; (T.R.); (S.S.); (D.W.Y.K.)
| | - Sulaiman Sulaiman
- Faculty of Sports Science, Universitas Negeri Semarang, Semarang 50229, Indonesia; (T.R.); (S.S.); (D.W.Y.K.)
| | - Donny Wira Yudha Kusuma
- Faculty of Sports Science, Universitas Negeri Semarang, Semarang 50229, Indonesia; (T.R.); (S.S.); (D.W.Y.K.)
| | - A.M.G.C.P. Adikari
- Sports Science Programme, Faculty of Sports Science and Recreation, Universiti Teknologi MARA, Shah Alam 40450, Malaysia; (R.M.S.); (M.N.A.A.); (M.R.A.R.); (A.M.G.C.P.A.); (M.S.M.R.)
- Department of Sports Science, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda 10250, Sri Lanka
| | - Muhammad Syafiq Mohd Razam
- Sports Science Programme, Faculty of Sports Science and Recreation, Universiti Teknologi MARA, Shah Alam 40450, Malaysia; (R.M.S.); (M.N.A.A.); (M.R.A.R.); (A.M.G.C.P.A.); (M.S.M.R.)
| | - Ammu K. Radhakrishnan
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Sunway 47500, Malaysia;
| | - Mahenderan Appukutty
- Sports Science Programme, Faculty of Sports Science and Recreation, Universiti Teknologi MARA, Shah Alam 40450, Malaysia; (R.M.S.); (M.N.A.A.); (M.R.A.R.); (A.M.G.C.P.A.); (M.S.M.R.)
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Sunway 47500, Malaysia;
- Correspondence: (G.K.); (M.A.)
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