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Sakuko Ishizaki, Takako Koshimizu, Kae Yanagisawa, Yoshiko Akiyama, Yuko Mekada, Nobuhiro Shiozawa, Noriko Takahaski, Jun Yamakawa and Yukari Kawano

This study was to assess the effect of a fixed dietary intake on biomarkers of red blood cell (RBC) biosynthesis and degradation. Over a two-year period, eight collegiate rhythmic gymnasts participated in this study. During the first year, they ate self-selected diets. During the second year, a fixed dietary intake involving consumption of common Japanese foods containing 15 mg iron and 1500 kcal energy was maintained for 4 wk at the beginning of the program. Fixed dietary intakes resulted in significantly increased intakes of protein, minerals and vitamins, and significantly decreased fat intake, but total energy and carbohydrate intakes were unchanged. Mean values of RBC, Hb, Ht, or TIBC were not affected by the intervention. A fixed dietary intervention appeared to enhance RBC turnover by increasing the capacity for erythrocyte biosynthesis and degradation, although the prevalence of iron-deficiency anemia remained unchanged.

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Nenad Ponorac, Mira Popović, Dea Karaba-Jakovljević, Zorislava Bajić, Aaron Scanlan, Emilija Stojanović and Dragan Radovanović

Impaired iron status has been associated with typical symptoms, such as fatigue, lethargy, and negative mood states (Stage 1), and in more severe cases (e.g., iron-deficient erythropoiesis [IDE], iron deficiency anemia [IDA]), it compromises exercise capacity ( Sim et al., 2019 ). Although

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Göran Landahl, Peter Adolfsson, Mats Börjesson, Clas Mannheimer and Stig Rödjer

The objective of the study was to determine the prevalence of iron deficiency and iron deficiency anemia among elite women soccer players. Hemoglobin, serum iron, serum total iron binding capacity, and ferritin were determined in 28 female soccer players called up for the national team. Of the investigated female soccer players, 57% had iron deficiency and 29% iron deficiency anemia 6 months before the FIFA Women’s World Cup. It is concluded that iron deficiency and iron deficiency anemia is common in female soccer players at the top international level. Some might suffer from relative anemia and measurement of hemoglobin alone is not sufficient to reveal relative anemia. Regular monitoring of hemoglobin concentration and iron status is necessary to institute iron supplementation when indicated.

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Laura A. Garvican, Louisa Lobigs, Richard Telford, Kieran Fallon and Christopher J. Gore

Haemoglobin mass in a female endurance athlete was measured via carbon monoxide rebreathing upon diagnosis of iron-deficiency anemia (haemoglobin concentration = 8.8 g/dL, ferritin = 9.9 ng/mL) and regularly during treatment thereafter. Haemoglobin mass increased by 49% in the 2 wk following an intramuscular iron injection and continued to increase with oral iron supplementation for 15 wk. The presented case illustrates that haemoglobin mass is readily responsive to iron supplementation in a severely iron-defcient anemic athlete and that changes can be tracked efficiently using the CO-rebreathing method.

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Michael J. Ashenden, David T. Martin, Geoffrey P. Dobson, Colin Mackintosh and Allan G. Hahn

The aim of this study was to establish whether extremely low serum ferritin values in female athletes were associated with indications of iron deficiency anemia and whether serum ferritin values were influenced by the type of training or participants' body size. Hematological data collected during 6 years at the Australian Institute of Sport were reviewed to quantify changes in serum ferritin concentration associated with training and to establish whether decrements in serum ferritin were associated with any change in hemoglobin concentration, mean corpuscular volume, or mean corpuscular hemoglobin concentration. Mean serum ferritin concentrations of 7.5 μg ⋅ L−1 were not associated with any indication of iron-deficiency anemia. Serum ferritin declined by approximately 25% with the onset of rigorous daily training (p <.01) whether training was predominantly weight-bearing or non-weight-bearing. Rowers had significantly higher ferritin concentrations than basketball players of similar stature (p = .02). We conclude that considerable background information such as the stage of training, specific sport, and previous blood results should be sought when interpreting serum ferritin concentrations in female athletes.

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Thaiz Mattos Sureira, Olga Silverio Amancio and Josefina Aparecida Pellegrini Braga

This study evaluates the relationship between body iron losses and gains in artistic gymnastics female athletes. It shows that despite the low iron intake and exercise-induced hemolysis, iron deficiency or iron-deficiency anemia does not occur, but partial changes in the hematological profile do. The hypothesis that gymnasts’ nutritional behavior contributes to anemia, which may be aggravated by exercise-induced hemolysis, led to this cross-sectional study, conducted with 43 female artistic gymnasts 6–16 yr old. The control group was formed by 40 nontraining girls, paired by age. Hemogram, serum iron, ferritin, soluble transferrin receptor, haptoglobin, total and fractional bilirubin, Type I urine, and parasitologic and occult fecal blood tests were evaluated. The athletes presented mean hematimetric and serum iron values (p = .020) higher than those of the control group. The bilirubin result discarded any hemolytic alteration in both groups. The haptoglobin results were lower in the athlete group (p = .002), confirming the incidence of exercise-induced hemolysis. Both groups presented low iron intake. The results suggest that artistic gymnastics practice leads to exerciseinduced hemolysis and partially changes the hematological profile, although not causing iron deficiency or iron-deficiency anemia, even in the presence of low iron intake.

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Penny Harris Rosenzweig and Stella L. Volpe

Iron plays an important role in thyroid hormone metabolism; thus, iron deficiency anemia may lead to alterations in resting metabolic rate (RMR). Based on this premise, two iron-deficient-anemic female athletes, 18 (A 1) and 21 (A2) years of age, were supplemented with 23 mg/day of elemental iron to assess its effects on iron and thyroid hormone status and RMR at 0, 8, and 16 weeks. Anemia was clinically corrected in both subjects (hemoglobin: Al = 11.0 to 13.0 to 12.6 g/dL and A2 = 11.5 to 13.9 to 12.6 g/dL, 0 to 8 to 16 weeks, respectively). Serum ferritin (SF) concentration also improved in both subjects (Al: 5.0 to 11.0 to 15.0 ng/dL and A2: 5.0 to 16.0 to 20.0 ng/dL; 0 to 8 to 16 weeks, respectively); however, 16 weeks of iron supplementation did not fully replete iron stores. A2 increased dietary iron and ascorbic acid intakes from 8 to 16 weeks, possibly accounting for her higher SF concentrations. RMR and total thyroxine changed over time: Al increased while A2 decreased in these variables. Although clinical correction of iron deficiency anemia occurred after 16 weeks of low-level iron supplementation, RMR and thyroid hormone metabolism were oppositely affected in the two subjects.

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Gal Dubnov and Naama W. Constantini

Iron depletion, with or without anemia, may have a negative effect on physical and mental performance. Even with current recognition of the problem, its incidence among athletes remains high. Most studies describe iron status in endurance athletes. This study examined the prevalence of iron depletion and anemia among male and female top-level basketball players. Adolescents and adults (N = 103) from 8 national basketball teams were screened for anemia and iron stores status, which included a complete blood count and levels of plasma ferritin, transferrin, and serum iron. Iron depletion, defined by a ferritin level below 20 μg/L, was found among 22% of study participants (15% in males vs. 35% in females, p = .019). Anemia was found among 25% of athletes (18% in males vs. 38% in females, p = .028). Iron deficiency anemia, defined by the presence of anemia, ferritin levels below 12 μg/L, and transferrin saturation below 16%, was found among 7% of players (3% in males vs. 14% in females, p = .043). In summary, a high prevalence of iron depletion, anemia, and iron deficiency anemia was found among basketball players of both genders. We recommend screening ballgame players for blood count and iron store status, and providing nutritional counseling and iron supplementation when necessary.

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Xiaoya Ma, Kaitlyn J. Patterson, Kayla M. Gieschen and Peter F. Bodary

The prevalence of iron deficiency tends to be higher in athletic populations, especially among endurancetrained females. Recent studies have provided evidence that the iron-regulating hormone hepcidin is transiently increased with acute exercise and suggest that this may contribute to iron deficiency anemia in athletes. The purpose of this study was to determine whether resting serum hepcidin is significantly elevated in highly trained female distance runners compared with a low exercise control group. Due to the importance of the monocyte in the process of iron recycling, monocyte expression of hepcidin was also measured. A single fasted blood sample was collected midseason from twenty female distance runners averaging 81.9 ± 14.2 km of running per week. Ten age-, gender-, and BMI-matched low-exercise control subjects provided samples during the same period using identical collection procedures. There was no difference between the runners (RUN) and control subjects (CON) for serum hepcidin levels (p = .159). In addition, monocyte hepcidin gene expression was not different between the two groups (p = .635). Furthermore, no relationship between weekly training volume and serum hepcidin concentration was evident among the trained runners. The results suggest that hepcidin is not chronically elevated with sustained training in competitive collegiate runners. This is an important finding because the current clinical conditions that link hepcidin to anemia include a sustained elevation in serum hepcidin. Nevertheless, additional studies are needed to determine the clinical relevance of the well-documented, transient rise in hepcidin that follows acute sessions of exercise.

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Kathryn L. Beck, Sarah Mitchell, Andrew Foskett, Cathryn A Conlon and Pamela R. Von Hurst

Ballet dancing is a multifaceted activity requiring muscular power, strength, endurance, flexibility, and agility; necessitating demanding training schedules. Furthermore dancers may be under aesthetic pressure to maintain a lean physique, and adolescent dancers require extra nutrients for growth and development. This cross-sectional study investigated the nutritional status of 47 female adolescent ballet dancers (13–18 years) living in Auckland, New Zealand. Participants who danced at least 1 hr per day 5 days per week completed a 4-day estimated food record, anthropometric measurements (Dual-energy X-ray Absorptiometry) and hematological analysis (iron and vitamin D). Mean BMI was 19.7 ± 2.4kg/m2 and percentage body fat, 23.5 ± 4.1%. The majority (89.4%) of dancers had a healthy weight (5th-85th percentile) using BMI-for-age growth charts. Food records showed a mean energy intake of 8097.3 ± 2155.6kJ/day (48.9% carbohydrate, 16.9% protein, 33.8% fat, 14.0% saturated fat). Mean carbohydrate and protein intakes were 4.8 ± 1.4 and 1.6 ± 0.5g/kg/day respectively. Over half (54.8%) of dancers consumed less than 5g carbohydrate/kg/day, and 10 (23.8%) less than 1.2 g protein/kg/day. Over 60% consumed less than the estimated average requirement for calcium, folate, magnesium and selenium. Thirteen (28.3%) dancers had suboptimal iron status (serum ferritin (SF) <20μg/L). Of these, four had iron deficiency (SF < 12μg/L, hemoglobin (Hb) ≥ 120g/L) and one iron deficiency anemia (SF < 12μg/L, Hb < 120g/L). Mean serum 25-hydroxy vitamin D was 75.1 ± 18.6nmol/L, 41 (91.1%) had concentrations above 50nmol/L. Female adolescent ballet dancers are at risk for iron deficiency, and possibly inadequate nutrient intakes.