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Hans Braun, Karsten Koehler, Hans Geyer, Jens Kleinert, Joachim Mester and Wilhelm Schänzer

Little is known about the prevalence and motives of supplement use among elite young athletes who compete on national and international levels. Therefore, the current survey was performed to assess information regarding the past and present use of dietary supplements among 164 elite young athletes (16.6 ± 3.0 years of age). A 5-page questionnaire was designed to assess their past and present (last 4 weeks) use of vitamins, minerals, carbohydrate, protein, and fat supplements; sport drinks; and other ergogenic aids. Furthermore, information about motives, sources of advice, supplement sources, and supplement contamination was assessed. Eighty percent of all athletes reported using at least 1 supplement, and the prevalence of use was significantly higher in older athletes (p < .05). Among supplement users, minerals, vitamins, sport drinks, energy drinks, and carbohydrates were most frequently consumed. Only a minority of the athletes declared that they used protein/amino acids, creatine, or other ergogenic aids. Major motives for supplement use were health related, whereas performance enhancement and recommendations by others were less frequently reported. Supplements were mainly obtained from parents or by athletes themselves and were mostly purchased in pharmacies, supermarkets, and health-food stores. Among all athletes, only 36% were aware of the problem of supplement contamination. The survey shows that supplement use is common and widespread among German elite young athletes. This stands in strong contrast to recommendations by leading sport organizations against supplement use by underage athletes.

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Jeffery Sobal and Leonard F. Marquart

Vitamin/mineral supplements are often used by athletes as ergogenic aids to improve performance. This paper reviews studies of the prevalence, patterns, and explanations for vitamin/mineral supplement use among athletes. Fifty-one studies provided quantitative prevalence data on 10,274 male and female athletes at several levels of athletic participation in over 15 sports. The overall mean prevalence of athletes’ supplement use was 46%. Most studies reported that over half of the athletes used supplements (range 6% to 100%), and the larger investigations found lower prevalence levels. Elite athletes used supplements more than college or high school athletes. Women used supplements more often than men. Varying patterns existed by sport. Athletes appear to use supplements more than the general population, and some take high doses that may lead to nutritional problems. Sport nutritionists should include a vitamin/mineral supplement history as part of their dietary assessment so they can educate athletes about vitamin/mineral supplements and athletic performance.

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Robert E. Keith, Michael H. Stone, Ralph E. Carson, Robert G. Lefavi and Steven J. Fleck

Fourteen trained male anabolic steroid-using bodybuilders (SBBs) (19-41 years) were recruited for the study. Three-day diet records were obtained from SBBs and analyzed. A resting venous blood sample was drawn, and serum/ plasma was subsequently analyzed for various nutritionally related factors. Results showed that mean dietary energy (4,469 ± 1,406 kcal), protein (252 ± 109 g), and vitamin and mineral intakes of SBBs greatly exceeded U.S. Recommended Dietary Allowances. Dietary cholesterol intake was 2.8 times the recommended levels. Mean serum/plasma nutrient concentrations of SBBs were within normal range. However, individual SBBs had a number of serum/ plasma values outside of the normal or recommended range, the most notable of which was hypercalcemia, which was present in 42% of SBBs. Serum/plasma lipids were such as to increase the risk of cardiovascular disease in these subjects.

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Laurel M. Wentz, Pei-Yang Liu, Jasminka Z. Ilich and Emily M. Haymes

Background:

High rates of vitamin D deficiency have been reported in athletes. The purpose of this study was to evaluate the associations between vitamin D with bone health and parathyroid hormone (PTH) concentrations in female runners who trained at 30.4° degrees north.

Methods:

Serum 25-hydroxyvitamin D (25(OH) D), PTH, body composition, and bone mineral density (BMD) were measured in 59 female runners, aged 18–40 years. Stress fracture history, training duration and frequency were evaluated by questionnaire. As per National Endocrine Society cut-offs, serum vitamin D ranges were: 25(OH)D < 50 nmol/L for deficient; 50–75 nmol/L for insufficient; and ≥ 75 nmol/L for sufficient status.

Results:

Mean serum 25(OH)D concentrations were 122.6 ± 63.9 nmol/L, with 18.6% of subjects in the deficient (5.1%) or insufficient (13.5%) range. No significant differences were observed between sufficient and deficient/insufficient subjects for BMD, PTH, history of stress fractures, or demographic data.

Conclusions:

The majority of distance runners maintained sufficient vitamin D status, suggesting that training outdoors in latitude where vitamin D synthesis occurs year-round reduces the risk for vitamin D deficiency. Data do not support the indiscriminate supplementation of outdoor athletes in southern latitudes without prior screening.

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Jenna E. Heller, Joi J. Thomas, Bruce W. Hollis and D. Enette Larson-Meyer

Excess body fat or obesity is known to increase risk of poor vitamin D status in nonathletes but it is not known if this is the case in athletes. Furthermore, the reason for this association is not understood, but is thought to be due to either sequestration of the fat-soluble vitamin within adipose tissue or the effect of volume dilution related to obese individuals’ larger body size. Forty two US college athletes (24 men 18 women, 20.7 ± 1.6 years, 85.0 ± 28.7 kg, BMI = 25.7 ± 6.1 kg/m2) provided blood samples during the fall and underwent measurement of body composition via dual energy X-ray absorptiometry. Serum samples were evaluated for 25-hydroxyvitamin D (25(OH)D) concentration to assess vitamin D status using Diasorin 25(OH)D radioiodine assay. Serum 25(OH)D concentration was negatively associated with height (r = -0.45), total body mass (r = -0.57), BMI (r = -0.57), body fat percentage (r = -0.45), fat mass (r = -0.60) and fat-free mass (r = -0.51) (p < .05). These associations did not change after controlling for sex. In a linear regression mixed model, fat mass (coefficient -0.47, p = .01), but not fat-free mass (coefficient -0.18, p = .32) significantly predicted vitamin D status and explained approximately 36% of the variation in serum 25(OH)D concentration. These results suggest that athletes with a large body size and/or excess adiposity may be at higher risk for vitamin D insufficiency and deficiency. In addition, the significant association between serum 25(OH)D concentration and fat mass in the mixed model, which remained after controlling for sex, is in support of vitamin D sequestration rather than volume dilution as an explanation for such association.

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Chad J. Krumbach, Dave R. Ellis and Judy A. Driskell

The influences of gender, ethnicity, and sport of varsity athletes on their vitamin/mineral supplementation habits were examined. Subjects included 145 females and 266 males from 22 varsity teams; 80% were Caucasian; 12% African American; and 8% Combined-Other. Over half of the subjects took supplements. Males were more likely than females to give "too expensive" as a reason for not taking supplements, and "improve athletic performance" and "build muscle" as reasons for taking supplements. The most common supplement was multivitamins plus minerals. Females were more likely to take calcium and iron, and males vitamins B 12 and A. African Americans were the most likely to take vitamin A. Males were more likely to get supplement information from nutritionists/dietitians and self, and females from family members or friends and physicians or pharmacists. Football players were more likely to get supplement information from nutritionists/dietitians, and males in other sports from coaches/trainers. There were some differences in vitamin/mineral supplement habits of the athletes by gender, ethnicity, and sport.

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Regina M. Lewis, Maja Redzic and D. Travis Thomas

The purpose of this 6-month randomized, placebo-controlled trial was to determine the effect of season-long (September–March) vitamin D supplementation on changes in vitamin D status, which is measured as 25(OH) D, body composition, inflammation, and frequency of illness and injury. Forty-five male and female athletes were randomized to 4,000 IU vitamin D (n = 23) or placebo (n = 22). Bone turnover markers (NTx and BSAP), 25(OH)D, and inflammatory cytokines (TNF-alpha, IL-6, and IL1-β) were measured at baseline, midpoint, and endpoint. Body composition was assessed by DXA and injury and illness data were collected. All athletes had sufficient 25(OH)D (> 32 ng/ml) at baseline (mean: 57 ng/ml). At midpoint and endpoint, 13% and 16% of the total sample had 25(OH)D < 32 ng/ml, respectively. 25(OH)D was not positively correlated with bone mineral density (BMD) in the total body, proximal dual femur, or lumbar spine. In men, total body (p = .04) and trunk (p = .04) mineral-free lean mass (MFL) were positively correlated with 25(OH)D. In women, right femoral neck BMD (p = .02) was positively correlated with 25(OH)D. 25(OH)D did not correlate with changes in bone turnover markers or inflammatory cytokines. Illness (n = 1) and injury (n = 13) were not related to 25(OH)D; however, 77% of injuries coincided with decreases in 25(OH)D. Our data suggests that 4,000 IU vitamin D supplementation is an inexpensive intervention that effectively increased 25(OH)D, which was positively correlated to bone measures in the proximal dual femur and MFL. Future studies with larger sample sizes and improved supplement compliance are needed to expand our understanding of the effects of vitamin D supplementation in athletes.

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Richard D. Telford, Edward A. Catchpole, Vicki Deakin, Allan G. Hahn and Ashley W. Plank

The effect of vitamin and mineral supplementation was studied over 7 to 8 months of training and competition in 82 athletes from four sports: basketball, gymnastics, rowing, and swimming. Matched subgroups were formed and a double-blind design used, with subgroups being given either the supplementation or a placebo. All athletes were monitored to ensure that the recommended daily intakes (RDI) of vitamins and minerals were provided by diet alone. Sport-specific and some common tests of strength as well as aerobic and anaerobic fitness were performed. Coaches' assessment of improvement was also obtained. The only significant effect of supplementation was observed in the female basketball players, in which the supplementation was associated with increased body weight, skinfold sum, and jumping ability. A significant increase in skinfold sum was also demonstrated over the whole group as a result of supplementation. In general, however, this study provided little evidence of any effect of supplementation to athletic performance for athletes consuming the dietary RDIs.

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Evelien Backx, Cindy van der Avoort, Michael Tieland, Kamiel Maase, Arie Kies, Luc van Loon, Lisette de Groot and Marco Mensink

Studies monitoring vitamin D status in athletes are seldom conducted for a period of 12 months or longer, thereby lacking insight into seasonal fluctuations. The objective of the current study was to identify seasonal changes in total 25-hydroxyvitamin D (25(OH)D) concentration throughout the year. Fifty-two, mainly Caucasian athletes with a sufficient 25(OH)D concentration (>75 nmol/L) in June were included in this study. Serum 25(OH)D concentration was measured every three months (June, September, December, March, June). In addition, vitamin D intake and sun exposure were assessed by questionnaires at the same time points. Highest total 25(OH)D concentrations were found at the end of summer (113 ± 26 nmol/L), whereas lowest concentrations were observed at the end of winter (78 ± 30 nmol/L). Although all athletes had a sufficient 25(OH)D concentration at the start of the study, nearly 20% of the athletes were deficient (<50 nmol/L) in late winter.

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Terry L. Bazzarre, Susan M. Kleiner and Barbara E. Ainsworth

This research compared nutrient intake data with blood lipids and anthropometric data. Height, weight, and seven skinfolds were collected 3 days prior to competition at the official weigh-in. The lipids measured were total cholesterol (TC), HDL-cholesterol (HDL-C), and the HDL2 and HDL3 cholesterol subfractions. The subjects were 17 males and 17 females. Descriptive data are presented as means and standard deviations of the means. Protein, fat, and carbohydrate provided about 40, 12, and 48%, respectively, of total energy intake; vitamin C was >200 mgfday. Only dietary fat was significantly (p < 0.05) associated with TC for females. Fiber was significantly associated with HDL-C and HDL2-C for males and with HDL-C for females. Vitamin C was significantly associated with HDL-C, HDL2-C, and HDL3-C for males, and with HDL-C and HDL3-C for females. These findings are consistent with those reported by Bazzarre et al. in farmers and suggest that vitamin C may favorably influence HDL-C metabolism.