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1.
Nutrients ; 16(2)2024 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-38257108

RESUMO

Vitamin D, calcium, and iron are micronutrients crucial for bone health. However, their effect has been studied primarily in the cortical bone, with vitamin D status being assessed mainly from the total 25(OH)D serum fraction. The study aimed to investigate the impact of vitamin D (total and free fraction) and iron status (i.e., serum ferritin or soluble transferrin receptor) and calcium intake (ADOS-Ca questionnaire) on lumbar cortical and trabecular bone. In a cohort of 113 male subjects (76 athletes, 37 non-athletes) aged 15-19, the lumbar spine status (Z-score, bone mineral apparent density (BMAD), and trabecular bone score (TBS)) was determined using dual-energy X-ray absorptiometry (DXA). Relationships between the examined micronutrients and bone health parameters were observed only in athletes. Free 25(OH)D was significantly (p < 0.001) correlated with Z-score and BMAD, while total 25(OH)D (p < 0.001) and iron status (ferritin, Fe stores; p < 0.01) correlated solely with BMAD. Free 25(OH)D and ferritin concentrations were the best determinants of bone status (R2 = 0.330; p < 0.001) and explained 25% and 7% of the BMAD variance, respectively. No relationships were found between the micronutrients and TBS. The results confirmed the positive influence of vitamin D and iron on cortical, but not trabecular, bone status solely in physically active subjects. In athletes, free 25(OH)D seems to be a superior indicator of bone health to a total 25(OH)D fraction.


Assuntos
Cálcio da Dieta , Vitamina D , Humanos , Masculino , Densidade Óssea , Cálcio , Ferritinas , Ferro , Micronutrientes , Vitaminas , Adolescente , Adulto Jovem
2.
Biol Sport ; 41(1): 295-303, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38188111

RESUMO

HTR1A (5-hydroxytryptamine receptor 1A) and its polymorphic variants are highly important for athletes in different aspects, allowing us to hypothesize their biological influences. Hence, to investigate at least part of the relationship mentioned in the case literature, it was decided to study the association of the selected HTR1A polymorphism with personality traits measured by the Temperament and Character Inventory (TCI). The participants consisted of 250 mixed martial arts (combat sport) athletes and 209 healthy male participants (control group). The personality traits were measured for the Revised Temperament and Character Inventory (TCI-R). Genetic material was isolated from whole blood collected from patients, and then all samples were genotyped using the real-time PCR method. Statistical analysis was performed using a 2 × 3 factorial ANOVA. The research revealed a statistically significant effect of a complex factor of rs6295 of the HTR1A serotonin receptor gene with combat sport/control and with Novelty Seeking (F2,453 = 6.126; p = 0.0024; η2 = 0.026) and Harm Avoidance (F2,453 = 3.709; p = 0.0252; η2 = 0.016). The presence of the HTR1A GG genotype (rs6295) was found to be associated with higher scores in self-management and lower scores in harm avoidance, indicating genetic predispositions in the strength group towards better results in combat sports.

3.
J Hum Kinet ; 89: 89-99, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-38053955

RESUMO

Physical performance has been the focus of studies examining genetic influences in martial arts. There has been little quantitative analysis of the interaction between psychological traits and gene variants in athletes. This study aimed to determine whether the rs4680 polymorphism of the COMT gene (catechol-O-methyltransferase) was linked to other sports phenotypes such as temperament, mental toughness, and stress tolerance. In our study, we concentrated on the case-control analysis of athletes in the aspect of their personality traits in association with the COMT gene polymorphism. Participants comprised 258 combat sports athletes and 278 healthy male individuals as a control group. Psychometric properties were assessed with the Revised Temperament and Character Inventory (TCI-R). COMT polymorphism testing was performed using real-time PCR. We found a statistically significant effect of a complex factor COMT rs4680 genotype with combat athletes/controls and novelty seeking (F2,530 = 5.958, p = 0.0028, η2 = 0.022), self-management (F2,530 = 6.772, p = 0.0012, η2 = 0.025), and with self-transcendence skills (F2,530 = 9.387, p = 0.00009, η2 = 0.034). The results are important for encouraging further studies on the genetic makeup of athletes in conjunction with personality traits. Due to the multigene and multifactorial nature of determinants of sports predispositions, we propose to take into account also other features, especially when studying genes related to cerebral neurotransmission. It is a holistic departure, and it clearly illustrates the relationship between the given characteristics of an athlete.

4.
Biol Sport ; 40(4): 1229-1237, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37867745

RESUMO

The effect of strenuous exercise on sleep patterns in swimmers is equivocal. Therefore, the purpose of the study was to describe possible changes in sleep parameters among elite swimmers subjected to different training loads (TL). Methods: Eighteen elite swimmers (8 females) were monitored across two high-volume preparatory 1-wk periods (P1, P2) and a lower-volume tapering 1-wk period (P3) before a major competition. Internal (the session rating of perceived exertion [sRPE]) and external TL (training duration and volume) were measured, along with several sleep indices (e.g., bedtime, get-up time, sleep time, wake after sleep onset [WASO]). Serum measurements of urea, creatine kinase (CK), testosterone and cortisol were taken before and after training sessions at the beginning (Mondays) and end (Fridays) of each micro cycle. Athlete TL decreased significantly in a stepwise manner from P1 to P2 and from P2 to P3. Of all sleep parameters, only significant differences in bedtime and get-up time emerged (P3 > P1 and/or P2). Sleep duration (~6.3 h) or quality (WASO: 41-45 min) were also unaffected by TL. CK levels declined from P1 to P3 (d = -0.8), and from P2 to P3 (d = -0.6). Positive exercise-induced changes in CK were also seen in each training period. The other biomarkers did not show the same temporal or acute patterns. Irrespective of the TL, the monitored swimmers experienced insufficient and fragmented sleep across this study. Neither sleep quality nor quantity were affected by different magnitudes of TL. Among the biochemical markers of fatigue, baseline plasma CK activity best reflected the physiological response to TL.

5.
PLoS One ; 18(7): e0287330, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37399218

RESUMO

AIM: The trabecular bone score (TBS) is a tool for assessing bone quality and health. Current TBS algorithm corrects for body mass index (BMI), as a proxy of regional tissue thickness. However, this approach fails to consider BMI inaccuracies due to individual differences in body stature, composition and somatotype. This study investigated the relationship between TBS and body size and composition in subjects with a normal BMI, but with large morphological diversity in body fatness and height. METHODS: Young male subjects (n = 97; age 17.2±1.0 years), including ski jumpers (n = 25), volleyball players (n = 48) and non-athletes (controls n = 39), were recruited. The TBS was determined from L1-L4 dual-energy X-ray absorptiometry (DXA) scans using TBSiNsight software. RESULTS: TBS correlated negatively with height and tissue thickness in the L1-L4 area in ski jumpers (r = -0.516 and r = -0.529), volleyball players (r = -0.525 and r = -0.436), and the total group (r = -0.559 and r = -0.463), respectively. Multiple regression analyses revealed that height, L1-L4 soft tissue thickness, fat mass and muscle mass were significant determinants of TBS (R2 = 0.587, p<0.001). L1-L4 soft tissue thickness explained 27% and height 14% of the TBS variance. CONCLUSION: The negative association of TBS and both features suggests that a very low L1-L4 tissue thickness may lead to overestimation of the TBS, while tall stature may have the opposite effect. It seems that the utility of the TBS as a skeletal assessment tool in lean and/or tall young male subjects could be improved if tissues thickness in the lumbar spine area and stature instead of BMI were considered in the algorithm.


Assuntos
Densidade Óssea , Osso Esponjoso , Humanos , Masculino , Adolescente , Osso Esponjoso/diagnóstico por imagem , Densidade Óssea/fisiologia , Absorciometria de Fóton , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/fisiologia , Tamanho Corporal
6.
Res Q Exerc Sport ; 93(4): 795-803, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-34727008

RESUMO

Purpose: Sauna bathing is recommended to improve the sports training process, yet empirical evidence confirming its effectiveness is still inconclusive. We examined the effects of post-exercise sauna bathing on hematological adaptations and exercise capacity in healthy men. Methods: Thirteen physical education students participated in randomized cross-over study: two, 4-week interventions, with 10-week washout. The interventions involved 3 times per week 60-min stationary cycling either with 30-min of post-exercise sauna bathing (89 ± 3°C, 10 ± 2% RH) or without; no fluid was ingested during both exercise and sauna sessions. Before and after both interventions, participants were tested for total hemoglobin mass (tHb-mass), intravascular volumes, erythropoietin, ferritin, red blood cell parameters with reticulocyte fractions, along with maximal/peak and submaximal variables in a graded exercise test (GXT). Results: Regardless of intervention type, tHb-mass increased (p = .014) whereas ferritin concentration decreased (p = .027); however, changes in tHb-mass were within the range of typical error (<1.8%). Absolute and relative values of maximal power and power at gas exchange threshold, as well as peak oxygen uptake (all p < .010), also increased irrespective of intervention type. Conclusions: The use of post-exercise sauna bathing with fluid intake restrictions does not provide any additional benefits in tested variables over endurance training alone. Thus, further evidence is required before recommendations to utilize this post-exercise conditioning strategy are deemed valid.


Assuntos
Adaptação Fisiológica , Fenômenos Fisiológicos Sanguíneos , Exercício Físico , Banho a Vapor , Humanos , Masculino , Estudos Cross-Over , Ferritinas
7.
J Sports Med Phys Fitness ; 61(10): 1423-1428, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34109946

RESUMO

The reliability of dual energy X-ray absorptiometry (DXA) to assess body composition is influenced by factors like hydration status. Hence, any factor affecting total body water (TBW) content, such as menstrual shifts in sex hormones, might influence DXA estimates of lean soft tissue (LST) and fat mass (FM). To address this possibility, interrelationships between menstrual fluctuations in sex hormones, LST and FM were examined in a premenopausal female. The participant was monitored over 40 consecutive days for LST, FM and TBW by bioelectrical impedance. Daily capillary blood samples were taken to track 17ß-estradiol, progesterone, and luteinizing hormone (LH). Using a graphical vector autoregression model, variable interrelationships were tested in a contemporaneous network (same measurement window) and temporal network (next measurement window). In the contemporaneous network, LST was related to TBW (r=0.42) and FM (r=-0.34). The temporal network uncovered directional effects of TBW (r=0.14), FM (r=-0.59) and LST (r=-0.50) on progesterone concentration. Hormonal interrelationships also emerged in the temporal network, whereby LH (r=0.24) and 17ß-estradiol (r=0.13) were related to progesterone, and each hormone was related (r=0.50-0.69) to itself. The menstrual profiling of a premenopausal female revealed interrelationships between body composition and water content, but sex hormone fluctuations did not correlate with TBW, FM and LST on the same day or following day in the hypothesized direction. The temporal between- and within-hormone linkages reflect those natural feedback loops that control hormone secretion.


Assuntos
Composição Corporal , Hormônios Esteroides Gonadais , Absorciometria de Fóton , Impedância Elétrica , Feminino , Humanos , Reprodutibilidade dos Testes
8.
J Funct Morphol Kinesiol ; 6(1)2021 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-33803237

RESUMO

The ability to produce force rapidly has the potential to directly influence sprinting performance through changes in stride length and stride frequency. This ability is commonly referred to as the rate of force development (RFD). For this reason, many elite sprinters follow a combined program consisting of resistance training and sprint training. The purpose of this study was to investigate the strength, endocrine and body composition adaptations that occur during distinct phases of a block periodized training cycle in a 400 m Olympic level sprinter. The athlete is an elite level 400 m male sprinter (age 31 years, body mass: 74 kg, years of training: 15 and Personal Best (PB): 45.65 s). This athlete completed four distinct training phases of a block periodized training program (16 weeks) with five testing sessions consisting of testosterone:cortisol (T/C) profiles, body composition, vertical jump, and maximum strength testing. Large fluctuations in T/C were found following high volume training and the taper. Minor changes in body mass were observed with an abrupt decrease following the taper which coincided with a small increase in fat mass percentage. Jump height (5.7%), concentric impulse (9.4%), eccentric impulse (3.4%) and power ratio (18.7%) all increased substantially from T1 to T5. Relative strength increased 6.04% from T1 to T5. Lastly, our results demonstrate the effectiveness of a competitive taper in increasing physiological markers for performance as well as dynamic performance variables. Block periodization training was effective in raising the physical capabilities of an Olympic level 400 m runner which have been shown to directly transfer to sprinting performance.

9.
Nutrients ; 12(10)2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33050316

RESUMO

Dietary fat subtypes may play an important role in the regulation of muscle mass and function during ageing. The aim of the present study was to determine the impact of isocaloric macronutrient substitutions, including different fat subtypes, on sarcopenia risk in older men and women, while accounting for physical activity (PA) and metabolic risk. A total of 986 participants, aged 65-79 years, completed a 7-day food record and wore an accelerometer for a week. A continuous sex-specific sarcopenia risk score (SRS), including skeletal muscle mass assessed by dual-energy X-ray absorptiometry (DXA) and handgrip strength, was derived. The impact of the isocaloric replacement of saturated fatty acids (SFAs) by either mono- (MUFAs) or poly-unsaturated (PUFAs) fatty acids on SRS was determined using regression analysis based on the whole sample and stratified by adherence to a recommended protein intake (1.1 g/BW). Isocaloric reduction of SFAs for the benefit of PUFAs was associated with a lower SRS in the whole population, and in those with a protein intake below 1.1 g/BW, after accounting for age, smoking habits, metabolic disturbances, and adherence to PA guidelines. The present study highlighted the potential of promoting healthy diets with optimised fat subtype distribution in the prevention of sarcopenia in older adults.


Assuntos
Gorduras Insaturadas na Dieta/administração & dosagem , Ingestão de Alimentos/fisiologia , Ácidos Graxos Insaturados/administração & dosagem , Ácidos Graxos/efeitos adversos , Fenômenos Fisiológicos da Nutrição/fisiologia , Sarcopenia/prevenção & controle , Idoso , Estudos de Coortes , Proteínas Alimentares/administração & dosagem , Exercício Físico , Feminino , Força da Mão , Humanos , Masculino , Recomendações Nutricionais , Risco , Sarcopenia/diagnóstico , Sarcopenia/etiologia , Fatores Sexuais
10.
Nutrients ; 12(9)2020 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-32887460

RESUMO

BACKGROUND: The purpose of this study was to evaluate the traits of orthorexia nervosa (ON) and its relation to body composition and anthropometric indices among elite athletes. METHODS: We studied 273 (125 female, 148 male) competitive athletes. ON was assessed with the self-administered ORTO-15 questionnaire. Total body composition was determined using dual-energy X-ray absorptiometry (DXA). RESULTS: The ORTO-15 score was independent of sex, type of effort or age. The ORTO-15 score was related to: total body mass (TBM) (p = 0.037; R = 0.170), body mass index (BMI) (p = 0.022; R = 0.187), bone mineral content (BMC) (p = 0.035; R = 0.172), lean soft tissue (p = 0.026; R = 0.182) and visceral adipose tissue (VAT) (p = 0.007; R = 0.255) in the male; BMI (p = 0.045; R = 0.412) and BMC (p = 0.012; R = 0.506) in weight-dependent male athletes. There was no relationship between ORTO-15 score and body composition in the total study group and subgroup of female athletes. In female athletes, ON tendencies were related to the weekly training time (p = 0.039), but in sprint and high-intensity intermittent efforts subgroup exclusively. CONCLUSIONS: Factors related to ON tendencies concerned exclusively BMI and body composition in male, and the weekly training time in female athletes. The results from this study demonstrate that a significant percentage of athletes, irrespective of sex, age, type of sport or hours of training per week, may manifest traits of orthorexia nervosa.


Assuntos
Antropometria/métodos , Atletas , Composição Corporal , Absorciometria de Fóton/métodos , Adolescente , Adulto , Índice de Massa Corporal , Peso Corporal , Densidade Óssea , Feminino , Humanos , Masculino , Esportes , Inquéritos e Questionários , Adulto Jovem
11.
Nutrients ; 11(11)2019 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-31739525

RESUMO

In athletes, no reliable indices exist for an unambiguous evaluation of hematological and iron status. Therefore, the utility of some new red blood cell (RBC) parameters was explored in 931 elite male athletes aged 13-35 years. To diagnose iron status, the values of ferritin and soluble transferrin receptor (sTfR), total iron binding capacity (TIBC), and basic blood morphology were determined in blood. The new hematological markers included among others: mean cellular hemoglobin content in reticulocytes (CHr), percentage of erythrocytes (HYPOm) and reticulocytes (HYPOr) with decreased cellular hemoglobin concentration, percentage of erythrocytes (LowCHm) and reticulocytes (LowCHr) with decreased cellular hemoglobin content, mean volume of reticulocytes (MCVr), and percentage of erythrocytes with decreased volume (MICROm). Despite adverse changes in reticulocyte hypochromia indices (CHr, LowCHr, HYPOr; p < 0.001) in the iron depletion state, the area under the receiver operating characteristic curve (AUC-ROC) values calculated for them were relatively low (0.539-0.722). In iron-deficient erythropoiesis (IDE), unfavorable changes additionally concern microcythemia indices in both reticulocytes and erythrocytes (MCVr, MCV, MICROm, and red cell volume distribution width-RDW), with especially high values of AUC-ROC (0.947-0.970) for LowCHm, LowCHr, and CHr. Dilutional sports anemia was observed in 6.1% of athletes. In this subgroup, only hemoglobin concentration (Hb), hematocrit (Hct), and RBC (all dependent on blood volume) were significantly lower than in the normal group. In conclusion, the diagnostic utility of the new hematology indices was not satisfactory for the detection of an iron depletion state in athletes. However, these new indices present high accuracy in the detection of IDE and sports anemia conditions.


Assuntos
Anemia Ferropriva/sangue , Desempenho Atlético , Eritrócitos/metabolismo , Hematologia/métodos , Hemoglobinas/metabolismo , Ferro/sangue , Reticulócitos/metabolismo , Adolescente , Adulto , Anemia , Área Sob a Curva , Atletas , Biomarcadores/sangue , Aptidão Cardiorrespiratória , Índices de Eritrócitos , Eritropoese , Ferritinas/sangue , Hematócrito , Humanos , Masculino , Estado Nutricional , Curva ROC , Receptores da Transferrina , Medicina Esportiva , Adulto Jovem
12.
Biol Sport ; 36(4): 341-349, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31938005

RESUMO

The benefits of altitude/hypoxic training for sea level performance are still under debate. This study examined the effects of low altitude training supported by normobaric hypoxia on hematological status and endurance performance predictors in elite female cyclists. Twenty-two female cyclists trained for 3 weeks at low altitude (<1100 m) and 2 weeks near sea level. During the first 3 weeks, 15 subjects stayed in hypoxic rooms simulating an altitude of 2200 m (+NH group, n = 8) or 1000 m (placebo group, n = 7), and 7 (control group) stayed in regular rooms. Significant increases in total hemoglobin mass (tHb-mass: p = 0.008, p = 0.025), power at 4 mmol·l-1 lactate (PAT4: p = 0.004, p = 0.005) (in absolute and relative values, respectively) and maximal power (PF: p = 0.034) (in absolute values) were observed. However, these effects were not associated with normobaric hypoxia. Changes in tHb-mass were not associated with initial concentrations of ferritin or transferrin receptor, whereas changes in relative tHb-mass (r = -0.53, p = 0.012), PF (r = -0.53, p = 0.01) and PAT4 (r = -0.65, p = 0.001) were inversely correlated with initial values. Changes in tHb-mass and PAT4 were positively correlated (r = 0.50, p = 0.017; r = 0.47, p = 0.028). Regardless of normobaric hypoxia application, low altitude training followed by sea-level training might improve hematological status in elite female cyclists, especially with relatively low initial values of tHb-mass, which could translate into enhanced endurance performance.

13.
Front Physiol ; 9: 1693, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30555339

RESUMO

Body composition (BC) is an emerging important factor for the characterization of metabolic status. The assessment of BC has been studied in various populations and diseases such as obesity, diabetes, endocrine diseases as well as physiological and paraphysiological conditions such as growth and aging processes, and physical training. A gold standard technique for the assessment of human BC at molecular level is represented by dual-energy X-ray absorptiometry (DXA), which is able to precisely assess the body mass (and areal bone mineral density-aBMD) on a regional and whole-body basis. For the first time, within the framework of the NU-AGE project, BC has been assessed by means of a whole-body DXA scan in 1121 sex-balanced free-living, apparently healthy older adults aged 65-79 years enrolled in 5 European countries (Italy, France, United Kingdom, Netherlands, and Poland). The aim of this analysis is to provide a complete profile of BC in healthy elderly participants from five European countries and to investigate country- and sex-related differences by state-of-the-art DXA technology. To compare BC data collected in different centers, specific indexes and ratios have been used. Non-parametric statistical tests showed sex-specific significant differences in certain BC parameters. In particular, women have higher fat mass (FM) (Fat/Lean mass ratio: by 67%, p < 2.2e-16) and lower lean mass (Lean Mass index: by -18%, p < 2.2e-16) than men. On the other hand, men have higher android FM than women (Android/gynoid FM ratio: by 56%, p < 2.2e-16). Interesting differences also emerged among countries. Polish elderly have higher FM (Fat/Lean mass ratio: by 52%, p < 2.2e-16) and lower lean mass (Skeletal Mass index: by -23%, p < 2.2e-16) than elderly from the other four countries. At variance, French elderly show lower FM (Fat/Lean mass ratio: by -34%, p < 2.2e-16) and higher lean mass (Skeletal Mass index: by 18%, p < 2.2e-16). Moreover, five BC profiles in women and six in men have been identified by a cluster analysis based on BC parameters. Finally, these data can serve as reference for normative average and variability of BC in the elderly populations across Europe.

14.
Nutrients ; 10(2)2018 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-29385099

RESUMO

Vitamin D may influence iron metabolism and erythropoiesis, whereas iron is essential for vitamin D synthesis. We examined whether vitamin D deficiencies (VDD) are associated with reduced iron status and whether progressive iron deficiency (ID) is accompanied by inferior vitamin D status. The study included 219 healthy female (14-34 years old) athletes. VDD was defined as a 25(OH)D concentration < 75 nmol/L. ID was classified based on ferritin, soluble transferrin receptor (sTfR), total iron binding capacity (TIBC) and blood morphology indices. The percentage of ID subjects was higher (32%) in the VDD group than in the 25(OH)D sufficient group (11%) (χ² = 10.6; p = 0.001). The percentage of VDD subjects was higher (75%) in the ID than in the normal iron status group (48%) (χ² = 15.6; p = 0.001). The odds ratios (ORs) for VDD increased from 1.75 (95% CI 1.02-2.99; p = 0.040) to 4.6 (95% CI 1.81-11.65; p = 0.001) with progressing iron deficiency. ID was dependent on VDD in both VDD groups (25(OH)D < 75 and < 50 nmol/L). The ID group had a lower 25(OH)D concentration (p = 0.000). The VDD group had lower ferritin (p = 0.043) and iron (p = 0.004) concentrations and higher values of TIBC (p = 0.016) and sTfR (p = 0.001). The current results confirm the association between vitamin D and iron status in female athletes, although it is difficult to assess exactly which of these nutrients exerts a stronger influence over the other.


Assuntos
Anemia Ferropriva/sangue , Atletas , Ferro/sangue , Aptidão Física , Deficiência de Vitamina D/sangue , Vitamina D/análogos & derivados , Adolescente , Adulto , Anemia Ferropriva/diagnóstico , Anemia Ferropriva/epidemiologia , Biomarcadores/sangue , Distribuição de Qui-Quadrado , Feminino , Ferritinas/sangue , Nível de Saúde , Humanos , Deficiências de Ferro , Modelos Logísticos , Análise Multivariada , Razão de Chances , Polônia/epidemiologia , Receptores da Transferrina/sangue , Vitamina D/sangue , Deficiência de Vitamina D/diagnóstico , Deficiência de Vitamina D/epidemiologia , Adulto Jovem
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