Cholesterol-lowering properties of different pectin types in mildly hyper-cholesterolemic men and women.

BACKGROUND/OBJECTIVES: Viscous fibers typically reduce total cholesterol (TC) by 3-7% in humans. The cholesterol-lowering properties of the viscous fiber pectin may depend on its physico-chemical properties (viscosity, molecular weight (MW) and degree of esterification (DE)), but these are not typically described in publications, nor required by European Food Safety Authority (EFSA) with respect to its generic pectin cholesterol-lowering claim. SUBJECTS/METHODS: Here, different sources and types of well-characterized pectin were evaluated in humans. Cross-over studies were completed in mildly hyper-cholesterolemic persons receiving either 15 g/day pectin or cellulose with food for 4 weeks. RESULTS: Relative low-density lipoprotein (LDL) cholesterol (LDL-C) lowering was as follows: citrus pectin DE-70=apple pectin DE-70 (7-10% reduction versus control)>apple pectin DE-35=citrus pectin DE-35>OPF (orange pulp fiber) DE-70 and low-MW pectin DE-70>citrus DE-0. In a subsequent 3-week trial with 6 g/day pectin, citrus DE-70 and high MW pectin DE-70 reduced LDL-C 6-7% versus control (without changes in TC). In both studies, high DE and high MW were important for cholesterol lowering. Source may also be important as citrus and apple DE-70 pectin were more effective than OPF DE-70 pectin. Pectin did not affect inflammatory markers high-sensitivity C-reactive protein (hsCRP) nor plasma homocysteine. CONCLUSIONS: Pectin source and type (DE and MW) affect cholesterol lowering. The EFSA pectin cholesterol-lowering claim should require a minimum level of characterization, including DE and MW.

Vitamin K1 supplementation retards bone loss in postmenopausal women between 50 and 60 years of age.

Although several observational studies have demonstrated an association between vitamin K status and bone mineral density (BMD) in postmenopausal women, no placebo-controlled intervention trials of the effect of vitamin K1 supplementation on bone loss have been reported thus far. In the trial presented here we have investigated the potential complementary effect of vitamin K1 (1 mg/day) and a mineral + vitamin D supplement (8 microg/day) on postmenopausal bone loss. The design of our study was a randomized, double-blind, placebo-controlled intervention study; 181 healthy postmenopausal women between 50 and 60 years old were recruited, 155 of whom completed the study. During the 3-year treatment period, participants received a daily supplement containing either placebo, or calcium, magnesium, zinc, and vitamin D (MD group), or the same formulation with additional vitamin K1 (MDK group). The main outcome was the change in BMD of the femoral neck and lumbar spine after 3 years, as measured by DXA. The group receiving the supplement containing additional vitamin K1 showed reduced bone loss of the femoral neck: after 3 years the difference between the MDK and the placebo group was 1.7% (95% Cl: 0.35-3.44) and that between the MDK and MD group was 1.3% (95% Cl: 0.10-3.41). No significant differences were observed among the three groups with respect to change of BMD at the site of the lumbar spine. If co-administered with minerals and vitamin D, vitamin K1 may substantially contribute to reducing postmenopausal bone loss at the site of the femoral neck.

Safety of soy-derived phosphatidylserine in elderly people.

Phosphatidylserine (PS) is a phospholipid which has been claimed to enhance neuronal membrane function, and can be derived from several sources. Earlier studies used brain cortex derived PS, of which the human tolerability of 300mg daily in 130 patients has been shown. The human tolerability of PS derived from soybean has not been reported, although it is widely sold as a nutritional supplement which may improve cognitive function in the elderly. We report the results of a study of the safety of two dosages of soy-phosphatidylserine (S-PS) in elderly. Subjects were 120 elderly of both sexes who fulfilled the more stringent criteria for age-associated memory impairment; some also fulfilled the criteria for age-associated cognitive decline. Subjects were allocated at random to one of the three treatment groups: placebo, 300 or 600 mg S-PS daily. Standard biochemical and hematological safety parameters, blood pressure, heart rate and adverse events were assessed at baseline, after 6 and 12 weeks of treatment. No significant differences were found in any of the outcome variables between the treatment groups after Bonferonni-Holme correction. In conclusion, soy derived PS is a safe nutritional supplement for older persons if taken up to a dosage of 200 mg three times daily.

The effect of guar gum addition to a semisolid meal on appetite related to blood glucose, in dieting men.

OBJECTIVE: To investigate whether addition of modified guar gum (GG) to a low-energy semisolid meal might be effective on appetite by modifying the response of blood glucose and other blood parameters. DESIGN: Three intervention periods of 2 weeks each, separated by washout periods of 4 weeks. Randomized and cross-over design. SUBJECTS: Fifteen overweight male subjects (mean+/-s.d.; age, 44+/-9 y; body mass index, 28.6+/-1.8 kg/m(2)). INTERVENTION: Subjects consumed a low-energy diet divided over three times a day, consisting of a semisolid meal with (SSM+) or without (SSM) addition of 2.5 g GG, or a solid meal (SM) with the same energy content (947 kJ) and macronutrient composition, plus a dinner of the subject's own choice. At the end of each intervention, time and number of meal initiations, dynamics of blood glucose and other blood parameters, and appetite ratings such as hunger and satiety were determined in a time-blinded situation. RESULTS: The changes in blood glucose from meal initiation to blood glucose peak and from peak to nadir were smaller with SSM+ and SM compared to SSM. Satiety before the third meal was higher with SSM+ and SM compared to SSM (P<0.01). Meal pattern, general appetite and total energy intake were similar for all treatments. CONCLUSIONS: We conclude that, similar to SM, SSM+ resulted in a more moderate change in blood glucose compared to SSM and positively affected satiety before the third meal, while general appetite, total energy intake and meal pattern did not differ.

No effects of oral ribose supplementation on repeated maximal exercise and de novo ATP resynthesis.

A double-blind randomized study was performed to evaluate the effect of oral ribose supplementation on repeated maximal exercise and ATP recovery after intermittent maximal muscle contractions. Muscle power output was measured during dynamic knee extensions with the right leg on an isokinetic dynamometer before (pretest) and after (posttest) a 6-day training period in conjunction with ribose (R, 4 doses/day at 4 g/dose, n = 10) or placebo (P, n = 9) intake. The exercise protocol consisted of two bouts (A and B) of maximal contractions, separated by 15 s of rest. Bouts A and B consisted of 15 series of 12 contractions each, separated by a 60-min rest period. During the training period, the subjects performed the same exercise protocol twice per day, with 3-5 h of rest between exercise sessions. Blood samples were collected before and after bouts A and B and 24 h after bout B. Knee-extension power outputs were approximately 10% higher in the posttest than in the pretest but were similar between P and R for all contraction series. The exercise increased blood lactate and plasma ammonia concentrations (P < 0.05), with no significant differences between P and R at any time. After a 6-wk washout period, in a subgroup of subjects (n = 8), needle-biopsy samples were taken from the vastus lateralis before, immediately after, and 24 h after an exercise bout similar to the pretest. ATP and total adenine nucleotide content were decreased by approximately 25 and 20% immediately after and 24 h after exercise in P and R. Oral ribose supplementation with 4-g doses four times a day does not beneficially impact on postexercise muscle ATP recovery and maximal intermittent exercise performance.

Effects of 2-week ingestion of (-)-hydroxycitrate and (-)-hydroxycitrate combined with medium-chain triglycerides on satiety and food intake.

The aim of this study was to assess the effects of 2 weeks of supplementation with (-)-hydroxycitrate (HCA) and HCA combined with medium-chain triglycerides (MCT) on satiety and energy intake. The experimental design consisted of three intervention periods of 2 weeks separated by washout periods of 2 or 6 weeks in a double-blind, placebo-controlled, randomized, and crossover design. Seven male and 14 female normal to moderately obese subjects (mean+/-S.D.; age, 43+/-10 years; body mass index, 27.6+/-2.0 kg/m(2)) participated in this study. Subjects consumed three self-selected meals and four isoenergetic snacks daily with either no supplementation (PLA), with 500 mg HCA (HCA), or 500 mg HCA and 3 g MCT (HCA+MCT). Each intervention period ended with a test day, consisting of a standardized breakfast and ad libitum a lunch and a dinner. There was a significant body weight (BW) loss during the 2 weeks of intervention (PLA, -0.5+/-0.3 kg, P<.05; HCA, -0.4+/-0.2 kg, P<.05; HCA+MCT, -0.7+/-0.2 kg, P<.01), but this reduction was not different between treatments. Twenty-four-hour energy intake (PLA, 8.1+/-0.3 MJ; HCA, 8.3+/-0.3 MJ; HCA+MCT, 8.4+/-0.3 MJ) and the area under the curve of the appetite-related parameters during the test day were similar for all treatments. Two weeks of supplementation with HCA and HCA combined with MCT did not result in increased satiety or decreased energy intake compared to placebo in subjects losing BW.

The influence of soy-derived phosphatidylserine on cognition in age-associated memory impairment.

Phosphatidylserine (PS) is a phospholipid widely sold as a nutritional supplement. PS has been claimed to enhance neuronal membrane function and hence cognitive function, especially in the elderly. We report the results of a clinical trial of soybean-derived PS (S-PS) in aging subjects with memory complaints. Subjects were 120 elderly (> 57 years) of both sexes who fulfilled the more stringent criteria for age-associated memory impairment (AAMI); some also fulfilled the criteria for age-associated cognitive decline. Subjects were allocated at random to one of the three treatment groups: placebo, 300mg S-PS daily, or 600mg S-PS daily. Assessments were carried out at baseline, after 6 and 12 weeks of treatment, and after a wash-out period of 3 weeks. Tests of learning and memory, choice reaction time, planning and attentional functions were administered at each assessment. Delayed recall and recognition of a previously learned word list comprised the primary outcome measures. No significant differences were found in any of the outcome variables between the treatment groups. There were also no significant interactions between treatment and 'severity of memory complaints'. In conclusion, a daily supplement of S-PS does not affect memory or other cognitive functions in older individuals with memory complaints.

Improved bone metabolism in female elite athletes after vitamin K supplementation.

In female elite athletes strenuous exercise may result in hypoestrogenism and amenorrhoea. As a consequence a low peak bone mass and rapid bone loss are often seen in relatively young athletes. In postmenopausal women, increased intake of vitamin K may result in an increase of serum markers for bone formation, a decrease of urinary markers for bone resorption, and a decrease in urinary calcium loss. In the present paper we report an intervention study among eight female athletes, four of whom had been amenorrhoeic for more than one year, whereas the others had been using oral contraceptives. All participants received vitamin K supplementation (10 mg/day) during one month, and various bone markers were measured before and after treatment. At baseline the athletes not using oral contraceptives were biochemically vitamin K-deficient as deduced from the calcium binding capacity of the circulating bone protein osteocalcin. In all subjects increased vitamin K was associated with an increased calcium-binding capacity of osteocalcin. In the low-estrogen group vitamin K supplementation induced a 15-20% increase of bone formation markers and a parallel 20-25% decrease of bone resorption markers. This shift is suggestive for an improved balance between bone formation and resorption.

Aspects of food and fluid intake during labour. Policies of midwives and obstetricians in The Netherlands.

OBJECTIVE: This study outlines the current policies on food and fluid intake during labour in The Netherlands and discusses the pro's and con's of food-restriction. STUDY DESIGN: 50 midwives and 30 obstetricians were asked about their actual policy on food and fluid-intake during labour. RESULTS: A restrictive policy during normal labour is followed by 20% of the midwives and 14% of the obstetricians. About 75% leaves the decision on food and fluid-intake to the women themselves. CONCLUSIONS: Despite the non-restrictive policy in The Netherlands, the mortality due to the Mendelson-syndrome is not higher than in countries where a restrictive policy is followed. During normal labour there are no conclusive reasons for food or fluid-restriction. From a metabolic point of view it is hypothesized that the intake of energy-rich substrates may have a positive influence on labour progression. Further study on the subject seems indicated.

Strategies to enhance fat utilisation during exercise.

Compared with the limited capacity of the human body to store carbohydrate (CHO), endogenous fat depots are large and represent a vast source of fuel for exercise. However, fatty acid (FA) oxidation is limited, especially during intense exercise, and CHO remains the major fuel for oxidative metabolism. In the search for strategies to improve athletic performance, recent interest has focused on several nutritional procedures which may theoretically promote FA oxidation, attenuate the rate of muscle glycogen depletion and improve exercise capacity. In some individuals the ingestion of caffeine improves endurance capacity, but L-carnitine supplementation has no effect on either rates of FA oxidation, muscle glycogen utilisation or performance. Likewise, the ingestion of small amounts of medium-chain triglyceride (MCT) has no major effect on either fat metabolism or exercise performance. On the other hand, in endurance-trained individuals, substrate utilisation during submaximal [60% of peak oxygen uptake (VO2peak)] exercise can be altered substantially by the ingestion of a high fat (60 to 70% of energy intake), low CHO (15 to 20% of energy intake) diet for 7 to 10 days. Adaptation to such a diet, however, does not appear to alter the rate of working muscle glycogen utilisation during prolonged, moderate intensity exercise, nor consistently improve performance. At present, there is insufficient scientific evidence to recommend that athletes either ingest fat, in the form of MCTs, during exercise, or "fat-adapt" in the weeks prior to a major endurance event to improve athletic performance.

Utilization of lipids during exercise in human subjects: metabolic and dietary constraints.

During endurance exercise, skeletal muscle relies mainly on both carbohydrate (CHO) and fat oxidation to cover energy needs. Numerous scientific studies have shown that increasing the exercise intensity leads to a progressive utilization of CHO. The latter will induce a state of glycogen depletion which is generally recognized as being a limiting factor for the continuation of strenuous exercise. Different dietary interventions have been proposed to overcome this limitation. A high-CHO diet during periods of intense training and competition, as well as CHO intake during exercise, are known to maintain a high rate of CHO oxidation and to delay fatigue. However, it has been recognized also that enhancing fatty acid (FA) oxidation during exercise induces a reduced rate of glycogen degradation, resulting in an improved endurance capacity. This is most strikingly observed as a result of frequent endurance exercise which improves a number of factors known to govern the FA flux and the oxidative capacity of skeletal muscle. Such factors are: (1) blood flow and capillarization; (2) lipolysis of triacylglycerol (TAG) in adipose tissue and circulating TAG and transport of FA from blood plasma to the sarcoplasm; (3) availability and rate of hydrolysis of intramuscular TAG; (4) activation of the FA and transport across the mitochondrial membrane; (5) the activity of enzymes in the oxidative pathway; (6) hormonal adaptations, i.e. sensitivity to catecholamines and insulin. The observation that the plasma FA concentration is an important factor in determining the rate of FA oxidation, and that some dietary factors may influence the rate of FA supply to muscle as well as to the mitochondria, has led to a number of dietary interventions with the ultimate goal to enhance FA oxidation and endurance performance. It appears that experimental data are not equivocal that dietary interventions, such as a high-fat diet, medium-chain TAG-fat emulsions and caffeine intake during exercise, as well as L-carnitine supplementation, do significantly enhance FA oxidation during exercise. So far, only regular endurance exercise can be classified as successful in achieving adaptations which enhance FA mobilization and oxidation.

Exercise performance, red blood cell deformability, and lipid peroxidation: effects of fish oil and vitamin E.

Previous studies have indicated that fish oil supplementation increases red blood cell (RBC) deformability, which may improve exercise performance. Exercise alone, or in combination with an increase in fatty acid unsaturation, however, may enhance lipid peroxidation. Effects of a bicycle time trial of approximately 1 h on RBC characteristics and lipid peroxidation were, therefore, studied in 24 trained cyclists. After 3 wk of fish oil supplementation (6 g/day), without or with vitamin E (300 IU/day), trial performance, RBC characteristics, and lipid peroxidation were measured again. RBC deformability appeared to decrease during endurance exercise. After correction for hemoconcentration, plasma total tocopherol concentrations decreased by 0.77 micromol/l (P = 0. 012) or 2.9% and carotenoid concentrations by 0.08 micromol/l (P = 0. 0008) or 4.5%. Endurance exercise did not affect the lag time and rate of in vitro oxidation of low-density lipoproteins (LDLs), but the maximum amount of conjugated dienes formed decreased by 2.1 +/- 1.0 micromol/mmol LDL cholesterol (P = 0.042) or 1.2%. Fish oil supplementation with and without vitamin E did not affect RBC characteristics or exercise performance. Both supplements decreased the rate of LDL oxidation, and fish oil supplementation with vitamin E delayed oxidation. The amount of dienes, however, was not affected. The supplements also did not change effects of exercise. We conclude that the changes observed during endurance exercise may indicate increased oxidative stress, but further research is necessary to confirm this. Fish oil supplementation does not improve endurance performance, but it also does not cause or augment changes in antioxidant levels or LDL oxidation during exercise.

Effects of carbohydrate (CHO) and fat supplementation on CHO metabolism during prolonged exercise.

The aim of the study was to examine carbohydrate (CHO) utilization in subjects receiving CHO or CHO + medium-chain triglycerides (MCT) supplements during 180 minutes of exercise at 50% maximal aerobic work rate ([Wmax] 57% maximal oxygen consumption [VO2max]). In a double-blind crossover design, nine trained athletes cycled four times. Subjects received a bolus of 4 mL x kg(-1) at the start and 2 mL x kg(-1) every 20 minutes during exercise of either a 150-g x L(-1) CHO solution (CHO trial), an equicaloric 70 energy% (en%) CHO-30 en% MCT suspension containing 29 g MCT (CHO + MCT trial), or a 150-g x L(-1) CHO (high-CHO [HCHO]) solution plus 20 g MCT (HCHO + MCT trial). A fourth trial consisted of a 13C-background control trial (CON). The four trials were randomized. Before and after the exercise bout, muscle biopsies were taken from the quadriceps muscle and muscle glycogen levels were determined. During exercise, breath samples were collected for estimation of exogenous and endogenous CHO oxidation. No significant differences were detected in glycogen breakdown among the trials (277 +/- 14 mmol x kg dry weight(-1) CHO, 249 +/- 20 CHO + MCT, and 240 +/- 18 HCHO + MCT) or in the respiratory exchange ratio during exercise. Mean exogenous CHO oxidation rates during the final hour of exercise were 0.79, 0.63, and 0.73 g x min(-1), respectively. No differences were observed between the trials regarding exogenous or endogenous CHO oxidation. Plasma free fatty acid (FFA) concentrations were elevated during exercise to a level of approximately 500 micromol x L(-1) and were comparable in all trials, whereas plasma ketone concentrations significantly increased after MCT ingestion as compared with the CHO trial. It is concluded that 29 g MCT co-ingested with CHO during 180 minutes of exercise does not influence CHO utilization or glycogen breakdown.

Effect of endogenous carbohydrate availability on oral medium-chain triglyceride oxidation during prolonged exercise.

The present study examined the medium-chain triglyceride (MCT) oxidation rate of oral carbohydrate (CHO) + MCT supplements after a glycogen-depletion trial [low glycogen (LG)] and in the glycogen-loaded state [normal-to-high glycogen (HG)]. Eight elite athletes cycled four times 90 min at 50% maximal workload (57% maximal O2 uptake). In two trials, they followed a LG protocol to achieve low-glycogen stores in the leg muscles the evening before the experiment, and in two trials they followed a HG protocol. Subjects received a bolus of 4 ml/kg at the start and 2 ml/kg every 20 min during exercise of either a 15% CHO (long-chain glucose polymer) solution or an equicaloric CHO + MCT suspension. Exogenous MCT oxidation was measured by adding a [1,1,1-13C]trioctanoate tracer to the MCT oil and measuring 13CO2 production in the breath. The results show that 85% of MCT ingested was oxidized in LG and 69% in HG during the 60- to 90-min period. There was no statistically significant difference in MCT utilization between LG and HG. Peak oxidation rates were 0.15 and 0.13 g/min, respectively. MCT contributed 7.6% (LG) and 6.5% (HG) to total energy expenditure during the 60- to 90-min period. Total fatty acid oxidation was significantly elevated in the LG trial but was not influenced by MCT ingestion. Concomitantly, CHO oxidation was reduced in LG but no effect of MCT was observed. We conclude that 1) the contribution of MCT to total energy expenditure was small and 2) strenuous exercise the day before the experiment, followed by a low CHO intake and leading to a low CHO availability, substantially increased total fat oxidation but did not significantly increase MCT oxidation.

Chronic oral lactate supplementation does not affect lactate disappearance from blood after exercise.

This study tested the hypothesis that a 3-week oral lactate supplementation affects postexercise blood lactate disappearance in untrained male subjects. Fifteen men were randomly assigned to either a lactate supplementation (n = 8) or a placebo (n = 7) treatment. During the treatment period they drank an oral lactate or a maltodextrin (placebo) supplement twice a day. The lactate drink contained 10 g of lactate as calcium, sodium, and potassium salts. Blood lactate concentrations were studied before, during, and immediately after three exercise tests, both pre- and posttreatment. Peak lactate values for placebo (PL) or lactate (L) treatment groups during different tests were as follows: Test 1 PL, 13.49 +/- 3.71; L, 13.70 +/- 1.90; Test 2 PL, 12.64 +/- 2.32; L, 12.00 +/- 2.23; Test 3 PL, 12.29 +/- 2.92; L, 11.35 +/- 1.38 and were reached 3 min postexercise. The decrease in blood lactate during the long (30- to 45-min) recovery periods amounted to / 10 mmol/L. Blood lactate changes were highly reproducible. However, a 3-week oral lactate supplementation did not result in differences in lactate disappearance. This study does not support the hypothesis that regular oral lactate intake at rest enhances the removal of lactate during and following exercise, that is, not with the given lactate load and supplementation period.

Breath 13CO2 background enrichment during exercise: diet-related differences between Europe and America.

A traditional North American diet contains a high percentage of carbohydrates (CHO) derived from C4 plants (maize, sugar cane), whereas a European diet contains primarily CHO derived from C3 plants (potato, sugar beet). The natural 13C enrichment of the first type of CHO is higher than that of the latter type. 13CO2 production from orally ingested C4 plant-derived CHO can, therefore, be used to quantify oxidation rates of orally ingested CHO at rest and during exercise. Recently it has been shown that oxidation rates assessed this way in North Americans should be corrected for an increase in breath background 13CO2 during exercise. We hypothesized that the indicated difference in metabolic origin of CHO would imply that no such correction is required for subjects on a European diet. We therefore studied changes from rest in breath 13CO2 enrichment in Dutch volunteers during cycle ergometry at 65% maximal work load (experiment 1, 2h, 6 subjects) and 70% maximal oxygen uptake (experiment 2, 90 min, 8 subjects) while ingesting water (experiments 1 and 2) and potato starch-derived glucose (experiment 2). Experiment 1 was done before and after careful instruction of the subjects to refrain from nutrient sources potentially containing CHO of C4 metabolic origin. No significant changes from rest 13CO2 enrichment were observed in tests with water and potato-derived glucose ingestion in subjects who excluded CHO of C4 metabolic origin from their diet.

Carbohydrate supplementation, glycogen depletion, and amino acid metabolism during exercise.

Eight highly trained cyclists were studied during exercise after glycogen depletion (test A) and during carbohydrate (CHO) loading (test B). In test B subjects were able to complete 2 h of exercise at 70-75% maximal workload (Wmax), whereas the initial intensity of 70% Wmax had to be reduced to 50% in test A. Plasma ammonia increased more rapidly, and plasma alanine, glutamate, and glutamine were lower in test A. Exercise caused a 3.6-fold increase in the proportion of active branched-chain 2-oxoacid dehydrogenase (BC) complex in muscle in test A. No activation occurred in test B. There was an inverse correlation between the activity of the BC complex and the glycogen content of the postexercise biopsies. Exercise did not cause changes in the muscle content of ATP, ADP, AMP, IMP, hypoxanthine, and lactate. It is concluded that CHO loading abolishes increases in branched-chain amino acid (BCAA) oxidation during exercise and that part of the ammonia production during prolonged exercise originates from deamination of amino acids. The data appear to confirm the hypothesis (A.J. M. Wagenmakers, J.H. Coakley, and R.H.T. Edwards. Int. J. Sports Med. 11: S101-S113, 1990) that acceleration of the BCAA aminotransferase reaction may drain the tricarboxylic acid cycle and that glycogen is a carbon chain precursor of tricarboxylic acid cycle intermediates and glutamine.

Study on food intake and energy expenditure during extreme sustained exercise: the Tour de France.

Food intake and energy expenditure (EE) were studied in five cyclists during the 22-day race of the Tour de France. The course is about 4000 km including 30 mountain passages (up to 2700 m altitude) and can be considered as one of the most strenuous endurance endeavors. Nutritional intake was calculated from daily food records. EE was estimated from sleeping time and the low activity period. EE during cycling was predicted based on detailed information. Mean energy intake (EI) was 24.7 MJ with a highest mean daily EI of 32.4 MJ. Mean EE was 25.4 MJ with a highest mean daily EE of 32.7 MJ. Relative contribution of protein, CHO, and fat was 15, 62, and 23 En% resp. 49% of EI was taken during the race resulting in a CHO intake of 94 g.h-1 representing 69 en%. It is questioned whether this amount of CHO is optimal in relation to CHO oxidation and performance. About 30% from CHO intake came from CHO-rich liquids. High EI resulted in high Ca and Fe intake. For vitamins, especially B1, this relation was not found. Vitamin B1 nutrient density dropped to 0.25 mg/4.2 MJ during the race caused by a large intake of refined CHO-rich food items. However, vitamin supplementation was high. Daily water intake was 6.71 with extremes up to 11.81. Therefore, the strategy of intake of large quantities of CHO-rich liquids seems to be the appropriate answer to maintain energy and fluid balance under these extreme conditions.

Adequacy of vitamin supply under maximal sustained workloads: the Tour de France.

In the Tour de France competing cyclists must pedal about 4000 km over a period of three weeks with only one day allowed for rest. The course includes 30 mountains, the highest of which reaches an altitude of approximately 2700 m. The energy expenditure values of these cyclists range from a mean of 25.4 MJ/day to peak values of 32.7 MJ/day. These are the highest values that have ever been reported for a period longer than seven days. On the basis of the food records of 5 cyclists, it turned out that 62 En.% is derived from CHO, 15 En.% from protein, and 23 En.% from fat. Since the food choice is primarily focused on digestibility and energy content, this results in a frequent consumption of sweet cakes and CHO-rich fluids. Some 49% of the energy is consumed in between meals. Such a nutritional pattern leads to a lowering of the nutrient density especially with respect to the B-vitamins. Intake of vitamins B1, B2, B6, and C, including contribution from enriched sport drinks, was 1.97 mg, 4.96 mg, 2.40 mg, and 158 mg, respectively. Besides this, intramuscular injections of megadosis vitamins of B1, B2, B6, nicotinamide, pantothenic acid, and especially B12 did increase the intake drastically. This was reflected in high blood concentrations of vitamins. Except for folic acid, vitamins (B1, B2, B6, and B12) exceeded the upper limits of the values from a reference group, particularly B12, which exceeded the reference values by up to 400%. During the Tour, vitamin concentrations remained essentially unchanged.