Effect of dietary intake on immune function in athletes

Athletes' nutritional demands: a narrative review of nutritional requirements

Nutrition serves as the cornerstone of an athlete's life, exerting a profound impact on their performance and overall well-being. To unlock their full potential, athletes must adhere to a well-balanced diet tailored to their specific nutritional needs. This approach not only enables them to achieve optimal performance levels but also facilitates efficient recovery and reduces the risk of injuries. In addition to maintaining a balanced diet, many athletes also embrace the use of nutritional supplements to complement their dietary intake and support their training goals. These supplements cover a wide range of options, addressing nutrient deficiencies, enhancing recovery, promoting muscle synthesis, boosting energy levels, and optimizing performance in their respective sports or activities. The primary objective of this narrative review is to comprehensively explore the diverse nutritional requirements that athletes face to optimize their performance, recovery, and overall well-being. Through a thorough literature search across databases such as PubMed, Google Scholar, and Scopus, we aim to provide evidence-based recommendations and shed light on the optimal daily intakes of carbohydrates, protein, fats, micronutrients, hydration strategies, ergogenic aids, nutritional supplements, and nutrient timing. Furthermore, our aim is to dispel common misconceptions regarding sports nutrition, providing athletes with accurate information and empowering them in their nutritional choices.

Effect of Saengmaeksan on Fatigue, Liver Function, and Immunity Combined with High-Intensity Training

Saengmaeksan (SMS) is a traditional drink that consists of three natural herbs, Lirio platyphlla, Panax ginseng, and Schisandra chinensis, and improves fatigue, liver function, and immunity. Moderate-intensity exercise has a positive effect on fatigue, liver function, and immune function, whereas long-term high-intensity training has a negative effect on these aspects. We hypothesized that SMS intake will improve fatigue (ammonia, lactic acid), liver function (aspartate transaminidase (AST) and alanine aminotransferase (ALT)), and immunity (IgA, IgG, IgM) with high-intensity training. To investigate this hypothesis, 17 male college tennis players were randomly assigned to SMS and placebo groups with high-intensity training. SMS and placebo were consumed in 110 mL doses for a total of 770 mL. High-intensity training was performed at 70%-90% of heart rate reserve, conducted five times weekly for 4 weeks. A significant interaction effect was observed between the SMS and control (CON) groups regarding ammonia, ALT, and IgA levels. Ammonia levels significantly decreased in the SMS group, but there was no difference in the lactic acid levels. AST significantly decreased in the SMS group. IgA significantly increased in the SMS group, IgM significantly decreased in both groups, but there was no change in IgG. The correlation analysis revealed positive correlation in ΔAST vs. ΔALT, ΔALT vs. ΔIgG, and ΔIgA vs. ΔIgG in the SMS group. These findings demonstrate that SMS intake can reduce ammonia, AST, ALT, and IgM levels, while causing an increase in IgA, which has a positive effect on fatigue reduction, liver function, and immunoglobulins in a high-intensity training or related environment.

Immunity and Growth Plasticity of Asian Short-Toed Lark Nestlings in Response to Changes in Food Conditions: Can It Buffer the Challenge of Climate Change-Induced Trophic Mismatch?

Passerine nestlings frequently suffer from sub-optimal food conditions due to climate change-induced trophic mismatch between the nestlings and their optimal food resources. The ability of nestlings to buffer this challenge is less well understood. We hypothesized that poor food conditions might induce a higher immune response and lower growth rate of nestlings, and such physiological plasticity is conducive to nestling survival. To test this, we examined how food (grasshopper nymphs) abundance affects the expression of interferon-γ (IFN-γ), tumor necrosis factor-α (TNF-α), interleukin-1 β (IL-1β) genes, plasma IGF-1 levels, body mass, and fledging rates in wild Asian short-toed lark (Alaudala cheleensis) nestlings. Linear mixed models revealed that nymph biomass significantly influenced the expression of IFN-γ, TNF-α, and IL-1β genes, and the level of plasma IGF-1. The expressions of IFN-γ, TNF-α, and IL-1β genes were negatively correlated with nymph biomass and plasma IGF-1 level. Plasma IGF-1 level, nestling body mass growth rate, was positively correlated with nymph biomass. Despite a positive correlation between the nestling fledge rate and nymph biomass, more than 60% of nestlings fledged when nymph biomass was at the lowest level. These results suggest that immunity and growth plasticity of nestlings may be an adaptation for birds to buffer the negative effects of trophic mismatch.

The association between B vitamins and the risk of COVID-19

The fast spread of the coronavirus disease 2019 (COVID-19) epidemic and its high mortality were quickly noticed by the health community. B vitamins are essential micronutrients for the body with antioxidant, anti-inflammatory and immune-regulating properties. The present study can provide a comprehensive picture of the associations between B vitamins and COVID-19 incidence. This study was undertaken on 9189 adult participants of the Yazd Health Study (YaHS) and Taghzieh Mardom-e-Yazd (TAMIZ) study aged 20 to 69 years. Data on dietary intakes were obtained using a validated FFQ. Multivariable logistic regression analysis was used to evaluate the association between B vitamins and COVID-19. Our findings indicated that participants in the fourth quartile of vitamin B₅ intake compared with the first quartile had a protective effect against COVID-19 (OR: 0·53, 95 % CI 0·28, 0·99, P-trend = 0·02) after adjustment for all possible confounds in model 3. In addition, participants in the third quartile of vitamin B₁₂ intake compared with the first quartile (OR: 0·63, 95 % CI 0·40, 0·98, P-trend = 0·11) had fewer odds of COVID-19 after full adjustments for confounders. Our findings indicated no significant relationship between dietary intake of vitamin B₁, B₂, B₃, B₉ and B-complex and COVID-19. A higher intake of vitamin B₅ could reduce the odds of COVID-19 by 47 %, and a moderate intake of vitamin B₁₂ had a protective effect on COVID-19. Although our study has promising results, stronger clinical studies are needed.

A systematic review update of athletes' nutrition knowledge and association with dietary intake

Athletes' dietary intakes sometimes do not meet sports nutrition guidelines. Nutrition knowledge (NK) is one factor that may influence dietary intake, but NK measurement tools are often outdated or unvalidated, and results regarding athletes' NK are equivocal. The aims of this systematic review were to update previous systematic reviews by examining athletes' NK and to assess the relationship between athletes' general NK, sport NK and dietary intake. MEDLINE, CINAHL, Scopus, SPORTDiscus, Web of Science and Cochrane were searched for studies published between November 2015 and November 2020 that provided a quantitative measure of NK and described the NK tool used. Twenty-eight studies were included, study quality was assessed using JBI checklists and data on NK score and diet intake was extracted. Eight studies utilised validated, up-to-date NK measurement tools. Mean general and sport NK% scores varied between 40·2% ± 12·4 and 70 % ± 9. Mean protein and carbohydrate consumption was 1·1-3·4 g/kg.bw/d and 2·4-4·6 g/kg.bw/d, respectively. Weak-to-moderate, positive associations were found between NK and positive dietary behaviours. Due to a wide variety of NK measurement tools used, it is difficult to synthesise results to determine overall NK in athletes. Overall, there appears to be a low standard of knowledge. Quality of measurement tools for NK has improved but remains an issue. Future studies should use relevant, current validated NK tools or validate tools in their study population. More research is needed into the relationship between NK and other modifiable factors influencing dietary intake.

Vitamin D, exercise, and immune health in athletes: A narrative review

Vitamin D exerts important extra-skeletal effects, exhibiting an exquisite immune regulatory ability, affecting both innate and adaptive immune responses through the modulation of immunocyte function and signaling. Remarkably, the immune function of working skeletal muscle, which is fully recognized to behave as a secretory organ with immune capacity, is under the tight control of vitamin D as well. Vitamin D status, meaning hormone sufficiency or insufficiency, can push toward strengthening/stabilization or decline of immune surveillance, with important consequences for health. This aspect is particularly relevant when considering the athletic population: while exercising is, nowadays, the recommended approach to maintain health and counteract inflammatory processes, “too much” exercise, often experienced by athletes, can increase inflammation, decrease immune surveillance, and expose them to a higher risk of diseases. When overexercise intersects with hypovitaminosis D, the overall effects on the immune system might converge into immune depression and higher vulnerability to diseases. This paper aims to provide an overview of how vitamin D shapes human immune responses, acting on the immune system and skeletal muscle cells; some aspects of exercise-related immune modifications are addressed, focusing on athletes. The crossroad where vitamin D and exercise meet can profile whole-body immune response and health.

Balanced diet and daily calorie consumption: Consumer attitude during the COVID-19 pandemic from an emerging economy

This article tries to explore consumer attitudes regarding a balanced diet and daily calorie intake monitoring during the COVID-19 pandemic in India. It has become vital to boost people’s immunity because of reoccurring diseases such as COVID-19, Ebola, and other chronic diseases such as diabetes, thyroid disease, etc. Healthy diets are important for supporting immune systems and keeping track of daily calorie consumption is an accompaniment to this. The research on attitudes toward a balanced diet is reviewed in this empirical study. Researchers employed a tri-component attitude model to assess consumer attitudes about a balanced diet and to track daily calorie consumption. A sample of 400 respondents was surveyed and data were collected with a structured questionnaire. The data were analysed using the structural equation modelling technique. The majority of respondents were found to lack declarative knowledge of both a balanced diet and daily calorie consumption. The effects of the COVID-19 pandemic on consumer attitudes about a healthy diet and daily calorie intake were effectively evaluated using beliefs, affection, and intentions. The repercussions for the government and business community were discussed. This study also evaluates the usefulness of the tri-component attitude model in the Indian context.

Supply of Antioxidants vs. Recruit Firefighters' Cellular Immune Status: A Randomized Double-Blinded Placebo-Controlled Parallel-Group Trial

Background: Physical exercise can affect the immune system. We studied the effect of antioxidants on hematological and immune biomarkers after heavy training. Methods: 24 well-trained and well-fed male firefighters were randomly divided into supplemented and placebo groups, and tested for immunology-related variables using venous blood samples in the fasting state, pre- (M1) and post- (M2) five weeks of daily micronutrient supplementation (15 mg of beta-carotene, 200 mg of vitamin C, 136 mg of vitamin E, 200 μg of selenium, 15 mg of zinc, 100 mg of magnesium). Total leukocytes and a differential count for five populations were determined using standard procedures (MAXM—Beckman Coulter Diagnostics; Brea, CA, USA). Lymphocyte subsets were determined through immunophenotyping. Results: Although all values were within the normal range for healthy adults and athletes in the supplemented group (SG), mean CD3+CD8+, CD8+ and CD16+CD56+ decreased (p < 0.05; small to moderate effects), while mean CD4+, CD19+ and CD4+/CD8+ increased (p < 0.05; small effects) after five-weeks. Regarding the placebo group (PG), higher total leukocyte count (p < 0.05; trivial effect) and natural killer cells percentage (CD16+CD56+; p < 0.05; moderate effect) were observed when comparing M1 and M2. Conclusions: Antioxidants supplementation did not alter well-fed male firefighters recruit firefighters’ immune cell response during the five-week physical training program.

Immunity boosting roles of biofunctional compounds available in aquafoods: A review

Aquafoods are diverse and rich in containing various health functional compounds which boost natural immunity. In this manuscript, the contents of biofunctional compounds such as vitamins, minerals, protein and amino acids, ω-3 polyunsaturated fatty acids, and pigments, etc. in various aquafoods like fishes, molluscs, crustaceans, seaweeds etc. are reported. The functional roles of those compounds are also depicted which enhance the immunecompetence and immunomodulation of the consumers. This paper provides an account of the recommended daily dietary intake level of those compounds for human. Those compounds available in aquafoods are recommended as they fight against various infectious diseases by enhancing immunity. Available reports on the bioactive compounds in aquafoods reveal the immunity boosting performances which may offer a new insight into controlling infectious diseases.

Physical activity can change the physiological and psychological circumstances during COVID-19 pandemic: A narrative review

Background: With the outbreak of Coronavirus disease 2019 (COVID-19), many studies’ attention to this world’s complexity increased dramatically. Different views on sports and physical activities have been presented, which have addressed the advantages and disadvantages of sports activities in this period differently. The purpose of this review was to investigate the physiological and psychological effects of physical activity during the COVID-19 pandemic. Methods: Using PubMed, Science Direct, Medline, and Web of Science electronic databases, this review summarizes the current knowledge of direct and indirect effects of physical activity during the COVID-19 pandemic, evaluating the advantages and drawbacks of specific exercise physiology conditions. All types of studies were assessed, including systematic reviews, case-studies, and clinical guidelines. The literature search identified 40 articles that discussed COVID-19, immune system, the relation between immune system and exercise or diet, and psychological impacts of physical activity. Results: Forty articles review showed that the immune system depends on the type, frequency, intensity, and duration of the exercise. Intense or prolonged exercise with short recovery periods can progressively weaken the immune system and increase the risk of COVID-19. One of the acute responses after moderate-intensity training is improved immune function and a decrease in inflammatory cytokines. Paying attention to dietary intakes of micro-and macronutrients in conjunction with exercise can strengthen the condition to fight against coronavirus. Exercise can also affect the psychological dimensions of the COVID-19 pandemic, including depression, anxiety, and stress, which improve community mental health during the quarantine. Conclusion: Setting appropriate physical activity based on individuals’ properties and proper diet plan may enhance the physiological and psychological body’s condition to fight against coronavirus.

The Impact of Sleep Duration on Performance Among Competitive Athletes: A Systematic Literature Review

The athletic advantage of sleep, although commonly touted by coaches, trainers, and sports physicians, is still unclear and likely varies by sport, athletic performance metric, and length of sufficient or insufficient sleep. Although recent literature reviews have highlighted circadian and nutritional factors that influence different aspects of athletic performance, a systematic summary of the effects of sleep duration and sleep quality on performance among competitive athletes is lacking. Here we systematically review the relationship between sleep duration and sleep quality and objective athletic performance among competitive athletes across 19 studies representing 12 sports. Taken holistically, we find that the sports requiring speed, tactical strategy, and technical skill are most sensitive to sleep duration manipulations. Furthermore, longer-term sleep manipulations are more likely than acute sleep manipulations (whether deprivation or extension) to affect athletic performance. Thus, the importance of sleep for competitive athletes to achieve high performance is dependent on the demands of the sport as well as the length of sleep interventions. In light of the limited number of studies investigating sleep quality and performance, the potential relevance of subjective sleep quality remains an interesting question for future work.

A 3-Week, Low-Carbohydrate, High-Fat Diet Improves Multiple Serum Inflammatory Markers in Endurance-Trained Males

Waldman, HS, Heatherly, AJ, Killen, LG, Hollingsworth, A, Koh, Y, and O'Neal, EK. A three-week, low-carbohydrate, high-fat diet improves multiple serum inflammatory markers in endurance-trained males. J Strength Cond Res XX(X): 000-000, 2020-This study examined the effects of a low-carbohydrate, high-fat diet (LCHF) on inflammatory marker responses in middle-aged endurance athletes. Eight male runners maintained their habitual mixed diet (HMD) in the first phase of the study before switching to a noncalorically restricted LCHF diet (∼70% of kcals from fat; carbohydrate <50 g) for 3 weeks. Subjects completed a 50-minute fixed pace treadmill running protocol in a hot environment, followed by a 5-km outdoor time trial. Fasting serum samples were collected immediately after exercise and heat stress restriction, and again 24 hours after the exercise/heat stressor. Thirty inflammation markers were assessed using the multiplex flow immunoassay technique. Seven markers (BAFF/TNFSF-13, sCD30/TNFRSF8, sCD163, Chitinase3-like1, gp130SIL-6Rβ, sTNFR-1, and sTNFR-2) reached statistical significance (p < 0.05) favoring LCHF before exercise, and sCD30/TNFRSF8 favored (p < 0.05) LCHF before (HMD = 459 ± 111; LCHF = 296 ± 100) and after (HMD = 385 ± 104; LCHF = 285 ± 104 pg·ml) exercise. Although the current dietary intervention was short in duration, LCHF seems to offer some protection against multiple chronic inflammation markers for physically active men between ages 30 and 50 years.

Nutrition and Athlete Immune Health: New Perspectives on an Old Paradigm

Respiratory and gastrointestinal infections limit an athlete's availability to train and compete. To better understand how sick an athlete will become when they have an infection, a paradigm recently adopted from ecological immunology is presented that includes the concepts of immune resistance (the ability to destroy microbes) and immune tolerance (the ability to dampen defence yet control infection at a non-damaging level). This affords a new theoretical perspective on how nutrition may influence athlete immune health; paving the way for focused research efforts on tolerogenic nutritional supplements to reduce the infection burden in athletes. Looking through this new lens clarifies why nutritional supplements targeted at improving immune resistance in athletes show limited benefits: evidence supporting the old paradigm of immune suppression in athletes is lacking. Indeed, there is limited evidence that the dietary practices of athletes suppress immunity, e.g. low-energy availability and train- or sleep-low carbohydrate. It goes without saying, irrespective of the dietary preference (omnivorous, vegetarian), that athletes are recommended to follow a balanced diet to avoid a frank deficiency of a nutrient required for proper immune function. The new theoretical perspective provided sharpens the focus on tolerogenic nutritional supplements shown to reduce the infection burden in athletes, e.g. probiotics, vitamin C and vitamin D. Further research should demonstrate the benefits of candidate tolerogenic supplements to reduce infection in athletes; without blunting training adaptations and without side effects.

The role of glucose homeostasis on immune function in response to exercise: The impact of low or higher energetic conditions

Immune cells are bioenergetically expensive during activation, which requires tightly regulated control of metabolic pathways. Both low and high glycemic conditions can modulate immune function. States of undernourishment depress the immune system, and in the same way, excessive intake of nutrients, such as an obesity state, compromise its functioning. Multicellular organisms depend on two mechanisms to survive: the regulation and ability to store energy to prevent starvation and the ability to fight against infection. Synergic interactions between metabolism and immunity affect many systems underpinning human health. In a chronic way, the breakdown of glycemic homeostasis in the body can influence cells of the immune system and consequently contribute to the onset of diseases such as type II diabetes, obesity, Alzheimer's, and fat and lean mass loss. On the contrary, exercise, recognized as a primary strategy to control hyperglycemic disorders, also induces a coordinated immune-neuro-endocrine response that acutely modulates cardiovascular, respiratory, and muscle functions and the immune response to exercise is widely dependent on the intensity and volume that may affect an immunodepressive state. These altered immune responses induced by exercise are modulated through the "stress hormones" adrenaline and cortisol, which are a threat to leukocyte metabolism. In this context, carbohydrates appear to have a positive acute response as a strategy to prevent depression of the immune system by maintaining plasma glucose concentrations to meet the energy demand from all systems involved during strenuous exercises. Therefore, herein, we discuss the mechanisms through which exercise may promotes changes on glycemic homeostasis in the metabolism and how it affects immune cell functions under higher or lower glucose conditions.

Innovative Nutritious Biscuits Limit Aflatoxin Contamination

BACKGROUND AND OBJECTIVE

Incorporation of food byproducts in biscuit could increase the safety, nutritional and enhance dough properties. These byproducts were wheat bran (WB), goldenberry fruit (GBF) and goldenberry peel (GBP) contains active ingredients.

MATERIAL AND METHODS

Wheat flour (WF) was partially replaced in biscuit dough. Antioxidant activity, chemical composition and baking quality were evaluated. Anti-aflatoxigenic and antifungal activities of WB, GBF and GBP have estimated also aflatoxin reduction was evaluated.

RESULTS

The results were showed biscuit acceptable sensories. The GBF and GBP exhibited the highest antioxidant and phenolic content explaining its antimicrobial behaviour. The addition of WB, GBF or GBP to fungal media inhibited the growth, however, using 20% GBF in Aspergillus flavus media showed the greatest aflatoxin reduction. The biscuit-specific volume was more pronounced when GBF and GBP were included in the formulation. No great differences were seen for colour, baking quality or texture of biscuit mixes.

CONCLUSION

This novel safe biscuit appears a safer alternative to traditional biscuits.

Biomarkers of Physiological Responses to Periods of Intensified, Non-Resistance-Based Exercise Training in Well-Trained Male Athletes: A Systematic Review and Meta-Analysis

BACKGROUND

Intensified training is important for inducing adaptations to improve athletic performance, but detrimental performance effects can occur if prescribed inappropriately. Monitoring biomarker responses to training may inform changes in training load to optimize performance.

OBJECTIVE

This systematic review and meta-analysis aimed to identify biomarkers associated with altered exercise performance following intensified training.

METHODS

Embase, MEDLINE, CINAHL, Scopus and SPORTDiscus were searched up until September 2017. Included articles were peer reviewed and reported on biomarkers collected at rest in well-trained male athletes before and after periods of intensified training.

RESULTS

The full text of 161 articles was reviewed, with 59 included (708 participants) and 42 (550 participants) meta-analysed. In total, 118 biomarkers were evaluated, with most being cellular communication and immunity markers (n = 54). Studies most frequently measured cortisol (n = 34), creatine kinase (n = 25) and testosterone (n = 20). Many studies reported decreased immune cell counts following intensified training, irrespective of performance. Moreover, reduced performance was associated with a decrease in neutrophils (d = - 0.57; 95% confidence interval (CI) - 1.07 to - 0.07) and glutamine (d = - 0.37; 95% CI - 0.43 to - 0.31) and an increase in urea concentration (d = 0.80; 95% CI 0.30 to 1.30). In contrast, increased performance was associated with an increased testosterone:cortisol ratio (d = 0.89; 95% CI 0.54 to 1.24). All remaining biomarkers showed no consistent patterns of change with performance.

CONCLUSIONS

Many biomarkers were altered with intensified training but not in a manner related to changes in exercise performance. Neutrophils, glutamine, urea and the testosterone:cortisol ratio exhibited some evidence of directional changes that corresponded with performance changes therefore indicating potential to track performance. Additional investigations of the potential for these markers to track altered performance are warranted.

Impact of Nutritional Intake on Function in People with Mild-to-Moderate Multiple Sclerosis

Background

We sought to assess the associations between nutrition and ambulation, daily activity, quality of life (QOL), and fatigue in individuals with mild-to-moderate disability with multiple sclerosis (MS).

Methods

This cross-sectional pilot study included 20 ambulatory adult volunteers with MS (14 women and 6 men; mean ± SD age, 57.9 ± 10.2 years; mean ± SD Expanded Disability Status Scale score = 4.1 ± 1.8). Primary outcome variables included dietary assessment and the 6-Minute Walk Test (6MWT). Secondary measures included the Timed 25-Foot Walk test, Timed Up and Go test, daily activity, and three self-report questionnaires: the 12-item Multiple Sclerosis Walking Scale, the 36-item Short Form Health Survey (SF-36), and the Modified Fatigue Impact Scale.

Results

Significant correlations were seen between the percentage of diet comprising fats and the 6MWT (r = 0.51, P = .02) and the physical functioning component of the SF-36 (r = 0.47, P = .03). The percentage of carbohydrates was significantly correlated with the 6MWT (r = -0.43, P = .05), daily activity (r = -0.59, P = .005), and the physical functioning component of the SF-36 (r = -0.47, P = .03). Cholesterol, folate, iron, and magnesium were significantly positively correlated with the physical functioning component of the SF-36 and the 6MWT.

Conclusions

These findings indicate better ambulation, daily function, and QOL with increased fat intake, decreased carbohydrate intake, and increased intake of the micronutrients cholesterol, folate, iron, and magnesium in people with mild-to-moderate MS. This pilot study highlights the potential impact of diet on function and QOL in MS.

A Review of Prevention, Diagnosis, and Treatment of Relative Energy Deficiency in Sport in Artistic (Synchronized) Swimming

The syndrome of relative energy deficiency in sport (RED-S) is a clinical entity characterized by low energy availability, which can negatively affect the health and performance of both male and female athletes. The underlying mechanism of RED-S is an inadequacy of dietary energy to support optimal health and performance. This syndrome refers to impaired physiological function, including metabolic rate, menstrual function, bone health, immunity, protein synthesis, and cardiovascular health, with psychological consequences that can either precede (through restrictive dietary habits) or result from RED-S. The term RED-S extends beyond the condition termed the "Female Athlete Triad." Formerly known as synchronized swimming, artistic swimming is an Olympic sport requiring a high level of fitness as well as technical skill and artistry. The risk of RED-S is high in artistic swimming as it is an aesthetic, judged sport with an emphasis on a lean physique. RED-S is of significant concern in the sport of artistic swimming because of the potential negative effects on physical and mental health as well as consequences on athletic performance. This paper reviews health and performance consequences associated with low energy availability resulting in RED-S in artistic swimming. Medical and nutritional considerations specific to artistic swimming are reviewed, and methods to help detect and manage RED-S are discussed. Prevention and management of RED-S in this athlete population should be a priority for coaches, and the sport medicine professionals working with artistic swimming athletes should utilize the RED-S CAT, a Clinical Assessment Tool for screening and managing RED-S.

Interactions of Gut Microbiota, Endotoxemia, Immune Function, and Diet in Exertional Heatstroke

Exertional heatstroke (EHS) is a medical emergency that cannot be predicted, requires immediate whole-body cooling to reduce elevated internal body temperature, and is influenced by numerous host and environmental factors. Widely accepted predisposing factors (PDF) include prolonged or intense exercise, lack of heat acclimatization, sleep deprivation, dehydration, diet, alcohol abuse, drug use, chronic inflammation, febrile illness, older age, and nonsteroidal anti-inflammatory drug use. The present review links these factors to the human intestinal microbiota (IM) and diet, which previously have not been appreciated as PDF. This review also describes plausible mechanisms by which these PDF lead to EHS: endotoxemia resulting from elevated plasma lipopolysaccharide (i.e., a structural component of the outer membrane of Gram-negative bacteria) and tissue injury from oxygen free radicals. We propose that recognizing the lifestyle and host factors which are influenced by intestine-microbial interactions, and modifying habitual dietary patterns to alter the IM ecosystem, will encourage efficient immune function, optimize the intestinal epithelial barrier, and reduce EHS morbidity and mortality.

Effect of rapid weight loss and glutamine supplementation on immunosuppression of combat athletes: a double-blind, placebo-controlled study

The role of plasma glutamine concentration and glutamine supplementation on immunosuppression was investigated in combat athletes. Twenty-three male athletes were randomly assigned to receive glutamine (21 g/day, n=12) or placebo (ovalbumin, n=11) for 10 days. Six athletes who did not lose weight served as controls. Athletes were assessed 21 days before (−21d), 1 day before (−1d) and 5 days after (+5d) a competition. Weight reduction was similar between glutamine (−8.2%± 4.1%) and placebo (−8.5%±2.4%) and negligible in control (−0.6%±1.4%). In both weight-loss groups, the majority of athletes reported symptoms of upper respiratory symptoms, as assessed by the Wisconsin upper respiratory symptom survey questionnaire. Only two athletes reported symptoms in the control group. Immune cell function remained unchanged throughout the study except for an increase in neutrophil phagocytic activity (placebo: −21d=5,251±2,986; −1d=17,428±22,374; +5d=21,125±21,934; glutamine: −21d=6,096±3,549; −1d=11,029±17,113; +5d=28,186±21,032 FI) and a minor change in monocyte phagocytic activity (placebo: −21d=4,421±3,634; −1d=3,329±6,283; +5d=3,243± 2,553; glutamine: −21d=4,051±3,186; −1d=3,106±2,625; +5d=4,981± 4,598) in both glutamine and placebo after weight loss. Plasma glutamine and cortisol remained unchanged across the study. creatine kinase levels were increased in placebo (−21d=125.2±54.1; −1d=187.2± 73.5; +5d=111.3±59.1 U/L) but not in glutamine (−21d=136.2±58.2; −1d= 168.8±65.0; +5d=129.7±64.0 U/L). Rapid weight loss increased the frequency and severity of infection symptoms, but this was neither associated with plasma glutamine depletion nor counteracted by glutamine supplementation.

Vegan diets: practical advice for athletes and exercisers

With the growth of social media as a platform to share information, veganism is becoming more visible, and could be becoming more accepted in sports and in the health and fitness industry. However, to date, there appears to be a lack of literature that discusses how to manage vegan diets for athletic purposes. This article attempted to review literature in order to provide recommendations for how to construct a vegan diet for athletes and exercisers. While little data could be found in the sports nutrition literature specifically, it was revealed elsewhere that veganism creates challenges that need to be accounted for when designing a nutritious diet. This included the sufficiency of energy and protein; the adequacy of vitamin B12, iron, zinc, calcium, iodine and vitamin D; and the lack of the long-chain n-3 fatty acids EPA and DHA in most plant-based sources. However, via the strategic management of food and appropriate supplementation, it is the contention of this article that a nutritive vegan diet can be designed to achieve the dietary needs of most athletes satisfactorily. Further, it was suggested here that creatine and β-alanine supplementation might be of particular use to vegan athletes, owing to vegetarian diets promoting lower muscle creatine and lower muscle carnosine levels in consumers. Empirical research is needed to examine the effects of vegan diets in athletic populations however, especially if this movement grows in popularity, to ensure that the health and performance of athletic vegans is optimised in accordance with developments in sports nutrition knowledge.

Development of a specific index to detect malnutrition in athletes: Validity in weight class or intermittent fasted athletes

Fasted or weight-category athletes manage their training under strict diet conditions that could impair the stress-recovery balance and result in acute or chronic fatigue. However, to date, no validated biomarker are available to quantify this phenomena. The aim of this study was to assess the validity of a specific index combining plasma albumin and weight change to detect nutrition-related risks of fatigue increase and under-performance in athletes experiencing particular nutritional conditions.

An athlete's nutrition risk index (ANRI) equation, based on data from lightweight and heavyweight rowers, was developed using relationship between plasma albumin concentrations combined to weight changes with sport performance and overtraining scores and was tested by odds ratio for failure. The accuracy and sensitivity of this former specific equation was subsequently tested on runners observing the Ramadan-fasting as well as on boxers after a short weight-loss period.

Independently of training and performance, lightweight rowers presented lower nutritional parameters than heavyweight (albumin: 37.4 ± 2.7 vs 39.9 ± 1.8 g·L⁻¹, P < 0.05; weight state: 94.5 ± 1.8 vs 99.9 ± 0.9%, P < 0.01). In lightweight, ANRI was related with overtraining score (R² = 0.21, P < 0.01), risks for failure in competition were enhanced when ANRI increased (OR:2.5, P = 0.03). Relationship of ANRI with overtraining score tended to be also significant in runners (R² = 0.32, P = 0.06) but not in boxers (P = 0.4).

Albumin concentrations combined to weight loss appeared relevant to delineate nutrition-related risks of fatigue and/or competitive failure associated with mid-term diets (about 30 days) as observed in rowers and Ramadan-fasted runners. ANRI may benefit to athletes monitoring by delineating effects of their weight loss program.

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Albumin or weight loss, alone, are not related with fatigue scores.

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A combination of albumin and weight loss can highlight nutritional risk of fatigue.

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A specific and valuable athlete's nutrition risk index can be built.

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Risks for failure in competition increase when ANRI increases in rowers and runners.

Plane of nutrition x tick burden interaction in cattle: effect on fecal composition

Effective tick management on grazing animals is facilitated by accurate noninvasive detection methods. Fecal analysis provides information about animal health and nutrition. Diet affects fecal composition; stress may do likewise. The constituents in feces that may be affected by tick burdens and in turn affect near-infrared spectra have not been reported. Our objective was to examine the interaction between plane of nutrition and tick burden on fecal composition in cattle. Angus cross steers (n = 28; 194 ± 3.0 kg) were assigned to 1 of 4 treatments (n = 7 per group) in a 2 × 2 factorial arrangement: moderate (14.0 ± 1.0% CP and 60 ± 1.5% TDN) vs. low (9.0 ± 1.0% CP and 58 ± 1.5% TDN) plane of nutrition and control (no tick) vs. tick treatment [infestation of 300 pair of adult Lone Star ticks (Amblyomma americanum) per treated animal]. Fecal samples were collected at approximately 0700 h on d -7, 0, 7, 10, 14, 17, and 21 relative to tick infestation. Fecal constituents measured were DM, OM, pH, Lactobacillus spp., Escherchia coli, acetate, propionate, butyrate, isobutyrate, valerate, isovalerate, IgA, and cortisol. Experimental day affected (P < 0.05) all constituents measured. Plane of nutrition affected (P < 0.05) DM, OM, VFA, and IgA. Tick treatment numerically (P = 0.13) reduced cortisol. A multivariate stepwise selection model containing cortisol and E. coli values on d 10 and d 14 accounted for 33% of the variation in daily adult female tick feeding counts across both planes of nutrition (P < 0.07). Within the moderate plane of nutrition, a model containing only cortisol on d 10 and d 14 described 59% of the variation in the number of feeding ticks (P < 0.02). Similarly, a model including cortisol, propionate, isovalerate, and DM at d 10 and d 14 d described 95% of the variation in total feeding ticks in the low plane of nutrition. Of the constituents measured, fecal cortisol offers the best possibility of noninvasively assessing stress by way of a single assay but the presence of ticks would still need to be confirmed visually. Although several constituents measured in this study should exist in sufficient quantity to directly affect near-infrared spectra, none stood out as a clear descriptor of prior observed differences in fecal spectra between tick-treated versus non-tick-treated animals. There were, however, groups of fecal constituents related to daily adult female tick feeding numbers (as a visual estimation of tick stress).

Dietary supplementation and doping-related factors in high-level sailing

Background

Although dietary supplements (DSs) in sports are considered a natural need resulting from athletes’ increased physical demands, and although they are often consumed by athletes, data on DS usage in Olympic sailing are scarce. The aim of this study was to study the use of and attitudes towards DSs and doping problems in high-level competitive sailing.

Methods

The sample consisted of 44 high-level sailing athletes (5 of whom were female; total mean age 24.13 ± 6.67 years) and 34 coaches (1 of whom was female; total mean age 37.01 ± 11.70). An extensive, self-administered questionnaire of substance use was used, and the subjects were asked about sociodemographic data, sport-related factors, DS-related factors (i.e., usage of and knowledge about DSs, sources of information), and doping-related factors. The Kruskal-Wallis ANOVA was used to determine the differences in group characteristics, and Spearman’s rank order correlation and a logistic regression analysis were used to define the relationships between the studied variables.

Results

DS usage is relatively high. More than 77% of athletes consume DSs, and 38% do so on a regular basis (daily). The athletes place a high degree of trust in their coaches and/or physicians regarding DSs and doping. The most important reason for not consuming DSs is the opinion that DSs are useless and a lack of knowledge about DSs. The likelihood of doping is low, and one-third of the subjects believe that doping occurs in sailing (no significant differences between athletes and coaches). The logistic regression found crew number (i.e., single vs. double crew) to be the single significant predictor of DS usage, with a higher probability of DS consumption among single crews.

Conclusion

Because of the high consumption of DSs future investigations should focus on real nutritional needs in sailing sport. Also, since athletes reported that their coaches are the primary source of information about nutrition and DSs, further studies are necessary to determine the knowledge about nutrition, DSs and doping problems among athletes and their support teams (i.e., coaches, physicians, and strength and conditioning specialists).

Effects of easy-to-use protein-rich energy bar on energy balance, physical activity and performance during 8 days of sustained physical exertion

BACKGROUND

Previous military studies have shown an energy deficit during a strenuous field training course (TC). This study aimed to determine the effects of energy bar supplementation on energy balance, physical activity (PA), physical performance and well-being and to evaluate ad libitum fluid intake during wintertime 8-day strenuous TC.

METHODS

Twenty-six men (age 20±1 yr.) were randomly divided into two groups: The control group (n = 12) had traditional field rations and the experimental (Ebar) group (n = 14) field rations plus energy bars of 4.1 MJ•day(-1). Energy (EI) and water intake was recorded. Fat-free mass and water loss were measured with deuterium dilution and elimination, respectively. The energy expenditure was calculated using the intake/balance method and energy availability as (EI/estimated basal metabolic rate). PA was monitored using an accelerometer. Physical performance was measured and questionnaires of upper respiratory tract infections (URTI), hunger and mood state were recorded before, during and after TC.

RESULTS

Ebar had a higher EI and energy availability than the controls. However, decreases in body mass and fat mass were similar in both groups representing an energy deficit. No differences were observed between the groups in PA, water balance, URTI symptoms and changes in physical performance and fat-free mass. Ebar felt less hunger after TC than the controls and they had improved positive mood state during the latter part of TC while controls did not. Water deficit associated to higher PA. Furthermore, URTI symptoms and negative mood state associated negatively with energy availability and PA.

CONCLUSION

An easy-to-use protein-rich energy bars did not prevent energy deficit nor influence PA during an 8-day TC. The high content of protein in the bars might have induced satiation decreasing energy intake from field rations. PA and energy intake seems to be primarily affected by other factors than energy supplementation such as mood state.

One week of multifactorial high-stress military ranger training affects Gram-negative signalling

BACKGROUND

Toll-like receptor 4 (TLR4), especially expressed on monocytes/macrophages, connects microbial and sterile innate immune activation. Lipopolysaccharide (LPS) from Gram-negative bacteria and several endogenous molecules, among others saturated fatty acids (SFAs), are able to induce signalling through this receptor. Downstream inflammatory cytokines orchestrate the immune response. Our aim was to investigate how long-lasting multifactorial stress affects Gram-negative signalling and search for possible correlations between cytokine production and TLR4 expression or SFA concentration.

METHODS

Eight healthy males were studied during a 7-day ranger-training course with semi-continuous physical strain, together with energy and sleep restrictions. Blood drawn on days 0, 3, 5 and 7 was incubated ex vivo for 6 h with or without LPS 10 ng/mL, whereupon surface expression of TLR4 on CD14⁺ monocytes and supernatant concentrations of inflammatory cytokines (TNF-α, IL-1β and IL-6) were measured. In addition, plasma free fatty acids were quantified.

RESULTS

Monocyte TLR4 expression was elevated throughout the course (p < 0.05 vs. baseline). Corresponding results were found for SFAs. The concentration of TNF-α increased significantly on day 3 and thereafter normalized, and a similar pattern was seen for IL-1β. No correlations were found between cytokine concentrations and monocyte TLR4 expression or plasma SFAs.

CONCLUSION

Multifactorial stress significantly affected ex vivo production of TNF-α and monocyte surface expression of TLR4. In addition, mobilization of fat resulted in increased plasma concentrations of SFAs. No associations between inflammatory cytokines and monocyte TLR4 expression or SFAs were found.

Combined astaxanthin and fish oil supplementation improves glutathione-based redox balance in rat plasma and neutrophils

The present study aimed to investigate the effects of daily (45 days) intake of fish oil (FO; 10mg EPA/kg body weight (BW) and 7 mg DHA/kg BW) and/or natural ASTA (1mg ASTA/kg BW) on oxidative stress and functional indexes of neutrophils isolated from Wistar rats by monitoring superoxide (O(2)(-)), hydrogen peroxide (H(2)O(2)), and nitric oxide (NO()) production compared to the progression of auto-induced lipid peroxidation and Ca(2+) release in activated neutrophils. Furthermore, phagocytic capacity, antioxidant enzyme activities, glutathione-recycling system, and biomarkers of lipid and protein oxidation in neutrophils were compared to the redox status. Our results show evidence of the beneficial effects of FO+ASTA supplementation for immune competence based on the redox balance in plasma (significant increase in GSH-dependent reducing power), non-activated neutrophils (increased activity of the glutathione-recycling enzymes GPx and GR) and PMA-activated neutrophils (lower O(2)(-), H(2)O(2), and NO() generation, reduced membrane oxidation, but higher phagocytic activity). Combined application of ASTA and FO promoted hypolipidemic/hypocholesterolemic effects in plasma and resulted in increased phagocytic activity of activated neutrophils when compared with ASTA or FO applied alone. In PMA-activated neutrophils, ASTA was superior to FO in exerting antioxidant effects. The bulk of data reinforces the hypothesis that habitual consumption of marine fish (e.g. salmon, which is a natural source of both astaxanthin and fish oil) is beneficial to human health, in particular by improving immune response and lowering the risk of vascular and infectious diseases.

Influence of exercise on nutritional requirements

There is no consensus on the best diet for exercise, as many variables influence it. We propose an approach that is based on the total energy expenditure of exercise and the specific macro- and micronutrients used. di Prampero quantified the impact of intensity and duration on the energy cost of exercise. This can be used to determine the total energy needs and the balance of fats and carbohydrates (CHO). There are metabolic differences between sedentary and trained persons, thus the total energy intake to prevent overfeeding of sedentary persons and underfeeding athletes is important. During submaximal sustained exercise, fat oxidation (FO) plays an important role. This role is diminished and CHO's role increases as exercise intensity increases. At super-maximal exercise intensities, anaerobic glycolysis dominates. In the case of protein and micronutrients, specific recommendations are required. We propose that for submaximal exercise, the balance of CHO and fat favors fat for longer exercise and CHO for shorter exercise, while always maintaining the minimal requirements of each (CHO: 40% and fat: 30%). A case for higher protein (above 15%) as well as creatine supplementation for resistance exercise has been proposed. One may also consider increasing bicarbonate intake for exercise that relies on anaerobic glycolysis, whereas there appears to be little support for antioxidant supplementation. Insuring minimal levels of substrate will prevent exercise intolerance, while increasing some components may increase exercise tolerance.

Haematological, inflammatory, and immunological responses in elite judo athletes maintaining high training loads during Ramadan

During Ramadan, Muslims abstain from food and fluid intake from dawn to sunset for 1 month. These behavioural changes that accompany Ramadan may impact upon Muslim athletes who continue to train intensely. The aim of the present study was to evaluate the effect of Ramadan intermittent fasting (RIF) on the haematological, inflammatory, and immunological measures in elite judo athletes maintaining their usual high training loads. Haematological markers of inflammation, hormones, and immune status were studied in 15 elite male judo athletes before, during, and after Ramadan. The RIF produced small but significant changes in inflammatory, hormonal, and immunological profiles in judo athletes. Serum C-reactive protein increased from 2.93 +/- 0.26 mg.L-1 pre-Ramadan to 4.60 +/- 0.51 mg.L-1 at the end of Ramadan. Haptoglobin and antitrypsin also significantly increased at different phases during Ramadan, whereas homocysteine and prealbumin remained relatively unchanged. Albumin decreased slightly by mid-Ramadan, then recovered. Immunoglobulin Aincreased from 1.87 +/- 0.56 g.L-1 before Ramadan to 2.49 +/- 0.75 g.L-1 at the end, and remained high 3 weeks after. There were no changes in the leucocyte cell counts throughout the study. The mean blood level of thyroid-stimulating hormone and free thyroxine increased significantly during RIF. Most of these changes were within the normal ranges. These results suggest that athletes who continue to train intensely during Ramadan are liable to experience a myriad of small fluctuations in hormones, immunoglobulins, antioxidants, and inflammatory responses.

Short-term high fat-feeding results in morphological and metabolic adaptations in the skeletal muscle of C57BL/6J mice

The prevalence of the metabolic syndrome (MS) is rapidly increasing all over the world. Consequently, there is an urgent need for more effective intervention strategies. Both animal and human studies indicate that lipid oversupply to skeletal muscle can result in insulin resistance, which is one of the characteristics of the MS. C57BL/6J mice were fed a low-fat (10 kcal%) palm oil diet or a high-fat (45 kcal%; HF) palm oil diet for 3 or 28 days. By combining transcriptomics with protein and lipid analyses we aimed to better understand the molecular events underlying the early onset of the MS. Short-term HF feeding led to altered expression levels of genes involved in a variety of biological processes including morphogenesis, energy metabolism, lipogenesis, and immune function. Protein analysis showed increased levels of the myosin heavy chain, slow fiber type protein, and the complexes I, II, III, IV, and V of the oxidative phosphorylation. Furthermore, we observed that the main mitochondrial membrane phospholipids, phosphatidylcholine and phosphatidylethanolamine, contained more saturated fatty acids. Altogether, these results point to a morphological as well as a metabolic adaptation by promoting a more oxidative fiber type. We hypothesize that after this early positive adaptation, a continued transcriptional downregulation of genes involved in oxidative phosphorylation will result in decreased oxidative capacity at a later stage. Together with increased saturation of phospholipids of the mitochondrial membrane this can result in decreased mitochondrial function, which is a hallmark observed in insulin resistance and Type 2 diabetes.

Special attention to the weight-control strategies employed by Olympic athletes striving for leanness is required

BACKGROUND

Optimization of body weight and composition is a key priority for elite athletes striving for a competitive advantage. The present investigation was designed to characterize various parameters related to weight control in Olympic competitors.

DESIGN

Cross-sectional study.

SETTING

Research unit at a University Hospital.

PARTICIPANTS

223 athletes (125 men and 98 women, with only 1 drop-out), all members of the Swedish teams participating in the Olympic Games of 2002 and 2004.

MAIN OUTCOME MEASUREMENTS

Self-reported body weight and height, from which BMI was calculated, variation in weight during the year prior to Olympic competition, and self-reported weight control strategies by questionnaire. The athletes were divided into two groups on the basis of whether their sporting discipline emphasized leanness or not.

RESULTS

The athletes participating in disciplines that emphasize leanness demonstrated a lower mean BMI (22.7 +/- 2.7 vs 3.7 +/- 2.3 for nonlean athletes, P < 0.05), greater variation in weight (5.3% vs 4.7%, P < 0.05), more frequent attempts to lose weight (P < 0.001), longer total training time (P < 0.001), a higher training load yet weighed more than they desired at the time of competition. These differences were most evident in male athletes. Furthermore, 9.4% of lean athletes reported previously suffering from an eating disorder, in comparison to 2.7% of the nonlean athletes (P < 0.05). More athletes in disciplines emphasizing leanness also reported being ill during the prior 3 month period (38.5% vs 21.6%, P < 0.05).

CONCLUSIONS

This investigation reveals that the weight control practices employed by Olympic athletes participating disciplines that emphasize leanness appear to be suboptimal. Counseling concerning weight control could be used as a tool to prevent illness and enhance performance.

Use of permitted drugs in Italian professional soccer players

OBJECTIVES

To assess the frequency and quantity of usage of permitted drugs by Italian professional soccer players.

METHODS

A cohort of 1041 professional soccer players from the two Italian major leagues was assembled during the season 2003-4; 743 of the 785 (94.6%) subjects available on the day of the interview answered an epidemiological questionnaire, which included questions on the type and frequency of use of several permitted drugs.

RESULTS

92.6% of players reported having used oral anti-inflammatory products in the previous year, and most of them were current users (86.1%). 36% of the players, mostly current users, reported the use of analgesics. 82.8% of the players reported current use of supplements, and 28% reported using vitamins.

CONCLUSIONS

The regular use of several permitted drugs is very high among professional soccer players. The description of players' behaviour is the first step towards regular monitoring of the players' need for, and use of, vitamins, supplements and other permitted drugs.

[Optimal strategies to loose bodyweight for weight-class sports]

Weight-class sports incite the sportsmen to loose weight to change class and increase their chance of success in competition. Although these sports are very demanding on the physiological level (high intensity), most of the competitors undertake caloric restrictions that are likely to induce physiological disorders detrimental to their health and sport performances. Two strategies allow to loose bodyweight. The first is maintained over a very short time (less than 1 week), the second is maintained over a longer period (several weeks). Managing weight reduction, food intake, and physical activities over several weeks is a particularly efficient way to conserve the sportsman's performance abilities. On the other hand, the transgression of certain principles in only one of these fields is enough to deteriorate the sportsman's capacities of performance and (or) his health, whatever the duration of the period of the loss of weight. During food restriction, the carbohydrate and protein rations must be increased to prevent the unavoidable involutions of body composition and performance. In spite of food restriction, the training intensity must be high, and only the training volume must decrease to remain competitive.

The effect of dietary control and carbohydrate supplementation on the immune and hormonal responses to rowing exercise

To determine the effect of carbohydrate supplementation on the immune and stress hormone responses to 1 h of strenuous rowing exercise, 22 male subjects were randomly assigned to a placebo (PLA, n = 11) or carbohydrate (CHO, n = 11) group. Subjects completed 3 d of modified dietary intake, a standardized pre-exercise meal, and consumed either a carbohydrate beverage (1 g·kg body mass–1) or a non-caloric placebo drink before, during, and after a 1 h rowing trial. Increases were observed in adrenocorticotrophic hormone, cortisol, blood leukocytes, neutrophils, and natural killer cell concentrations and activity, whereas the ability of peripheral blood monouclear cells (PBMCs) to respond (interleukin-2 (IL-2) production) to stimulation was reduced 5 min after exercise in both groups (p < 0.05). Lymphocytes were also elevated, but in the PLA group only (p < 0.05). One hour after exercise, blood leukocytes remained elevated owing to increased neutrophil concentrations, whereas a number of lymphocyte subsets (CD3+, CD3+/4+, CD3+/8+, CD20+, CD25+, CD4+/25+, CD8+/25+) and the ability of PBMCs to respond to stimulation (IL-2, interferon-γ (IFN-γ) production) were lower than resting values in both groups (p < 0.05). Carbohydrate supplementation to athletes in the post-prandial state undergoing a 1 h rowing trial resulted in attenuation of the post-exercise increase in peripheral blood lymphocyte concentration, but had little effect on the ability of PBMCs to produce cytokines following stimulation, natural killer cell activity, stress hormone concentrations, exercise performance, or self-reported incidence of illness during the 14 d period following the experimental trial.

Glucocorticosteroids in football: use and misuse

BACKGROUND AND OBJECTIVES

Glucocorticosteroids are widely used in medicine and have shown unchallenged therapeutic potential in several chronic inflammatory and other diseases. They are also widely used in sports medicine for the treatment of conditions such as asthma and acute injuries. In fact, as banned substances, most requests for therapeutic use exemption concern glucocorticosteroids. Nevertheless, their beneficial effect in certain conditions in sports, where inflammation is only a secondary reaction, remains to be validated. This paper aimed to provide a comprehensive review of the literature covering the therapeutic use of glucocorticosteroids since 1977 in conditions ranging from chronic rheumatic illness to peritendinous or intra-articular injection in acute injuries.

METHODS

Search of the medical literature published between 1977 and 2006 using PubMed. Articles relevant to the question "When and if at all is the use of glucocorticosteroids justified in football?" were selected and analysed.

RESULTS AND CONCLUSIONS

The findings clearly point out that, despite the common use of glucocorticosteroids in acute injuries in sports, there is actually limited evidence of the true benefits of such a practice. Physicians must take the possible adverse effects into consideration. In an athlete with clinically verified asthma, inhalational glucocorticosteroids remain first line therapy. Finally, for the purposes of education and prevention of misuse, it should be stressed that a measurable performance enhancing effect of glucocorticoids could not be proved on the basis of the results of the scientific studies to date.

Influence of carbohydrate delivery on the immune response during exercise and recovery from exercise

Acute, sustained, moderate- to high-intensity exercise has been shown to induce significant alterations in the distribution and function of leukocytes during recovery. In many instances, these changes have been found to reflect a transient impairment of immune function in vitro during recovery from such exercise. Carbohydrate supplementation during exercise has been associated with an attenuation of cortisol production. Because cortisol has been linked to immunosuppression, a growing body of research has examined the influence of carbohydrate supplementation on immune function in response to exercise. New areas along this line of inquiry involve examination of the cytokine response to exercise and the role that carbohydrate may play in regulating the production of proinflammatory cytokines. Inter-relations among the immune response, production of specific cytokines, and cortisol are also examined. The clinical significance of an attenuated immune response when exercising as a result of the administration of supplemental carbohydrate is yet to be determined.

Exercise immunology: the current state of man and mouse

The mechanisms governing the body's response to physical exercise have been investigated from various perspectives including metabolism, nutrition, age and sex. Increased attention to the immune system during recent decades is reflected by a rapidly growing number of publications in the field. This article highlights the most recent findings and only briefly summarises more basic concepts already reviewed by others. Topics include Th1/Th2 cytokine balance, inoculation time, age and immune compensation. Some less investigated areas are discussed including studies in children, the environment and dendritic cells. Because physical exercise enhances some aspects and suppresses other aspects of immunity, the biological significance of alterations in the immune system are unknown. So far, no link between immunological alterations and infection rate has been established and infection after strenuous physical exercise is equally likely to be the result of exercising with an already established rather than a new infection. If there is an increased risk for infections with increased exercise duration and intensity, why do overtrained athletes not display the greatest risk for upper respiratory tract infections? Increased knowledge on immune system modulations with physical exercise is relevant both from a public health and elite athlete's point of view.

Photoperiod influences the effects of exercise and food restriction on an antigen-specific immune response in Siberian hamsters

Environmental conditions influence the onset and severity of illness and infection and may compromise survival. Energetically challenging conditions during winter may directly induce death through hypothermia, starvation, or shock. The ability to forecast and prepare for the arrival of challenging conditions associated with winter (e.g. low temperatures, decreased food) likely confers survival advantages. Siberian hamsters (Phodopus sungorus) stop reproduction and reduce body mass (approximately 25%) during short, winter-like day lengths, resulting in energetic savings. Hamsters also increase circulating glucocorticoids and lymphocytes (e.g. T cells, NK cells), and exhibit enhanced antigen-specific delayed-type-hypersensitivity (DTH) responses in the skin during short days (SDs). We tested the hypothesis that Siberian hamsters use SD lengths to signal the onset of winter to mediate the energetic trade-offs among body mass, reproductive function, and immune function. Long-day (LD; 16 h light, 8 h dark) and SD (8 h light, 16 h dark) hamsters were either food restricted (25%) or provided ad libitum (ad lib) food for 4 wk; half of all hamsters in each food condition had voluntary access to a running wheel, and half remained sedentary. SD hamsters enhanced DTH responses compared with LD hamsters under sedentary ad lib conditions. Exercise enhanced DTH in LD hamsters regardless of food intake. Furthermore, food-restriction did not significantly influence DTH in LD hamsters. In contrast, food-restriction suppressed DTH in SD hamsters regardless of activity condition, and exercise modestly enhanced DTH only in SD hamsters with ad lib access to food. In sum, moderate energetic deficiency suppressed DTH in SD (but not LD) hamsters, and this suggests that hamsters may have evolved to enhance immune responses during winter in preparation for increased metabolic stressors.

The Cardiovascular Effects of Chronic Hypoestrogenism in Amenorrhoeic Athletes

In premenopausal women, the most severe menstrual dysfunction is amenorrhoea, which is associated with chronic hypoestrogenism. In postmenopausal women, hypoestrogenism is associated with a number of clinical sequelae related to cardiovascular health. A cardioprotective effect of endogenous oestrogen is widely supported, yet recent studies demonstrate a deleterious effect of hormone replacement therapy for cardiovascular health. What remain less clear are the implications of persistently low oestrogen levels in much younger amenorrhoeic athletes. The incidence of amenorrhoea among athletes is much greater than that observed among sedentary women. Recent data in amenorrhoeic athletes demonstrate impaired endothelial function, elevated low- and high-density lipoprotein levels, reduced circulating nitrates and nitrites, and increased susceptibility to lipid peroxidation. Predictive serum markers of cardiovascular health, such as homocysteine and C-reactive protein, have not yet been assessed in amenorrhoeic athletes, but are reportedly elevated in postmenopausal women. The independent and combined effects of chronic hypoestrogenism and exercise, together with subclinical dietary behaviours typically observed in amenorrhoeic athletes, warrants closer examination. Although no longitudinal studies exist, the altered vascular health outcomes reported in amenorrhoeic athletes are suggestive of increased risk for premature cardiovascular disease. Future research should focus on the presentation and progression of these adverse cardiovascular parameters in physically active women and athletes with hypoestrogenism to determine their effects on long-term health.

Stressed to death: implication of lymphocyte apoptosis for psychoneuroimmunology

Psychological and physical stressors best exemplify the intercommunication of the immune and the nervous systems. It has been shown that stress significantly impacts leukocyte cellularity and immune responses and alters susceptibility to various diseases. While acute stress has been shown to enhance immune responses, chronic stress often leads to immunosuppression. Among many criteria examined upon exposure to chronic stress, the reduction in lymphocyte mitogenic response and lymphocyte cellularity are commonly assessed. We have reported that chronic restraint stress could induce lymphocyte reduction, an effect dependent on endogenous opioids. Interestingly, the effect of endogenous opioids was found to be exerted through increasing the expression of a cell death receptor, Fas, and an increased sensitivity of lymphocytes to apoptosis. Stress-induced lymphocyte reduction was not affected by adrenalectomy. In this review, based on available literature and our recent data, we will discuss the role of the hypothalamic-pituitary-adrenal axis and endogenous opioids and examine the mechanisms by which chronic stress modulates lymphocyte apoptosis.