Mental skills in Serbian handball players: In relation to the position and gender of players.

Objectives: Despite the potential link between mental skills and athletic performance, little is done to examine handball players' present level of mental skills concerning their performance. To begin with, the study has three folded aims; the first one is to examine the factor structure of Bull's Mental Skills Questionnaire, which was developed in the United Kingdom to measure selected mental skill, of Serbian athlete population. The second aim is to determine gender differences in those mental skills, and the third aim is to determine differences between the playing positions in the mental skills of handball players to create a mental profile of Serbian handball players. Materials and methods: The sample consisted of 170 handball players, aged 14 to 39, who have played handball at the semi-elite, competitive-elite, and successful-elite level. The modified exploratory factor analysis was used to determine the latent dimensions of the Bull's Mental Skills Questionnaire. For examining gender differences in the manifestation of mental skills Mann-Whitney U test was used. Results: Compared to the original structure of the questionnaire, which singles out seven factors of mental skills (imagery ability, mental preparation, self-confidence, anxiety and worry management, concentration ability, relaxation ability, and motivation), five factors were singled out in the sample of Serbian male and female handball players (anxiety and concentration management-α = 0.74; self-confidence-α = 0.75; relaxation ability-α = 0.66; mental preparation-α = 0.68, and imagery ability-α = 0.66). With these five subscales as dependent variables, results of the Mann-Whitney U test show that there are significant gender differences in variable anxiety and concentration management (U = 2893.5, p = 0.049) and relaxation ability (U = 2833.0, p = 0.031). Female handball players score higher on anxiety and concentration management and lower on relaxation ability. When playing positions are in question, results of Kruskal-Wallis's one-way analysis of variance, i.e., Mann-Whitney's post hoc analysis, suggest that statistically significant differences were observed between wings and center backs and wings and goalkeepers in the imagery ability. Conclusion: The Bull's Mental Skills Questionnaire in Serbian sample of handball players show satisfactory psychometric characteristics but has singled out five factors of mental skills compared to the original questionnaire.

Effects of osteopathic manipulative treatment of the pivots on lower limb function in young professional football players.

INTRODUCTION: The most frequent injuries in professional soccer players are those pertinent to the lower limbs. In particular, strains of the hamstrings and ligamentous injuries of the knee. Therefore, preventive measures are aimed to reduce such events. We aimed to investigate if an osteopathic manipulative treatment (OMT) of the pivots could improve lower limb function in young professional football players. METHODS: Thirty-eight young male professional football players were recruited (mean age 17.8 ± 0.44 years). These were randomly assigned to an OMT or control group (n = 20 and 18, respectively). Both groups underwent osteopathic evaluation. A sit-and-reach test, a vertical jump test, a hand-grip strength test, a cervical ROM test and a balance evaluation were also performed. RESULTS: A significant improvement (p < 0.01) was observed between pre and post measures in the OMT for dysfunctional assessment of the pivots. However, only L3 and C2 also differed from the control group post evaluation (p < 0.0001). No differences were present for any functional measure in the control group. Only the sit-&-reach of the OMT increased significantly (p < 0.001). Static balance with open eyes in the OMT, but not in the control group, improved during post evaluation (p < 0.01). CONCLUSION: The OMT of the pivots was able to increase the sit-and-reach measure, improve postural control with open eyes and improve dysfunctional patterns of the lumbosacral and upper cervical spine in young professional football players.

The Role of Psychological Factors in Judo: A Systematic Review.

(1) Background: Psychological parameters are relevant in the practice of judo. Previous studies have shown that parameters such as anxiety or motivation can have a negative or positive impact on the athlete's performance and general well-being, depending on the athlete's perception. This systematic review aimed to summarize the studies examining the influence of various psychological parameters on well-being and performance in judo athletes; (2) Methods: We followed preferred reporting elements for systematic reviews and meta-analyses. We searched the Web of Science database for studies that explained the role of these parameters in elite athletes. Of the 286 articles initially identified, 17 met our eligibility criteria and were included in the review. In total, we analyzed data from 721 judo athletes; (3) Results: The studies found have demonstrated the impact of various psychological parameters during high-level performance and how these parameters can influence and lead an athlete to win or lose a competition. The feelings of tension, anger, anxiety, and nervousness were significantly increased in athletes who were facing defeat, while a decrease in the same segments and an increase in motivation among athletes who were experiencing better performance was observed. Further research under standardized conditions is needed to better understand the effects of these parameters on judo athletes; (4) Conclusions: Considering the athlete's psychological state can affect performance, and it is therefore important to monitor and train these factors.

Redox and autonomic responses to acute exercise-post recovery following Opuntia ficus-indica juice intake in physically active women.

BACKGROUND: The aim of this study was to investigate if the supplementation with Opuntia ficus-indica (OFI) juice may affect plasma redox balance and heart rate variability (HRV) parameters following a maximal effort test, in young physically active women. METHODS: A randomized, double blind, placebo controlled and crossover study comprising eight women (23.25 ± 2.95 years, 54.13 ± 9.05 kg, 157.75 ± 0.66 cm and BMI of 21.69 ± 0.66 kg/m2) was carried out. A juice containing OFI diluted in water and a Placebo solution were supplied (170 ml; OFI = 50 ml of OFI juice + 120 ml of water; Placebo = 170 ml beverage without Vitamin C and indicaxanthin). Participants consumed the OFI juice or Placebo beverage every day for 3 days, before performing a maximal cycle ergometer test, and for 2 consecutive days after the test. Plasma hydroperoxides and total antioxidant capacity (PAT), Skin Carotenoid Score (SCS) and HRV variables (LF, HF, LF/HF and rMSSD) were recorded at different time points. RESULTS: The OFI group showed significantly lower levels of hydroperoxides compared to the Placebo group in pre-test, post-test and 48-h post-test. PAT values of the OFI group significantly increased compared to those of the Placebo group in pre-test and 48-h post-test. SCS did not differ between groups. LF was significantly lower in the OFI group 24-h after the end of the test, whereas rMSSD was significantly higher in the OFI group 48-h post-test. CONCLUSION: OFI supplementation decreased the oxidative stress induced by intense exercise and improved autonomic balance in physically active women.

Effects of Rapid Weight Loss on Kidney Function in Combat Sport Athletes.

Even though scientific literature shows numerous heath complications and performance decrements associated with rapid weight loss (RWL), its prevalence remains exceedingly high across various combat sports. The aim of this study was to thoroughly search the existing literature to explore the influence of RWL on kidney function in Olympic and non-Olympic combat sport athletes. PubMed and Web of Science were searched for the relevant studies. Only original articles published from 2005 onwards, written in English, that included healthy males and females who prompted ~5% weight loss within a week or less, were included in the study. Retrieved studies showed that creatinine, blood urea nitrogen and urine specific gravity values were significantly increased after RWL in the majority of the included studies. This observation indicates that RWL caused dehydration and subsequent acute kidney damage despite various degrees of weight lost during the RWL phase, which can lead to adverse events in other body systems. Alternative methods of weight reduction that prioritize athletes' health should be considered.

Rapid Weight Loss Habits before a Competition in Sambo Athletes.

BACKGROUND: Like other combat sports, sambo has competition rules that divide athletes into categories based on gender, age and weight. Athletes in combat sports often resort to rapid weight loss (RWL) methods to be more competitive in lower weight categories and gain an advantage against lighter, smaller and weaker competitors. The aim of this study was to examine the methodology implemented by two different sambo age categories, junior and senior athletes, in order to attain RWL. METHODS: The sample consisted of 103 male sambo elite athletes (seniors/juniors: age 28.5 ± 4.3/18.9 ± 0.8; height (m): 1.7 ± 0.1/1.8 ± 0.1; weight (kg): 76.3 ± 17.8/74.4 ± 16.3; BMI (kg/m2): 25.0 ± 3.8/23.7 ± 3.9) who completed a survey on RWL. RESULTS: Athletes reported losing a mean of 5 kg starting approximately 12 days before a competition. The most common methodology reported by senior and junior sambo athletes was gradually increasing dieting, followed by sauna and plastic suit training. Less common methods adopted were laxatives, diuretics, the use of diet pills and vomiting. There were significant group differences for sauna and diet pill ingestion. Coaches and parents are influential people in the lives of athletes concerning the weight loss strategy to be adopted. CONCLUSIONS: This study's results unequivocally confirm the prevalent practice of RWL in both senior and junior sambo athletes. Although athletes prevalently chose "less harmful" methods, there is a need to inform parents and coaches of the risks and benefits of RWL.

Effects of Rapid Weight Loss on Judo Athletes: A Systematic Review.

Rapid weight loss (RWL) is commonly practiced among judo athletes. Although it helps them to gain the advantage over their lighter opponents, previous studies have shown that RWL can have a negative impact on the athlete's performance and overall well-being. This systematic review aimed to synthesize the evidence that examines the influence of rapid weight loss on physiological parameters, biomarkers, and psychological well-being in judo athletes. We followed the preferred reporting items for systematic reviews and meta-analyses guidelines. We searched for studies on Web of Science and PubMed that elaborate on the influence of ≥5% RWL achieved over ≤7-day period in judokas. Out of 52 studies initially found, 14 studies met our eligibility criteria and were included in the review. In total, we examined data from 1103 judo athletes. Retrieved studies showed conflicting data concerning physiological parameters and biomarkers, while psychological well-being parameters were more consistent than physiological and biomarkers. The feeling of tension, anger, and fatigue significantly increased while a decrease in vigor was demonstrated among athletes who lost weight rapidly. The evidence on the impact of RWL on performance remains ambiguous. More studies under standardized conditions are needed in order to provide firm evidence. Considering the harmful effects of RWL outlined in the existing literature, it is important to determine and monitor athlete's minimal competitive weight to prioritize the health and safety of the athlete, emphasize fairness, and ultimately benefit the sport.

The effects of rapid weight loss on skeletal muscle in judo athletes.

OBJECTIVE: To observe the effect of rapid weight loss (RWL) methods over 3 days on muscle damage in judokas. METHODS: Eighteen judokas participated in this crossover study, meaning that judo athletes were subjected to exercise-only phase (4 days) and RWL phase (3 days). Subjects were tested for myoglobin, creatine kinase, aldolase, hemoglobin, and hematocrit values on seven consecutive days. These biomarkers served as indicators of acute muscle damage. RESULTS: During the exercise-only phase, no significant changes were observed. Myoglobin (Mb) (p < 0.001), creatine kinase (CK) (p < 0.001) and aldolase (ALD) (p < 0.001) significantly increased only during the RWL phase, as well as hemoglobin (Hb) (p < 0.001) and hematocrit (Hct) (p < 0.005) values. It was detected that peak values for muscle damage biomarkers were reached on the sixth day, while Hct and Hb values were the highest on the seventh day of the study. CONCLUSION: Our study showed significant muscle damage induced by RWL. The prevalence of RWL use by judokas is high but firm scientific evidence is lacking in the evaluation of the current practice of it. Therefore, further knowledge must be gained to evaluate the effectiveness of RWL on performance and its impact on judokas' wellbeing.

The "Journal of Functional Morphology and Kinesiology" Journal Club Series: Highlights on Recent Papers in Corrective Exercise.

We are glad to introduce the Journal Club of Volume Five, fourth Issue. This edition is focused on relevant studies published in the last few years in the field of corrective exercise, chosen by our Editorial Board members and their colleagues. We hope to stimulate your curiosity in this field and to share a passion for sport with you, seen also from the scientific point of view. The Editorial Board members wish you an inspiring lecture.

The efficacy of muscle energy techniques in symptomatic and asymptomatic subjects: a systematic review.

Background: Muscle energy techniques are applied to reduce pain and increase range of motion. These are applied to a variety of pathological conditions and on asymptomatic subjects. There is however limited knowledge on their effectiveness and which protocol may be the most beneficial. Objective: The aim of this review is to determine the efficacy of muscle energy techniques (MET) in symptomatic and asymptomatic subjects. Design: Systematic Review. Methods: A literature search was performed using the following database: Cochrane Library, MEDLINE, NLM Pubmed and ScienceDirect. Studies regarding MET in asymptomatic and symptomatic patients were considered for investigation. The main outcomes took into account range of motion, chronic and acute pain and trigger points. Two trained investigators independently screened eligible studies according to the eligibility criteria, extracted data and assessed risk of bias. Randomized control trials (RCT's) were analyzed for quality using the PEDro scale. Results: A total of 26 studies were considered eligible and included in the quantitative synthesis: 14 regarding symptomatic patients and 12 regarding asymptomatic subjects. Quality assessment of the studies through the PEDro scale observed a "moderate to high" quality of the included records. Conclusions: MET are an effective treatment for reducing chronic and acute pain of the lower back. MET are also effective in treating chronic neck pain and chronic lateral epicondylitis. MET can be applied to increase range of motion of a joint when a functional limitation is present. Other techniques seem to be more appropriate compared to MET for trigger points.

What drives athletes toward dietary supplement use: objective knowledge or self-perceived competence? Cross-sectional analysis of professional team-sport players from Southeastern Europe during the competitive season.

BACKGROUND: Issues related to knowledge of nutrition and dietary supplementation (DS) are understudied in professional athletes. This study aimed to examine the possible association between knowledge of nutrition and DS (KN&DS) and dietary supplement use (DSU) among professional athletes involved in team sports. METHODS: The sample comprised professional team-sport athletes (N = 912, age: 22.11 ± 3.37 years, 356 females) involved in four Olympic sports: basketball (N = 228), soccer (N = 324), volleyball (N = 154), and handball (N = 206). The participants were tested by previously validated questionnaires to examine their self-perceived competence on nutrition and DS (S/KN&DS), their objectively evaluated (tested) KN&DS (O/KN&DS), sociodemographic and sport-specific variables (predictors), and DSU (criterion). Associations between the predictors and the criterion (No-DSU - Irregular-DSU - Regular-DSU) were determined by multinomial regression analysis for the total sample and separately for the studied sports. RESULTS: DSU was found to be less prevalent in older and more successful players. The O/KN&DS and S/KN&DS were positively correlated with DSU, but S/KN&DS was a stronger predictor of DSU than O/KN&DS. Sport-specific associations between predictors and criterion were identified, with stronger correlations in sports with a higher prevalence of DSU. CONCLUSIONS: Due to the low correlations between O/KN&DS and S/KN&DS in the studied players, this study highlights the necessity for more frequent monitoring of biomarkers of nutritional status and its usage by coaches and practitioners to provide quantitative instruction.

The "Journal of Functional Morphology and Kinesiology" Journal Club Series: Highlights of Recent Papers in Pediatric Exercise.

We are glad to introduce the ninth Journal Club. This edition is focused on several relevant studies published in the last years in the field of Pediatric Exercise, chosen by our Editorial Board members and their colleagues. We hope to stimulate your curiosity in this field and to share with you the passion for the sport as seen also from the scientific point of view. The Editorial Board members wish you an inspiring lecture.

The "Journal of Functional Morphology and Kinesiology" Journal Club Series: Highlights on Recent Papers in Overtraining and Exercise Addiction.

We are glad to introduce the seventeenth Journal Club. This edition is focused on several relevant studies published in the last years in the field of Overtraining and Exercise Addiction, chosen by our Editorial Board members and their colleagues. We hope to stimulate your curiosity in this field and to share with you the passion for the sport seen also from the scientific point of view. The Editorial Board members wish you an inspiring lecture.

The "Journal of Functional Morphology and Kinesiology" Journal Club Series: Highlights on Recent Papers in Athletic Training.

We are glad to introduce the tenth Journal Club. This edition is focused on several relevant studies published in the last years in the field of athletic training, chosen by our Editorial Board members and their colleagues. We hope to stimulate your curiosity in this field and to share with you the passion for the sport seen also from the scientific point of view. The Editorial Board members wish you an inspiring lecture.

Session-RPE for quantifying load of different youth taekwondo training sessions.

BACKGROUND: The session rating of perceived exertion (session-RPE) proved to be a valuable method to quantify the internal training load (ITL) in taekwondo. However, no study validated this method in youth taekwondo athletes performing different training sessions. Thus this study aimed at evaluating the reliability of the session-RPE to monitor the ITL of prepubescent taekwondo athletes during pre-competitive (PC) and competitive (C) training sessions. METHODS: Five female (age: 12.0±0.7 y; height: 1.54±0.08 m; body mass: 48.8±7.3 kg) and four male (age: 12.0±0.8 yrs; height: 1.55±0.07 m; body mass: 47.3±5.3 kg) taekwondo athletes were monitored during 100 individual sessions (PC: N.=33; C: N.=67). The Edwards' HR method was used as reference measure of ITL; the CR-10 RPE scale was administered at 1- and 30-minutes from the end of each session. RESULTS: No difference for gender emerged. The ITLs of C (Edwards: 228±40 arbitrary units, AU) resulted higher than that of PC (192±26 AU; P=0.04). Although all training typologies and data collections achieved significant correlations between Edwards' and session-RPE methods, a large relationship (r =0.71, P<0.001) emerged only for PC sessions evaluated at 30 minutes of the recovery phases. CONCLUSIONS: Findings support coaches of prepubescent taekwondo athletes to successfully use session-RPE to monitor the ITL of different training typologies. However, PC training evaluated at 30 minutes of the recovery phase represents the best condition for a highly reliable ITL perception.

The Effects of Different High-Protein Low-Carbohydrates Proprietary Foods on Blood Sugar in Healthy Subjects.

The aim of this study was to analyze the effects on blood sugar concentrations through the calculation of the glycemic score (GS) of 10 different high-protein low-carbohydrates (CHOs) proprietary foods that are commonly used as meals during very low-CHO ketogenic diets or during low-CHO diets. Fourteen healthy females were tested for their glycemic response curve elicited by 1000 kJ of glucose three times within a 3-week period (one test each week) compared with one of 10 test foods once on separate days twice a week. After determining the GS of each food in each individual, the mean GS of each test food was calculated. All test foods, compared with glucose, produced a significantly lower glycemic response. The GS of all test food resulted in being lower than 25 and the difference between the mean glycemia after the intake of glucose (mean 122 ± 15 mg/dL) and after the intake of the sweet test foods (mean 89 ± 7 mg/dL) was 33 mg/dL (P < .001), whereas the difference between the mean glycemia after the intake of glucose and after the intake of savory test foods (mean 91 ± 8 mg/dL) was of 31 mg/dL (P < .001). CONCLUSIONS: The reformulation of ultraprocessed ready-to-consume foods in a low-CHO, high-protein version can produce a significantly lower glycemic response whilst maintaining the valued ready-to-use format and high palatability demanded by consumers. The low impact on postprandial glycemia and the nutritional characteristics of these proprietary foods makes them useful in both weight control management strategies and in the care management of diabetes.

The role and working conditions of Movement Science students employed in sport and recreational facilities: An Italian multicenter study.

BACKGROUND: In Italy, students from Movement Science (MS) Degree Courses often work in sport and recreational facilities before graduation. OBJECTIVE: The employment conditions of Movement Science students working in sport/recreational facilities were investigated, and the management and structural features of the facilities were evaluated, including safety policies. Regional differences were also considered. METHODS: Questionnaires were administered to undergraduate and graduate students (N = 4,217) in 17 Universities. Students' perceptions of the quality of the facilities where they had been employed was evaluated using multivariate analysis. A latent class model with covariates was used to evaluate how variables relating to participants, employment facilities or regions influence their opinions. RESULTS: A high proportion of MS students were employed in sporting facilities (undergraduate level: 33% ; graduate level: 55%), in most cases without any formal employment contracts. Both the structural and hygienic features, as well as the professional knowledge of the staff, were considered good to excellent by the majority of participants (about 70%). Communication of the basic behavioral rules was considered adequate by 61-63% of undergraduate students and 71-75% of graduate students, while nearly half of the participants were dissatisfied with the staff safety training. Correlations between the perceived good structural/hygienic conditions, the presence of regulations and training programs for the staff were investigated. Differences regarding occupational level and safety training among different regions of Italy were also observed. CONCLUSIONS: Italian students in Movement Science were easily employed in sport/recreational facilities, but frequently without a formal contract. This is a consequence of the lack of specific regulations in the field of recreational/leisure employment and could have negative implications, especially in terms of safety.

One repetition maximum bench press performance: a new approach for its evaluation in inexperienced males and females: a pilot study.

The aim of this study was to evaluate a new method to perform the one repetition maximum (1RM) bench press test, by combining previously validated predictive and practical procedures. Eight young male and 7 females participants, with no previous experience of resistance training, performed a first set of repetitions to fatigue (RTF) with a workload corresponding to ⅓ of their body mass (BM) for a maximum of 25 repetitions. Following a 5-min recovery period, a second set of RTF was performed with a workload corresponding to ½ of participants' BM. The number of repetitions performed in this set was then used to predict the workload to be used for the 1RM bench press test using Mayhew's equation. Oxygen consumption, heart rate and blood lactate were monitored before, during and after each 1RM attempt. A significant effect of gender was found on the maximum number of repetitions achieved during the RTF set performed with ½ of participants' BM (males: 25.0 ± 6.3; females: 11.0x± 10.6; t = 6.2; p < 0.001). The 1RM attempt performed with the workload predicted by Mayhew's equation resulted in females performing 1.2 ± 0.7 repetitions, while males performed 4.8 ± 1.9 repetitions. All participants reached their 1RM performance within 3 attempts, thus resulting in a maximum of 5 sets required to successfully perform the 1RM bench press test. We conclude that, by combining previously validated predictive equations with practical procedures (i.e. using a fraction of participants' BM to determine the workload for an RTF set), the new method we tested appeared safe, accurate (particularly in females) and time-effective in the practical evaluation of 1RM performance in inexperienced individuals.

Comparative validity of the ASSO-Food Frequency Questionnaire for the web-based assessment of food and nutrients intake in adolescents.

BACKGROUND: A new web-based food frequency questionnaire (the ASSO-FFQ) was developed within the ASSO Project funded by the Italian Ministry of Health. OBJECTIVE: The aim of the present study is to assess the validity of the ASSO-FFQ at food groups, energy, and nutrients level. DESIGN AND SUBJECTS: The validation study compared the ASSO-FFQ against a weighted food record (WFR) measuring foods, beverages and supplements intake, compiled during the week following the ASSO-FFQ administration. Ninety-two subjects aged 14-17, recruited from secondary schools in Palermo (Italy), completed the ASSO-FFQ and WFR. The intake of 24 food groups, energy, and 52 nutrients were taken as main outcomes. Tests for paired observations, Spearman and Pearson's correlation coefficients (cc), kappa statistics and classification in quintiles, Bland-Altman plots and multiple regressions, on untransformed and transformed data were used for the statistical analysis. RESULTS: High cc (≥0.40) were found for soft drinks, milk, tea/coffee, vegetables, and lactose; fair energy-adjusted cc (0.25-0.40) for water, alcoholic drinks, breakfast cereals, fishery products, savory food, fruit juice, eggs, and 19 nutrients. The subjects classified in the same or adjacent quintile for food groups ranged from 40% (alcoholic drinks) to 100% (dried fruit); for energy and nutrients from 43% (phosphorus, thiamin, niacin) to 77% (lactose). Mean differences were not significant for water, soft drinks, meat, sweets, animal fats, milk and white bread, and vitamin B12 and folate. Limits of Agreement were broad for all food groups and nutrients. School, gender, alcohol consumption and between meals mainly affected most food groups' intake differences. Gender stratification showed females had increased Pearson's cc for energy and 28 nutrients, such as almost all fats, carbohydrates, vitamins and minerals. CONCLUSIONS: The ASSO-FFQ could be applied in epidemiological studies for the assessment of dietary consumption in adolescents to adequately rank food, energy and nutrient intakes at a group level.

Effects of n-3 polyunsaturated fatty acids (ω-3) supplementation on some cardiovascular risk factors with a ketogenic Mediterranean diet.

BACKGROUND: the ketogenic diet (KD) has become a widely used nutritional approach for weight loss. Some of the KD's positive effects on metabolism and cardiovascular risk factors are similar to those seen after n-3 polyunsaturated fatty acids (ω-3) supplementation. We hypothesized that a ketogenic Mediterranean diet with phytoextracts combined with ω-3 supplementation may have increased positive effects on cardiovascular risk factors and inflammation. METHODS: We analyzed 34 male overweight subjects; aged between 25 and 65 years who were overall healthy apart from overweight. The subjects followed a ketogenic diet protocol for four weeks; with (KDO3) or without (KD) ω-3 supplementation. RESULTS: All subjects experienced a significant loss of body weight and body fat and there was no significant differences between treatment (body weight: KD-4.7 kg, KDO3-4.03 kg, body fat KD-5.41 kg, KDO3-5.86 kg). There were also significant decreases in total cholesterol, LDL-c, and glucose levels. Triglycerides and insulin levels decreased more in KDO3 vs. KD subjects, with a significant difference. All the investigated inflammatory cytokines (IL-1ß, IL-6, TNF-α) decreased significantly in KDO3 subjects whilst only TNF-α showed a significant decrease in KD subjects over the 12 month study period. No significant changes were observed in anti-inflammatory cytokines (IL-10 and IL-1Ra), creatinine, urea and uric acid. Adiponectin increased significantly only in the KDO3 group. CONCLUSIONS: ω-3 supplementation improved the positive effects of a ketogenic Mediterranean diet with phytoextracts on some cardiovascular/metabolic risk factors and inflammatory state.