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Kuwabara AM, Tenforde AS, Finoff JT, Fredericson M. Iron Deficiency in Athletes: A Narrative Review. PM R 2022; 14:620-642. [DOI: 10.1002/pmrj.12779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/17/2022] [Accepted: 01/24/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Anne M. Kuwabara
- Stanford University, Department of Physical Medicine and Rehabilitation, 450 Broadway Street, Pavilion C, 4th Floor Redwood City California United States
| | - Adam S. Tenforde
- Harvard Medical School, Department of Physical Medicine and Rehabilitation Assistant Professor of Physical Medicine and Rehabilitation
| | | | - Michael Fredericson
- Department of Physical Medicine and Rehabilitation Stanford University Medical Center
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Iron Status and Homeostasis Across 2 Competitive Seasons in NCAA Division I Collegiate Cross-Country Runners Residing at Low Altitude. Int J Sports Physiol Perform 2022; 17:1716-1724. [DOI: 10.1123/ijspp.2021-0546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 07/13/2022] [Accepted: 08/25/2022] [Indexed: 11/09/2022]
Abstract
Purpose: Inflammatory cytokines including interleukin-6 can upregulate hepcidin and decrease iron absorption. Endurance exercise is associated with transient increases in cytokines, which may alter the risk of iron deficiency (ID). This study examined whether chronic elevations in basal levels of cytokines and hepcidin were associated with ID in highly trained runners. Methods: Fifty-four collegiate runners (26 males and 28 females) living at ∼1625 m were recruited from an NCAA Division I cross-country team for this prospective cohort study. Over 2 seasons, fasted, preexercise blood draws were performed in the morning 4 times per season and were analyzed for hemoglobin concentration, ferritin, soluble transferrin receptor (sTfR), hepcidin, and 10 cytokines. Stages of ID were defined using ferritin, sTfR, and hemoglobin concentration. During the study, a registered dietician provided all runners with iron supplements using athletic department–created guidelines. Results: Fifty-seven percent of females and 35% of males exhibited stage 2 ID (ferritin <20 ng/mL or sTfR >29.5 nmol/L) at least once. Cytokines, ferritin, and sTfR exhibited changes through the 2 years, but changes in cytokines were not associated with alterations in hepcidin, ferritin, or sTfR. In males and females, lower ferritin was associated with lower hepcidin (both P < .0001). One female exhibited higher hepcidin and lower iron stores compared with other individuals, suggesting a different etiology of ID. Conclusion: ID is common in highly trained collegiate runners. In general, the high prevalence of ID in this population is not associated with alterations in basal hepcidin or cytokine levels.
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Holtzman B, Ackerman KE. Recommendations and Nutritional Considerations for Female Athletes: Health and Performance. Sports Med 2021; 51:43-57. [PMID: 34515972 PMCID: PMC8566643 DOI: 10.1007/s40279-021-01508-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 11/29/2022]
Abstract
Optimal nutrition is an important aspect of an athlete’s preparation to achieve optimal health and performance. While general concepts about micro- and macronutrients and timing of food and fluids are addressed in sports science, rarely are the specific effects of women’s physiology on energy and fluid needs highly considered in research or clinical practice. Women differ from men not only in size, but in body composition and hormonal milieu, and also differ from one another. Their monthly hormonal cycles, with fluctuations in estrogen and progesterone, have varying effects on metabolism and fluid retention. Such cycles can change from month to month, can be suppressed with exogenous hormones, and may even be manipulated to capitalize on ideal timing for performance. But before such physiology can be manipulated, its relationship with nutrition and performance must be understood. This review will address general concepts regarding substrate metabolism in women versus men, common menstrual patterns of female athletes, nutrient and hydration needs during different phases of the menstrual cycle, and health and performance issues related to menstrual cycle disruption. We will discuss up-to-date recommendations for fueling female athletes, describe areas that require further exploration, and address methodological considerations to inform future work in this important area.
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Affiliation(s)
- Bryan Holtzman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Kathryn E Ackerman
- Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, Boston, MA, USA. .,Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
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Thakkar D, Sicova M, Guest NS, Garcia-Bailo B, El-Sohemy A. HFE Genotype and Endurance Performance in Competitive Male Athletes. Med Sci Sports Exerc 2021; 53:1385-1390. [PMID: 33433155 DOI: 10.1249/mss.0000000000002595] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Hereditary hemochromatosis can cause individuals to absorb too much iron from their diet. Higher tissue iron content, below the threshold of toxicity, may enhance oxygen carrying capacity and offer a competitive advantage. Single nucleotide polymorphisms (SNP) in the homeostatic iron regulator (HFE) gene have been shown to modify iron metabolism and can be used to predict an individual's risk of hemochromatosis. Several studies have shown that HFE genotypes are associated with elite endurance athlete status; however, no studies have examined whether HFE genotypes are associated with endurance performance. PURPOSE The objectives of this study were to determine whether there was an association between HFE risk genotypes (rs1800562 and rs1799945) and endurance performance in a 10-km cycling time trial as well as maximal oxygen uptake (V˙O2peak), an indicator of aerobic capacity. METHODS Competitive male athletes (n = 100; age = 25 ± 4 yr) completed a 10-km cycling time trial. DNA was isolated from saliva and genotyped for the rs1800562 (C282Y) and rs1799945 (H63D) SNP in HFE. Athletes were classified as low risk (n = 88) or medium/high risk (n = 11) based on their HFE genotype for both SNP using an algorithm. ANCOVA was conducted to compare outcome variables between both groups. RESULTS Individuals with the medium- or high-risk genotype were ~8% (1.3 min) faster than those with the low-risk genotype (17.0 ± 0.8 vs 18.3 ± 0.3 min, P = 0.05). V˙O2peak was ~17% (7.9 mL·kg-1⋅min-1) higher in individuals with the medium- or high-risk genotype compared with those with the low-risk genotype (54.6 ± 3.2 vs 46.7 ± 1.0 mL·kg-1⋅min-1, P = 0.003). CONCLUSION Our findings show that HFE risk genotypes are associated with improved endurance performance and increased V˙O2peak in male athletes.
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Affiliation(s)
- Drishti Thakkar
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, CANADA
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Badenhorst CE, Goto K, O'Brien WJ, Sims S. Iron status in athletic females, a shift in perspective on an old paradigm. J Sports Sci 2021; 39:1565-1575. [PMID: 33583330 DOI: 10.1080/02640414.2021.1885782] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Iron deficiency is a common nutrient deficiency within athletes, with sport scientists and medical professionals recognizing that athletes require regular monitoring of their iron status during intense training periods. Revised considerations for athlete iron screening and monitoring have suggested that males get screened biannually during heavy training periods and females require screening biannually or quarterly, depending on their previous history of iron deficiency. The prevalence of iron deficiency in female athletes is higher than their male counterparts and is often cited as being a result of the presence of a menstrual cycle in the premenopausal years. This review has sought to revise our current understanding of female physiology and the interaction between primary reproductive hormones (oestrogen and progesterone) and iron homoeostasis in females. The review highlights an apparent symbiotic relationship between iron metabolism and the menstrual cycle that requires additional research as well as identifying areas of the menstrual cycle that may be primed for nutritional iron supplementation.
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Affiliation(s)
- Claire E Badenhorst
- School of Sport, Exercise and Nutrition, College of Health, Massey University, Auckland, New Zealand
| | - Kazushige Goto
- Graduate School of Sport and Health Science, Ritsumeikan University, Kusatsu, Japan
| | - Wendy J O'Brien
- School of Sport, Exercise and Nutrition, College of Health, Massey University, Auckland, New Zealand
| | - Stacy Sims
- Te Huataki Waiora - School of Health, the University of Waikato, Hamilton, New Zealand
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Semenova EA, Miyamoto-Mikami E, Akimov EB, Al-Khelaifi F, Murakami H, Zempo H, Kostryukova ES, Kulemin NA, Larin AK, Borisov OV, Miyachi M, Popov DV, Boulygina EA, Takaragawa M, Kumagai H, Naito H, Pushkarev VP, Dyatlov DA, Lekontsev EV, Pushkareva YE, Andryushchenko LB, Elrayess MA, Generozov EV, Fuku N, Ahmetov II. The association of HFE gene H63D polymorphism with endurance athlete status and aerobic capacity: novel findings and a meta-analysis. Eur J Appl Physiol 2020; 120:665-673. [PMID: 31970519 PMCID: PMC7042188 DOI: 10.1007/s00421-020-04306-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 01/16/2020] [Indexed: 12/04/2022]
Abstract
PURPOSE Iron is an important component of the oxygen-binding proteins and may be critical to optimal athletic performance. Previous studies have suggested that the G allele of C/G rare variant (rs1799945), which causes H63D amino acid replacement, in the HFE is associated with elevated iron indexes and may give some advantage in endurance-oriented sports. The aim of the present study was to investigate the association between the HFE H63D polymorphism and elite endurance athlete status in Japanese and Russian populations, aerobic capacity and to perform a meta-analysis using current findings and three previous studies. METHODS The study involved 315 international-level endurance athletes (255 Russian and 60 Japanese) and 809 healthy controls (405 Russian and 404 Japanese). Genotyping was performed using micro-array analysis or by PCR. VO2max in 46 male Russian endurance athletes was determined using gas analysis system. RESULTS The frequency of the iron-increasing CG/GG genotypes was significantly higher in Russian (38.0 vs 24.9%; OR 1.85, P = 0.0003) and Japanese (13.3 vs 5.0%; OR 2.95, P = 0.011) endurance athletes compared to ethnically matched controls. The meta-analysis using five cohorts (two French, Japanese, Spanish, and Russian; 586 athletes and 1416 controls) showed significant prevalence of the CG/GG genotypes in endurance athletes compared to controls (OR 1.96, 95% CI 1.58-2.45; P = 1.7 × 10-9). Furthermore, the HFE G allele was associated with high V̇O2max in male athletes [CC: 61.8 (6.1), CG/GG: 66.3 (7.8) ml/min/kg; P = 0.036]. CONCLUSIONS We have shown that the HFE H63D polymorphism is strongly associated with elite endurance athlete status, regardless ethnicities and aerobic capacity in Russian athletes.
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Affiliation(s)
- Ekaterina A. Semenova
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia
- Department of Biochemistry, Kazan Federal University, Kazan, Russia
| | - Eri Miyamoto-Mikami
- Graduate School of Health and Sports Science, Juntendo University, Chiba, Japan
| | | | - Fatima Al-Khelaifi
- Anti Doping Laboratory Qatar, Sports City, Doha, Qatar
- UCL-Medical School, Royal Free Campus, London, UK
| | - Haruka Murakami
- Department of Physical Activity Research, National Institutes of Biomedical Innovation, Health and Nutrition, NIBIOHN, Tokyo, Japan
| | - Hirofumi Zempo
- Graduate School of Health and Sports Science, Juntendo University, Chiba, Japan
- Faculty of Health and Nutrition, Tokyo Seiei College, Tokyo, Japan
| | - Elena S. Kostryukova
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia
| | - Nikolay A. Kulemin
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia
| | - Andrey K. Larin
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia
| | - Oleg V. Borisov
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia
- Institute for Genomic Statistics and Bioinformatics, University Hospital Bonn, Bonn, Germany
| | - Motohiko Miyachi
- Department of Physical Activity Research, National Institutes of Biomedical Innovation, Health and Nutrition, NIBIOHN, Tokyo, Japan
| | - Daniil V. Popov
- Laboratory of Exercise Physiology, Institute for Biomedical Problems of the Russian Academy of Sciences, Moscow, Russia
| | | | - Mizuki Takaragawa
- Graduate School of Health and Sports Science, Juntendo University, Chiba, Japan
| | - Hiroshi Kumagai
- Graduate School of Health and Sports Science, Juntendo University, Chiba, Japan
- Research Fellow of Japanese Society for the Promotion of Science, Tokyo, Japan
| | - Hisashi Naito
- Graduate School of Health and Sports Science, Juntendo University, Chiba, Japan
| | - Vladimir P. Pushkarev
- Medical Genetic Centre “Progen”, Moscow, Russia
- Moscow Center of Advanced Sport Technologies, Moscow, Russia
- Department of the Theory of Physical Culture and Biomechanics, Ural State University of Physical Culture, Chelyabinsk, Russia
| | - Dmitry A. Dyatlov
- Department of the Theory of Physical Culture and Biomechanics, Ural State University of Physical Culture, Chelyabinsk, Russia
| | - Eugene V. Lekontsev
- Methodical and Analytical Department, Regional Center for Sports Training, Chelyabinsk, Russia
- Research Institute of Olympic Sports, Ural State University of Physical Culture, Chelyabinsk, Russia
| | - Yuliya E. Pushkareva
- Department of Pediatrics, South Ural State Medical University, Chelyabinsk, Russia
| | | | | | - Edward V. Generozov
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia
| | - Noriyuki Fuku
- Graduate School of Health and Sports Science, Juntendo University, Chiba, Japan
| | - Ildus I. Ahmetov
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia
- Department of Physical Education, Plekhanov Russian University of Economics, Moscow, Russia
- Laboratory of Molecular Genetics, Kazan State Medical University, Kazan, Russia
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Byrom St, Liverpool, L3 5AF UK
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Nabhan D, Bielko S, Sinex JA, Surhoff K, Moreau WJ, Schumacher YO, Bahr R, Chapman RF. Serum ferritin distribution in elite athletes. J Sci Med Sport 2019; 23:554-558. [PMID: 31901316 DOI: 10.1016/j.jsams.2019.12.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 10/21/2019] [Accepted: 12/19/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVES It is not uncommon for athletes to be diagnosed with iron deficiency, yet there remains uncertainty whether the prevalence of suboptimal iron status in elite athletes differs from the normal population or warrants routine screening. The purpose of this study is to describe the distribution of serum ferritin (SF) in a cohort of elite athletes. DESIGN Retrospective cohort study. METHODS Electronic health records of 1085 elite adult athletes (570 women, 515 men) from 2012-2017 were examined retrospectively. SF values were compared to published normal population data. The proportion of athletes meeting criterion values for iron deficiency or initiation of treatment was examined. RESULTS SF distributions in male athletes were significantly lower than normal males aged 20 to <24yrs. (χ2 28.8, p<0.001) and aged 24 to <28yrs. (χ2 91.9, p<0.001). SF status was similar in female athletes and normal women aged 20 to <24yrs. (χ2 9.5, p>0.05) or aged 24 to <28yrs. (χ2 11.5, p>0.05). Using 35ng/ml as the criterion value for stage one iron deficiency, 15% of male athletes and 52% of female athletes displayed suboptimal iron status. CONCLUSIONS Male athletes have a significantly lower population distribution of SF values as compared to normative data on healthy males, with 15% of male athletes having suboptimal SF status. The distribution of SF values in elite female athletes did not differ from population values, however approximately half women athletes were iron deficient. These data suggest that iron screening should be considered in both male and female athlete populations.
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Affiliation(s)
- Dustin Nabhan
- Sports Medicine Division, United States Olympic and Paralympic Commitee, USA.
| | - Shane Bielko
- Human Performance Laboratory, Department of Kinesiology, Indiana University, USA
| | - Jacob A Sinex
- Human Performance Laboratory, Department of Kinesiology, Indiana University, USA
| | - Kendall Surhoff
- Department of Allied Health Services, University of North Carolina Chapel Hill, USA
| | | | | | - Roald Bahr
- Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Norway
| | - Robert F Chapman
- Human Performance Laboratory, Department of Kinesiology, Indiana University, USA
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Okazaki K, Stray-Gundersen J, Chapman RF, Levine BD. Iron insufficiency diminishes the erythropoietic response to moderate altitude exposure. J Appl Physiol (1985) 2019; 127:1569-1578. [DOI: 10.1152/japplphysiol.00115.2018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The effects of iron stores and supplementation on erythropoietic responses to moderate altitude in endurance athletes were examined. In a retrospective study, red cell compartment volume (RCV) responses to 4 wk at 2,500 m were assessed in athletes with low ( n = 9, ≤20 and ≤30 ng/mL for women and men, respectively) and normal ( n = 10) serum ferritin levels ([Ferritin]) without iron supplementation. In a subsequent prospective study, the same responses were assessed in athletes ( n = 26) with a protocol designed to provide sufficient iron before and during identical altitude exposure. The responses to a 4-wk training camp at sea level were assessed in another group of athletes ( n = 13) as controls. RCV and maximal oxygen uptake (V̇o2max) were determined at sea level before and after intervention. In the retrospective study, athletes with low [Ferritin] did not increase RCV (27.0 ± 2.9 to 27.5 ± 3.8 mL/kg, mean ± SD, P = 0.65) or V̇o2max (60.2 ± 7.2 to 62.2 ± 7.5 mL·kg−1·min−1, P = 0.23) after 4 wk at altitude, whereas athletes with normal [Ferritin] increased both (RCV: 27.3 ± 3.1 to 29.8 ± 2.4 mL/kg, P = 0.002; V̇o2max: 62.0 ± 3.1 to 66.2 ± 3.7 mL·kg−1·min−1, P = 0.003). In the prospective study, iron supplementation normalized low [Ferritin] observed in athletes exposed to altitude ( n = 14) and sea level ( n = 6) before the altitude/sea-level camp and maintained [Ferritin] within normal range in all athletes during the camp. RCV and V̇o2max increased in the altitude group but remained unchanged in the sea-level group. Finally, the increase in RCV correlated with the increase in V̇o2max [( r = 0.368, 95% confidence interval (CI): 0.059–0.612, P = 0.022]. Thus, iron deficiency in athletes restrains erythropoiesis to altitude exposure and may preclude improvement in sea-level athletic performance. NEW & NOTEWORTHY Hypoxic exposure increases iron requirements and utilization for erythropoiesis in athletes. This study clearly demonstrates that iron deficiency in athletes inhibits accelerated erythropoiesis to a sojourn to moderate high altitude and may preclude a potential improvement in sea-level athletic performance with altitude training. Iron replacement therapy before and during altitude exposure is important to maximize performance gains after altitude training in endurance athletes.
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Affiliation(s)
- Kazunobu Okazaki
- Research Center for Urban Health and Sports, Osaka City University, Osaka, Japan
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
| | | | | | - Benjamin D. Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
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Malczewska-Lenczowska J, Surała O, Orysiak J, Turowski D, Szczepańska B, Tomaszewski P. Utility of Novel Hypochromia and Microcythemia Markers in Classifying Hematological and Iron Status in Male Athletes. Nutrients 2019; 11:nu11112767. [PMID: 31739525 PMCID: PMC6893463 DOI: 10.3390/nu11112767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/04/2019] [Accepted: 11/11/2019] [Indexed: 01/01/2023] Open
Abstract
In athletes, no reliable indices exist for an unambiguous evaluation of hematological and iron status. Therefore, the utility of some new red blood cell (RBC) parameters was explored in 931 elite male athletes aged 13–35 years. To diagnose iron status, the values of ferritin and soluble transferrin receptor (sTfR), total iron binding capacity (TIBC), and basic blood morphology were determined in blood. The new hematological markers included among others: mean cellular hemoglobin content in reticulocytes (CHr), percentage of erythrocytes (HYPOm) and reticulocytes (HYPOr) with decreased cellular hemoglobin concentration, percentage of erythrocytes (LowCHm) and reticulocytes (LowCHr) with decreased cellular hemoglobin content, mean volume of reticulocytes (MCVr), and percentage of erythrocytes with decreased volume (MICROm). Despite adverse changes in reticulocyte hypochromia indices (CHr, LowCHr, HYPOr; p < 0.001) in the iron depletion state, the area under the receiver operating characteristic curve (AUC-ROC) values calculated for them were relatively low (0.539–0.722). In iron-deficient erythropoiesis (IDE), unfavorable changes additionally concern microcythemia indices in both reticulocytes and erythrocytes (MCVr, MCV, MICROm, and red cell volume distribution width—RDW), with especially high values of AUC-ROC (0.947–0.970) for LowCHm, LowCHr, and CHr. Dilutional sports anemia was observed in 6.1% of athletes. In this subgroup, only hemoglobin concentration (Hb), hematocrit (Hct), and RBC (all dependent on blood volume) were significantly lower than in the normal group. In conclusion, the diagnostic utility of the new hematology indices was not satisfactory for the detection of an iron depletion state in athletes. However, these new indices present high accuracy in the detection of IDE and sports anemia conditions.
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Affiliation(s)
- Jadwiga Malczewska-Lenczowska
- Department of Nutrition Physiology and Dietetics, Institute of Sport, National Research Institute, Trylogii 2/16, 01-982 Warsaw, Poland; (O.S.); (J.O.); (B.S.)
- Correspondence: ; Tel.: +48-22-569-99-00
| | - Olga Surała
- Department of Nutrition Physiology and Dietetics, Institute of Sport, National Research Institute, Trylogii 2/16, 01-982 Warsaw, Poland; (O.S.); (J.O.); (B.S.)
| | - Joanna Orysiak
- Department of Nutrition Physiology and Dietetics, Institute of Sport, National Research Institute, Trylogii 2/16, 01-982 Warsaw, Poland; (O.S.); (J.O.); (B.S.)
| | - Dariusz Turowski
- Department of Biochemistry, Institute of Sport, National Research Institute, Trylogii 2/16, 01-982 Warsaw, Poland;
| | - Beata Szczepańska
- Department of Nutrition Physiology and Dietetics, Institute of Sport, National Research Institute, Trylogii 2/16, 01-982 Warsaw, Poland; (O.S.); (J.O.); (B.S.)
| | - Paweł Tomaszewski
- Department of Biometry, Józef Piłsudski University of Physical Education, Marymoncka 34, 00-968 Warsaw, Poland
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Iron considerations for the athlete: a narrative review. Eur J Appl Physiol 2019; 119:1463-1478. [PMID: 31055680 DOI: 10.1007/s00421-019-04157-y] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 05/02/2019] [Indexed: 02/07/2023]
Abstract
Iron plays a significant role in the body, and is specifically important to athletes, since it is a dominant feature in processes such as oxygen transport and energy metabolism. Despite its importance, athlete populations, especially females and endurance athletes, are commonly diagnosed with iron deficiency, suggesting an association between sport performance and iron regulation. Although iron deficiency is most common in female athletes (~ 15-35% athlete cohorts deficient), approximately 5-11% of male athlete cohorts also present with this issue. Furthermore, interest has grown in the mechanisms that influence iron absorption in athletes over the last decade, with the link between iron regulation and exercise becoming a research focus. Specifically, exercise-induced increases in the master iron regulatory hormone, hepcidin, has been highlighted as a contributing factor towards altered iron metabolism in athletes. To date, a plethora of research has been conducted, including investigation into the impact that sex hormones, diet (e.g. macronutrient manipulation), training and environmental stress (e.g. hypoxia due to altitude training) have on an athlete's iron status, with numerous recommendations proposed for consideration. This review summarises the current state of research with respect to the aforementioned factors, drawing conclusions and recommendations for future work.
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11
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Exercise-Induced Illness and Inflammation: Can Immunonutrition and Iron Help? Int J Sport Nutr Exerc Metab 2019; 29:181-188. [PMID: 30507260 DOI: 10.1123/ijsnem.2018-0288] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The main focus of this review is illness among elite athletes, how and why it occurs, and whether any measures can be taken to combat it or to prevent its onset. In particular, there is particular interest in exercise-induced immunodepression, which is a result of the immune system regarding exercise (e.g., prolonged, exhaustive exercise) as a challenge to its function. This promotes the inflammatory response. There is often a high incidence of illness in athletes after undertaking strenuous exercise, particularly among those competing in endurance events, not only mainly in terms of upper respiratory tract illness, but also involving gastrointestinal problems. It may well be that this high incidence is largely due to insufficient recovery time being allowed after, for example, a marathon, a triathlon, or other endurance events. Two examples of the incidence of upper respiratory tract illness in moderate versus endurance exercise are provided. In recent years, increasing numbers of research studies have investigated the origins, symptoms, and incidence of these bouts of illness and have attempted to alleviate the symptoms with supplements, sports foods, or immunonutrition. One aspect of the present review discusses iron deficiency, which has been primarily suggested to have an impact upon cell-mediated immunity. Immunonutrition is also discussed, as are new techniques for investigating links between metabolism and immune function.
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Petkus DL, Murray-Kolb LE, Scott SP, Southmayd EA, De Souza MJ. Iron status at opposite ends of the menstrual function spectrum. J Trace Elem Med Biol 2019; 51:169-175. [PMID: 30466928 DOI: 10.1016/j.jtemb.2018.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/04/2018] [Accepted: 10/15/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Although exercising women are at high risk of poor iron status, it is unknown how non-pathological, physiological menstrual function affects iron status. As such, this study investigates the association between menstrual function and iron status in exercising women with amenorrhea and exercising women with ovulatory, eumenorrheic menstrual cycles. DESIGN Cross-sectional analysis of iron depletion prevalence, iron status indices, exercise parameters, and diet composition. METHODS Women aged 18-35 years performing at least 2 h per week of aerobic exercise were recruited. Women with amenorrhea (AMEN) were defined by the absence of menses for at least 90 days or less than 6 menses in the past 12 months (n = 82). Women with ovulatory, eumenorrheic menstrual cycles (OvEU) were defined by the presence of ovulatory cycles of 26-35 days in length for the past 6 months (n = 109). Group differences in serum ferritin (Ft), soluble transferrin receptor (sTfR), total body iron (TBI), hemoglobin (Hb), hematocrit (Hct), iron depletion prevalence (Ft <15 μg/L), peak oxygen consumption (VO2peak), exercise minutes per week, and diet logs were assessed. RESULTS The prevalence of iron depletion was greater in OvEU when compared to AMEN (26% vs. 15%, p = 0.04). No significant differences were observed between AMEN and OvEU in Ft (30.2 ± 2.2 vs. 24.9 ± 2.6 μg/L; p = 0.62), sTfR (5.2 ± 1.4 vs. 4.9 ± 1.5 mg/L; p = 0.95), TBI (5.3 ± 2.7 vs. 4.8 ± 3.7 mg/kg; p = 0.42), Hb (13.2 ± 0.4 vs. 13.4 ± 0.6 g/dL; p = 0.80), Hct (39.5 ± 0.8% vs. 39.8 ± 4.1%; p = 0.93), or exercise parameters. AMEN consumed more vitamin C than OvEU (269 ± 180 vs. 129 ± 141 mg/day, p < 0.001), but all other dietary factors were similar between AMEN and OvEU. CONCLUSION Exercising women with ovulatory, eumenorrheic cycles are at a greater risk of iron depletion than exercising, amenorrheic women. Thus, menstrual function must be considered when screening for poor iron status in exercising women.
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Affiliation(s)
- Dylan L Petkus
- The Women's Health and Exercise Laboratory, The Pennsylvania State University, 104 Noll Laboratory, University Park, PA 16802, United States.
| | - Laura E Murray-Kolb
- Department of Nutritional Sciences, The Pennsylvania State University, 219 Chandlee Laboratory, University Park, PA 16802, United States.
| | - Samuel P Scott
- Department of Nutritional Sciences, The Pennsylvania State University, 219 Chandlee Laboratory, University Park, PA 16802, United States.
| | - Emily A Southmayd
- The Women's Health and Exercise Laboratory, The Pennsylvania State University, 104 Noll Laboratory, University Park, PA 16802, United States.
| | - Mary Jane De Souza
- The Women's Health and Exercise Laboratory, The Pennsylvania State University, 104 Noll Laboratory, University Park, PA 16802, United States.
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Alcock R, McCubbin A, Camões-Costa V, Costa RJS. Case Study: Providing Nutritional Support to an Ultraendurance Runner in Preparation for a Self-Sufficient Multistage Ultramarathon: Rationed Versus Full Energy Provisions. Wilderness Environ Med 2018; 29:508-520. [PMID: 30249353 DOI: 10.1016/j.wem.2018.06.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 05/14/2018] [Accepted: 06/13/2018] [Indexed: 01/24/2023]
Abstract
To assess the impact of rationed versus full estimated energy provisions on markers of physiological strain in response to a simulated 250 km multistage ultramarathon (MSUM), on two separate occasions, the ultraendurance runner performed a laboratory simulated MSUM, with rationed (RP: 3303±75 kcal⋅day-1) and full (FP: 7156±359 kcal⋅day-1) provisions. Total daily energy expenditure was determined using dual-method indirect calorimetry. Resting metabolic rate, iDXA, and body water were measured at baseline, day 3, and post-MSUM. Blood, urine, and feces were collected, and mood state was measured, d 1 to 5 (before and after running) to determine various physiological strain indices. Heart rate, RPE, thermal comfort, gastrointestinal symptoms, and non-protein oxidation rates were measured every 30 min during running. Data were analyzed using single-subject design analysis and interpreted using Cohen's effect size. Energy expenditure was lower on RP (6943±145 kcal⋅day-1) than FP (7486±143 kcal⋅day-1) (Cohen's δ=-3.1). More pronounced exertional strain (RPE δ=1.2, thermal conform δ=0.6, rectal temperature δ=1.0, and plasma cortisol concentration δ=1.7) was observed on RP as the MSUM progressed. Total carbohydrate and fat oxidation during running decreased (0.76 vs. 1.82 g⋅min-1; δ=-3.9) and increased (0.91 vs. 0.54 g⋅min-1; δ=3.7), respectively, more profoundly on RP as the MSUM progressed. Gastrointestinal symptoms were modestly lower in RP (δ=-0.26). Exercise-induced leukocytosis, cytokinaemia, and neutrophil responses were higher on RP. Iron status markers were trivial. Higher mood disturbance and fatigue were reported on RP. The ultraendurance runner presented greater physiological and psychophysiological disturbances, in response to a laboratory simulated MSUM, on rationed energy provisions, despite the lighter pack-weight.
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Affiliation(s)
- Rebekah Alcock
- Sports Nutrition, Australian Institute of Sport, Australian Sports Commission, Bruce, Australia (Ms Alcock)
| | - Alan McCubbin
- Department of Nutrition, Dietetics & Food, Monash University, Victoria, Australia (Mr McCubbin and Drs Camões-Costa and Costa)
| | - Vera Camões-Costa
- Department of Nutrition, Dietetics & Food, Monash University, Victoria, Australia (Mr McCubbin and Drs Camões-Costa and Costa); Health & Aging Research Group, Swinburne University of Technology, Victoria, Australia (Dr Camões-Costa)
| | - Ricardo J S Costa
- Department of Nutrition, Dietetics & Food, Monash University, Victoria, Australia (Mr McCubbin and Drs Camões-Costa and Costa).
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Orysiak J, Mazur-Rozycka J, Fitzgerald J, Starczewski M, Malczewska-Lenczowska J, Busko K. Vitamin D status and its relation to exercise performance and iron status in young ice hockey players. PLoS One 2018; 13:e0195284. [PMID: 29630669 PMCID: PMC5891016 DOI: 10.1371/journal.pone.0195284] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 03/19/2018] [Indexed: 12/20/2022] Open
Abstract
Objectives The aim was to examine the association between serum vitamin D concentration and isometric strength of various muscle groups, vertical jump performance, and repeated sprint ability in young ice hockey players. The secondary aim was to determine the association between vitamin D deficiency and indices of iron status. Methods Fifty male ice hockey players (17.2±0.9 years) participated in this cross-sectional study. Exercise performance was evaluated using isometric strength measures of upper and lower extremities, vertical jump performance and repeated sprint ability (RSA). Blood samples were collected for the determination of serum 25-hydroxyvitamin D (25(OH)D) and multiple indicies of iron status. Results The mean serum 25(OH)D concentration was 30.4 ng·ml-1 and ranged from 12.5 to 91.4 ng·ml-1. Eleven participants (22%) had vitamin D deficiency and 20 athletes (40%) had vitamin D insufficiency. Serum 25(OH)D concentration was not positively correlated with isometric muscle strength, vertical jump performance, or RSA after adjusting for age, training experience, fat mass, fat free mass and height. Serum 25(OH)D concentration was not associated with indices of iron status. Conclusion Vitamin D insufficiency is highly prevalent in ice hockey players, but 25(OH)D concentration but it is not associated with exercise performance or indices of iron status.
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Affiliation(s)
- Joanna Orysiak
- Department of Nutrition Physiology and Dietetics, Institute of Sport – National Research Institute, Warsaw, Poland
| | - Joanna Mazur-Rozycka
- Central Institute For Labour Protection – National Research Institute (CIOP- PIB), Department of Ergonomics, Warsaw, Poland
| | - John Fitzgerald
- Department of Kinesiology and Public Health Education, University of North Dakota, Grand Forks, North Dakota, United States of America
| | - Michal Starczewski
- Department of Physiology, Institute of Sport – National Research Institute, Warsaw, Poland
| | | | - Krzysztof Busko
- Department of Anatomy and Biomechanics, Kazimierz Wielki University, Bydgoszcz, Poland
- * E-mail:
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Komatsu T, Yamasawa F, Dohi M, Akama T, Masujima A, Kono I, Kawahara T. The prevalence of anemia in Japanese Universiade athletes, detected with longitudinal preparticipation medical examinations. J Gen Fam Med 2018; 19:102-108. [PMID: 29744264 PMCID: PMC5931355 DOI: 10.1002/jgf2.164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 02/04/2018] [Indexed: 11/11/2022] Open
Abstract
Background No reports have evaluated the long-term trends of the prevalence of anemia in Universiade athletes using preparticipation medical examinations (PPMEs). We aimed to investigate the prevalence of anemia among Japanese Universiade athletes, using longitudinal PPMEs. Methods In this retrospective, observational study, athletes with published data from official reports of the Japanese delegation of the summer Universiade games between 1977 and 2011 were included, as were similar-aged nonathletes with published health data, extracted from official national reports from the Japanese Ministry of Health, Labour and Welfare. PPME data and national health survey data included blood tests for anemia and the age of each participant. We compared the anemia prevalence in both groups using an unpaired t test. Results Anemia prevalence among Universiade athletes decreased by 11.6% over the study period (13.3% in 1977 to 1.7% in 2011). Moreover, anemia prevalence between 1991 and 2011 in the total Universiade athlete population was significantly lower than that in the nonathletic population (mean ± standard deviation: 5.2 ± 2.9% vs 9.8 ± 1.5%, respectively; P = .025). In female Universiade athletes, anemia prevalence between 1977 and 1981 was higher than that in the nonathletic populations (48.1% vs 19.7%, respectively). However, in 2003, this value was lower than that in nonathletic female populations (8.5% vs 19.8%, respectively). Conclusions A decrease in anemia prevalence in Japanese Universiade athletes was revealed with longitudinal PPMEs. Hematological parameters should be evaluated longitudinally in athletes to provide continuous performance support throughout the athlete's career.
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Affiliation(s)
- Takayuki Komatsu
- Department of Emergency and Critical Care Medicine Juntendo University Nerima Hospital Tokyo Japan.,Medical Center Japan Institute of Sports Science Tokyo Japan
| | - Fumihiro Yamasawa
- Medical Center Japan Institute of Sports Science Tokyo Japan.,Marubeni Health Promotion Center Tokyo Japan
| | - Michiko Dohi
- Medical Center Japan Institute of Sports Science Tokyo Japan
| | - Takao Akama
- Medical Center Japan Institute of Sports Science Tokyo Japan.,Faculty of Sport Sciences Waseda University Saitama Japan
| | - Atsushi Masujima
- Department of Sports Medicine and Orthopedic Surgery Toshiba General Hospital Tokyo Japan
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Epstein D, Borohovitz A, Merdler I, Furman M, Atalli E, Sorkin A, Stainfeld Y, Isenberg Y, Mashiach T, Shapira S, Weisshof R, Dann EJ. Prevalence of Iron Deficiency and Iron Deficiency Anemia in Strenuously Training Male Army Recruits. Acta Haematol 2018; 139:141-147. [PMID: 29478071 DOI: 10.1159/000485736] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 11/25/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The objectives of our study were to determine the effect of strenuous physical training on the prevalence of iron deficiency anemia (IDA), iron deficiency (ID) with normal hemoglobin (Hb), and anemia without ID. METHODS Our study was a prospective observational study. We followed 115 healthy male recruits in the Israel Defense Forces elite units during 15 months of training. Blood samples were collected at recruitment and at 6-, 9- and 15-month follow-ups. RESULTS Upon recruitment, anemia (Hb < 14 g/dL), ID, and ID anemia (IDA) were diagnosed in 28, 31, and 9% of individuals, respectively. Sixty-three subjects (54%) were followed for 6 months; 9 of them (14%) developed new-onset IDA. Among them, the prevalence of anemia rose from 19 to 52%, and ID from 33 to 35%. At the 15-month follow-up, 29% had developed new-onset IDA and 65% showed evidence of ID. CONCLUSION We report a high prevalence of anemia, ID, and IDA among young healthy males participating in prolonged strenuous training programs. These findings can be partly explained by the physiological changes associated with strenuous physical activity. Further investigations aiming to develop specific diagnostic guidelines for this unique population are warranted.
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Affiliation(s)
- Danny Epstein
- Israeli Medical Corps, Israel Defense Forces, Tel HaShomer, Israel
- Rambam Health Care Campus, Haifa, Israel
| | - Ariel Borohovitz
- Israeli Medical Corps, Israel Defense Forces, Tel HaShomer, Israel
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ilan Merdler
- Israeli Medical Corps, Israel Defense Forces, Tel HaShomer, Israel
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Moran Furman
- Israeli Medical Corps, Israel Defense Forces, Tel HaShomer, Israel
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Emmanuel Atalli
- Israeli Medical Corps, Israel Defense Forces, Tel HaShomer, Israel
| | - Alex Sorkin
- Israeli Medical Corps, Israel Defense Forces, Tel HaShomer, Israel
- Assaf HaRofeh Medical Center, Tzrifin, Israel
| | - Yaniv Stainfeld
- Israeli Medical Corps, Israel Defense Forces, Tel HaShomer, Israel
- Rambam Health Care Campus, Haifa, Israel
| | - Yoni Isenberg
- Israeli Medical Corps, Israel Defense Forces, Tel HaShomer, Israel
- Rambam Health Care Campus, Haifa, Israel
| | | | - Shachar Shapira
- Israeli Medical Corps, Israel Defense Forces, Tel HaShomer, Israel
| | | | - Eldad J Dann
- Rambam Health Care Campus, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
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Parks RB, Hetzel SJ, Brooks MA. Iron Deficiency and Anemia among Collegiate Athletes: A Retrospective Chart Review. Med Sci Sports Exerc 2018; 49:1711-1715. [PMID: 28277407 DOI: 10.1249/mss.0000000000001259] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE To describe the prevalence of anemia among incoming female college athletes and to characterize the results and expenses of iron-related testing at one National Collegiate Athletic Association Division I institution. METHODS In this retrospective medical record review, hemoglobin (Hgb) and ferritin laboratory values were obtained for student-athletes at a single institution, 2002 to 2014. Laboratories were collected either as part of the preparticipation examination (PPE) for female athletes, routine screening for cross-country athletes, or as needed for medical evaluation. Anemia was defined as Hgb < 11.6 g·dL for females and < 13.6 g·dL for male athletes. Iron deficiency was defined as Fer < 20 ng·mL for both sexes. RESULTS A total of 5674 laboratory draws were obtained for 2749 individuals (56% female) from 25 different teams. The prevalence of low Hgb among female athletes at PPE was 5.7% (95% confidence interval, 4.4%-6.9%). At PPE, the incidence of anemia was not significantly higher for any sport when compared with the group mean. Ferritin and Hgb were collected together in approximately one third of all blood draws from females (n = 1059) and one sixth of blood draws from males (n = 411). For female athletes, 2.2% indicated iron deficiency anemia and 30.9% indicated iron deficiency without anemia. For male athletes, 1.2% indicated iron deficiency anemia and 2.9% indicated iron deficiency without anemia. The median cost of iron testing exceeded US $20,000 annually for the institution. CONCLUSIONS One in 20 incoming female athletes was identified with anemia at the PPE. Given the costs of testing, screening practices at each institution should be thoughtfully selected and routinely reassessed.
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Affiliation(s)
- Rachel B Parks
- 1Division of Sports Medicine, Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI; and 2Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI
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The Association between Iron and Vitamin D Status in Female Elite Athletes. Nutrients 2018; 10:nu10020167. [PMID: 29385099 PMCID: PMC5852743 DOI: 10.3390/nu10020167] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 01/23/2018] [Accepted: 01/27/2018] [Indexed: 12/31/2022] Open
Abstract
Vitamin D may influence iron metabolism and erythropoiesis, whereas iron is essential for vitamin D synthesis. We examined whether vitamin D deficiencies (VDD) are associated with reduced iron status and whether progressive iron deficiency (ID) is accompanied by inferior vitamin D status. The study included 219 healthy female (14–34 years old) athletes. VDD was defined as a 25(OH)D concentration < 75 nmol/L. ID was classified based on ferritin, soluble transferrin receptor (sTfR), total iron binding capacity (TIBC) and blood morphology indices. The percentage of ID subjects was higher (32%) in the VDD group than in the 25(OH)D sufficient group (11%) (χ2 = 10.6; p = 0.001). The percentage of VDD subjects was higher (75%) in the ID than in the normal iron status group (48%) (χ2 = 15.6; p = 0.001). The odds ratios (ORs) for VDD increased from 1.75 (95% CI 1.02–2.99; p = 0.040) to 4.6 (95% CI 1.81–11.65; p = 0.001) with progressing iron deficiency. ID was dependent on VDD in both VDD groups (25(OH)D < 75 and < 50 nmol/L). The ID group had a lower 25(OH)D concentration (p = 0.000). The VDD group had lower ferritin (p = 0.043) and iron (p = 0.004) concentrations and higher values of TIBC (p = 0.016) and sTfR (p = 0.001). The current results confirm the association between vitamin D and iron status in female athletes, although it is difficult to assess exactly which of these nutrients exerts a stronger influence over the other.
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Wachsmuth NB, Aigner T, Völzke C, Zapf J, Schmidt WF. Monitoring recovery from iron deficiency using total hemoglobin mass. Med Sci Sports Exerc 2016; 47:419-27. [PMID: 24977693 DOI: 10.1249/mss.0000000000000420] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Using hemoglobin concentration ([Hb]) to diagnose borderline iron deficiency and monitor the progress of its treatment is difficult because of the confounding effects of plasma volume. Because hemoglobin mass (Hbmass) is not affected by plasma volume, it may be a more sensitive parameter. The aim of this study was to monitor Hbmass, iron storage, and maximal oxygen consumption (V˙O2max) during and after oral iron therapy in subjects with severe and moderate iron deficiency. METHODS Three groups of female recreational athletes were monitored for at least 22 wk, as follows: 1) severe iron deficiency group (SID) (n = 8; ferritin, ≤12 ng·mL), 2) moderate iron deficiency group (MID) (n = 14; ferritin, ≤25 ng·mL), and 3) control group (n = 8; ferritin, >25 ng·mL). Hbmass and iron status were determined before, during, and up to 12 wk after at least 10 wk of oral iron supplementation. In total, five V˙O2max tests were performed before, during, and after the supplementation period. RESULTS Hbmass increased markedly in the SID group (15.6% ± 11.0%, P < 0.001) and slightly in the MID group (2.2% ± 3.7%, P < 0.05) by the end of the supplementation period and remained at this level for the following 12 wk. [Hb] and Hbmass were similarly affected, but Hbmass was more closely related to mean corpuscular volume and mean corpuscular hemoglobin than [Hb]. The SID group incorporated 534 ± 127 mg of iron into ferritin and hemoglobin, whereas the MID group incorporated 282 ± 68 mg of iron. V˙O2max increased only in the SID group by 0.20 ± 0.18 L·min (P < 0.05) and was closely related to Hbmass (P < 0.01). CONCLUSIONS Hbmass is a sensitive tool for monitoring recovery from iron deficiency anemia and assessing the effectiveness of iron supplementation in individuals with severe or moderate iron deficiency.
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Affiliation(s)
- Nadine B Wachsmuth
- Department of Sports Medicine/Sports Physiology, University of Bayreuth, Bayreuth, GERMANY
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Nabhan DC, Moreau WJ, Barylski C. Laboratory Tests Ordered By a Chiropractic Sports Physician on Elite Athletes Over a 1-Year Period. J Chiropr Med 2015; 14:68-76. [PMID: 26257590 DOI: 10.1016/j.jcm.2015.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Revised: 04/12/2015] [Accepted: 04/15/2015] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE The purpose of this study is to describe and discuss laboratory tests ordered on elite athletes in an interdisciplinary sports medicine clinic by a doctor of chiropractic over 1 calendar year. METHODS A retrospective review of laboratory tests ordered during routine clinical practice as standard screening and diagnostic tests from November 1, 2009, to November 1, 2010 was performed. Data were collected during clinical encounters at one sports medicine clinic and entered into a database for analysis. Descriptive and frequency statistics were used to describe the tests ordered and the frequency of abnormal findings. RESULTS Five hundred and thirty-nine studies were ordered for diagnostic and routine screenings on 137 athlete patients (86 males, 51 females), representing 49 types of tests. Sample sources included blood, urine, skin lesions, and fecal matter. The most commonly ordered tests were complete blood count, comprehensive metabolic panel, serum ferritin, creatine kinase, serum iron and total iron binding capacity, total cortisol, thyroid stimulating hormone, and lipid panels. There were 217 studies (40%) flagged as abnormal by the reporting laboratory. CONCLUSION This report provides greater insight into the diverse array of laboratory studies ordered over a 1-year period for diagnosis and screening of elite athletes. A high percentage of the results were flagged as abnormal by the laboratory. These findings show that the unique physiology of the elite athlete must be considered when interpreting laboratory findings in this population.
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Affiliation(s)
- Dustin C Nabhan
- Associate Director, Clinical Research and Multidisciplinary Care United State Olympic Committee, Colorado Springs, Colorado
| | - William J Moreau
- Managing Director of Sports Medicine, United States Olympic Committee, Colorado Springs, Colorado
| | - Chad Barylski
- Nurse Practitioner, Annadel Medical Group Family Medicine/UCSF Medical Center Department of Orthopedics/Neurosurgery, Santa Rosa, California
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Conley KM, Bolin DJ, Carek PJ, Konin JG, Neal TL, Violette D. National Athletic Trainers' Association position statement: Preparticipation physical examinations and disqualifying conditions. J Athl Train 2015; 49:102-20. [PMID: 24499039 DOI: 10.4085/1062-6050-48.6.05] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To present athletic trainers with recommendations for the content and administration of the preparticipation physical examination (PPE) as well as considerations for determining safe participation in sports and identifying disqualifying conditions. BACKGROUND Preparticipation physical examinations have been used routinely for nearly 40 years. However, considerable debate exists as to their efficacy due to the lack of standardization in the process and the lack of conformity in the information that is gathered. With the continuing rise in sports participation at all levels and the growing number of reported cases of sudden death in organized athletics, the sports medicine community should consider adopting a standardized process for conducting the PPE to protect all parties. RECOMMENDATIONS Recommendations are provided to equip the sports medicine community with the tools necessary to conduct the PPE as effectively and efficiently as possible using available scientific evidence and best practices. In addition, the recommendations will help clinicians identify those conditions that may threaten the health and safety of participants in organized sports, may require further evaluation and intervention, or may result in potential disqualification.
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Recomendaciones nutricionales para el niño deportista. An Pediatr (Barc) 2014; 81:125.e1-6. [DOI: 10.1016/j.anpedi.2013.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 08/02/2013] [Accepted: 08/27/2013] [Indexed: 11/20/2022] Open
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Abstract
Iron is a trace mineral that is highly significant to endurance athletes. Iron is critical to optimal athletic performance because of its role in energy metabolism, oxygen transport, and acid-base balance. Endurance athletes are at increased risk for suboptimal iron status, with potential negative consequences on performance, because of the combination of increased iron needs and inadequate dietary intake. This review paper summarizes the role of iron in maximal and submaximal exercise and describes the effects of iron deficiency on exercise performance. Mechanisms that explain the increased risk of iron deficiency in endurance athletes, including exercise-associated inflammation and hepcidin release on iron sequestration, are described. Information on screening athletes for iron deficiency is presented, and suggestions to increase iron intake through diet modification or supplemental iron are provided.
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Affiliation(s)
- Pamela S Hinton
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO 65211, USA
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GARVICAN LAURAA, SAUNDERS PHILOU, CARDOSO TANUSHA, MACDOUGALL IAINC, LOBIGS LOUISAM, FAZAKERLEY RUTH, FALLON KIERANE, ANDERSON BEV, ANSON JUDITHM, THOMPSON KEVING, GORE CHRISTOPHERJ. Intravenous Iron Supplementation in Distance Runners with Low or Suboptimal Ferritin. Med Sci Sports Exerc 2014; 46:376-85. [DOI: 10.1249/mss.0b013e3182a53594] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
Adequate body stores of iron are necessary for optimal endurance exercise performance. Severe iron depletion resulting in overt iron-deficiency anemia clearly depresses endurance fitness, but it is not clear if milder degrees of iron deficiency (low serum ferritin with normal hemoglobin levels) impair physical capacity. The question is an important one for athletes, particularly females, who are particularly prone to iron deficiency without anemia. This review examines research data, in both animals and humans, which have addressed this issue. Constructing guidelines based on this often-conflicting body of information is difficult. Routine screening is advocated for at-risk athletes, particularly elite-level female competitors in distance sports, and, although controversial, many authorities recommend iron treatment for athletes with hypoferritemia (ferritin <12-20 ng/mL), even without overt anemia. However, “blind” supplementation with oral iron by athletes is not recommended.
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Affiliation(s)
- Thomas Rowland
- Department of Pediatrics, Baystate Medical Center, Springfield, Massachusetts
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Iron status in elite young athletes: gender-dependent influences of diet and exercise. Eur J Appl Physiol 2011; 112:513-23. [PMID: 21594695 DOI: 10.1007/s00421-011-2002-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Accepted: 05/09/2011] [Indexed: 01/01/2023]
Abstract
Iron depletion seems to occur more frequently among athletes than in the general population and may affect performance capacity. Only little information is available about the prevalence of iron status abnormalities in young elite athletes and whether iron depletion is associated with gender, sport, age or nutrition- and exercise-related factors in this group. Hence, diet, exercise and haematological data from 193 elite athletes (96 males, 97 females; 16.2 ± 2.7 years) from 24 different sports were analyzed retrospectively. Most female athletes failed to meet the recommended daily allowance for iron, even though dietary iron density was higher than in males (5.75 ± 0.78 vs. 6.17 ± 0.98 mg/1,000 kcal; P = 0.001). Iron depletion (serum ferritin < 35 μg/L) occurred in 31% of male and 57% of female athletes (P < 0.001). Low haemoglobin (males: <13 g/dL; females: <12 g/dL) and haematocrit (males: <40%; females: <36%) values were equally prevalent in both genders [haemoglobin: 7.3% (males), 6.2% (females); haematocrit: 13.5% (males); 15.5% (females)]. In females, reduced ferritin levels were associated with a lower dietary iron density (5.9 ± 0.8 vs. 6.6 ± 1.1 mg/1,000 kcal; P = 0.002). Males with iron depletion had a significantly higher estimated energy expenditure (48.7 ± 7.0 vs. 44.4 ± 7.6 kcal/kg/day; P = 0.009).
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Haemoglobin mass in an anaemic female endurance runner before and after iron supplementation. Int J Sports Physiol Perform 2011; 6:137-40. [PMID: 21487157 DOI: 10.1123/ijspp.6.1.137] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Haemoglobin mass in a female endurance athlete was measured via carbon monoxide rebreathing upon diagnosis of iron-deficiency anemia (haemoglobin concentration = 8.8 g/dL, ferritin = 9.9 ng/mL) and regularly during treatment thereafter. Haemoglobin mass increased by 49% in the 2 wk following an intramuscular iron injection and continued to increase with oral iron supplementation for 15 wk. The presented case illustrates that haemoglobin mass is readily responsive to iron supplementation in a severely iron-deficient anemic athlete and that changes can be tracked efficiently using the CO-rebreathing method.
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Milic R, Martinovic J, Dopsaj M, Dopsaj V. Haematological and iron-related parameters in male and female athletes according to different metabolic energy demands. Eur J Appl Physiol 2010; 111:449-58. [PMID: 20882295 DOI: 10.1007/s00421-010-1656-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2010] [Indexed: 11/24/2022]
Abstract
We investigated the iron-related haematological parameters in both male and female athletes participating in different sporting disciplines necessitating different metabolic energy demands. A total of 873 athletes (514 males, mean age: 22.08 ± 4.95 years and 359 females, mean age: 21.38 ± 3.88 years) were divided according to gender and to the predominant energy system required for participation in sport (aerobic, anaerobic or mixed) and haematological and iron-related parameters were measured. For both male and female athletes, significant differences related to the predominant energy system were found at a general level: male (Wilks' λ = 0.798, F = 3.047, p < 0.001) and female (Wilks' λ = 0.762, F = 2.591, p < 0.001). According to the ferritin cutoff value of 35 μg/L, whole body iron and sTfR significantly differed in all three groups of male and female athletes (p < 0.001). The percentage of hypochromic erythrocytes in male athletes was significantly higher only in those who required an anaerobic energy source (p < 0.001), whilst in the females hypochromic erythrocytes (p < 0.001) and haemoglobin (anaerobic, p = 0.042; mixed, p = 0.006) were significantly different only in anaerobic and mixed energy source athletes. According to the ferritin cutoff value of 22 μg/L, in females, whole body iron, sTfR and hypochromic erythrocytes were significantly higher in all three groups of athletes than those below the aforementioned cutoff value (p < 0.001). We conclude that the predominant energy system required for participation in sport affects haematological parameters. sTfR and body iron proved to be reliable parameters for monitoring the dynamics of iron metabolism and could contribute to successful iron-deficiency prevention.
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Affiliation(s)
- Radoje Milic
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
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Abstract
OBJECTIVE Vitamin D insufficiency is prevalent in various populations worldwide but with scarce data on physically active individuals. Vitamin D is important to athletes, affecting bone mass, immunity, and physical performance. This study evaluated the prevalence of vitamin D insufficiency and deficiency among young athletes and dancers. DESIGN Cross-sectional study. SETTING : Sport medicine clinic. PATIENTS Data on 98 athletes and dancers (age, 14.7 +/- 3.0 years; range, 10-30 years; 53% men), who had undergone screening medical evaluations, were extracted from medical records. INDEPENDENT VARIABLE Serum 25(OH)D concentrations. MAIN OUTCOME MEASURES Serum 25(OH)D concentrations, age, sex, sport discipline, month of blood test, and serum ferritin. Vitamin D insufficiency was defined as serum 25(OH)D concentration <30 ng/mL. RESULTS Mean serum 25(OH)D concentration was 25.3 +/- 8.3 ng/mL. Seventy-three percent of participants were vitamin D insufficient. Prevalence of vitamin D insufficiency was higher among dancers (94%), basketball players (94%), and Tae Kwon Do fighters (67%) and among athletes from indoor versus outdoor sports (80% vs 48%; P = 0.002). 25(OH)D levels adjusted for age and sex correlated with serum ferritin and season. CONCLUSIONS In this study, conducted among young athletes and dancers from various disciplines in a sunny country, a high prevalence of vitamin D insufficiency was identified. A higher rate of vitamin D insufficiency was found among participants who practice indoors, during the winter months, and in the presence of iron depletion. Given the importance of vitamin D to athletes for several reasons, we suggest that athletes and dancers be screened for vitamin D insufficiency and treated as needed.
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The International Olympic Committee (IOC) consensus statement on periodic health evaluation of elite athletes: March 2009. J Athl Train 2010; 44:538-57. [PMID: 19771295 DOI: 10.4085/1062-6050-44.5.538] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Touhami I, Fattoum S, Bibi A, Siala H, Messaoud T, Koubaa D, Mankai R, Bartagi Z, Le Gallais D. The epidemiology of abnormal hemoglobins in Mediterranean high-level athletes. Eur J Appl Physiol 2009; 108:1075-81. [PMID: 20013288 DOI: 10.1007/s00421-009-1314-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2009] [Indexed: 11/30/2022]
Abstract
The aim of this study was to determine the prevalence and nature of hemoglobin (Hb) defects in a Mediterranean high-level (HL) athlete population. Five hundred and ninety-four HL male and female athletes were recruited during the annual follow-up of the members of Tunisian national teams. Hematological data, Hb electrophoresis, and DNA analysis were assessed using conventional techniques. Sporting discipline, type of sport, and performance levels were assessed using a questionnaire. The results showed that 32 HL athletes had abnormal Hb (5.4%): beta-thalassemia (2.2%), alpha-thalassemia (0.5%), HbAS (1.5%), HbAC (0.5%), and rare Hb variants (0.7%). Of the 32 defect carriers, all but one (a alpha-thalassemia) were heterozygous. All the detected hemoglobinopathies but one (an Hb Hope) had already been reported in the country. The prevalence of Hb defect in the HL athletes was similar to that described in the general Tunisian population (P > 0.05). The percentage of Hb defect in the athletes was not dependent on gender, or performance level (P > 0.05). Within each type of sport the percentages of athletes with normal and abnormal Hb were similar (P > 0.05). The hematological data revealed the diversity of anemia, microcytosis, and hypochromia in thalassemic HL athletes. We concluded that HL athletes in Tunisia were a representative sample of the general Tunisian population regarding the prevalence and nature of benign abnormal Hb. The hematological data of the thalassemia carriers exhibited high variability and raised the question of genetic and sporting counseling, as well as biological follow-up for these carriers.
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Affiliation(s)
- Imed Touhami
- Dynamics of Cardiovascular Incoherencies, Montpellier 1 University, Montpellier, France
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The International Olympic Committee (IOC) consensus statement on periodic health evaluation of elite athletes, March 2009. Clin J Sport Med 2009; 19:347-65. [PMID: 19741306 DOI: 10.1097/jsm.0b013e3181b7332c] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Abstract
PURPOSE OF REVIEW There is a growing interest in the field of pediatric sports nutrition because of the will to lead the child athlete to high achievements, with minimal impairment of growth and development. In this article, we review some of the new data concerning the possible short-term and long-term effects of nutrition on children's performance, current and future health. RECENT FINDINGS Growing children engaged in strenuous exercise have several physiologic and metabolic characteristics that distinguish them from adults and require specific nutritional considerations. There is currently not enough evidence to support either carbohydrate loading or increased protein intake in the diet of the child athlete. Creatine use, although common among youth, is not recommended. Adequate hydration is essential to optimal performance. Consumption of iron-rich foods should be encouraged, as depleted iron stores are common in young athletes. In female athletes, nutritional deficiencies could lead to athletic amenorrhea and bone loss, and the resolution of energy deficits can restore normal bone formation and the return of menses. SUMMARY In the highly competitive world of the child athlete, proper nutrition is of essence. Unfortunately, most of the knowledge in this field is based on adult literature. Age-specific research would lead to a better understanding of what constitutes 'a healthy diet' in the context of the growing athlete and may be a first step toward achieving these necessary insights.
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Affiliation(s)
- Dan Nemet
- Child Health and Sports Center, Pediatric Department, Meir General Hospital, Kfar-Saba, Israel
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Di Santolo M, Stel G, Banfi G, Gonano F, Cauci S. Anemia and iron status in young fertile non-professional female athletes. Eur J Appl Physiol 2007; 102:703-9. [DOI: 10.1007/s00421-007-0647-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2007] [Indexed: 10/22/2022]
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