Iron status and the female athlete

Iron deficiency (ID) is the most prevalent micronutrient deficiency disorder in the world. In the developed world, the greatest prevalence of ID and iron deficiency anemia (IDA) occurs in premenopausal women. Premenopausal women experience ID and IDA due to inadequate consumption of dietary iron coupled with iron losses through physiologic processes such as menstruation. Further, female athletes may experience an elevated risk of ID and IDA, as hepcidin, a peptide hormone that inhibits iron absorption and sequesters iron in the macrophage, may rise in response to physical activity. Declines in physical and cognitive performance have been demonstrated in female athletes with ID and IDA. Performance decrements are attenuated as iron status improves. This review will focus on iron status in female athletes, and will include a review of nutritional countermeasures to prevent ID and IDA.     

Vitamin D in athletes: focus on physical performance and musculoskeletal injuries

[Purpose]The aim of this review was to discuss the effects of vitamin D on physical performance and musculoskeletal injuries in athletes and provide information on the field applications of vitamin D. [Methods]A systematic review was conducted to identify studies on vitamin D in athletes that assessed serum vitamin D levels, vitamin D and physical performance, vitamin D and musculoskeletal injuries, and practical guidelines for supplementation of vitamin D. [Results]Several studies reported that a high proportion of athletes had vitamin D insufficiency or deficiency. Low serum levels of vitamin D in athletes were more pronounced in winter than in other seasons, and indoor athletes had lower serum vitamin D levels than outdoor athletes. Low vitamin D levels have been demonstrated to have negative effects on muscle strength, power, and endurance; increase stress fractures and other musculoskeletal injuries; and affect acute muscle injuries and inflammation following high-intensity exercises. Therefore, periodic assessment and monitoring of vitamin D levels are necessary in athletes; the recommended serum level of 25(OH)D is > 32 ng/mL and the preferred level is > 40 ng/mL (-1). In those with low levels of vitamin D, exposure to sunlight and an improved diet or supplements may be helpful. Particularly, 2000–6000 IU of supplemental vitamin D3 can be consumed daily. [Conclusion]Vitamin D is a potential nutritional factor that can significantly affect physical performance and musculoskeletal injuries in athletes. The importance and role of vitamin D in athletes should be emphasized, and the current levels of vitamin D should be assessed. Therefore, it is essential to periodically evaluate and monitor serum vitamin D levels in athletes.     

Hemoglobin values: comparative survey of the 1976 Canadian Olympic team.

In view of the role of hemoglobin in oxygen transport, the hemoglobin concentration in whole blood may indicate readiness for maximal physical performance. Hemoglobin concentrations were determined in members of the 1976 Canadian Olympic team and compared with those of the 1975 Canadian general population and with published data for the 1968 Australian and Dutch Olympic teams. The mean hemoglobin concentrations of the 123 male and 64 female Canadian Olympic athletes were 14.7 +/- 1.0 and 12.9 +/- 0.7 g/dL, respectively. Both male and female Canadian Olympic athletes had significantly lower (P less than 0.01) values than the other three groups. The suboptimal hemoglobin concentrations may be related to inadequate dietary intake of protein and iron.     

Iron and vitamin status biomarkers and its association with physical fitness in adolescents: the HELENA study

There is a lack of studies that analyze the association between micronutrient-related biomarker status and physical fitness in adolescents. In the present study, biochemical parameters for iron and vitamin status were studied, along with objective measures of physical fitness in healthy male and female European adolescents. One thousand eighty-nine adolescents (580 girls, 12.5-17.5 yr) from the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) cross-sectional study were included. Hierarchical linear models were performed to determine the associations between micronutrient biomarkers and physical fitness. Age, seasonality, latitude, body mass index, menarche (in girls), and physical activity were used as covariates. For cardiorespiratory fitness, concentrations of hemoglobin, retinol, and vitamin C in male adolescents and β-carotene and 25(OH)D in female adolescents were associated with maximal oxygen consumption. For muscular fitness, concentrations of hemoglobin, β-carotene, retinol, and α-tocopherol in male adolescents and β-carotene and 25(OH)D in female adolescents were associated with better performance of the standing long jump test. In summary, concentrations of hemoglobin and most antioxidant vitamins in male adolescents and β-carotene and 25(OH)D in female adolescents were positively associated with cardiorespiratory and muscular fitness, after controlling for relevant confounders. The associations between physical fitness and iron or vitamin status observed in this cross-sectional study in adolescents should be followed up by a study specifically designed to evaluate causal relationships.     

Ingestion of calcium solutions by common marmosets (Callithrix jacchus)

Callithrix jacchus, the common marmoset, is a small New World primate that feeds on insects, fruit, and gum, and has a high reproductive rate for a primate. Insects are generally a poor source of dietary calcium, while gums may contain significant levels of calcium. Their high reproductive rate also suggests that reproductive female C. jacchus might be susceptible to calcium deficiency. Thus, we hypothesized that common marmosets might find solutions containing calcium to be palatable. We used choice experiments to examine this phenomenon in 14 male and 19 female common marmosets. Animals were presented with identical water bottles containing either deionized water or a calcium lactate solution (either 2% or 4% calcium lactate by weight) and intake was measured. Serum 25-OH-vitamin D was monitored in a subset of the animals in the experiment to examine the role of vitamin D in this behavior. Our results demonstrated that C. jacchus can distinguish between plain water and a calcium lactate solution, and that in general they prefer calcium solutions. Although animals with marginal vitamin D status did have strong preferences for calcium solutions, they did not ingest significantly more of the calcium solutions than animals that were vitamin D-replete. Nulliparous females and males did not differ in the amounts of calcium solutions ingested. Lactating females ingested the greatest volume of the calcium solutions.     

Vitamin D is a major determinant of bone mineral density at school age

Background

Vitamin D insufficiency in children may have long-term skeletal consequences as vitamin D affects calcium absorption, bone mineralization and bone mass attainment.

Methodology/Principal Findings

This school-based study investigated vitamin D status and its association with vitamin D intake and bone health in 195 Finnish children and adolescents (age range 7–19 years). Clinical characteristics, physical activity and dietary vitamin D intake were evaluated. Blood and urine samples were collected for serum 25-hydroxyvitamin D (25-OHD) and other parameters of calcium homeostasis. Bone mineral density (BMD) and body composition were measured with dual-energy X-ray absorptiometry (DXA). Altogether 71% of the subjects were vitamin D insufficient (25-OHD <50 nmol/L). The median 25-OHD was 41 nmol/L for girls and 45 nmol/L for boys, and the respective median vitamin D intakes 9.1 µg/day and 10 µg/day. In regression analysis, after adjusting for relevant factors, 25-OHD concentration explained 5.6% of the variance in lumbar BMD; 25-OHD and exercise together explained 7.6% of the variance in total hip BMD and 17% of the variance in whole body BMD. S-25-OHD was an independent determinant of lumbar spine and whole body BMD and in magnitude surpassed the effects of physical activity.

Conclusions/Significance

Vitamin D insufficiency was common even when vitamin D intake exceeded the recommended daily intake. Vitamin D status was a key determinant of BMD. The findings suggest urgent need to increase vitamin D intake to optimize bone health in children.     

Association between serum uncarboxylated osteocalcin levels and nutritional intake in Japanese female athletes

[Purpose] The current study aimed to determine the association between serum uncarboxylated osteocalcin (ucOC) levels and dietary vitamin K intake in female Japanese athletes.[Methods] The nutritional profile and food group intake of 52 Japanese female athletes were investigated using a digital photographic method with data obtained from 3-day dietary records. The food groups were categorized into 18 groups in line with the standard tables of food composition in Japan. Fasting blood samples were collected for serum ucOC levels, and dual-energy X-ray absorptiometry (DXA) evaluated body composition and bone parameters.[Results] The results showed that dietary vitamin K intake level was 235 ± 148 µg/day, and approximately 70% (n = 36) of participants consumed more than the adequate intake (AI) level, based on the Dietary Reference Intakes for Japanese females aged 18–29. Serum ucOC levels were negatively associated with daily vitamin K intake (r = −0.388, P = 0.004) and calcium (r = −0.596, P = 0.004) after adjusting for energy intake.[Conclusion] Our study revealed that serum ucOC levels were negatively associated with dietary vitamin K intake in female Japanese athletes. Serum ucOC levels reflected dietary vitamin K intake in female athletes. In summary, female athletes consume more vitamin K than the general population to maintain bone health. Furthermore, our results indicated that serum ucOC levels might be linked to dietary calcium intake.     

Elements in Sera of Elite Taekwondo Athletes: Effects of Vitamin E Supplementation

Many researchers have emphasized the relation between nutrition and development and sustaining performance. Two methods are commonly employed to identify the interaction between physical activity and nutrition. The first consists of administering food with a variety of contents to people engaged in physical activity and observing their performance responses, and the other is concerned with determining the effects of physical activity on nutrition. Therefore, it can be said that there has been a growing interest in the explorations into the relation between exercise and vitamins, minerals, and elements. The present study reports the effects of 6 weeks administration of 300 mg/day vitamin E on the distribution of serum elements in elite taekwondo athletes. Seven male athletes, mean ages 22.1 ± 0.5 years weighing on average 66.4 ± 2.4 kg were included in the study. The athletes had been practicing taekwondo for 10–12 years. Resting blood samples were collected in duplicate before and after supplementation for determination of serum levels of cobalt, boron, cadmium, chromium, nickel, manganese, sulfur, copper, iron, zinc, phosphorus, sodium, potassium, and calcium. Supplementation resulted in significant increases of all elements relative to values before supplementation (p < 0.001), with the exception of boron and sulfur, which remained without change. The results of the present study demonstrate that vitamin E supplementation crucially influences the element and mineral metabolism in elite athletes.     

The estimation of mineral contents in oriental supplements consumed by elite athletes

The purpose of this study is twofold: to examine macro (calcium, magnesium, and phosphorus) and trace mineral (iron) concentration in oriental supplements (OS), and to define OS prevalence in elite athletes. Participants of this study were 928 varsity athletes (male: 680, female: 248) with 23 sports types. Recent 3-month dietary supplements (DS) and OS practice was surveyed during training period, and mineral concentration in 72 randomly collected OS samples were analyzed. DS use was 41% and OS use was 20% in university elite athletes. Most common OS use informants were parents (74%). OS intake reason was for health maintenance (37%), energy supplement (25%), and recovery improvement (15%). Moreover, health maintenance was higher in females (47%) than males (32%) while energy supplement was higher in males (28%) than females (18%) (χ²(8) = 17.676, p = 0.024). Beliefs in OS efficacy and importance were significantly higher in female athletes compared to male athletes (p < 0.05). Macro mineral concentration in OS was calcium (7.54 ppm), magnesium (4.63 ppm), and phosphorus (205.34 ppb) and trace mineral concentration in OS was iron (8.10 ppb), which was a small amount. An association between OS intake reason and mineral concentration in calcium, phosphorus, and iron was found, but no association between OS intake and magnesium. In conclusion, an association between OS intake reason and mineral concentration differed by the ingredients. Minerals in OS were very small amount, which would be improved for mineral balance in elite athletes.     

Nitric oxide and changes of iron metabolism in exercise

Accumulated data imply that exercise itself might not lead to a true iron deficiency or 'sport anaemia' in a healthy athlete who has adequate iron intake. The higher prevalence of iron deficiency anaemia in younger female athletes might be not due to exercise itself, but probably results from dietary choices, inadequate iron intake and menstruation. These factors can also induce iron deficiency or anaemia in the general population. However, exercise does affect iron metabolism, leading to low or sub-optimal iron status. The underlying mechanism is unknown. In this review, recent advances in the study of the effect of exercise on iron metabolism and nitric oxide, and the relationship between nitric oxide and iron status in exercise are discussed. A hypothesis that increased production of nitric oxide might contribute to sub-optimal iron status in exercise is proposed.     

Rates of insufficiency and deficiency of vitamin D levels in elite professional male and female skiers: A chronobiologic approach

Vitamin D is essential for the maintenance and promotion of musculoskeletal health, for the functioning of the immune, cardiovascular and reproductive systems, and its main action is to keep calcium and phosphate plasmatic physiological concentrations at intestinal, renal and bony level. Vitamin D affects several parameters related to physical performance too and a particularly high percentage of vitamin D insufficiency and deficiency in professional athletes has been observed. Several variables are able to impair the synthesis of 25(OH)D in athletes, specifically both genetic and environmental factors, but the most probable explanation for the deficient/insufficient vitamin D levels is the insufficient ultraviolet B light (UVB) exposure during winter. To confirm this, the existence of a circannual rhythm of vitamin D in professional soccer players, highlighting a peak in summer and lowest values in winter regardless the period of the season, has been documented. Nonetheless, from what we are aware of, no other study adopted a chronobiologic approach to better understand and describe the circannual variations of serum 25(OH)D in other sport disciplines. Therefore, we studied serum vitamin D in a cohort of top-level professional skiers, during a period of three consecutive competitive seasons (2015, 2016 and 2017), in order to evaluate, with a rhythmometric approach, the vitamin D behavior along the year. The study population was composed by 152 professional Italian alpine skiers of FISI (Winter Sport Italian Federation), 63 females and 89 males (mean age: 24.1 ± 3.2 years) and a total of 298 blood drawings were carried out to determine plasma 25(OH)D. Vitamin D data were compared between genders and then processed with the population mean cosinor tests to evaluate the presence of a circannual rhythm, both for female and male athletes. In total, 77 skiers (50.7%) showed, at least once during the three competitive seasons, an insufficient level of 25(OH)D and other 45 subjects (29.6%) showed a deficient status; no differences were observed between genders (mean for females: 26.9 ± 8.1 ng/mL; mean for males: 27.4 ± 7.6 ng/mL). In addition, the rhythmometric analysis highlighted the existence of a significant circannual rhythm for both female and male professional skiers; the acrophases (Φ) occurred in July and both MESOR (M) and amplitude (A) were comparable between the two groups. Our data indicate that, despite the physical effort spent, vitamin D follows a classical season-associated rhythm with a peak in summer and a nadir in winter. Moreover, the percentage of insufficiency and deficiency is in line with that of the general population. In conclusion, our findings reinforce the hypothesis that there is no direct effect of physical activity on vitamin D metabolism and that the factors involved in the determination of vitamin D levels in the general population are valid also for athletes.     

Calcium and vitamin D modulate mouse colon epithelial proliferation and growth characteristics of a human colon tumor cell line

The role of calcium and vitamin D in the prevention of colorectal cancer is only now being investigated at the organismal, cellular, and molecular biologic levels. Recent epidemiologic studies have supported the hypothesis that dietary calcium and vitamin D may be related to a reduced risk for colon cancer. The evidence from laboratory investigations in animals and in cell culture also indicate a possible preventative effect. Addition of calcium and vitamin D to the roster of developmental cancer chemopreventative agents for further research is warranted.     

Dietary vitamin E reduces labile iron in rat tissues

Previous studies have shown that dietary vitamin E reduced generation and/or levels of superoxide. As superoxide has potential to release iron from its transport and storage proteins, and labile or available form of iron is capable of catalyzing the formation of reactive hydroxyl radicals, the effect of dietary vitamin E on labile iron pool was studied in rats. One-month-old Sprague-Dawley male and female rats were fed a basal vitamin E-deficient diet supplemented with 0, 20, 200, or 2,000 IU vitamin E/kg diet for 90 days. The levels of labile iron were measured in the liver, kidney, spleen, heart and skeletal muscle. Additionally, the levels of lipid peroxidation products were measured. The results showed that, except for labile iron in the heart of male rats, dietary vitamin E dose dependently reduced the levels of labile iron and lipid peroxidation products in all tissues of male and female rats. The findings suggest that dietary vitamin E may protect against oxidative tissue damage by reducing the generation and/or level of superoxide, which in turn attenuates the release of iron from its protein complexes.     

Involvement of 1,25-dihydroxyvitamin D3 in regulating myocardial calcium metabolism: physiological and pathological actions

The role of the prohormone vitamin D3 in regulating calcium and phosphate metabolism in the intestine, kidney, and bone has been known for several decades. Recent studies have provided evidence that vitamin D3, may also play an important role in regulating metabolism in other organs, including heart. This role has been suggested by the identification of a specific receptor for 1,25-dihydroxyvitamin D3 [1,25(OH)2D3], the active metabolite of vitamin D3, in these tissues, as well as the presence of a 1,25(OH)2D3-dependent calcium binding protein. Although administration of excessive quantities of vitamin D3 has been shown in many studies to produce myocardial calcinosis and heart failure, the importance of vitamin D3 in regulating myocardial metabolism under normal conditions has only recently been demonstrated. The purpose of the present review is to assess the current status of research regarding the pathological and physiological actions of vitamin D3 on the heart. The initial section of this report will focus on the pathological effects of excessive vitamin D3 on cardiovascular function, while the latter sections will describe recent studies related to the involvement of 1,25(OH)2D3 in regulating calcium homeostasis in ventricular cells and the relationship between vitamin D3 and myocardial contractility.     

Vitamin D in foods and as supplements

Numerous studies have shown that the vitamin D status is far from optimal in many countries all over the world. The main reason for this is lack of sunshine. Only a limited number of foods naturally contain vitamin D. Good sources of vitamin D(3) are fish (not only fatty fish), egg yolk, and offal such as liver. Some foods such as milk are fortified with vitamin D in some countries. Dietary vitamin D intake is low in many countries, especially as the dietary sources are limited. The use of supplements is important and seems to be high in some countries. Current dietary intake recommendations are too low to preserve/reach optimal S-25-OHD concentrations, when UVB radiation is not available. We suggest that the recommendations should be increased to at least 10 microg per day in all age groups when solar UVB is scarce. The elderly may need a daily vitamin D intake of 25 microg. If dietary intake of vitamin D is to be increased, food habits will have to change. From a public health point of view it is better to increase the potential sources of vitamin D by fortifying specific products that are consumed commonly in a whole population, or if necessary by especially vulnerable groups. Supplement use is probably the right alternative for vulnerable groups such as infants and inactive elderly in whom this is more easily implemented.     

Effect of boron on vitamin D deficient rats

The effects of different levels of dietary boron were determined in vitamin D deficient rats. Vitamin D deficient diets containing either 0.158 ppm or 2.72 ppm of boron were fed to rats for 11 w, and calcium, magnesium, and phosphorus apparent absorption and balance were measured in the twelfth week. Higher apparent absorption and balance values for calcium and phosphorus were observed in the rats with higher dietary boron, but very few differences were seen in body wt, organ wt, and bone parameters. Balance measurements represented the present status of the rats after 12 w on the diets, but other measurements represented an accumulation over the lifetime of the rat, including a suckling period with ample vitamin D and boron. The data demonstrated that when rats are vitamin D deficient, as indicated by hypocalcemia, the level of boron in the diet affects mineral balance.     

Effect of dietary tin deficiency on growth and mineral status in rats

To clarify the influence of dietary tin deficiency on growth and mineral status, the following two different synthetic diets were fed to male Wistar rats: group 1—a diet containing 1.99 μg tin/g; group 2—a diet containing 17 ng tin/g. The rats in group 2 showed poor growth, lowered response to sound, and alopecia, with decreased food efficiency compared with rats in group 1. The changes of mineral concentrations in tissues observed in group 2, compared with group 1, are summarized as follows: calcium concentration in lung increased; magnesium concentration in lung decreased; iron concentrations in spleen and kidney increased; iron concentration in femoral muscle decreased; zinc concentration in heart decreased; copper concentrations in heart and tibia decreased; manganese concentrations in femoral muscle and tibia decreased. These results suggest that tin may be essential for rat growth.