Artigos Científicos · Nutrição Esportiva

Research on lean, energy-deficient athletic and military cohorts has broadened the concept of the Female Athlete Triad into the Relative Energy Deficiency in Sport (REDs) syndrome. REDs represents a spectrum of abnormalities induced by low energy availability (LEA), which serves as the underlying cause of all symptoms described within the REDs concept, affecting exercising populations of either biological sex. Both short- and long-term LEA, in conjunction with other moderating factors, may produce a multitude of maladaptive changes that impair various physiological systems and adversely affect health, well-being, and sport performance. Consequently, the comprehensive definition of REDs encompasses a broad spectrum of physiological sequelae and adverse clinical outcomes related to LEA, such as neuroendocrine, bone, immune, and hematological effects, ultimately resulting in compromised health and performance. In this review, we discuss the pathophysiology of REDs and associated disorders. We briefly examine current treatment recommendations for REDs, primarily focusing on nonpharmacological, behavioral, and lifestyle modifications that target its underlying cause-energy deficit. We also discuss treatment approaches aimed at managing symptoms, such as menstrual dysfunction and bone stress injuries, and explore potential novel treatments that target the underlying physiology, emphasizing the roles of leptin and the activin-follistatin-inhibin axis, the roles of which remain to be fully elucidated, in the pathophysiology and management of REDs. In the near future, novel therapies leveraging our emerging understanding of molecules and physiological axes underlying energy availability or lack thereof may restore LEA-related abnormalities, thus preventing and/or treating REDs-related health complications, such as stress fractures, and improving performance.

Relative Energy Deficiency in Sport (RED-S) refers to a condition in which energy imbalance leads to impaired physiological function of multiple organ systems and expands on the diagnosis previously known as the Female Athlete Triad. Researchers attribute the medical complications of RED-S to low energy availability, in which energy availability is defined as dietary energy intake minus exercise energy expenditure divided by fat-free mass. This article reviews the history of this diagnosis, the changing terminology, and the reasons for the expansion. Accepted definitions of each part of the energy availability equation are considered and the difficulties that exist using these equations in practice or comparatively in the literature are assessed. The review analyzes the broad spectrum of health consequences of RED-S, especially as it relates to hypoestrogenemia and menstrual function, gives guidance to those caring for athletes on the identification and management of RED-S, and sheds lights on the important role of coaches, athletic trainers, and families in recognizing this diagnosis and in helping getting patients to care.

Evidence suggests low energy availability (LEA) is prevalent in elite male Gaelic football (GF) players. Previous research in male and female team sports found LEA may negatively impact endocrine function. The aim of this study was to examine the seasonal variations in energy availability (EA) and its associations with salivary measures in elite male GF players across the competitive season.

A 24-year-old premenopausal female adult completed the entire Pacific Crest Trail, an arduous backpacking thru-hike of 4265 km. Dual-energy x-ray absorptiometry measurements were taken before and after the trek. Her body fat percentage dropped from 33.2% to 24.9%, and there was a 52% decrease in visceral adipose tissue mass and area. Total body bone mineral content and bone mineral density (BMD) were retained; however, lumbar BMD decreased 3.8%. The hiker eventually regained this loss of lumbar BMD. A decrease in lumbar BMD despite engaging in load-bearing activity was also observed in two recent case study reports of male thru-hikers, suggesting a maladaptive response that warrants further investigation.

Stress fractures (SF) represent 10%-20% of all injuries in sport medicine. An SF occurs when abnormal and repetitive loading is applied on normal bone: The body cannot adapt quickly enough, leading to microdamage and fracture. The etiology is multifactorial with numerous risk factors involved. Diagnosis of SF can be achieved by identifying intrinsic and extrinsic factors, obtaining a good history, performing a physical exam, and ordering laboratory and imaging studies (magnetic resonance imaging is the current gold standard). Relative energy deficiency in sport (RED-S) is a known risk factor. In addition, for women, it is very important know the menstrual status to identify long periods of amenorrhea in the past and the present. Early detection is important to improve the chance of symptom resolution with conservative treatment. Common presentation involves complaints of localized pain, with or without swelling, and tenderness on palpation of bony structures that begins earlier in training and progressively worsens with activity over a 2- to 3-week period. Appropriate classification of SF based on type, location, grading, and low or high risk is critical in guiding treatment strategies and influencing the time to return to sport. Stress injuries at low-risk sites are typically managed conservatively. Studies have suggested that calcium and vitamin D supplementation might be helpful. Moreover, other treatment regimens are not well established. Understanding better the pathophysiology of SFs and the potential utility of current and future bone-active therapeutics may well yield approaches that could treat SFs more effectively.

Relative Energy Deficiency in Sport (REDs) was first introduced in 2014 by the International Olympic Committee's expert writing panel, identifying a syndrome of deleterious health and performance outcomes experienced by female and male athletes exposed to low energy availability (LEA; inadequate energy intake in relation to exercise energy expenditure). Since the 2018 REDs consensus, there have been >170 original research publications advancing the field of REDs science, including emerging data demonstrating the growing role of low carbohydrate availability, further evidence of the interplay between mental health and REDs and more data elucidating the impact of LEA in males. Our knowledge of REDs signs and symptoms has resulted in updated Health and Performance Conceptual Models and the development of a novel Physiological Model. This Physiological Model is designed to demonstrate the complexity of either problematic or adaptable LEA exposure, coupled with individual moderating factors, leading to changes in health and performance outcomes. Guidelines for safe and effective body composition assessment to help prevent REDs are also outlined. A new REDs Clinical Assessment Tool-Version 2 is introduced to facilitate the detection and clinical diagnosis of REDs based on accumulated severity and risk stratification, with associated training and competition recommendations. Prevention and treatment principles of REDs are presented to encourage best practices for sports organisations and clinicians. Finally, methodological best practices for REDs research are outlined to stimulate future high-quality research to address important knowledge gaps.

The female athlete triad (TRIAD) is a spectrum of disorders involving low energy availability (LEA), low bone mineral density, and menstrual disorders. It is increasingly common to use the term 'relative energy deficiency in sport' (RED), emphasising the extensive impact of LEA on the body. The aim of this narrative review was to gather original research encompassing female athletes across various sports as well as to collect findings on the potential of a nutrition-focused approach to prevent or treat the aforementioned disorders. A comprehensive search was conducted in PubMed and Scopus. Several challenges were identified regarding the adequacy of the energy availability, protein, and carbohydrate requirements in the diets of female athletes. Moreover, insufficient intake of vitamin D has been observed across all athlete groups studied. This insufficiency also extends to the average requirement for Ca, Mg, the Ca/P ratio, Zn, and Fe. To address those concerns, a nutritional approach is proposed in the latter part of this review. The factors that can improve the absorption of micronutrients have also been discussed. The TRIAD/REDs affect an ever-growing number of women and require appropriate therapeutic management, particularly through nutritional care. Therefore, cooperation within an interdisciplinary team comprising a physician, nutritionist, physiotherapist, and psychologist is crucial.

Low energy availability (LEA) occurs when energy expenditure from athletic training and bodily functions exceeds caloric intake. This imbalance results in declines in athletic performance and increases the risk of injury. Relative energy deficiency in sport (REDs) is a condition that occurs when the energy deficit is severe enough to cause alterations to metabolic rate, menstrual function, immune function, bone health, protein synthesis, and cardiovascular function. Many athletes, particularly those competing in endurance, aesthetic, or weight-class sports, are adversely impacted by this condition.

Overtraining syndrome (OTS) is a condition characterized by a long-term performance decrement, which occurs after a persisting imbalance between training-related and nontraining-related load and recovery. Because of the lack of a gold standard diagnostic test, OTS remains a diagnosis of exclusion.

Intermittent fasting is one of the most popular types of diet at the moment because it is an effective nutritional strategy in terms of weight loss. The main objective of this review is to analyze the effects that intermittent fasting has on sports performance. We analyzed physical capacities: aerobic capacity, anaerobic capacity, strength, and power, as well as their effect on body composition. For this, a bibliographic search was carried out in several databases where 25 research articles were analyzed to clarify these objectives. Inclusion criteria: dates between 2013 and present, free full texts, studies conducted in adult human athletes, English and/or Spanish languages, and if it has been considered that intermittent fasting is mainly linked to sports practice and that this obtains a result in terms of performance or physical capacities. This review was registered in PROSPERO with code ref. 407024, and an evaluation of the quality or risk of bias was performed. After this analysis, results were obtained regarding the improvement of body composition and the maintenance of muscle mass. An influence of intermittent fasting on sports performance and body composition is observed. It can be concluded that intermittent fasting provides benefits in terms of body composition without reducing physical performance, maintenance of lean mass, and improvements in maximum power. But despite this, it is necessary to carry out new studies focusing on the sports field since the samples have been very varied. Additionally, the difference in hours of intermittent fasting should be studied, especially in the case of overnight fasting.

The study aimed to investigate the impact of nutrient timing in relation to evening exercise. Specifically, it examined the effects of pre- or post-exercise carbohydrate (CHO) ingestion on glucose metabolism, glucose regulation, and overall substrate oxidation in well-trained athletes during and after physical exercise (PE), spanning the nocturnal period and the subsequent morning.

Energy intake (EI) from daily meals, corresponding to total energy expenditure (TEE), is essential for maintaining good physical condition and performance in athletes. Athletes who continue high-intensity training while consuming insufficient energy from their daily diet are at risk for health problems, such as iron deficiency anemia, endocrine dysfunction, and energy metabolism disorders.

Creatine is a widely studied ergogenic aid known for its effects on muscle performance and body composition. However, its impact or utility for athletes involved in combat sports, who often aim to reduce body mass to meet a specific weight class, remains unclear. To conduct a narrative systematic review of peer-reviewed published studies that examined the effects of creatine supplementation on body mass, body composition, muscular strength, power, endurance, fatigue, recovery, and cognitive performance in combat sport athletes. A comprehensive search was conducted in multiple public databases up to March 2025. Databases searched included PubMed, Scopus, Web of Science, and Google Scholar. Studies evaluating creatine supplementation in combat sports (eg wrestling, judo, taekwondo, boxing) were included. Outcomes assessed included changes in body mass and body composition, performance metrics, and markers of fatigue and recovery. Nineteen studies met the inclusion criteria. Creatine supplementation increased body mass, especially during longer-term interventions (≥6 wk) or when combined with structured resistance training. Creatine supplementation also increased measures of body mass and fat-free mass (FFM). Muscular power and maximal strength outcomes improved significantly after creatine supplementation, particularly in studies utilizing short-duration, high-intensity exercise protocols. Creatine supplementation did not influence measures of sport-specific endurance, recovery or fatigue. No serious adverse effects were reported across studies for creatine supplementation. Creatine supplementation enhances body mass, FFM, muscle strength and power in combat sport athletes. Given its safety and efficacy profile, creatine supplementation remains a promising supplement for supporting some aspects of athletic performance in combat sports.

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

Resting metabolic rate (RMR) prediction equations are often used to calculate RMR in athletes; however, their accuracy and precision can vary greatly.

The assessment of body composition (BC) in sport raises concern for athlete health, especially where an overfocus on being lighter or leaner increases the risk of Relative Energy Deficiency in Sport (REDs) and disordered eating.

Endurance athletes typically consume carbohydrate-rich diets to allow for optimal performance during competitions and intense training. However, acute exercise studies have revealed that training or recovery with low muscle glycogen stimulates factors of importance for mitochondrial biogenesis in addition to favourable metabolic adaptations in trained athletes. Compromised training quality and particularly lower intensities in peak intervals seem to be a major drawback from dietary interventions with chronic carbohydrate (CHO) restriction. Therefore, the concept of undertaking only selected training sessions with restricted CHO availability (periodized CHO restriction) has been proposed for endurance athletes. However, the overall performance effect of this concept has not been systematically reviewed in highly adapted endurance-trained athletes. We therefore conducted a meta-analysis of training studies that fulfilled the following criteria: a) inclusion of females and males demonstrating a VO2max ≥ 55 and 60 ml · kg- 1 · min- 1, respectively; b) total intervention and training periods ≥ 1 week, c) use of interventions including training and/or recovery with periodized carbohydrate restriction at least three times per week, and d) measurements of endurance performance before and after the training period. The literature search resulted in 407 papers of which nine studies fulfilled the inclusion criteria. The subsequent meta-analysis demonstrated no overall effect of CHO periodization on endurance performance compared to control endurance training with normal (high) CHO availability (standardized mean difference = 0.17 [- 0.15, 0.49]; P = 0.29). Based on the available literature, we therefore conclude that periodized CHO restriction does not per se enhance performance in endurance-trained athletes. The review discusses different approaches to CHO periodization across studies with a focus on identifying potential physiological benefits.

To ensure the long-term performance of proton-exchange membrane fuel cells (PEMFCs), proton-exchange membranes (PEMs) have stringent requirements at high temperatures and humidities, as they may lose proton carriers. This issue poses a serious challenge to maintaining their proton conductivity and mechanical performance throughout their service life. Ionogels are ionic liquids (ILs) hybridized with another component (such as organic, inorganic, or organic-inorganic hybrid skeleton). This design is used to maintain the desirable properties of ILs (negligible vapor pressure, thermal stability, and non-flammability), as well as a high ionic conductivity and wide electrochemical stability window with low outflow. Ionogels have opened new routes for designing solid-electrolyte membranes, especially PEMs. This paper reviews recent research progress of ionogels in proton-exchange membranes, focusing on their electrochemical properties and proton transport mechanisms.

Every conflict follows its own course, and every peace its own design. Engineering shapes whether societies move toward confrontation or cooperation. That dual nature is evident in the divided legacy of nuclear technology to today's infrastructure-driven struggles. Every technical decision, from power grids to satellites and from semiconductors to supply chains, can fuel either contest or connection. Here, we ask whether peace can be engineered through professional competence, the ability to build systems that work as intended; through capability, the foresight to anticipate how they may be repurposed; and through character, the willingness to bear the moral weight of design choices. "Peace engineering" is not a distinct discipline, but rather a mode of practice guided by civic purpose, measuring success by how design choices reduce conflict and reinforce stability. We argue that durable peace requires addressing technical debt and ethical debt, where expedient fixes and divisive decisions erode trust. Drawing lessons from the institutionalization of safety and quality, we propose embedding conflict awareness into professional standards, procurement, and education. The goal is not to purge engineering's security functions, but rather to balance them with incentives for prevention and resilience. In a world in which every tool serves both harm and healing, peace becomes not the by-product of progress but its measure. Redirecting engineering toward stability may make peace its defining purpose. Can engineering truly foster enduring civic life, or remain bound to conflict?

The fundamental goal of nutrition for training is to provide the required energy and substrate to sustain the target training volume and intensity that is necessary to induce desired physiological adaptations. However, aside from fueling and recovery, it is now recognized that nutrient availability also modulates the activation of cell signaling pathways that regulate adaptations associated with both endurance and strength training. Such developments are the guiding principles underpinning "nutritional periodization" wherein energy, macronutrient, and micronutrient availability are deliberately manipulated across the microcycle, mesocycle, and macrocycle with the strategic goal to promote training adaptations, support recovery, manipulate body composition, and optimize competition performance. In addition to total "daily" nutrient intake, the elite athlete must, therefore, adjust their energy and carbohydrate intake in a meal-by-meal and day-by-day manner (i.e., carbohydrate periodization) in accordance with the energetic demands and training objectives of each specific training session. In addition to fueling (and refueling) for the work required, daily protein intake should at least be 1.6-2.1 g·kg-1·day-1 not only to account for amino acid oxidation during exercise but also, importantly, to promote tissue remodeling, notably skeletal muscle. Emerging evidence also supports the rationale for nutraceuticals to promote recovery and sleep, though the potential effect of such compounds in blunting training adaptation should also be considered. Taken together, it is increasingly clear that nutrition is a critical enabler to successful training outcomes, and as such, the sport nutritionist should be considered an integral member of an athlete's coaching and performance support team.

Next-generation implantable devices such as sensors, drug-delivery systems, and electroceuticals require efficient, reliable, and highly miniaturized power sources. Existing power sources such as the Li-I2 pacemaker battery exhibit limited scale-down potential without sacrificing capacity, and therefore, alternatives are needed to power miniaturized implants. This work shows that ceramic electrolytes can be used in potentially implantable glucose fuel cells with unprecedented miniaturization. Specifically, a ceramic glucose fuel cell-based on the proton-conducting electrolyte ceria-that is composed of a freestanding membrane of thickness below 400 nm and fully integrated into silicon for easy integration into bioelectronics is demonstrated. In contrast to polymeric membranes, all materials used are highly temperature stable, making thermal sterilization for implantation trivial. A peak power density of 43 µW cm-2 , and an unusually high statistical verification of successful fabrication and electrochemical function across 150 devices for open-circuit voltage and 12 devices for power density, enabled by a specifically designed testing apparatus and protocol, is demonstrated. The findings demonstrate that ceramic-based micro-glucose-fuel-cells constitute the smallest potentially implantable power sources to date and are viable options to power the next generation of highly miniaturized implantable medical devices.

A persistent cough producing sputum for at least 3 months annually over 2 consecutive years characterizes chronic bronchitis in adults. Goblet cell hyperplasia leads to excessive mucus production. This, combined with reduced mucus clearance, causes airway inflammation, structural changes, and obstruction. Characteristically, chronic bronchitis in children is due to persistent neutrophilic airway inflammation driven by chronic bacterial infection of the airways. For this reason, experts use the term “protracted bacterial bronchitis.” The defining features of protracted bacterial bronchitis (PBB) are an isolated chronic wet cough lasting longer than 4 weeks, resolution with a 2-week course of appropriate antibiotic treatment, and the absence of evidence indicating an alternative cause. Chronic bronchitis in childhood can persist into adulthood, and proper management is imperative as progression to bronchiectasis, asthma, and lung function impairment is possible. In addition, studies reveal that a chronic productive cough in young adults 18 to 30 results in an increased risk of future cardiovascular events and premature deaths, likely due to systemic inflammation. Likewise, childhood asthma and allergies are risk factors for chronic bronchitis in adults. Despite being a common finding in patients with chronic obstructive pulmonary disease (COPD), chronic bronchitis can be an isolated illness with or without airflow obstruction. However, patients with isolated chronic bronchitis are at risk factor for developing airflow obstruction, accelerated lung function decline, COPD exacerbations, and increased lung disease-related and all-cause mortality. In adults, a strong causal relationship with smoking exists; however, many cases of chronic bronchitis are not associated with smoking, indicating additional risk factors. Hard-rock mining, tunnel work, concrete manufacturing, non-mining industrial work, exposure to biomass fuel burning, and livestock farming are all well-known underlying causes explaining the presence of chronic bronchitis in patients who have never smoked.  Treatment of chronic bronchitis centers around reducing mucus production, improving mucus clearance, minimizing inflammation, and supporting effective cough mechanisms. Smoking cessation and secondhand smoke avoidance are critical for reducing airway damage and improving respiratory health. Clinicians tailor the management of acute exacerbations based on symptoms with antibiotics, short-acting bronchodilators, and systemic corticosteroids. Patient education regarding self-management and, when available, pulmonary rehabilitation are additional essential management components. Children with PBB require a minimum of 2 weeks of antibiotics, adjusted based on symptom resolution and guideline specifics. Chronic bronchitis and PBB significantly affect long-term lung function and overall mortality. Healthcare professionals should proactively manage these conditions, utilizing a well-balanced combination of pharmacologic and non-pharmacologic therapies. 

Altitude training has become an important training application for athletes due its potential for altering physiology and enhancing performance. This practice is commonly used by athletes, with a popular choice being the live high - train low approach. This model recommends that athletes live at high altitude (1250-3000 m), but train at low altitude or sea-level (0-1200 m). Exposure to altitude often leads to hypoxic stress and in turn stimulates changes in total haemoglobin mass, erythropoietin, and soluble transferrin receptors, which alter further underlying physiology. Through enhanced physiology, improved exercise performance may arise through enhancement of the oxygen transport system which is important for endurance events. Previous investigations into the effects of altitude training on exercise performance have been completed in a range of contexts, including running, cycling, swimming, and triathlon. Often following a LHTL altitude intervention, athletes realise improvements in maximal oxygen consumption capacity, time trial performance and peak power outputs. Although heterogeneity exists among LHTL methodologies, i.e., exposure durations and altitude ranges, we synthesised this data into kilometre hours, and found that the most common hypoxic doses used in LHTL interventions ranged from ∼578-687 km h. As this narrative review demonstrates, there are potential advantages to using altitude training to enhance physiology and improve performance for endurance athletes.

Obesity is a complex chronic condition linked to various comorbidities, such as hypertension, diabetes, and dyslipidaemia, with a significant global burden. Standard treatments, such as diet, exercise and behavioural changes, often have limited effects and poor compliance. Pharmacological options, including glucagon-like peptide receptor agonists (GLP-1RAs) and glucose-dependent insulinotropic polypeptide (GIP) dual agonists, show promise for individuals with obesity. This is one of three reviews investigating different GIP/GLP1-RAs for adults living with obesity.

The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease."

The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease."

Previous studies have investigated the effect of single or combined caffeine (CAF) and L-theanine (THE) intake on attention performance. However, its effect on shooting performance and cognitive performance in a sport is unknown. The aim of this study was to investigate the hypothesis "Does single or combined CAF and THE supplementation have an effect on shooting and cognitive performance in elite curling athletes?." It is predicted that over the next decade, studies based on nutritional ergogenic supplements in the developing sport of curling will continue to increase, leading to a significant increase in studies examining the effects of CAF and THE supplementation, alone or in combination, on throwing and cognitive performance in elite curling athletes.

As the world population ages, an expected increase in the prevalence of chronic kidney disease (CKD) among older individuals will pose a considerable challenge for health care systems in terms of resource allocation for disease management. Treatment strategies for older patients with CKD should ideally align with those applied to the general population, focusing on minimizing cardiovascular events and reducing the risk of progression to kidney failure. Emerging therapies, such as SGLT-2 inhibitors and GLP-1 receptor agonists, hold promise for the effective management of CKD in older individuals. In addition, non-pharmacological interventions such as nutritional and exercise therapies have a crucial role. These interventions enhance the effects of pharmacotherapy and, importantly, contribute to the maintenance of cognitive function and overall quality of life. Various factors beyond age and cognitive function must be taken into account when considering kidney replacement therapy for patients with kidney failure. Importantly, all treatment options, including dialysis, transplantation and conservative management approaches, should be tailored to the individual through patient-centred decision-making. The dynamic integration of digital technologies into medical practice has the potential to transform the management of CKD in the aging population.

Ergogenic aids include performance-enhancing substances, nutritional supplements, and a variety of techniques aimed to improve an athlete's exercise performance capacity. Dietary supplement consumption in athletes is common and is higher in those with desire to become Olympic or world champions. Supplements with performance benefits include caffeine, creatine, nitrate, and sodium bicarbonate. Anabolic-androgenic steroids; stimulants, such as ephedrine; and body mass builders, such as human growth hormone, are the most used performance-enhancing substances in competition. The World Anti-Doping Agency (WADA) is responsible for generating the list of banned performance-enhancing substances as well as establishing the testing standards for national and international events. Makers of dietary supplements are not required to prove the products are safe or test them for quality. Products with third-party testing certifications can help minimize the risk of ingesting contaminated or banned substances. Therapeutic use exemptions may be granted in Olympic, professional, or NCAA sports for athletes with a medical necessity for banned substances. The role of the physician or other medical professional is to guide informed decision-making.

The term "glycation compounds" comprises a wide range of structurally diverse compounds that are formed endogenously and in food via the Maillard reaction, a chemical reaction between reducing sugars and amino acids. Glycation compounds produced endogenously are considered to contribute to a range of diseases. This has led to the hypothesis that glycation compounds present in food may also cause adverse effects and thus pose a nutritional risk to human health. In this work, the Senate Commission on Food Safety (SKLM) of the German Research Foundation (DFG) summarized data on formation, occurrence, exposure and toxicity of glycation compounds (Part A) and systematically assessed potential associations between dietary intake of defined glycation compounds and disease, including allergy, diabetes, cardiovascular and renal disease, gut/gastrotoxicity, brain/cognitive impairment and cancer (Part B). A systematic search in Pubmed (Medline), Scopus and Web of Science using a combination of keywords defining individual glycation compounds and relevant disease patterns linked to the subject area of food, nutrition and diet retrieved 253 original publications relevant to the research question. Of these, only 192 were found to comply with previously defined quality criteria and were thus considered suitable to assess potential health risks of dietary glycation compounds. For each adverse health effect considered in this assessment, however, only limited numbers of human, animal and in vitro studies were identified. While studies in humans were often limited due to small cohort size, short study duration, and confounders, experimental studies in animals that allow for controlled exposure to individual glycation compounds provided some evidence for impaired glucose tolerance, insulin resistance, cardiovascular effects and renal injury in response to oral exposure to dicarbonyl compounds, albeit at dose levels by far exceeding estimated human exposures. The overall database was generally inconsistent or inconclusive. Based on this systematic review, the SKLM concludes that there is at present no convincing evidence for a causal association between dietary intake of glycation compounds and adverse health effects.

Creatine is an important regulator of brain bioenergetics, yet the efficacy of creatine supplementation (CrS) in the brain remains largely unknown. Measurement of brain creatine using proton (1H) and phosphorus (³1P) magnetic resonance spectroscopy is highly sensitive to voxel placement, signal quality, analysis pipelines, and reporting conventions which can obscure the detection of biological responses to CrS. There is evidence that CrS increases brain creatine, but this response may be dose and/or duration dependent. CrS provides some benefits during acute periods of metabolic stress such as sleep deprivation, mental fatigue, and hypoxia. Emerging clinical data also suggest potential therapeutic effects from CrS for Alzheimer's disease, major depressive disorder, and mild traumatic brain injury (mTBI), although findings across conditions remain preliminary and inconsistent. Further, CrS shows some promise for improving aspects of sleep quality. The purpose of this narrative review is to: (1) outline methodological considerations in the quantification of brain creatine, (2) discuss the divergent effects of CrS on brain creatine levels and measures of brain function, (3) examine the purported mechanistic actions of CrS for improving brain health and function, (4) highlight critical gaps and limitations which should be considered moving forward, and (5) identify future research directions involving CrS and the brain.

Age-related loss of muscle mass, strength, and performance, commonly referred to as sarcopenia, has wide-ranging detrimental effects on human health, the ramifications of which can have serious implications for both morbidity and mortality. Various interventional strategies have been proposed to counteract sarcopenia, with a particular emphasis on those employing a combination of exercise and nutrition. However, the efficacy of these interventions can be confounded by an age-related blunting of the muscle protein synthesis response to a given dose of protein/amino acids, which has been termed "anabolic resistance." While the pathophysiology of sarcopenia is undoubtedly complex, anabolic resistance is implicated in the progression of age-related muscle loss and its underlying complications. Several mechanisms have been proposed as underlying age-related impairments in the anabolic response to protein consumption. These include decreased anabolic molecular signaling activity, reduced insulin-mediated capillary recruitment (thus, reduced amino acid delivery), and increased splanchnic retention of amino acids (thus, reduced availability for muscular uptake). Obesity and sedentarism can exacerbate, or at least facilitate, anabolic resistance, mediated in part by insulin resistance and systemic inflammation. This narrative review addresses the key factors and contextual elements involved in reduction of the acute muscle protein synthesis response associated with aging and its varied consequences. Practical interventions focused on dietary protein manipulation are proposed to prevent the onset of anabolic resistance and mitigate its progression.

Highlight contemporary evidence examining the effects of carbohydrate restriction on the intracellular regulation of muscle mass and anaerobic performance.

Precise protein supplementation strategies for muscle improvement are still lacking. The timing or type of protein supplementation has been debated as a window of opportunity to improve muscle mass, strength, and physical performance. We conducted a network meta-analysis of randomized controlled trials with protein supplements and resistance training. PubMed, Web of Science, Cochrane Library, and SPORTDiscus databases were searched until May 1, 2023. We included 116 eligible trials with 4,711 participants that reported on 11 timing and 14 types of protein supplementation. Compared with placebo, protein supplementation after exercise (mean difference [MD]: 0.54 kg [95% confidence intervals 0.10, 0.99] for fat-free mass, MD: 0.34 kg [95% confidence intervals 0.10, 0.58] for skeletal muscle mass) and at night (MD: 2.85 kg [0.49, 5.22] for handgrip strength, MD: 12.12 kg [3.26, 20.99] for leg press strength) was most effective in improving muscle mass and strength, respectively (moderate certainty). Milk proteins (milk, whey protein, yogurt, casein, and bovine colostrum), red meat, and mixed protein were effective for gains in both muscle mass and strength (moderate certainty). No timing or type of protein showed a significant enhancement in physical performance (timed up-to-go test, 6-min walk test, and gait speed). Pre/postexercise and Night are key recommended times of protein intake to increase muscle mass and strength, respectively. Milk proteins are the preferred types of protein supplements for improving muscle mass and strength. Future randomized controlled trials that directly compare the effects of protein timing or types are needed. This trial was registered at International Prospective Register of Systematic Reviews as CRD42022358766.

Muscle strength and mass are key determinants of exercise performance and a hallmark of health span. Recently, several meta-analyses have concluded that protein supplementation timing does not alter muscle strength and mass gains. However, these meta-analyses did not directly compare several supplementation timings within the same study, thus limiting their conclusions. The objective of this study was to conduct a meta-analysis including only studies directly comparing protein intake before and after exercise.

Dietary protein is an essential macronutrient derived from both plant and animal sources required for muscle building, immune function, and wound healing. However, in the United States, protein consumption worsens as individuals age, with 30% of men and 50% of women over 71 consuming inadequate dietary protein due to a variety of factors, including changes in gut function, loss of appetite, tooth loss, financial concerns, and social isolation. The aim of this review is to underscore the need for increased protein requirements in aging populations, highlight potential barriers, synthesize these protein requirements, and also recommend strategies to meet these increased protein needs. Achieving adequate protein status, especially when facing chronic or acute health concerns, is essential to promote muscle and bone strength (because aging is associated with significant decreases in postprandial muscle protein synthesis), to support immune health (due to immunosenescence), and to maintain a good quality of life. For older adults, the literature suggests that a dietary protein intake of at least 1.0-1.2 g/kg/day is required in healthy, aging populations, and intakes of 1.2-1.5 g/kg/day are necessary for those with chronic or acute conditions. These protein intake recommendations can increase to 2.0 g/kg/day in more severe cases of illness, malnutrition, and chronic conditions. The reviewed literature also suggests that evenly balanced protein distributions of 25-30 g of dietary protein (0.4 g/kg) per meal from animal and plant protein sources alike are sufficient to maximize muscle protein synthesis (MPS) rates in older populations. Additionally, pre-sleep protein feeds of 40 g/night may be another strategy to improve daily MPS and amino acid utilization.

Collagen is the central structural component of extracellular connective tissue, which provides elastic qualities to tissues. For skeletal muscle, extracellular connective tissue transmits contractile force to the tendons and bones. Connective tissue proteins are in a constant state of remodeling and have been shown to express a high level of plasticity. Dietary-protein ingestion increases muscle protein synthesis rates. High-quality, rapidly digestible proteins are generally considered the preferred protein source to maximally stimulate myofibrillar (contractile) protein synthesis rates. In contrast, recent evidence demonstrates that protein ingestion does not increase muscle connective tissue protein synthesis. The absence of an increase in muscle connective tissue protein synthesis after protein ingestion may be explained by insufficient provision of glycine and/or proline. Dietary collagen contains large amounts of glycine and proline and, therefore, has been proposed to provide the precursors required to facilitate connective tissue protein synthesis. This literature review provides a comprehensive evaluation of the current knowledge on the proposed benefits of dietary collagen consumption to stimulate connective tissue remodeling to improve health and functional performance.

Periods of skeletal muscle disuse lead to rapid declines in muscle mass (atrophy), which is fundamentally underpinned by an imbalance between muscle protein synthesis (MPS) and muscle protein breakdown (MPB). The complex interplay of molecular mechanisms contributing to the altered regulation of muscle protein balance during disuse have been investigated but rarely synthesised in the context of humans. This narrative review discusses human models of muscle disuse and the ensuing inversely exponential rate of muscle atrophy. The molecular processes contributing to altered protein balance are explored, with a particular focus on growth and breakdown signalling pathways, mitochondrial adaptations and neuromuscular dysfunction. Finally, key research gaps within the disuse atrophy literature are highlighted providing future avenues to enhance our mechanistic understanding of human disuse atrophy.

Adolescent athletes face unique nutritional challenges due to the simultaneous demands of growth, development, and athletic performance. This review synthesizes current evidence on energy and macronutrient requirements, hydration strategies, and key micronutrients, including iron, calcium, and vitamin D, which are essential for supporting health and performance in youth sport. It explores the physiological risks associated with low energy availability (LEA), while emphasizing the importance of carbohydrate and protein timing, quality, and distribution. The review also evaluates the role of dietary supplements and ergogenic aids, including creatine and energy drinks, highlighting safety concerns and advocating for a food-first approach. Practical strategies for nutrition education, interdisciplinary collaboration, and individualized care are presented to guide healthcare professionals, coaches, and caregivers in fostering sustainable, performance-supportive eating habits. By aligning intake with training demands and developmental needs, adolescent athletes can optimize performance, recovery, and long-term well-being.

Creatine monohydrate supplementation is widely used by athletes in high-intensity, power-based sports due to its ability to enhance short-term performance by increasing intramuscular phosphocreatine (PCr) stores, which aid in ATP resynthesis during intense muscle contractions. However, emerging evidence suggests that creatine monohydrate offers benefits beyond athletic performance. This narrative review explores the literature supporting the advantages of creatine supplementation in women, vegans, and clinical populations. In women, who typically have lower baseline intramuscular creatine levels, supplementation may help alleviate fatigue-related symptoms associated with the menstrual cycle, particularly during the early follicular and luteal phases. For vegans and vegetarians, who often have reduced creatine stores due to the absence of creatine-rich animal products in their diet, supplementation can improve both physical and cognitive performance while supporting adherence to plant-based diets. Additionally, creatine supplementation holds potential for various clinical populations. It may mitigate muscle wasting in conditions such as sarcopenia and cachexia, support neuroprotection in neurodegenerative diseases such as Parkinson's and Huntington's, improve exercise capacity in cardiovascular diseases, and enhance energy metabolism in chronic fatigue syndrome. Creatine may also aid recovery from traumatic brain injury by promoting brain energy metabolism and reducing neuronal damage. In conclusion, creatine monohydrate supplementation can enhance physical performance, cognitive function, and overall health in women, vegans, and clinical populations by addressing creatine deficiencies, improving energy metabolism, and supporting recovery from physical and neurological challenges. Most available evidence supports the effectiveness of creatine monohydrate, which should be considered the preferred form of creatine supplementation over other variants. Additionally, proper creatine dosing is essential to maximize benefits and minimize potential adverse effects that may arise from chronic ingestion of excessively high doses.

The inverse effects of creatine supplementation and sleep deprivation on high energy phosphates, neural creatine, and cognitive performances suggest that creatine is a suitable candidate for reducing the negative effects of sleep deprivation. With this, the main obstacle is the limited exogenous uptake by the central nervous system (CNS), making creatine only effective over a long-term diet of weeks. Thus far, only repeated dosing of creatine over weeks has been studied, yielding detectable changes in CNS levels. Based on the hypothesis that a high extracellular creatine availability and increased intracellular energy consumption will temporarily increase the central creatine uptake, subjects were orally administered a high single dose of creatinemonohydrate (0.35 g/kg) while performing cognitive tests during sleep deprivation. Two consecutive 31P-MRS scans, 1H-MRS, and cognitive tests were performed each at evening baseline, 3, 5.5, and 7.5 h after single dose creatine (0.35 g/kg) or placebo during sub-total 21 h sleep deprivation (SD). Our results show that creatine induces changes in PCr/Pi, ATP, tCr/tNAA, prevents a drop in pH level, and improves cognitive performance and processing speed. These outcomes suggest that a high single dose of creatine can partially reverse metabolic alterations and fatigue-related cognitive deterioration.

Based on a comprehensive review and critical analysis of the literature regarding the nutritional concerns of female athletes, conducted by experts in the field and selected members of the International Society of Sports Nutrition (ISSN), the following conclusions represent the official Position of the Society: 1. Female athletes have unique and unpredictable hormone profiles, which influence their physiology and nutritional needs across their lifespan. To understand how perturbations in these hormones affect the individual, we recommend that female athletes of reproductive age should track their hormonal status (natural, hormone driven) against training and recovery to determine their individual patterns and needs and peri and post-menopausal athletes should track against training and recovery metrics to determine the individuals' unique patterns. 2. The primary nutritional consideration for all athletes, and in particular, female athletes, should be achieving adequate energy intake to meet their energy requirements and to achieve an optimal energy availability (EA); with a focus on the timing of meals in relation to exercise to improve training adaptations, performance, and athlete health. 3. Significant sex differences and sex hormone influences on carbohydrate and lipid metabolism are apparent, therefore we recommend first ensuring athletes meet their carbohydrate needs across all phases of the menstrual cycle. Secondly, tailoring carbohydrate intake to hormonal status with an emphasis on greater carbohydrate intake and availability during the active pill weeks of oral contraceptive users and during the luteal phase of the menstrual cycle where there is a greater effect of sex hormone suppression on gluconogenesis output during exercise. 4. Based upon the limited research available, we recommend that pre-menopausal, eumenorrheic, and oral contraceptives using female athletes should aim to consume a source of high-quality protein as close to beginning and/or after completion of exercise as possible to reduce exercise-induced amino acid oxidative losses and initiate muscle protein remodeling and repair at a dose of 0.32-0.38 g·kg-1. For eumenorrheic women, ingestion during the luteal phase should aim for the upper end of the range due to the catabolic actions of progesterone and greater need for amino acids. 5. Close to the beginning and/or after completion of exercise, peri- and post-menopausal athletes should aim for a bolus of high EAA-containing (~10 g) intact protein sources or supplements to overcome anabolic resistance. 6. Daily protein intake should fall within the mid- to upper ranges of current sport nutrition guidelines (1.4-2.2 g·kg-1·day-1) for women at all stages of menstrual function (pre-, peri-, post-menopausal, and contraceptive users) with protein doses evenly distributed, every 3-4 h, across the day. Eumenorrheic athletes in the luteal phase and peri/post-menopausal athletes, regardless of sport, should aim for the upper end of the range. 7. Female sex hormones affect fluid dynamics and electrolyte handling. A greater predisposition to hyponatremia occurs in times of elevated progesterone, and in menopausal women, who are slower to excrete water. Additionally, females have less absolute and relative fluid available to lose via sweating than males, making the physiological consequences of fluid loss more severe, particularly in the luteal phase. 8. Evidence for sex-specific supplementation is lacking due to the paucity of female-specific research and any differential effects in females. Caffeine, iron, and creatine have the most evidence for use in females. Both iron and creatine are highly efficacious for female athletes. Creatine supplementation of 3 to 5 g per day is recommended for the mechanistic support of creatine supplementation with regard to muscle protein kinetics, growth factors, satellite cells, myogenic transcription factors, glycogen and calcium regulation, oxidative stress, and inflammation. Post-menopausal females benefit from bone health, mental health, and skeletal muscle size and function when consuming higher doses of creatine (0.3 g·kg-1·d-1). 9. To foster and promote high-quality research investigations involving female athletes, researchers are first encouraged to stop excluding females unless the primary endpoints are directly influenced by sex-specific mechanisms. In all investigative scenarios, researchers across the globe are encouraged to inquire and report upon more detailed information surrounding the athlete's hormonal status, including menstrual status (days since menses, length of period, duration of cycle, etc.) and/or hormonal contraceptive details and/or menopausal status.

Post-viral fatigue syndrome, classified as a neurological condition by the WHO (ICD-11 code: 8E49), manifests as persistent fatigue, cognitive difficulties, and post-exertional malaise following viral infections. It shares commonalities with chronic fatigue syndrome and myalgic encephalomyelitis but is distinct due to its association with preceding viral events. Emerging research identifies bioenergetic disruptions, particularly mitochondrial dysfunction and impaired creatine metabolism, as key contributors. Recent studies suggest creatine supplementation may alleviate symptoms and improve energy metabolism. This narrative review summarizes recent advancements in utilizing creatine as a diagnostic and therapeutic target for post-viral fatigue syndrome and explores future directions for its application in managing this perplexing condition.

Creatine monohydrate supplementation (CrM) is a safe and effective intervention for improving certain aspects of sport, exercise performance, and health across the lifespan. Despite its evidence-based pedigree, several questions and misconceptions about CrM remain. To initially address some of these concerns, our group published a narrative review in 2021 discussing the scientific evidence as to whether CrM leads to water retention and fat accumulation, is a steroid, causes hair loss, dehydration or muscle cramping, adversely affects renal and liver function, and if CrM is safe and/or effective for children, adolescents, biological females, and older adults. As a follow-up, the purpose of this paper is to evaluate additional questions and misconceptions about CrM. These include but are not limited to: 1. Can CrM provide muscle benefits without exercise? 2. Does the timing of CrM really matter? 3. Does the addition of other compounds with CrM enhance its effectiveness? 4. Does CrM and caffeine oppose each other? 5. Does CrM increase the rates of muscle protein synthesis or breakdown? 6. Is CrM an anti-inflammatory intervention? 7. Can CrM increase recovery following injury, surgery, and/or immobilization? 8. Does CrM cause cancer? 9. Will CrM increase urine production? 10. Does CrM influence blood pressure? 11. Is CrM safe to consume during pregnancy? 12. Does CrM enhance performance in adolescents? 13. Does CrM adversely affect male fertility? 14. Does the brain require a higher dose of CrM than skeletal muscle? 15. Can CrM attenuate symptoms of sleep deprivation? 16. Will CrM reduce the severity of and/or improve recovery from traumatic brain injury? Similar to our 2021 paper, an international team of creatine research experts was formed to perform a narrative review of the literature regarding CrM to formulate evidence-based responses to the aforementioned misconceptions involving CrM.

Creatine supplementation in women has gained attention for its potential benefits beyond muscle growth, including reproductive health, cognitive health and aging. Women exhibit distinct physiological differences from men, influenced by hormonal fluctuations during pre-menopause, pregnancy, and menopause, and these factors should be considered for their influence on creatine metabolism.

From an energy perspective, the brain is very metabolically demanding. It is well documented that creatine plays a key role in brain bioenergetics. There is some evidence that creatine supplementation can augment brain creatine stores, which could increase memory.

There is robust evidence that creatine monohydrate supplementation can enhance short-term high-intensity exercise in athletes. However, the effect of creatine monohydrate supplementation on aerobic performance and its role during aerobic activities is still controversial.

Iron deficiency anemia is common worldwide. In adult patients without inflammation, a ferritin level of less than 45 ng/mL or ferritin level of 46 to 99 ng/mL plus a transferrin saturation of less than 20% is diagnostic of iron deficiency. In patients with inflammation, a ferritin level of less than 100 ng/mL is diagnostic. Risk factors for iron deficiency anemia include low socioeconomic status, female sex, age younger than 5 years, and chronic inflammation. Underlying causes should be investigated. Recurrent blood loss is responsible for 94% of cases. In younger patients with a plausible cause of iron deficiency anemia (eg, heavy menstrual bleeding), a reasonable approach is to treat the bleeding and provide iron supplementation. In men and postmenopausal women, bidirectional endoscopy should be performed. Noninvasive testing for Helicobacter pylori infection and celiac disease is recommended because both are common causes of iron deficiency anemia. Oral iron replacement is the first-line treatment for most patients. However, intravenous iron is recommended in patients with heart failure to increase exercise capacity. Every-other-day dosing of oral iron improves absorption. Approximately 50% of patients have decreased adherence due to adverse effects. Patients taking oral iron therapy should be evaluated for response in 2 to 4 weeks. Patients who cannot tolerate oral iron or do not have adequate response should receive intravenous iron. Hypersensitivity to newer formulations of intravenous iron is rare (less than 1%).

Iron facilitates key biological functions underpinning sports performance, and up to 60% of female athletes experience iron deficiency. However, the effects of iron deficiency on sports performance in female athletes is unclear, as are the degree of benefits of iron supplementation (FeSup). This study characterizes the effects of iron deficiency and FeSup on sports performance in high-level female athletes.

Iron deficiency is the most prevalent nutritional disorder worldwide. Iron supplementation has modest efficacy, causes gastrointestinal side-effects that limit compliance, and has been associated with serious adverse outcomes in children across low-income settings. We aimed to compare two hepcidin-guided screen-and-treat regimens designed to reduce overall iron dosage by targeting its administration to periods when children were safe and ready to receive iron supplementation, with WHO's recommendation of universal iron supplementation.

This study investigated the impact of low-volume blood withdrawal on the hematological biomarkers currently considered for anti-doping purposes. After baseline measurement (D - 7), a 140 mL blood withdrawal was completed (D + 0) on 12 healthy volunteers, followed by weekly monitoring for 21 days (D + 7 - 21). Each visit consisted of a full blood count (Sysmex XN-1000) and duplicate blood volume measurements by CO-rebreathing. A significant decrease in total hemoglobin mass (Hbmass) (-2.3%, p = 0.007) and red blood cell volume (RBCV) (-2.8%, p = 0.028) was reported at D + 7. Despite no atypical passport finding (ATPF) when considering the athlete biological passport adaptive longitudinal model, hemoglobin concentration ([Hb]) increased significantly at D + 21 (+3.8%, p = 0.031). Besides, ferritin (FERR) was significantly downregulated at all points following blood withdrawal, with the largest decrease occurring at D + 7 (-26.6%, p < 0.001). Regardless of the presumable effect of blood reinfusion on ABP biomarkers, these results illustrate the challenge of monitoring hematological variables for the detection of low-volume blood withdrawal. Finally, this study outlines the sensitivity of FERR to altered erythropoiesis to support the implementation of iron markers as complementary variables for the longitudinal monitoring of blood doping, despite the potential influence of confounding factors (e.g., iron supplementations).

Absolute iron deficiency, defined as low iron stores with or without anemia, affects approximately 2 billion people worldwide and 14% of adults in the US. Iron-deficiency anemia, defined as low hemoglobin due to low iron stores, affects approximately 1.2 billion people worldwide, including 10 million in the US.

Hepcidin, the iron-regulatory hormone, determines plasma iron concentrations and total body iron content. Hepcidin, secreted by hepatocytes, functions by controlling the activity of the cellular iron exporter ferroportin, which delivers iron to plasma from intestinal iron absorption and from iron stores. Hepcidin concentration in plasma is increased by iron loading and inflammation and is suppressed by erythropoietic stimulation and during pregnancy. Hepcidin deficiency causes iron overload in hemochromatosis and anemias with ineffective erythropoiesis. Hepcidin excess causes iron-restrictive anemias including anemia of inflammation. The development of hepcidin diagnostics and therapeutic agonists and antagonists should improve the treatment of iron disorders.

Iron deficiency anemia (IDA) is estimated to affect over 1.2 billion people worldwide and is particularly common in children and reproductive-age women in low- and middle-income countries. Iron deficiency (ID) without anemia has an even higher prevalence. Absolute ID is caused by increased iron requirements, inadequate iron intake, impaired iron absorption, and chronic blood loss. ID triggers multiple adaptive physiological mechanisms, including modifications in cellular iron handling orchestrated by iron regulatory proteins, as well as alterations in systemic iron handling secondary to suppression of the iron regulatory hormone hepcidin. The laboratory diagnosis of ID is based on biochemical parameters and may be complicated during inflammatory conditions. ID is treated with oral or parenteral iron supplements, depending upon the severity of ID and its underlying cause(s). An improved understanding of systemic iron regulation has begun to inform oral iron dosing regimens and the selection of oral versus intravenous iron formulations for the management of ID.

Iron deficiency and anemia have serious consequences, especially for children and pregnant women. Iron salts are commonly provided as oral supplements to prevent and treat iron deficiency, despite poor bioavailability and frequently reported adverse side effects. Ferrous bisglycinate is a novel amino acid iron chelate that is thought to be more bioavailable and associated with fewer gastrointestinal (GI) adverse events as compared with iron salts.

The interplay between the skin microbiome and its host is a complex facet of dermatological health and has become a critical focus in the development of microbiome cosmetics. The skin microbiome, comprising various microorganisms, is essential from birth, develops over the lifespan, and performs vital roles in protecting our body against pathogens, training the immune system, and facilitating the breakdown of organic matter. Dysbiosis, an imbalance of these microorganisms, has been implicated in a number of skin conditions such as acne, atopic dermatitis, and skin cancer. Recent scientific findings have spurred cosmetic companies to develop products that preserve and enhance the skin's microbial diversity balance. These products may incorporate elements like prebiotics, probiotics, and postbiotics, which are beneficial for the skin microbiome. Beyond topical products, there's increasing interest in ingestible beauty supplements (i.e. oral probiotics), highlighting the connection between the gut and skin. This review examines the influence of the microbiome on skin health and the emerging trends of microbiome skincare products.

Recent years have witnessed an uptick in research highlighting the gut microbiota's role as a primary determinant of athletes' health, which has piqued interest in the hypothesis that it correlates with athletes' physical performance. Athletes' physical performances could be impacted by the metabolic activity of the assortment of microbes found in their gut. Intestinal microbiota impacts multiple facets of an athlete's physiology, including immune response, gut membrane integrity, macro- and micronutrient absorption, muscle endurance, and the gut-brain axis. Several physiological variables govern the gut microbiota; hence, an intricately tailored and complex framework must be implemented to comprehend the performance-microbiota interaction. Emerging evidence underscores the intricate relationship between the gut microbiome and physical fitness, revealing that athletes who engage in regular physical activity exhibit a richer diversity of gut microbes, particularly within the Firmicutes phylum, e.g., Ruminococcaceae genera, compared to their sedentary counterparts. In elite sport, it is challenging to implement an unconventional strategy whilst simultaneously aiding an athlete to accomplish feasible, balanced development. This review compiles the research on the effects of gut microbiota modulation on performance in sports and illustrates how different supplementation strategies for gut microbiota have the ability to improve athletic performance by enhancing physical capacities. In addition to promoting athletes' overall health, this study evaluates the existing literature in an effort to shed light on how interventions involving the gut microbiota can dramatically improve performance on the field. The findings should inform both theoretical and practical developments in the fields of sports nutrition and training.

The gut-brain axis is a highly complex, bidirectional communication link between the gut and the central nervous system (CNS), mainly through neural, endocrine, immunological, and metabolic pathways. This review outlines the growing contribution of gut microbiota in the remediation of neurological health and also emphasizes the controlling role of gut microbiota on the synthesis of neurotransmitters. Emerging evidence indicates that dysbiosis of the gut is related to a variety of neurodegenerative and neuropsychiatric diseases such as Parkinson's disease (PD), Alzheimer's disease (AD), multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), Huntington's disease (HD), autism spectrum disorders (ASD), depression, and glioblastoma. Mechanistic understandings show that gut microbes critically contribute to neuroimmune and blood-brain barrier (BBB) signaling. The peripheral association of gut microflora, networked with inflammasome activation, nuclear factor kappa B (NF-κB), and type-I IFN pathways highlights their role in CNS inflammation. Microbiota-targeted interventions with probiotics, prebiotics, synbiotics, antibiotics, dietary modifications, and fecal microbiota transplantation are examined for their therapeutic potential. These strategies appear to be promising to reinstate microbial balance, enhance neuroplastic responses, and ameliorate the disease symptoms. The review highlights personalized microbiome-based algorithms, underpinned by integrated multi-omics technologies and machine-learning-driven diagnostics. Future research should address underlying microbial mechanisms and perform large, randomized controlled trials in order to establish microbiota-based therapies for neurological disorders.

This review offers a comprehensive evaluation of current aspects related to nutritional strategies, brain modulation, and muscle recovery, focusing on their applications and the underlying mechanisms of physiological adaptation for promoting a healthy brain, not only in athletes but also for recreationally active and inactive individuals. We propose that applying the rule, among others, of good sleep, regular exercise, and a properly balanced diet, defined as "SPARKS", will have a beneficial effect on the function and regeneration processes of the gut-brain-muscle axis. However, adopting the formula, among others, of poor sleep, stress, overtraining, and dysbiosis, defined as "SMOULDER", will have a detrimental impact on the function of this axis and consequently on human health as well as on athletes. Understanding these dynamics is crucial for optimizing brain health and cognitive function. This review highlights the significance of these factors for overall well-being, suggesting that adopting the "SPARKS" approach may benefit not only athletes but also older adults and individuals with health conditions.

The human body contains approximately 100 trillion microorganisms, predominantly within the gastrointestinal tract, collectively called the gut microbiota. Investigations have revealed the bidirectional communication between the gut microbiota and the brain, characterized as the "microbiota-gut-brain axis." This axis represents an important regulator of brain development and function, immune system development, and nutrient metabolism, making it a target for efforts to alleviate the development and progression of neurodegenerative diseases (NDDs). Despite extensive biomedical and clinical research, our understanding of the causes, optimal treatment, and progression of NDDs remains limited. This paper aims to summarize the available knowledge on the role played by gut microbiota and how it is connected to the progression of neurodegenerative conditions; in particular, the relationship between the microbiota and gut-brain communications and the gut microbiota and neuro-immune conditions is reviewed. We discuss how and why the gut immune system communicates with the brain and how this communication impacts neurodegeneration. Next, we examine the alterations in the gut microbiota, immune response, and brain changes associated with gut dysbiosis. Finally, we highlight the preclinical and clinical evidence for probiotics, prebiotics, fecal microbiota transplantation, dietary supplements, natural drugs, and exercise intervention as potential therapeutic approaches that could lead to a new treatment paradigm for NDDs.

Exercise is well known to exert beneficial changes to the gut microbiota. An emerging area is how the gut microbiota may regulate exercise tolerance. This review will summarize the current evidence on how exercise influences gut microbial communities, with emphasis on how disruptions or depletion of an intact gut microbiota impacts exercise tolerance as well as future directions.

Triathlon is a multi-sport event that combines swimming, cycling and running. The distances vary and the physiological demands are high. Objectives: This review compiles information on nutritional strategies and ergogenic supplements for triathlon training, competition and recovery. It aims to provide an understanding of the specific challenges and needs of the sport to help triathletes and coaches optimise performance through effective training and nutrition plans. Methods: English-language publications were searched using the keywords triathlon, nutrition, recovery and ergogenic aids, alone or in combination, in databases. Results: Maintaining good glycogen levels, consuming enough carbohydrates and staying properly hydrated are key to athletic performance, especially for triathletes. Education regarding nutrition, the role of probiotics and supplements, and diet modification for the enhancement of performance and recovery are pivotal considerations. Conclusions: Triathletes are at risk of RED-S due to negative energy balance and high fibre/plant protein diets, especially women. Optimising muscle glycogen through tailored diet and training, especially pre- and in-race nutrition, including carbohydrate loading and hydration strategies, is critical. Education is needed to improve post-exercise nutrition, while probiotics and certain supplements may aid performance and recovery. Dietary support is important for resistance training to optimise performance and recovery.

Background/Objectives: The human gut microbiome is a complex ecosystem of microorganisms that can influence our health and exercise habits. On the other hand, physical exercise can also impact our microbiome, affecting our health. Our narrative review examines the bidirectional relationship between physical activity and the gut microbiome, as well as the potential for targeted probiotic regimens to enhance sports performance. Methods: We conducted a comprehensive literature review to select articles published up till January 2024 on the topics of physical exercise, sports, probiotics, and gut microbiota from major scientific databases, incorporating over 100 studies. Results: We found that the impact of physical activity on the gut microbiome varies with the type and intensity of exercise. Moderate exercise promotes a healthy immune system, while high-intensity exercise for a long duration can cause a leaky gut and consequent systemic inflammation, which may disrupt the microbial balance. Combining aerobic and resistance training significantly affects bacterial diversity, linked to a lower prevalence of chronic metabolic disorders. Furthermore, exercise enhances gut microbiome diversity, increases SCFA production, improves nutrient utilization, and modulates neural and hormonal pathways, improving gut barrier integrity. Our findings also showed probiotic supplementation is associated with decreased inflammation, enhanced sports performance, and fewer gastrointestinal disturbances, suggesting that the relationship between the gut microbiome and physical activity is mutually influential. Conclusions: The bidirectional relationship between physical activity and the gut microbiome is exemplified by how exercise can promote beneficial bacteria while a healthy gut microbiome can potentially enhance exercise ability through various mechanisms. These findings underscore the importance of adding potential tailored exercise regimens and probiotic supplementation that consider individual microbiome profiles into exercise programs.

Based on a comprehensive review and critical analysis of the literature regarding the nutritional concerns of female athletes, conducted by experts in the field and selected members of the International Society of Sports Nutrition (ISSN), the following conclusions represent the official Position of the Society: 1. Female athletes have unique and unpredictable hormone profiles, which influence their physiology and nutritional needs across their lifespan. To understand how perturbations in these hormones affect the individual, we recommend that female athletes of reproductive age should track their hormonal status (natural, hormone driven) against training and recovery to determine their individual patterns and needs and peri and post-menopausal athletes should track against training and recovery metrics to determine the individuals' unique patterns. 2. The primary nutritional consideration for all athletes, and in particular, female athletes, should be achieving adequate energy intake to meet their energy requirements and to achieve an optimal energy availability (EA); with a focus on the timing of meals in relation to exercise to improve training adaptations, performance, and athlete health. 3. Significant sex differences and sex hormone influences on carbohydrate and lipid metabolism are apparent, therefore we recommend first ensuring athletes meet their carbohydrate needs across all phases of the menstrual cycle. Secondly, tailoring carbohydrate intake to hormonal status with an emphasis on greater carbohydrate intake and availability during the active pill weeks of oral contraceptive users and during the luteal phase of the menstrual cycle where there is a greater effect of sex hormone suppression on gluconogenesis output during exercise. 4. Based upon the limited research available, we recommend that pre-menopausal, eumenorrheic, and oral contraceptives using female athletes should aim to consume a source of high-quality protein as close to beginning and/or after completion of exercise as possible to reduce exercise-induced amino acid oxidative losses and initiate muscle protein remodeling and repair at a dose of 0.32-0.38 g·kg-1. For eumenorrheic women, ingestion during the luteal phase should aim for the upper end of the range due to the catabolic actions of progesterone and greater need for amino acids. 5. Close to the beginning and/or after completion of exercise, peri- and post-menopausal athletes should aim for a bolus of high EAA-containing (~10 g) intact protein sources or supplements to overcome anabolic resistance. 6. Daily protein intake should fall within the mid- to upper ranges of current sport nutrition guidelines (1.4-2.2 g·kg-1·day-1) for women at all stages of menstrual function (pre-, peri-, post-menopausal, and contraceptive users) with protein doses evenly distributed, every 3-4 h, across the day. Eumenorrheic athletes in the luteal phase and peri/post-menopausal athletes, regardless of sport, should aim for the upper end of the range. 7. Female sex hormones affect fluid dynamics and electrolyte handling. A greater predisposition to hyponatremia occurs in times of elevated progesterone, and in menopausal women, who are slower to excrete water. Additionally, females have less absolute and relative fluid available to lose via sweating than males, making the physiological consequences of fluid loss more severe, particularly in the luteal phase. 8. Evidence for sex-specific supplementation is lacking due to the paucity of female-specific research and any differential effects in females. Caffeine, iron, and creatine have the most evidence for use in females. Both iron and creatine are highly efficacious for female athletes. Creatine supplementation of 3 to 5 g per day is recommended for the mechanistic support of creatine supplementation with regard to muscle protein kinetics, growth factors, satellite cells, myogenic transcription factors, glycogen and calcium regulation, oxidative stress, and inflammation. Post-menopausal females benefit from bone health, mental health, and skeletal muscle size and function when consuming higher doses of creatine (0.3 g·kg-1·d-1). 9. To foster and promote high-quality research investigations involving female athletes, researchers are first encouraged to stop excluding females unless the primary endpoints are directly influenced by sex-specific mechanisms. In all investigative scenarios, researchers across the globe are encouraged to inquire and report upon more detailed information surrounding the athlete's hormonal status, including menstrual status (days since menses, length of period, duration of cycle, etc.) and/or hormonal contraceptive details and/or menopausal status.

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.

Exertional rhabdomyolysis results from a breakdown of skeletal muscle cells after intense exercise in otherwise healthy patients, causing increased levels of creatine kinase (CK) or myoglobin, as well as urine dipstick positive for blood, and may result in kidney insufficiency. The aim of this study was to outline the current perspectives of exertional rhabdomyolysis in athletes and subsequent treatment based on the current literature.

Background: Body composition and hydration status, particularly the balance between intracellular (ICW) and extracellular (ECW) water compartments, are critical factors influencing performance and aesthetics in competitive bodybuilding. Despite their significance, limited research has explored sex-based differences in hydration strategies and their impact on competitive outcomes. Objectives: This study aimed to characterize and compare ICW and ECW distribution, as well as their relationship with key physiological parameters, between male and female elite bodybuilders during an international competition. Methods: A total of 34 elite bodybuilders (18 males and 16 females) participated in this cross-sectional study. Body composition was assessed using multifrequency bioelectrical impedance analysis (BIA). The parameters evaluated included total body water, ICW, ECW, and phase angle (PhA). Differences between sexes were analyzed using Student's t-tests, with statistical significance set at p < 0.05. Results: Significant sex-based differences were observed in water compartment distribution. Male bodybuilders exhibited higher ICW values (33.1 ± 2.8 L vs. 25.7 ± 2.5 L; p < 0.001) and PhA (8.2 ± 0.7 vs. 7.0 ± 0.9; p < 0.05), indicating greater muscle mass and cell integrity. In contrast, females had a higher ECW-to-total body water ratio (42.7% vs. 39.5%; p < 0.05), likely influenced by hormonal and metabolic factors. These findings suggest that sex-specific physiological characteristics should be considered when developing hydration and competition strategies. Conclusions: The study highlights the importance of sex-specific approaches to hydration and body composition management in bodybuilding. The observed differences in ICW and ECW distributions underscore the need for individualized training, nutrition, and hydration strategies to optimize competitive performance while maintaining athlete health. Future research should focus on longitudinal assessments to better understand hydration dynamics across different stages of competition preparation.

Sarcopenia is characterized by the progressive loss of skeletal muscle mass, strength, and function, significantly impacting overall health and quality of life in older adults. This narrative review explores emerging targets and potential treatments for sarcopenia, aiming to provide a comprehensive overview of current and prospective interventions.

Hyponatremia is one of the most common problems encountered in clinical practice and one of the least-understood because accurate diagnosis and management require some familiarity with water homeostasis physiology, making the topic seemingly complex. The prevalence of hyponatremia depends on the nature of the population studied and the criteria used to define it. Hyponatremia is associated with poor outcomes including increased mortality and morbidity. The pathogenesis of hypotonic hyponatremia involves the accumulation of electrolyte-free water caused by either increased intake and/or decrease in kidney excretion. Plasma osmolality, urine osmolality, and urine sodium can help to differentiate among the different etiologies. Brain adaptation to plasma hypotonicity consisting of solute extrusion to mitigate further water influx into brain cells best explains the clinical manifestations of hyponatremia. Acute hyponatremia has an onset within 48 hours, commonly resulting in severe symptoms, while chronic hyponatremia develops over 48 hours and usually is pauci-symptomatic. However, the latter increases the risk of osmotic demyelination syndrome if hyponatremia is corrected rapidly; therefore, extreme caution must be exercised when correcting plasma sodium. Management strategies depend on the presence of symptoms and the cause of hyponatremia and are discussed in this review.

Heat-related illnesses encompass a spectrum of disorders resulting from exposure to high temperatures and the body's inability to efficiently dissipate heat. These syndromes range from mild illnesses, such as heat edema, heat rash, and heat cramps, to more concerning manifestations such as exercise-associated collapse, heat exhaustion, and exertional rhabdomyolysis. The most severe and potentially life-threatening heat-related illnesses include exercise collapse associated with sickle cell trait, severe exercise-associated hyponatremia, and heat stroke. Common risk factors of heat-related illness are physical activity in high ambient temperatures, behavioral factors, lack of acclimatization, deconditioning, recent illness, inadequate hydration, predisposing medical conditions, use of certain drugs and supplements, and excessive clothing or equipment. Treatment of mild heat-related illness includes cessation of activity, removal of the patient from high temperatures, and oral hydration. Symptoms of heat exhaustion are nonspecific and may include the inability to continue physical activity, weakness, fatigue, headache, nausea, and vomiting. Management includes rest, hydration, and basic cooling measures. Heat stroke is a medical emergency requiring immersion in ice-cold water within 30 minutes to prevent significant morbidity and mortality. Diagnosis of severe exercise-associated hyponatremia and exercise collapse associated with sickle cell trait require a high index of suspicion because they can mimic heat stroke but require different treatments. Heat-related illnesses are largely preventable with proper acclimatization, adequate hydration, avoidance of physical activity in extreme temperatures, and promotion of population-based intervention programs, particularly during anticipated heat waves.

Hyponatremia and hypernatremia are electrolyte disorders that can be associated with poor outcomes. Hyponatremia is considered mild when the sodium concentration is 130 to 134 mEq per L, moderate when 125 to 129 mEq per L, and severe when less than 125 mEq per L. Mild symptoms include nausea, vomiting, weakness, headache, and mild neurocognitive deficits. Severe symptoms of hyponatremia include delirium, confusion, impaired consciousness, ataxia, seizures, and, rarely, brain herniation and death. Patients with a sodium concentration of less than 125 mEq per L and severe symptoms require emergency infusions with 3% hypertonic saline. Using calculators to guide fluid replacement helps avoid overly rapid correction of sodium concentration, which can cause osmotic demyelination syndrome. Physicians should identify the cause of a patient's hyponatremia, if possible; however, treatment should not be delayed while a diagnosis is pursued. Common causes include certain medications, excessive alcohol consumption, very low-salt diets, and excessive free water intake during exercise. Management to correct sodium concentration is based on whether the patient is hypovolemic, euvolemic, or hypervolemic. Hypovolemic hyponatremia is treated with normal saline infusions. Treating euvolemic hyponatremia includes restricting free water consumption or using salt tablets or intravenous vaptans. Hypervolemic hyponatremia is treated primarily by managing the underlying cause (e.g., heart failure, cirrhosis) and free water restriction. Hypernatremia is less common than hyponatremia. Mild hypernatremia is often caused by dehydration resulting from an impaired thirst mechanism or lack of access to water; however, other causes, such as diabetes insipidus, are possible. Treatment starts with addressing the underlying etiology and correcting the fluid deficit. When sodium is severely elevated, patients are symptomatic, or intravenous fluids are required, hypotonic fluid replacement is necessary.

Emergency contraception (EC), or postcoital contraception, is a therapy aimed at preventing unintended pregnancy after an act of unprotected or under-protected sexual intercourse. Options include both emergency contraceptive pills (most commonly containing levonorgestrel or ulipristal acetate) and insertion of an intrauterine device. The aim of this paper is to summarize current evidence surrounding the use of emergency contraceptives and to present an evidence-based approach to EC provision. Emergency contraception is a safe and effective option in preventing unwanted pregnancy, irrespective of age, weight, or breastfeeding status. Efforts should be made to increase their availability, as well as knowledge of these methods, both among patients and healthcare providers.

The debate about contraception has become increasingly important as more and more people seek safe and effective contraception. More than 1 billion women of reproductive age worldwide need a method of family planning, and wellbeing, socio-economic status, culture, religion and more influence the reasons why a woman may ask for contraception. Different contraceptive methods exist, ranging from 'natural methods' (fertility awareness-based methods - FABMs) to barrier methods and hormonal contraceptives (HCs). Each method works on a different principle, with different effectiveness.FABMs and HCs are usually pitted against each other, although it's difficult to really compare them. FABMs are a valid alternative for women who cannot or do not want to use hormone therapy, although they may have a high failure rate if not used appropriately and require specific training. HCs are commonly used to address various clinical situations, although concerns about their possible side effects are still widespread. However, many data show that the appropriate use of HC has a low rate of adverse events, mainly related to personal predisposition.The aim of this review is to summarize the information on the efficacy and safety of FABMs and HCs to help clinicians and women choose the best contraceptive method for their needs.

This study aimed to compare the interpersonal quality of contraceptive counseling between telehealth and in-person visits.

Background: Perimenopause is characterized by pronounced fluctuations in ovarian steroids, which are associated with an increase vulnerability to anxiety symptoms. Growing evidence indicates that declining estrogen levels influence gut microbiota composition and microbial metabolic activity, thereby modulating neuroimmune and neuroendocrine pathways involved in emotional regulation. This review explores gut microbiota alterations occurring during the menopausal transition and critically evaluates dietary strategies targeting microbiota-gut-brain mechanisms potentially relevant to perimenopausal anxiety. Methods: A structured literature search was conducted in PubMed, Scopus, and Web of Science to identify clinical, translational, and preclinical studies addressing: (i) gut microbiota changes across perimenopause and menopause; (ii) microbiota-gut-brain pathways implicated in anxiety; and (iii) dietary patterns, nutrients, probiotics, and prebiotics with documented microbiota-modulating effects. The available evidence was synthesized narratively, with particular attention to biological plausibility and clinical relevance. Results: The perimenopause transition is associated with reduced microbial diversity, depletion of Lactobacillus, Bifidobacterium, and short-chain fatty acid (SCFA)-producing taxa, and enrichment of pro-inflammatory microbial signatures. These alterations are linked to increased intestinal permeability, altered tryptophan-kynurenine metabolism, immune activation, and dysregulated hypothalamic-pituitary-adrenal axis activity. Dietary interventions, including Mediterranean-style diets, fiber- and polyphenol-rich foods, fermented products, and selected probiotic and prebiotic formulations, have been shown to modulate gut microbial composition, enhance SCFA production, and attenuate inflammatory and neuroendocrine stress pathways. Preliminary evidence suggests potential anxiolytic benefits; however, randomized controlled trials specifically targeting perimenopausal populations remain limited. Conclusions: Gut microbiota dysbiosis may contribute to anxiety vulnerability in perimenopausal women through interconnected immune, metabolic, and neuroendocrine mechanisms. Dietary modulation of the intestinal microbiota represents a biologically plausible and low-risk complementary approach to support emotional well-being during this transitional period. Well-designed, perimenopause-specific clinical trials are needed to confirm efficacy and inform microbiome-based nutritional strategies.

The latest statistics concerning contraceptive use in the world have been published in 2019 by the United Nations. Among the 1.9 billion of women of reproductive age (15-49 years), 1.1 billion have a need for family planning. Among them, 190 millions are not using any contraception, although they wanted to avoid a pregnancy. There is a significant discrepancy among continents concerning the percentage of contraceptive use and the distribution of the different types of contraception. Female sterilization is the most widespread method of contraception since it represents 24% of all contraception methods used. Male condoms is used by 21% of couples. Thus, progress is still needed to disseminate effective, well tolerated and potentially reversible methods of contraception. Education of females, couples, medical and paramedical staff is one of the priority targets to improve contraception throughout the world.

Contraception is a major global health issue, which is still dominated by female contraception. Developments in male contraception could help redistribute the contraceptive burden.

To investigate the effects of an 8-week supplementation with varying doses of creatine hydrochloride, administered alone or in combination with creatine ethyl ester, on cognitive function, clinical outcomes, brain creatine concentrations, and biochemical markers in perimenopausal and postmenopausal women. This study specifically aimed to evaluate the potential of low-dose creatine formulations with enhanced solubility as a targeted intervention for menopause-related neurocognitive and metabolic changes.

This article outlines the basics of all contraceptive options available in the United States, providing providers necessary information to best provide equitable contraceptive care for women. Long-acting reversible contraception should be considered in all women as there are few contraindications to use. Levonorgestrel intrauterine devices have been found to be safe for use for longer periods of time, in some cases up to eight years. Combination hormone contraceptives remain popular and offer benefits beyond contraception; importantly newer formulations exist providing patients with more contraceptive options. Education regarding emergency contraception should be provided to all patients.

Managing stress and having good quality sleep are inter-related factors that are essential for health, and both factors seem to be affected by physical activity. Although there is an established bidirectional relationship between stress and sleep, remarkably few studies have been designed to examine the effects of physical activity on cortisol, a key biomarker for stress, and sleep. Research is particularly scarce in older people despite both sleep and cortisol changing with age. This systematic literature review addresses this gap.

The female athlete triad (TRIAD) is a spectrum of disorders involving low energy availability (LEA), low bone mineral density, and menstrual disorders. It is increasingly common to use the term 'relative energy deficiency in sport' (RED), emphasising the extensive impact of LEA on the body. The aim of this narrative review was to gather original research encompassing female athletes across various sports as well as to collect findings on the potential of a nutrition-focused approach to prevent or treat the aforementioned disorders. A comprehensive search was conducted in PubMed and Scopus. Several challenges were identified regarding the adequacy of the energy availability, protein, and carbohydrate requirements in the diets of female athletes. Moreover, insufficient intake of vitamin D has been observed across all athlete groups studied. This insufficiency also extends to the average requirement for Ca, Mg, the Ca/P ratio, Zn, and Fe. To address those concerns, a nutritional approach is proposed in the latter part of this review. The factors that can improve the absorption of micronutrients have also been discussed. The TRIAD/REDs affect an ever-growing number of women and require appropriate therapeutic management, particularly through nutritional care. Therefore, cooperation within an interdisciplinary team comprising a physician, nutritionist, physiotherapist, and psychologist is crucial.

Poor vitamin D and magnesium status is observed in individuals who are overweight and obese (Owt/Ob) and is often associated with a heightened risk of cardiovascular disease. Magnesium is a cofactor that assists vitamin D metabolism. We aimed to determine the efficacy of a combined magnesium and vitamin D regimen compared with vitamin D only on increasing serum 25-hydroxyvitamin D (25OHD) concentrations and the effects of these supplements on cardiometabolic outcomes.

The relationship between cortisol and perceived stress is poorly understood. We sought to determine whether perceived stress is associated with cortisol biomarkers in adolescents. In a sample of 229 adolescents (mean age = 15.8 years) we measured perceived stress with the 14-item Perceived Stress Scale (PSS) questionnaire, serum cortisol (sCOR), salivary Cortisol Awakening Response (CAR: 30-minute post-awakening - awakening), salivary Diurnal Cortisol Slope (DCS: evening-awakening), and total daily salivary cortisol (TDC). Multivariable linear regression was used to estimate baseline associations between PSS, TDC, and sCOR Mixed effects linear regression was used to estimate baseline associations between PSS and CAR and DCS. A twelve-week longitudinal association between PSS and cortisol biomarkers using random effects regression was tested. Analyses were adjusted for age, gender, and BMI. There were statistically significant associations between PSS and TDC (beta= -104.36 ± 34.3; p = 0.002) at baseline and between PSS and DCS at 12 weeks (beta= -0.058 ± 0.02; p = 0.01), but no association between PSS and sCOR or CAR (p > 0.26 for all) at baseline or 12-weeks. There were no associations between change in PSS and change in cortisol biomarkers longitudinally. In adolescents, perceived stress, measured by the PSS, was inconsistently associated with TDC and DCS, and consistently unassociated with CAR and sCOR. Studies reporting on PSS outcomes should exercise caution when making conclusions about cortisol biomarkers. There is a need for greater specificity of psychological stress to understand their relationship with biomarkers of stress.

Creatine is a widely used ergogenic aid that enhances muscle strength and lean mass. However, concerns have been raised about the potential role in promoting hair loss by increasing dihydrotestosterone (DHT). Currently, there is no direct evidence examining the relationship between creatine supplementation and hair follicle health. Therefore, the purpose was to determine the effects of 12 weeks of creatine supplementation on androgen levels and hair follicle health in healthy young males.

It is estimated that three to five million sports injuries occur worldwide each year. The highest incidence is reported during competition periods with mainly affectation of the musculoskeletal tissue. For appropriate nutritional management and correct use of nutritional supplements, it is important to individualize based on clinical effects and know the adaptive response during the rehabilitation phase after a sports injury in athletes. Therefore, the aim of this PRISMA in Exercise, Rehabilitation, Sport Medicine and Sports Science PERSiST-based systematic integrative review was to perform an update on nutritional strategies during the rehabilitation phase of musculoskeletal injuries in elite athletes. After searching the following databases: PubMed/Medline, Scopus, PEDro, and Google Scholar, a total of 18 studies met the inclusion criteria (Price Index: 66.6%). The risk of bias assessment for randomized controlled trials was performed using the RoB 2.0 tool while review articles were evaluated using the AMSTAR 2.0 items. Based on the main findings of the selected studies, nutritional strategies that benefit the rehabilitation process in injured athletes include balanced energy intake, and a high-protein and carbohydrate-rich diet. Supportive supervision should be provided to avoid low energy availability. The potential of supplementation with collagen, creatine monohydrate, omega-3 (fish oils), and vitamin D requires further research although the effects are quite promising. It is worth noting the lack of clinical research in injured athletes and the higher number of reviews in the last 10 years. After analyzing the current quantitative and non-quantitative evidence, we encourage researchers to conduct further clinical research studies evaluating doses of the discussed nutrients during the rehabilitation process to confirm findings, but also follow international guidelines at the time to review scientific literature.

The primary objective of this cross-sectional study was to compare standard laboratory performance metrics of transgender athletes to cisgender athletes.

A questionnaire-based screening tool for male athletes at risk of low energy availability (LEA) could facilitate both research and clinical practice. The present options rely on proxies for LEA such screening tools for disordered eating, exercise dependence, or those validated in female athlete populations. in which the female-specific sections are excluded. To overcome these limitations and support progress in understanding LEA in males, centres in Australia, Norway, Denmark, and Sweden collaborated to develop a screening tool (LEAM-Q) based on clinical investigations of elite and sub-elite male athletes from multiple countries and ethnicities, and a variety of endurance and weight-sensitive sports. A bank of questions was developed from previously validated questionnaires and expert opinion on various clinical markers of LEA in athletic or eating disorder populations, dizziness, thermoregulation, gastrointestinal symptoms, injury, illness, wellbeing, recovery, sleep and sex drive. The validation process covered reliability, content validity, a multivariate analysis of associations between variable responses and clinical markers, and Receiver Operating Characteristics (ROC) curve analysis of variables, with the inclusion threshold being set at 60% sensitivity. Comparison of the scores of the retained questionnaire variables between subjects classified as cases or controls based on clinical markers of LEA revealed an internal consistency and reliability of 0.71. Scores for sleep and thermoregulation were not associated with any clinical marker and were excluded from any further analysis. Of the remaining variables, dizziness, illness, fatigue, and sex drive had sufficient sensitivity to be retained in the questionnaire, but only low sex drive was able to distinguish between LEA cases and controls and was associated with perturbations in key clinical markers and questionnaire responses. In summary, in this large and international cohort, low sex drive was the most effective self-reported symptom in identifying male athletes requiring further clinical assessment for LEA.

Evidence linking coffee and tea to cognitive health remains inconclusive, and most studies fail to differentiate caffeinated from decaffeinated coffee.

Background/Objectives: Sports supplements have become popular among fitness enthusiasts for enhancing the adaptive response to exercise. This review analyzes five of the most effective ergogenic aids: creatine, beta-alanine, nitrates, caffeine, and protein. Methods: We conducted a narrative review of the literature with a focus on the sport supplements with the most robust evidence for efficacy and safety. Results: Creatine, one of the most studied ergogenic aids, increases phosphocreatine stores in skeletal muscles, improving ATP production during high-intensity exercises like sprinting and weightlifting. Studies show creatine supplementation enhances skeletal muscle mass, strength/power, and muscular endurance. The typical dosage is 3-5 g per day and is safe for long-term use. Beta-alanine, when combined with the amino acid histidine, elevates intramuscular carnosine, which acts as a buffer in skeletal muscles and delays fatigue during high-intensity exercise by neutralizing hydrogen ions. Individuals usually take 2-6 g daily in divided doses to minimize paresthesia. Research shows significant performance improvements in activities lasting 1-4 min. Nitrates, found in beetroot juice, enhance aerobic performance by increasing oxygen delivery to muscles, enhancing endurance, and reducing oxygen cost during exercise. The recommended dosage is approximately 500 milligrams taken 2-3 h before exercise. Caffeine, a central nervous system stimulant, reduces perceived pain while enhancing focus and alertness. Effective doses range from 3 to 6 milligrams per kilogram of body weight, typically consumed an hour before exercise. Protein supplementation supports muscle repair, growth, and recovery, especially after resistance training. The recommended intake for exercise-trained men and women varies depending on their specific goals. Concluions: In summary, creatine, beta-alanine, nitrates, caffeine, and protein are the best ergogenic aids, with strong evidence supporting their efficacy and safety.

Dietary nitrate (NO3-) supplementation is purported to benefit exercise performance. However, previous studies have evaluated this nutritional strategy with various performance outcomes, exercise tasks, and dosing regimens, often yielding inconsistent results that limit the generalizability of the findings.

Collegiate dance is unique because it requires athletic and academic performance; therefore, optimizing physical and mental function is crucial. Research among athletic populations demonstrate improvements in body composition, performance, and cognition following creatine monohydrate (CR) supplementation, yet dancers have not been investigated. The purpose of this study was to determine the effects of CR supplementation on body composition, performance, and cognitive function in female collegiate dancers. Participants were randomized to CR (CR; n = 7; 0.1 g·kg -1·day -1 CM +0.1 g·kg -1·day -1 corn-starch maltodextrin) or placebo (PL; n = 6; 0.2 g·kg -1·day -1 corn-starch maltodextrin) for 42 days. Pre- and post-testing included body composition, total body water (TBW), Depression, Anxiety and Stress Scale, Diet History Questionnaire, the National Institute of Health Toolbox fluid cognition battery and isokinetic strength, vertical jump, medicine ball throw, and Wingate anaerobic power test. CR demonstrated a significant increase in TBW (pre, 32.2 ± 3.5 kg; post, 32.7 ± 3.6 kg; p = 0.024) and lean mass (LM; pre, 39.8 ± 3.6 kg; post, 41.5 ± 4.5 kg; p = 0.020). CR supplementation may be an effective strategy to increase TBW and estimates of LM in female collegiate dancers. Although this may optimize aesthetics, larger samples sizes with resistance training are needed to determine if CR supplementation increases muscle mass and translates to improved performance.

The inverse effects of creatine supplementation and sleep deprivation on high energy phosphates, neural creatine, and cognitive performances suggest that creatine is a suitable candidate for reducing the negative effects of sleep deprivation. With this, the main obstacle is the limited exogenous uptake by the central nervous system (CNS), making creatine only effective over a long-term diet of weeks. Thus far, only repeated dosing of creatine over weeks has been studied, yielding detectable changes in CNS levels. Based on the hypothesis that a high extracellular creatine availability and increased intracellular energy consumption will temporarily increase the central creatine uptake, subjects were orally administered a high single dose of creatinemonohydrate (0.35 g/kg) while performing cognitive tests during sleep deprivation. Two consecutive 31P-MRS scans, 1H-MRS, and cognitive tests were performed each at evening baseline, 3, 5.5, and 7.5 h after single dose creatine (0.35 g/kg) or placebo during sub-total 21 h sleep deprivation (SD). Our results show that creatine induces changes in PCr/Pi, ATP, tCr/tNAA, prevents a drop in pH level, and improves cognitive performance and processing speed. These outcomes suggest that a high single dose of creatine can partially reverse metabolic alterations and fatigue-related cognitive deterioration.

There is robust evidence that creatine monohydrate supplementation can enhance short-term high-intensity exercise in athletes. However, the effect of creatine monohydrate supplementation on aerobic performance and its role during aerobic activities is still controversial.

Creatine monohydrate supplementation (CrM) is a safe and effective intervention for improving certain aspects of sport, exercise performance, and health across the lifespan. Despite its evidence-based pedigree, several questions and misconceptions about CrM remain. To initially address some of these concerns, our group published a narrative review in 2021 discussing the scientific evidence as to whether CrM leads to water retention and fat accumulation, is a steroid, causes hair loss, dehydration or muscle cramping, adversely affects renal and liver function, and if CrM is safe and/or effective for children, adolescents, biological females, and older adults. As a follow-up, the purpose of this paper is to evaluate additional questions and misconceptions about CrM. These include but are not limited to: 1. Can CrM provide muscle benefits without exercise? 2. Does the timing of CrM really matter? 3. Does the addition of other compounds with CrM enhance its effectiveness? 4. Does CrM and caffeine oppose each other? 5. Does CrM increase the rates of muscle protein synthesis or breakdown? 6. Is CrM an anti-inflammatory intervention? 7. Can CrM increase recovery following injury, surgery, and/or immobilization? 8. Does CrM cause cancer? 9. Will CrM increase urine production? 10. Does CrM influence blood pressure? 11. Is CrM safe to consume during pregnancy? 12. Does CrM enhance performance in adolescents? 13. Does CrM adversely affect male fertility? 14. Does the brain require a higher dose of CrM than skeletal muscle? 15. Can CrM attenuate symptoms of sleep deprivation? 16. Will CrM reduce the severity of and/or improve recovery from traumatic brain injury? Similar to our 2021 paper, an international team of creatine research experts was formed to perform a narrative review of the literature regarding CrM to formulate evidence-based responses to the aforementioned misconceptions involving CrM.

Caffeine is a popular ergogenic aid that has a plethora of evidence highlighting its positive effects. A Google Scholar search using the keywords "caffeine" and "exercise" yields over 200,000 results, emphasizing the extensive research on this topic. However, despite the vast amount of available data, it is intriguing that uncertainties persist regarding the effectiveness and safety of caffeine. These include but are not limited to: 1. Does caffeine dehydrate you at rest? 2. Does caffeine dehydrate you during exercise? 3. Does caffeine promote the loss of body fat? 4. Does habitual caffeine consumption influence the performance response to acute caffeine supplementation? 5. Does caffeine affect upper vs. lower body performance/strength differently? 6. Is there a relationship between caffeine and depression? 7. Can too much caffeine kill you? 8. Are there sex differences regarding caffeine's effects? 9. Does caffeine work for everyone? 10. Does caffeine cause heart problems? 11. Does caffeine promote the loss of bone mineral? 12. Should pregnant women avoid caffeine? 13. Is caffeine addictive? 14. Does waiting 1.5-2.0 hours after waking to consume caffeine help you avoid the afternoon "crash?" To answer these questions, we performed an evidence-based scientific evaluation of the literature regarding caffeine supplementation.

In industry 4.0, where the automation and digitalization of entities and processes are fundamental, artificial intelligence (AI) is increasingly becoming a pivotal tool offering innovative solutions in various domains. In this context, nutrition, a critical aspect of public health, is no exception to the fields influenced by the integration of AI technology. This study aims to comprehensively investigate the current landscape of AI in nutrition, providing a deep understanding of the potential of AI, machine learning (ML), and deep learning (DL) in nutrition sciences and highlighting eventual challenges and futuristic directions. A hybrid approach from the systematic literature review (SLR) guidelines and the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines was adopted to systematically analyze the scientific literature from a search of major databases on artificial intelligence in nutrition sciences. A rigorous study selection was conducted using the most appropriate eligibility criteria, followed by a methodological quality assessment ensuring the robustness of the included studies. This review identifies several AI applications in nutrition, spanning smart and personalized nutrition, dietary assessment, food recognition and tracking, predictive modeling for disease prevention, and disease diagnosis and monitoring. The selected studies demonstrated the versatility of machine learning and deep learning techniques in handling complex relationships within nutritional datasets. This study provides a comprehensive overview of the current state of AI applications in nutrition sciences and identifies challenges and opportunities. With the rapid advancement in AI, its integration into nutrition holds significant promise to enhance individual nutritional outcomes and optimize dietary recommendations. Researchers, policymakers, and healthcare professionals can utilize this research to design future projects and support evidence-based decision-making in AI for nutrition and dietary guidance.

Existing dietary and lifestyle interventions and recommendations, to improve the risk factors of obesity and type 2 diabetes with the target to mitigate this double global epidemic, have produced inconsistent results due to interpersonal variabilities in response to these conventional approaches, and inaccuracies in dietary assessment methods. Precision nutrition, an emerging strategy, tailors an individual's key characteristics such as diet, phenotype, genotype, metabolic biomarkers, and gut microbiome for personalized dietary recommendations to optimize dietary response and health. Precision nutrition is suggested to be an alternative and potentially more effective strategy to improve dietary intake and prevention of obesity and chronic diseases. The purpose of this narrative review is to synthesize the current research and examine the state of the science regarding the effect of precision nutrition in improving the risk factors of obesity and type 2 diabetes.

Malnutrition is a critical complication among cancer patients, affecting ≤80% of individuals depending on cancer type, stage, and treatment. Artificial intelligence (AI) has emerged as a promising tool in healthcare, with potential applications in nutritional management to improve early detection, risk stratification, and personalized interventions. This systematic review evaluated the role of AI in identifying and managing malnutrition in cancer patients, focusing on its effectiveness in nutritional status assessment, prediction, clinical outcomes, and body composition monitoring. A systematic search was conducted across PubMed, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, and Excerpta Medica Database from June to July 2024, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Quantitative primary studies investigating AI-based interventions for malnutrition detection, body composition analysis, and nutritional optimization in oncology were included. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Tools, and evidence certainty was evaluated with the Oxford Centre for Evidence-Based Medicine framework. Eleven studies (n = 52,228 patients) met the inclusion criteria and were categorized into 3 overarching domains: nutritional status assessment and prediction, clinical and functional outcomes, and body composition and cachexia monitoring. AI-based models demonstrated high predictive accuracy in malnutrition detection (area under the curve >0.80). Machine learning algorithms, including decision trees, random forests, and support vector machines, outperformed conventional screening tools. Deep learning models applied to medical imaging achieved high segmentation accuracy (Dice similarity coefficient: 0.92-0.94), enabling early cachexia detection. AI-driven virtual dietitian systems improved dietary adherence (84%) and reduced unplanned hospitalizations. AI-enhanced workflows streamlined dietitian referrals, reducing referral times by 2.4 d. AI demonstrates significant potential in optimizing malnutrition screening, body composition monitoring, and personalized nutritional interventions for cancer patients. Its integration into oncology nutrition care could enhance patient outcomes and optimize healthcare resource allocation. Further research is necessary to standardize AI models and ensure clinical applicability. This systematic review followed a protocol registered prospectively on Open Science Framework (https://doi.org/10.17605/OSF.IO/A259M).

The feasibility of diagnosing malnutrition using facial features has been validated. A tool to integrate all facial features associated with malnutrition for disease screening is still demanded. This work aims to develop and evaluate a deep learning (DL) framework to accurately determine malnutrition based on a 3D facial points cloud.

Artificial intelligence (AI) refers to computer systems doing tasks that usually need human intelligence. AI is constantly changing and is revolutionizing the healthcare field, including nutrition. This review's purpose is four-fold: (i) to investigate AI's role in nutrition research; (ii) to identify areas in nutrition using AI; (iii) to understand AI's future potential impact; (iv) to investigate possible concerns about AI's use in nutrition research. Eight databases were searched: PubMed, Web of Science, EBSCO, Agricola, Scopus, IEEE Explore, Google Scholar and Cochrane. A total of 1737 articles were retrieved, of which 22 were included in the review. Article screening phases included duplicates elimination, title-abstract selection, full-text review, and quality assessment. The key findings indicated AI's role in nutrition is at a developmental stage, focusing mainly on dietary assessment and less on malnutrition prediction, lifestyle interventions, and diet-related diseases comprehension. Clinical research is needed to determine AI's intervention efficacy. The ethics of AI use, a main concern, remains unresolved and needs to be considered for collateral damage prevention to certain populations. The studies' heterogeneity in this review limited the focus on specific nutritional areas. Future research should prioritize specialized reviews in nutrition and dieting for a deeper understanding of AI's potential in human nutrition.

Despite clinical interventional studies on the influence of diet on periodontal inflammatory parameters, there has been no practice-based cross-sectional study from a German population to date that has conducted both a comprehensive dental and periodontal examination and a thorough validated assessment of dietary behavior. Therefore, the aim of this pilot study was to evaluate, in a proof of concept, whether there is a correlation between the overall periodontal inflammatory surface area (PISA), periodontal clinical parameters (pocket probing depths (PPD), clinical attachment loss (CAL), bleeding on probing (BOP), furcation involvement (FI), tooth mobility (TM)), and the dietary behavior of patients with periodontal disease when utilizing a practice-based research network. The primary outcome was the correlation between the periodontal inflammatory surface (PISA) and the dietary assessment data.

The rapid surge in artificial intelligence (AI) has dominated technological innovation in today's society. As experts begin to understand the potential, a spectrum of opportunities could yield a remarkable revolution. The upsurge in healthcare could transform clinical interventions and outcomes, but it risks dehumanization and increased unethical practices. The field of clinical nutrition and dietetics is no exception. This article finds a multitude of developments underway, which include the use of AI for malnutrition screening; predicting clinical outcomes, such as disease onset, and clinical risks, such as drug interactions; aiding interventions, such as estimating nutrient intake; applying precision nutrition, such as measuring postprandial glycemic response; and supporting workflow through chatbots trained on natural language models. Although the opportunity and scalability of AI is incalculably attractive, especially in the face of poor healthcare resources, the threat cannot be ignored. The risk of malpractice and lack of accountability are some of the main concerns. As such, the healthcare professional's responsibility remains paramount. The data used to train AI models could be biased, which could risk the quality of care to vulnerable or minority patient groups. Standardized AI-development protocols, benchmarked to care recommendations, with rigorous large-scale validation are required to maximize application among different settings. AI could overturn the healthcare landscape, and this article skims the surface of its potential in clinical nutrition and dietetics.

What we eat is a cornerstone of cardiovascular disease (CVD) prevention, but health professionals may not have a clear understanding of the current evidence-based research to underpin eating habits and recommendations. This study aims to appraise existing evidence-based research on the importance of diet on CVD risk biomarkers, specifically, the effects of dietary patterns, specific foods, and constituents including vitamins/minerals and plant-derived bioactive compounds on CVD risk. Plant-based dietary patterns rich in minimally processed foods, vegetables, and fruits reduce CVD risk, while patterns rich in ultra-processed foods, meat, salt, sugar, and saturated fat increase risk. The Mediterranean, Dietary Approaches to Stop Hypertension, and vegetarian diets reduce CVD risk, while vegan diets offer no additional benefit. Low-carbohydrate diets may be beneficial, but their long-term effect remains to be confirmed. Balanced distribution of caloric intake through different meals is associated with favourable effects. Fasting (e.g. alternate-day, intermittent, time-restricted, and periodic) can reduce CVD risk but is often challenging. Moderate coffee consumption is not associated with increased risk of CVD. The consumption of one unit of alcohol/day may contribute to a reduced cardiovascular risk without presenting an unfavourable risk profile. Generally, there is no evidence that vitamin and mineral supplementation reduces CVD risk. High potassium intake is beneficial in healthy individuals, calcium or selenium supplementation shows no added benefit, and high sodium intake is detrimental. Diet is a major component of CVD prevention, and health professionals should include dietary assessment and evidence-based recommendations in their clinical practice.

Cycling is predominantly an endurance sport in which fuel utilization for energy production relies on the availability and delivery of oxygen to exercising muscle. Nutrition and training interventions to improve endurance performance are continually evolving, but ultimately, prescription should aim to generate improvements in cycling power and velocity while prioritizing athlete health and well-being. The wide range of cycling events and the different environments in which events take place pose a variety of nutrition-related challenges for cyclists. This review addresses some of these challenges and highlights recent advancements in nutrition for cycling performance.

This systematic review aimed to evaluate the effectiveness of the independent or combined use of nutritional ergogenic aids belonging to Group A of the ABCD classification by the Australian Institute of Sport (AIS) in the context of cycling (caffeine, creatine, sodium bicarbonate, beta-alanine, nitrates, and glycerol). A comprehensive search was carried out using three databases: PubMed, Scopus, and Web of Science. All the databases were searched for Randomized Controlled Trials or crossover design studies assessing the effects of supplementation on cycling performance in comparison with placebos in healthy adults. The methodological quality of each study was evaluated using the Physiotherapy Evidence Database scale. Thirty-six articles involving 701 participants were included in this review, examining supplementation with caffeine (n = 5), creatine (n = 2), sodium bicarbonate (n = 6), beta-alanine (n = 3), and nitrates (n = 8). Additionally, supplemental combinations of caffeine and creatine (n = 3), caffeine and sodium bicarbonate (n = 3), caffeine and nitrates (n = 1), creatine and sodium bicarbonate (n = 1), and sodium bicarbonate and beta-alanine (n = 4) were analyzed. A benefit for cyclists' athletic performnce was found when consuming a caffeine supplement, and a potential positive effect was noted after the consumption of sodium bicarbonate, as well as after the combination of caffeine and creatine. However, no statistically significant effects were identified for the remaining supplements, whether administered individually or in combination.

The study aimed to investigate the impact of nutrient timing in relation to evening exercise. Specifically, it examined the effects of pre- or post-exercise carbohydrate (CHO) ingestion on glucose metabolism, glucose regulation, and overall substrate oxidation in well-trained athletes during and after physical exercise (PE), spanning the nocturnal period and the subsequent morning.

A growing body of evidence supports the use of supplements to enhance cycling performance through both direct and indirect mechanisms.

Endometriosis is a chronic inflammatory disease marked by the presence of endometrial tissue outside the uterus. Main symptoms include pain in the sacrum, pelvis, and abdomen, occurring at various stages of the menstrual cycle or during intercourse. These symptoms can severely affect daily functioning and quality of life.

Triathlon is a multi-sport event that combines swimming, cycling and running. The distances vary and the physiological demands are high. Objectives: This review compiles information on nutritional strategies and ergogenic supplements for triathlon training, competition and recovery. It aims to provide an understanding of the specific challenges and needs of the sport to help triathletes and coaches optimise performance through effective training and nutrition plans. Methods: English-language publications were searched using the keywords triathlon, nutrition, recovery and ergogenic aids, alone or in combination, in databases. Results: Maintaining good glycogen levels, consuming enough carbohydrates and staying properly hydrated are key to athletic performance, especially for triathletes. Education regarding nutrition, the role of probiotics and supplements, and diet modification for the enhancement of performance and recovery are pivotal considerations. Conclusions: Triathletes are at risk of RED-S due to negative energy balance and high fibre/plant protein diets, especially women. Optimising muscle glycogen through tailored diet and training, especially pre- and in-race nutrition, including carbohydrate loading and hydration strategies, is critical. Education is needed to improve post-exercise nutrition, while probiotics and certain supplements may aid performance and recovery. Dietary support is important for resistance training to optimise performance and recovery.

The purpose of this narrative review is to identify health and performance consequences associated with LCA in female endurance athletes. The intake of carbohydrates (CHO) before, during, and after exercise has been demonstrated to support sport performance, especially endurance activities which rely extensively on CHO as a fuel source. However, low energy availability (LEA) and low carbohydrate availability (LCA) are common in female athletes. LEA occurs when energy intake is insufficient compared to exercise energy expenditure, and LEA-related conditions (e.g., Female Athlete Triad (Triad) and Relative Energy Deficiency in Sport (RED-S)) are associated with a myriad of health and performance consequences. The RED-S model highlights 10 health consequences and 10 performance consequences related to LEA. The independent effect of LCA on health and performance has been under-researched, despite current CHO intake being commonly insufficient in athletes. It is proposed that LCA may not only contribute to LEA but also have independent health and performance consequences in athletes. Furthermore, this review highlights current recommendations for CHO intake, as well as recent data on LCA prevalence and menstrual cycle considerations. A literature review was conducted on PubMed, Science Direct, and ResearchGate using relevant search terms (i.e., "low carbohydrate/energy availability", "female distance runners"). Twenty-one articles were identified and twelve met the inclusion criteria. The total number of articles included in this review is 12, with 7 studies illustrating that LCA was associated with direct negative health and/or performance implications for endurance-based athletes. Several studies included assessed male athletes only, and no studies included a female-only study design. Overall, the cumulative data show that female athletes remain underrepresented in sports science research and that current CHO intake recommendations and strategies may fail to consider female-specific adaptations and hormone responses, such as monthly fluctuations in estrogen and progesterone throughout the menstrual cycle. Current CHO guidelines for female athletes and exercising women need to be audited and explored further in the literature to support female athlete health and performance.

There is no consensus on optimal nutrition for preterm infants, leading to substantial practice variation. We aimed to assess the quality of nutrition guidelines for preterm infants, the consistency of recommendations, and the gaps in recommendations.

Coffee and tea consumption account for most caffeine intake and 2-3 billion cups are taken daily around the world. Caffeine dependence is a widespread but under recognized problem.

The dynamic and versatile group of enzymes referred to as glutathione S-transferases (GSTs) play diverse roles in cellular detoxification, safeguarding hosts from oxidative damage, and performing various other functions. This review explores different classes of GST, existence of polymorphisms in GST, functions of GST and utilizations of GST inhibitors in treatment of human diseases. The study indicates that the cytosolic GSTs, mitochondrial GSTs, microsomal GSTs, and bacterial proteins that provide resistance to Fosfomycin are the major classes. Given a GST, variation in its expression and function among individuals is due to the presence of polymorphic alleles that encode it. Genetic polymorphism might result in the modification of GST activity, thereby increasing individuals' vulnerability to harmful chemical compounds. GSTs have been demonstrated to play a regulatory function in cellular signalling pathways through kinases, S-Glutathionylation, and in detoxification processes. Various applications of bacterial GSTs and their potential roles in plants were examined. Targeting GSTs, especially GSTP1-1, is considered a potential therapeutic strategy for treating cancer and diseases linked to abnormal cell proliferation. Their role in cancer cell growth, differentiation, and resistance to anticancer agents makes them promising targets for drug development, offering prospects for the future.

Obesity is a global health challenge marked by substantial inter-individual differences in responses to dietary and lifestyle interventions. Traditional weight loss strategies often overlook critical biological variations in genetics, metabolic profiles, and gut microbiota composition, contributing to poor adherence and variable outcomes. Our primary aim is to identify key biological and behavioral effectors relevant to precision medicine for weight control, with a particular focus on nutrition, while also discussing their current and potential integration into digital health platforms. Thus, this review aligns more closely with the identification of influential factors within precision medicine (e.g., genetic, metabolic, and microbiome factors) but also explores how these factors are currently integrated into digital health tools. We synthesize recent advances in nutrigenomics, nutritional metabolomics, and microbiome-informed nutrition, highlighting how tailored dietary strategies-such as high-protein, low-glycemic, polyphenol-enriched, and fiber-based diets-can be aligned with specific genetic variants (e.g., FTO and MC4R), metabolic phenotypes (e.g., insulin resistance), and gut microbiota profiles (e.g., Akkermansia muciniphila abundance, SCFA production). In parallel, digital health tools-including mobile health applications, wearable devices, and AI-supported platforms-enhance self-monitoring, adherence, and dynamic feedback in real-world settings. Mechanistic pathways such as gut-brain axis regulation, microbial fermentation, gene-diet interactions, and anti-inflammatory responses are explored to explain inter-individual differences in dietary outcomes. However, challenges such as cost, accessibility, and patient motivation remain and should be addressed to ensure the effective implementation of these integrated strategies in real-world settings. Collectively, these insights underscore the pivotal role of precision nutrition as a cornerstone for personalized, scalable, and sustainable obesity interventions.

This study investigated the effect of different prenatal nutrition approaches in 126 pregnant Nellore cows on reproductive and nutrigenetic traits of the male offspring during the finishing phase. For that purpose, three nutritional treatments were used in these cows during pregnancy: PP - protein-energy supplementation in the final third, FP - protein-energy supplementation during the entire pregnancy, and NP - (control) only mineral supplementation. The male progeny (63 bulls; 665 ± 28 days of age) were evaluated for scrotal circumference, seminal traits, number of Sertoli cells and testicular area. We performed a genomic association (700 K SNPs) for scrotal circumference at this age. In addition, a functional enrichment was performed in search of significant metabolic pathways (P < 0.05) with inclusion of genes that are expressed in these genomic windows by the MetaCore software. With the exception of major sperm defects (P < 0.1), the other phenotypes showed no difference between prenatal treatments. We found genes and metabolic pathways (P < 0.05) that are associated with genomic windows (genetic variance explained >1%) in different treatments. These molecular findings indicate that there is genotype-environment interaction among the different prenatal treatments and that the FP treatment showed greater major sperm defects compared to the NP treatment.

Genetic predisposition increases the risk of gout, while walking activity may reduce it. We evaluated whether genetic predisposition modifies the association between walking activity and gout risk.

The impact of genetics on physiology and sports performance is one of the most debated research aspects in sports sciences. Nearly 200 genetic polymorphisms have been found to influence sports performance traits, and over 20 polymorphisms may condition the status of the elite athlete. However, with the current evidence, it is certainly too early a stage to determine how to use genotyping as a tool for predicting exercise/sports performance or improving current methods of training. Research on this topic presents methodological limitations such as the lack of measurement of valid exercise performance phenotypes that make the study results difficult to interpret. Additionally, many studies present an insufficient cohort of athletes, or their classification as elite is dubious, which may introduce expectancy effects. Finally, the assessment of a progressively higher number of polymorphisms in the studies and the introduction of new analysis tools, such as the total genotype score (TGS) and genome-wide association studies (GWAS), have produced a considerable advance in the power of the analyses and a change from the study of single variants to determine pathways and systems associated with performance. The purpose of the present study was to comprehensively review evidence on the impact of genetics on endurance- and power-based exercise performance to clearly determine the potential utility of genotyping for detecting sports talent, enhancing training, or preventing exercise-related injuries, and to present an overview of recent research that has attempted to correct the methodological issues found in previous investigations.

Based on review and critical analysis of the literature regarding the contents and physiological effects of coffee related to physical and cognitive performance conducted by experts in the field and selected members of the International Society of Sports Nutrition (ISSN), the following conclusions represent the official Position of the Society:(1) Coffee is a complex matrix of hundreds of compounds. These are consumed with broad variability based upon serving size, bean type (e.g. common Arabica vs. Robusta), and brew method (water temperature, roasting method, grind size, time, and equipment).(2) Coffee's constituents, including but not limited to caffeine, have neuromuscular, antioxidant, endocrine, cognitive, and metabolic (e.g. glucose disposal and vasodilation) effects that impact exercise performance and recovery.(3) Coffee's physiologic effects are influenced by dose, timing, habituation to a small degree (to coffee or caffeine), nutrigenetics, and potentially by gut microbiota differences, sex, and training status.(4) Coffee and/or its components improve performance across a temporal range of activities from reaction time, through brief power exercises, and into the aerobic time frame in most but not all studies. These broad and varied effects have been demonstrated in men (mostly) and in women, with effects that can differ from caffeine ingestion, per se. More research is needed.(5) Optimal dosing and timing are approximately two to four cups (approximately 473-946 ml or 16-32 oz.) of typical hot-brewed or reconstituted instant coffee (depending on individual sensitivity and body size), providing a caffeine equivalent of 3-6 mg/kg (among other components such as chlorogenic acids at approximately 100-400 mg per cup) 60 min prior to exercise.(6) Coffee has a history of controversy regarding side effects but is generally considered safe and beneficial for healthy, exercising individuals in the dose range above.(7) Coffee can serve as a vehicle for other dietary supplements, and it can interact with nutrients in other foods.(8) A dearth of literature exists examining coffee-specific ergogenic and recovery effects, as well as variability in the operational definition of "coffee," making conclusions more challenging than when examining caffeine in its many other forms of delivery (capsules, energy drinks, "pre-workout" powders, gum, etc.).

Graphical abstract [Formula: see text] Role of precision nutrition in improving military performance.

Challenges to the accurate and precise measurement of testosterone include deficiencies in standardization, variable reference ranges, expenses related to gold standard equipment, and other challenges. Total testosterone remains the most accessible for standard laboratories, while free testosterone and bioavailable testosterone may be useful adjuncts, particularly in men with low borderline testosterone values. Mass spectrometry is the gold standard measurement modality for total testosterone, while equilibrium dialysis followed by direct assessment with a trusted method is the gold standard technique for measuring free testosterone. Although reference ranges may vary, efforts to adapt reference ranges to different populations include age-adjusted values.

Testosterone deficiency, or male hypogonadism, is a clinical syndrome that can be defined as persistently low serum testosterone levels in the setting of symptoms consistent with testosterone deficiency. Studies suggest that testosterone replacement therapy may improve sexual function, depressive symptoms, bone density, and lean body mass. Evidence is conflicting regarding its effect on cardiovascular events and mortality. Although prior studies suggested that testosterone replacement therapy increased the risk of cardiovascular disease, a large, randomized trial showed that it does not increase the risk of myocardial infarction or stroke, even in patients at high risk. After a detailed discussion of the potential benefits and risks through shared decision-making, testosterone replacement therapy should be considered for men with testosterone deficiency to correct selected symptoms and induce and maintain secondary sex characteristics. Treatment method should take into consideration patient preference, pharmacokinetics, potential for medication interactions, formulation-specific adverse effects, treatment burden, and cost. Clinicians should monitor men receiving testosterone replacement therapy for symptom improvement, potential adverse effects, and adherence. Serum testosterone, hematocrit, and prostate-specific antigen levels should be measured at baseline and at least annually in men 40 years or older receiving testosterone replacement therapy. (Am Fam Physician. 2024;109(6):543-549.

To compare the effects of semaglutide and testosterone replacement therapy (TRT) on semen quality and parameters of functional hypogonadism (FH) in men with type 2 diabetes mellitus and obesity.

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are antidiabetic agents that also induce weight loss. Their widespread use has prompted investigation of potential benefits beyond glycemic control, including effects on male sexual and reproductive function. Emerging evidence suggests that they may improve male reproductive parameters, particularly in men with metabolic dysfunction.

Osteoporosis, a disease classically attributed to postmenopausal women, is underappreciated, underdiagnosed, and undertreated in men. However, it is not uncommon for osteoporotic fractures to occur in men. About 40% of fractures occur in men with an incidence that has increased over the years. After a first fracture, the risk of a subsequent episode, as well as the risk of death, is higher in the male than in the female population. Despite these facts, only 10% of men with osteoporosis receive adequate treatment. Up to half of the cases of male osteoporosis have a secondary cause, the most common being hypogonadism, excessive alcohol consumption, and chronic use of glucocorticoids. The International Society for Clinical Densitometry (ISCD) recommends using the female database for the diagnosis of osteoporosis by DXA (T-score ≤ -2.5 in men over 50 years old). In addition, osteoporosis can also be diagnosed independently of the BMD if a fragility fracture is present, or if there is a high risk of fractures by FRAX. Treatment is similar to postmenopausal osteoporosis, because the data regarding changes in bone density track closely to those in women. Data concerning fracture risk reduction are not as certain because the clinical trials have included fewer subjects for shorter period of time. In men with symptomatic hypogonadism, testosterone replacement, if indicated, can improve BMD.

Testosterone treatment in men with hypogonadism improves bone density and quality, but trials with a sufficiently large sample and a sufficiently long duration to determine the effect of testosterone on the incidence of fractures are needed.

Testosterone plays a key role in the maintenance of physical and mental functions in men. Age-related testosterone decline is closely associated with sarcopenia and muscle deterioration, while testosterone decline is linked with the etiology and prevention of diseases such as angina pectoris, arteriosclerosis, obesity, metabolic syndrome, and dementia. Late-onset hypogonadism (LOH) is defined as a disease characterized by age-related testosterone decline and associated clinical symptoms. Testosterone replacement therapy improves health-related QOL in patients with LOH.

There is an age-related decline in male testosterone production. It is therefore surprising that young men are evaluated for testosterone deficiency with the same cutoff of 300 ng/dL that was developed from samples of older men. Our aim is to describe normative total testosterone levels and age-specific cutoffs for low testosterone levels in men 20 to 44 years old.

CrossFit is a high-intensity exercise program that has gained popularity over the past few decades. CrossFit combines movements from Olympic weight lifting, gymnastics, powerlifting, and high-intensity interval training. As CrossFit continues to expand, knowledge of the associated orthopaedic injuries to aid providers in diagnosis, treatment, and prevention will be increasingly important. The most common CrossFit injuries occur in the shoulder (25% of all injuries), spine (14%), and knee (13%). Male athletes are markedly more likely to experience injuries than female athletes, and injuries occur markedly less when there is supervised coaching of the athletes. The most common causes of injury in CrossFit include improper form and exacerbation of a prior injury. The purpose of this article was to review the literature to aid clinicians in identifying and treating common orthopaedic injuries in CrossFit athletes. Understanding the injury patterns, treatment, and prevention options is important for a successful recovery and return to sport.

Based on a comprehensive review and critical analysis of the literature regarding the nutritional concerns of female athletes, conducted by experts in the field and selected members of the International Society of Sports Nutrition (ISSN), the following conclusions represent the official Position of the Society: 1. Female athletes have unique and unpredictable hormone profiles, which influence their physiology and nutritional needs across their lifespan. To understand how perturbations in these hormones affect the individual, we recommend that female athletes of reproductive age should track their hormonal status (natural, hormone driven) against training and recovery to determine their individual patterns and needs and peri and post-menopausal athletes should track against training and recovery metrics to determine the individuals' unique patterns. 2. The primary nutritional consideration for all athletes, and in particular, female athletes, should be achieving adequate energy intake to meet their energy requirements and to achieve an optimal energy availability (EA); with a focus on the timing of meals in relation to exercise to improve training adaptations, performance, and athlete health. 3. Significant sex differences and sex hormone influences on carbohydrate and lipid metabolism are apparent, therefore we recommend first ensuring athletes meet their carbohydrate needs across all phases of the menstrual cycle. Secondly, tailoring carbohydrate intake to hormonal status with an emphasis on greater carbohydrate intake and availability during the active pill weeks of oral contraceptive users and during the luteal phase of the menstrual cycle where there is a greater effect of sex hormone suppression on gluconogenesis output during exercise. 4. Based upon the limited research available, we recommend that pre-menopausal, eumenorrheic, and oral contraceptives using female athletes should aim to consume a source of high-quality protein as close to beginning and/or after completion of exercise as possible to reduce exercise-induced amino acid oxidative losses and initiate muscle protein remodeling and repair at a dose of 0.32-0.38 g·kg-1. For eumenorrheic women, ingestion during the luteal phase should aim for the upper end of the range due to the catabolic actions of progesterone and greater need for amino acids. 5. Close to the beginning and/or after completion of exercise, peri- and post-menopausal athletes should aim for a bolus of high EAA-containing (~10 g) intact protein sources or supplements to overcome anabolic resistance. 6. Daily protein intake should fall within the mid- to upper ranges of current sport nutrition guidelines (1.4-2.2 g·kg-1·day-1) for women at all stages of menstrual function (pre-, peri-, post-menopausal, and contraceptive users) with protein doses evenly distributed, every 3-4 h, across the day. Eumenorrheic athletes in the luteal phase and peri/post-menopausal athletes, regardless of sport, should aim for the upper end of the range. 7. Female sex hormones affect fluid dynamics and electrolyte handling. A greater predisposition to hyponatremia occurs in times of elevated progesterone, and in menopausal women, who are slower to excrete water. Additionally, females have less absolute and relative fluid available to lose via sweating than males, making the physiological consequences of fluid loss more severe, particularly in the luteal phase. 8. Evidence for sex-specific supplementation is lacking due to the paucity of female-specific research and any differential effects in females. Caffeine, iron, and creatine have the most evidence for use in females. Both iron and creatine are highly efficacious for female athletes. Creatine supplementation of 3 to 5 g per day is recommended for the mechanistic support of creatine supplementation with regard to muscle protein kinetics, growth factors, satellite cells, myogenic transcription factors, glycogen and calcium regulation, oxidative stress, and inflammation. Post-menopausal females benefit from bone health, mental health, and skeletal muscle size and function when consuming higher doses of creatine (0.3 g·kg-1·d-1). 9. To foster and promote high-quality research investigations involving female athletes, researchers are first encouraged to stop excluding females unless the primary endpoints are directly influenced by sex-specific mechanisms. In all investigative scenarios, researchers across the globe are encouraged to inquire and report upon more detailed information surrounding the athlete's hormonal status, including menstrual status (days since menses, length of period, duration of cycle, etc.) and/or hormonal contraceptive details and/or menopausal status.

Sleep is vital for the maintenance of physical and mental health, recovery and performance in athletes. Sleep also has a restorative effect on the immune system and the endocrine system. Sleep must be of adequate duration, timing and quality to promote recovery following training and competition. Inadequate sleep adversely impacts carbohydrate metabolism, appetite, energy intake and protein synthesis affecting recovery from the energy demands of daily living and training/competition related fatigue. Sleep's role in overall health and well-being has been established. Athletes have high sleep needs and are particularly vulnerable to sleep difficulties due to high training and competition demands, as such the implementation of the potential nutritional interventions to improve sleep duration and quality is commonplace. The use of certain nutrition strategies and supplements has an evidence base i.e. carbohydrate, caffeine, creatine, kiwifruit, magnesium, meal make-up and timing, protein and tart cherry. However, further research involving both foods and supplements is necessary to clarify the interactions between nutrition and the circadian system as there is potential to improve sleep and recovery. Additional research is necessary to clarify guidelines and develop products and protocols for foods and supplements to benefit athlete health, performance and/or recovery. The purpose of this review is to highlight the potential interaction between sleep and nutrition for athletes and how these interactions might benefit sleep and/or recovery.

Facing pressure to train for victory, warfighters and athletes encounter numerous health risks that are directly related to their regular physical training. The concept of universal training precautions (UTPs) signifies universal processes designed to prevent unnecessary bodily harm, including injury, illness, and death, during physical training programs. Although no formal guidelines exist for collectively implementing a defined set of UTPs to address a broad scope of exercise-related health risks, recommendations and guidelines have been published relating to preventing sudden death during high school sports and collegiate conditioning sessions. A long list of critical topics must be considered as UTPs, including physical fitness factors, transition-period accommodation, hydration, environmental factors and acclimatization, appropriate recovery, use of medications and dietary supplements, and importantly, leadership. In this article, we outline in detail, with corresponding Strength of Recommendation Taxonomy ratings, what should be considered universal recommendations to minimize the risk of warfighters and athletes coming to harm when participating in group physical activities.

Elite athletes and coaches believe sleep is the most important recovery strategy and widely consider it critical to optimal performance. Despite this perceived importance, there are numerous circumstances that can reduce sleep quantity and quality in athletic populations. Because of the effects of sleep loss on various physical, neurophysiological, and cognitive parameters, such perturbations can have consequences for performance and recovery outcomes. Although peer-reviewed literature examining the interaction between sleep, performance, and recovery in athletes is increasing, understanding of these issues remains equivocal. Perhaps most pertinently, the effect of sleep on sport performance does not align with a one-size-fits-all approach and rather depends on numerous factors such as type of sport, scheduling, time of the season, and the intraindividual requirements for sleep. The relationship between brain plasticity and memory, which in turn can influence learning processes and long-term memory consolidation, suggests that sleep may play an important role in learning new skills and tactics for both elite and developing athletes. The aim of this special issue review was to analyze the evidence of sleep loss on sport performance and recovery, with a specific focus on elite athletes. An assessment of these sleep-compromising situations that elite athletes may face during a typical season and practical considerations for alleviating these issues is also provided to further the understanding for medical professionals, scientists, and applied sporting practitioners alike.

Stretching has wide appeal, but there seems to exist some mismatch between its purported applications and what the evidence shows. There is compelling evidence for some stretching applications, but for others, the evidence seems heterogeneous or unsupportive. The discrepancies even affect some systematic reviews, possibly due to heterogeneous eligibility criteria and search strategies. This consensus paper seeks to unify the divergent findings on stretching and its implications for both athletic performance and clinical practices by delivering evidence-based recommendations.

Carbohydrate (CHO) supplements such as bars, gels, drinks and powders have become ubiquitous as effective evidence-based CHO sources that improve endurance exercise performance. However, athletes are increasingly turning to more cost-effective 'food-first' approaches for CHO ingestion to improve exercise performance. Mixed CHO foods including cooked lentils, oats, honey, raisins, rice, and potatoes are all effective pre-exercise CHO food sources. Caution is advised when selecting some of these foods as a primary CHO source, as some athletes may be prone to gastrointestinal discomfort-especially regarding those foods where the quantities required for recommended CHO intake may be voluminous (e.g., potatoes). Palatability may be another barrier to the ingestion of some of these CHO-rich foods. Although most of these CHO-rich foods appear effective for exercise performance or recovery when consumed pre- and post-exercise, not all are viable to ingest during exercise due to difficulties in the quantities required, transport, and/or gastrointestinal discomfort. Raisins, bananas and honey may be particularly useful CHO foods for consumption during exercise, as they are easily transportable. Athletes should trial CHO food sources before, during and/or following training before implementation during competition.

The purpose of this narrative review is to provide an evidence-based update on the protein needs of endurance athletes with a focus on high-quality metabolic studies conducted on the topics of recovery and training adaptation over the past decade. We use the term 'protein needs' to delineate between the concepts of a daily protein requirement and per meal protein recommendations when devising scientific evidence-based protein guidelines for the endurance athlete to promote post-exercise recovery, enhance the adaptive response to endurance training and improve endurance performance. A habitual protein intake of 1.5 g/kg of body mass (BM)-1·day-1 is typical in male and female endurance athletes. Based on findings from a series of contemporary protein requirement studies, the evidence suggests a daily protein intake of ~ 1.8 g·kgBM-1·day-1 should be advocated for endurance athletes, with the caveat that the protein requirement may be further elevated in excess of 2.0 g·kgBM-1·day-1 during periods of carbohydrate-restricted training and on rest days. Regarding protein recommendations, the current lack of metabolic studies that determine the dose response of muscle protein synthesis to protein ingestion in relation to endurance exercise makes it difficult to present definitive guidelines on optimal per meal protein intakes for endurance athletes. Moreover, there remains no compelling evidence that co-ingesting protein with carbohydrate before or during endurance exercise confers any performance advantage, nor facilitates the resynthesis of liver or muscle glycogen stores during recovery, at least when carbohydrate recommendations are met. However, recent evidence suggests a role for protein nutrition in optimising the adaptive metabolic response to endurance training under conditions of low carbohydrate and/or energy availability that represent increasingly popular periodised strategies for endurance athletes.

We conducted a systematic review and network meta-analysis to compare the efficacy and safety of s.c. administered tirzepatide vs s.c. administered semaglutide for adults of both sexes with type 2 diabetes mellitus.

Tirzepatide, a glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist, promoted significant body weight reduction in the phase 3 clinical trials. We conducted a preclinical study and a phase 1 clinical trial (NCT04081337) to understand potential mechanisms mediating tirzepatide-induced weight loss in mice and people with obesity. In calorie-restricted, obese mice, chronic treatment with tirzepatide reduced the drop in energy expenditure that occurred in vehicle-treated and pair-fed mice, indicating that tirzepatide attenuated metabolic adaptation. Respiratory exchange ratio also decreased in tirzepatide-treated mice, indicating increased fat oxidation. In the clinical trial, tirzepatide appeared to have no impact on metabolic adaptation but led to increased fat oxidation and reductions in appetite and calorie intake during an ad libitum test meal (vs. placebo). This is the first study to provide insights into the mechanisms of action of tirzepatide on weight loss with respect to calorie intake, energy expenditure, and macronutrient utilization.

Semaglutide, a glucagon-like peptide-1 receptor agonist, is associated with significant weight loss, yet its impact on lean body mass remains insufficiently understood. This review investigates the effect of semaglutide on lean mass in the context of obesity management.

Although tirzepatide and semaglutide were shown to reduce weight in randomized clinical trials, data from head-to-head comparisons in populations with overweight or obesity are not yet available.

This indirect treatment comparison (ITC) compared the efficacy and safety of tirzepatide with semaglutide for managing obesity or overweight in participants with type 2 diabetes (T2D), informed by the pivotal trials SURMOUNT-2 and STEP 2.

Semaglutide, liraglutide and tirzepatide are glucagon-like peptide-1 (GLP-1) receptor agonists that are effective for weight reduction. Recent reports of patients experiencing suicidal thoughts and other psychiatric adverse events while using GLP-1 agonists have raised concerns about the potential risk of self-harm and led the European Medicines Agency to investigate these medications.

Tirzepatide and semaglutide are highly effective medications for obesity management. The efficacy and safety of tirzepatide as compared with semaglutide in adults with obesity but without type 2 diabetes is unknown.

Heart failure with preserved ejection fraction (HFpEF) is a major cause of hospitalization, often occurring in patients with cardiometabolic comorbidities such as obesity and type 2 diabetes. Although early trials of semaglutide and tirzepatide have shown promising results in improving symptoms, those findings were based on few clinical events, leaving treatment recommendations uncertain.