Associations of Serum Irisin and Fibroblast Growth Factor-21 Levels With Bone Mineral Characteristics in Eumenorrheic Adolescent Athletes With Different Training Activity Patterns.

PURPOSE: To describe serum irisin and fibroblast growth factor-21 (FGF-21) concentrations in healthy female adolescents with different training activity patterns and their associations with bone mineral properties and metabolic markers. METHODS: A total of 62 adolescent girls aged 14-18 years were recruited: 22 rhythmic gymnasts, 20 swimmers, and 20 untrained controls. Bone mineral characteristics by dual-energy X-ray absorptiometry, daily energy intake by dietary recall, serum irisin, FGF-21, undercarboxylated osteocalcin, and C-terminal telopeptide of type I collagen were measured in all girls. RESULTS: Whole body and lumbar spine areal bone mineral density and lumbar spine bone mineral content were higher in the rhythmic gymnasts group compared with swimmers and untrained controls groups (P < .05). Serum irisin, FGF-21, undercarboxylated osteocalcin, and C-terminal telopeptide of type I collagen levels were not significantly different between the groups. In the rhythmic gymnasts group, serum FGF-21 concentration was positively correlated with lumbar spine areal bone mineral density independently of confounding factors (r = .51; P = .027). CONCLUSIONS: Serum irisin and FGF-21 levels were not different between adolescent eumenorrheic girls with different training activity patterns. FGF-21 was positively associated with lumbar spine areal bone mineral density, which predominantly consists of trabecular bone in adolescent rhythmic gymnasts.

Estonian Parents' Awareness of Pediculosis and Its Occurrence in Their Children.

Background and Objectives: Pediculosis, or head lice infestation, is a widespread health problem that can affect anyone, regardless of gender, age, or social background. The purpose of this study was to clarify the occurrence of pediculosis among Estonian preschool- and primary school-aged children according to their parents and the parent's awareness of pediculosis and related behaviors. Materials and Methods: An online questionnaire was completed by the parents of the preschool children (n = 1141) in 2019 and the parents of the elementary school children (n = 362) in 2021. For the descriptive data, t-test, Mann−Whitney or χ2 test, linear regression, and logistic regression analyses were applied. Results: According to the parents, pediculosis had occurred in 34.7% of the children, and more than one-third of pediculosis patients had experienced it more than twice. Lice were mainly acquired from elementary school or preschool and less often from friends, relatives, or training environments. Parents' knowledge of head lice was rather good; the average score of the correct answers was 14.0 ± 3.4 (max. 20). In the multivariate analysis, higher age (coefficient 0.07, p < 0.001), healthcare education (coefficient 1.19, p < 0.001), and a previous occurrence of pediculosis in a family (coefficient 1.95; p < 0.001) were factors influencing better knowledge. In order to treat the infestation, antilice shampoo and combing were the most often used methods. Conclusion: Despite parents' awareness, pediculosis infestations continue to be common among our children.

Sclerostin, preadipocyte factor-1 and bone mineral values in eumenorrheic adolescent athletes with different training patterns.

INTRODUCTION: The specific aims of the study were to compare possible differences in sclerostin and preadipocyte factor-1 (Pref-1) between rhythmic gymnasts (RG), swimmers (SW) and untrained controls (UC), and to investigate the relationships of sclerostin and Pref-1 with bone mineral characteristics in studied groups. MATERIALS AND METHODS: This study included 62 eumenorrheic adolescents (RG = 22; SW = 20; UC = 20). Bone mineral and body composition characteristics were measured by dual-energy X-ray absorptiometry, and sclerostin, Pref-1, osteocalcin and C-terminal telopeptide of type I collagen (CTx) were measured. RESULTS: Sclerostin was higher (P = 0.001) in RG (129.35 ± 51.01 pg/ml; by 74%) and SW (118.05 ± 40.05 pg/ml; by 59%) in comparison with UC (74.32 ± 45.41 pg/ml), while no differences (P = 0.896) were seen in Pref-1 (RG: 1.42 ± 0.16 ng/ml; SW: 1.41 ± 0.20 ng/ml; UC: 1.39 ± 0.26 ng/ml) between groups. Osteocalcin (RG: 7.74 ± 4.09 ng/ml; SW: 8.05 ± 4.18 ng/ml; UC: 7.04 ± 3.92 ng/ml; P = 0.843) and CTx (RG: 0.73 ± 0.22 ng/ml; SW: 0.64 ± 0.16 ng/ml; UC: 0.62 ± 0.20 ng/ml; P = 0.173) were not different between groups. Sclerostin correlated (P < 0.05) with whole-body bone mineral content (r = 0.61) and lumbar spine (LS) areal bone mineral density (aBMD) (r = 0.43) in RG, and femoral neck aBMD (r = 0.45) in UC. No correlation was found between sclerostin and bone mineral values in SW, and Pref-1 was not correlated with any bone mineral characteristics in studied groups. Sclerostin was the independent variable that explained 14% of the total variance (R2 × 100) in LS aBMD value only in RG. CONCLUSIONS: Adolescent athletes have higher sclerostin compared to UC. Sclerostin was correlated with bone mineral values and predicted areal bone mineral density in RG.

The Impact of Marathons on the Recovery of Heart Rate and Blood Pressure in Non-Professional Male Marathoners' (≥45 Years).

Background and Objectives: Physical activity has a positive impact on health, and the participation in exercise and sports, including marathons, has increased in popularity. This kind of sport requires extreme endurance, which can cause different health problems and even lead to death. Participants without sufficient preparation and, in particular, men 45 years of age and older belong to a high risk group. The aim of this study was to determine the impact of marathons and cofactors associated with marathons on the recovery of heart rate (HR) and blood pressure (BP) of non-professional ≥ 45 years old male marathoners. Materials andMethods: A total of 136 ≥ 45 year old, non-professional (amateur marathoner), male participants were recruited. Data collection involved a questionnaire, body composition measures, and BP and HR results before and after finishing the marathon. Descriptive data, t-test, Mann-Whitney or χ2 test, and Pearson's correlation were applied. Results: Participants (skiing n = 81, cycling n = 29, running n = 26; mean age 51.7 ± 7.1 years old) had previously attended a median of 35 (IQR 17.5-66) marathons and travelled 2111.5 (IQR 920-4565) km. Recovery of HR and BP after finishing and recovery time was insufficient and not associated with marathon preparation. Running was the most burdensome for HR, and cycling was most taxing for BP. Chronic diseases did not influence participation in the marathon. Conclusions: The preparation for the marathon was mainly sufficient, but recovery after the marathon was worrisome. Marathons are demanding for ≥45 year old males and may be too strenuous an activity that has deleterious effects on health.

A Longitudinal Study of Bone Mineral Accrual during Growth in Competitive Premenarcheal Rhythmic Gymnasts.

The purpose of this investigation was to study whether prolonged competitive rhythmic gymnastics training influenced bone mineral accrual in premenarcheal girls. Eighty-nine girls (45 rhythmic gymnasts [RG] and 44 untrained controls [UC]) between 7 and 9 years of age were recruited and measured annually for four years (not all participants were measured at every occasion). Dual energy x-ray absorptiometry was used to assess the development of whole body (WB), femoral neck (FN) and lumbar spine (LS) bone mineral content (BMC). In addition, body composition, blood adipokine and jumping performance characteristics were obtained. For longitudinal analyses, hierarchical mixed-effects models were constructed to predict differences in the development of WB, FN and LS BMC between RG and UC groups, while accounting for differences in body composition, blood adipokine and jumping performance values. It appeared that from 8 years of age, RG had lower (p < 0.05) fat mass and leptin values, and higher (p < 0.05) jumping performance measures in comparison with UC girls. Hierarchical mixed-effects models demonstrated that RG had 71.9 ± 12.0, 0.23 ± 0.11 and 1.39 ± 0.42 g more (p < 0.05) WB, FN and LS BMC, respectively, in comparison with UC girls. In addition, WB, FN and LS BMC increased more (p < 0.05) between 7 to 12 years of age in RG girls in comparison with UC. In conclusion, these findings suggest that the prolonged exposure to competitive rhythmic gymnastics trainings in premenarcheal girls is associated with greater bone mineral accrual despite lower body fat mass and leptin values.

Bone Mineralization in Rhythmic Gymnasts Entering Puberty: Associations with Jumping Performance and Body Composition Variables.

This study examined bone mineral density (BMD) accrual in prepubertal rhythmic gymnasts entering puberty and their age-matched untrained control girls, and associations with baseline jumping performance and body composition over the 3-year period. Whole body (WB) and femoral neck (FN) BMD, WB fat mass (FM) and fat free mass (FFM), countermovement jump (CMJ) and rebound jumps for 15 s (RJ15s) were assessed in 25 rhythmic gymnasts and 25 untrained controls at baseline and after 3-year period. The changes over this period were calculated (Δ scores). Pubertal maturation over the 3-year period was slower in rhythmic gymnasts compared to untrained controls, while no difference in bone age development was seen. WB BMD increased similarly in both groups, while the increase in FN BMD was higher in rhythmic gymnasts compared with untrained controls. In rhythmic gymnasts, baseline FFM was the most significant predictor of ΔWB BMD explaining 19.2% of the variability, while baseline RJ15s was the most significant predictor of ΔFN BMD explaining 18.5% of the variability. In untrained controls, baseline FM explained 51.8 and 18.9% of the variability in ΔWB BMD and ΔFN BMD, respectively. In conclusion, mechanical loading of high-intensity athletic activity had beneficial effect on BMD accrual in rhythmic gymnasts and may have counterbalanced such negative factors on bone development as slower pubertal maturation and lower body FM. Baseline FFM and repeated jumps test performance were related to BMD accrual in rhythmic gymnasts, while baseline FM was related to BMD accrual in untrained controls.

Adipocytokine and ghrelin levels in relation to bone mineral density in prepubertal rhythmic gymnasts entering puberty: a 3-year follow-up study.

PURPOSE: To investigate changes in bone mineral density (BMD) in rhythmic gymnasts (RG) entering puberty and their age-matched untrained controls (UC) over the 36-month period, and associations with leptin, adiponectin and ghrelin over this period. METHODS: Whole body (WB), lumbar spine (LS) and femoral neck (FN) BMD, WB bone mineral content (BMC), and leptin, adiponectin and ghrelin were measured in 35 RG and 33 UC girls at baseline and at 12-month intervals over the next 3 years. The change over the 36 months was calculated (∆ score). RESULTS: The pubertal development over the next 36 months was slower in RG compard to UC, while there was no difference in bone age development between the groups. BMD at all sites was higher in RG in comparison with UC at every measurement point. ∆LS BMD and ∆FN BMD, but not ∆WB BMD and ∆WB BMC, were higher in RG compared with UC. None of the measured hormones at baseline or their ∆ scores correlated with ∆BMD and ∆BMC in RG. Baseline fat free mass correlated with ∆WB BMD and ∆WB BMC in RG, while baseline leptin was related to ∆WB BMC, ∆WB BMD and ∆LS BMD in UC. CONCLUSIONS: Measured baseline hormones and their ∆ scores did not correlate with increases in bone mineral values in RG entering puberty. Although the pubertal development in RG was slower than in UC, high-intensity training appeared to increase BMD growth and counterbalance negative effects of slow pubertal develpment, lower fat mass and leptin in RG.

Adipocytokine and ghrelin levels in relation to body composition in rhythmic gymnasts entering into puberty: a 3-year follow-up study.

The aim of this study was to describe longitudinal changes in body composition, leptin, adiponectin, and ghrelin over a 36-month period in prepubertal rhythmic gymnasts (RG) and their age-matched untrained controls (UC) entering into puberty. Thirty-five RG (8.0 ± 0.6 yrs) and 33 UC (8.2 ± 0.6 yrs) were followed at 12-month intervals for the next 3 years. Height, weight, pubertal stage, body composition, leptin, adiponectin, and ghrelin were measured at each time points. The pubertal development over the next 36 months was slower in the RG compared with UC. Leptin was increased in UC and remained unchanged in RG over 3-year study period (3.7 ± 3.6 vs. 0.2 ± 1.1 ng/ml; p < .05). In RG, baseline leptin was negatively correlated with the change in body fat percentage over a 36-month period (r = -0.34; p < .05). The change in adiponectin over the study period was negatively correlated with the change in BMI (r = -0.43; p < .05). RG had relative leptin deficiency per body fat mass. In conclusion, relatively high leptin concentration at the beginning of puberty may predict those girls who do not increase their body fat percentage through coming years and therefore may have increased risk for delayed puberty.

Follistatin Is Associated with Bone Mineral Density in Lean Adolescent Girls with Increased Physical Activity.

Follistatin is a member of the activin-follistatin-inhibin hormonal system and is proposed to affect bone metabolism. However, data regarding the effect of follistatin on bone are relatively scarce and contradictory in humans. The purpose of the current study was to investigate possible associations of serum follistatin concentration with bone mineral characteristics in lean and physically active adolescent girls. Bone mineral density, body composition, resting energy expenditure and different energy homeostasis hormones in serum including follistatin, leptin and insulin were investigated. Significant relationships (p < 0.05) between serum follistatin (1275.1 ± 263.1 pg/mL) and whole-body (WB) bone mineral content (r = 0.33), WB areal bone mineral density (aBMD) (r = 0.23) and lumbar spine (LS) aBMD (r = 0.29) values were observed. Serum follistatin remained associated with LS aBMD independent of body fat and lean masses (r = 0.21; p < 0.05). However, the follistatin concentration explained only 3% (R2 × 100; p = 0.049) of the total variance in LS aBMD values. In conclusion, serum follistatin concentrations were associated with bone mineral values in lean adolescent girls with increased physical activity. Follistatin was an independent predictor of lumbar spine areal bone mineral density, which predominantly consists of trabecular bone.

Changes in the Mental Health Indicators and Training Opportunities for Estonian Elite Athletes Compared to the COVID-19 Isolation Period.

Background: In spring 2020, two-thirds of Estonian elite athletes had symptoms of emotional distress. The aim of this study was to evaluate the mental health indicators and training opportunities for elite Estonian athletes a year after the complete COVID-19 isolation period compared to June 2020. Methods: In both cross-sectional studies, athletes completed self-reported questionnaires, including the Emotional State Questionnaire. Descriptive statistics, t-tests, and Chi2 tests were applied to compare the study groups (p < 0.05). Results: A total of 172 out of approximately 600 elite Estonian athletes participated in the survey (102 in 2020 and 70 in 2021). More than a year after the COVID-19 lockdown period, the mental health problems of elite athletes (particularly the symptoms of depression and fatigue) are even greater concern than in June 2020, despite the recovery in training conditions and competition. Of all of the subjects, 80% had high levels of distress in 2021 compared to 36% in 2020. According to the athletes, the availability of health care services was good (78.6%), but there was a lack of close cooperation with the coach. However, the athletes considered their coaches to be their main supporters, along with their family members and partners. Only 4.3% of the respondents considered a sports psychologist to be their main supporter (n = 6). Conclusions: More than a year after the COVID-19 lockdown period, the mental health indicators of Estonian elite athletes were worrisome. Most of subjects had high levels of distress even though their training conditions had returned to normal (i.e., to as they had been before COVID-19).

Associations of Circulating Irisin and Fibroblast Growth Factor-21 Levels with Measures of Energy Homeostasis in Highly Trained Adolescent Rhythmic Gymnasts.

The aim of this investigation was to determine the associations of serum irisin and fibroblast growth factor-21 (FGF-21) with the measures of energy homeostasis, training stress and other energy homeostasis hormones in highly trained adolescent rhythmic gymnasts (RG). Thirty-three RG and 20 untrained controls (UC) aged 14−18 years participated in this study. Body composition, resting energy expenditure (REE), peak oxygen consumption, and different energy homeostasis hormones in serum, including irisin, FGF-21, leptin, and resistin, were measured. Irisin and FGF-21 were not significantly different (p > 0.05) between RG and UC groups. In RG, serum irisin was positively associated with REE (r = 0.40; p = 0.021) and leptin (r = 0.60; p = 0.013), while serum FGF-21 was related to body fat mass (r = 0.46; p = 0.007) and leptin (r = 0.45; p = 0.009). Irisin was related to FGF-21, independent of age, body fat, and lean masses (r = 0.36; p = 0.049) in RG. In conclusion, serum irisin concentration was associated with energy expenditure and serum FGF-21 level with energy availability measures in lean adolescent athletes, while no relationships of irisin and FGF-21 with energy status measures were observed in lean nonathletic adolescents.

Impact of the COVID-19 Pandemic on Estonian Elite Athletes: Survey on Mental Health Characteristics, Training Conditions, Competition Possibilities, and Perception of Supportiveness.

Background: The postponement and cancellation of the competition season due to COVID-19 could cause significant mental health problems for an elite athlete. The aim of this study was to describe the mental health characteristics of Estonian elite athletes, their training conditions, competition possibilities, and the support they received during COVID-19. Methods: Athletes completed self-reported questionnaires (including Emotional State Questionnaire). The authors applied descriptive statistics, t-test, and χ2 test for comparison of study groups (p < 0.05). Results: Altogether 102 athletes (♂ = 44) were surveyed. The most disturbing issue for athletes was the closing of training centers (57.8%) and cancellation of competitions (50%); 64.7% of athletes reported a negative response from not being able to visit healthcare specialists. Fortunately, athletes could receive virtual coaching. Two-thirds of the athletes had some indication of distress (♀ > ♂): 25% of males and 39.7% of females had symptoms indicating depression; ♀ = 27.6%, ♂ = 13.6% anxiety; ♀ = 56.9%, ♂ = 31.8% fatigue (p = 0.021); ♀ = 55.1%, ♂ = 27.2% insomnia (p = 0.009); 27.5% thought about ending their career (frequency in high distress group compared with low: p = 0.022); and 2.9% were certain they would stop their training completely. Family members were the biggest emotional supporters; 16.7% did not get support from anyone. Conclusion: The Estonian sport community needs to adapt to life in a pandemic environment and help athletes to maintain training and competition activities and in turn, their mental health.

The Associations of Body Image Perception with Serum Resistin Levels in Highly Trained Adolescent Estonian Rhythmic Gymnasts.

Rhythmic gymnasts (RGs) are more likely to be dissatisfied with their body mass and shape compared to untrained controls (UCs). However, due to the lack of information, the aim of this study was to investigate the associations of body image perception (BIP) with body composition, daily energy consumption and different blood biochemical markers in adolescent RGs compared to UCs. Thirty-three highly trained RG girls and 20 UC girls aged 14-18 years participated in this cross-sectional study. Height, body mass, body composition, energy intake, resting energy expenditure, training volume and different blood biochemical markers were measured. The body attitude test (BAT) was used to evaluate the BIP of the participants. There were no differences in the total BAT scores between the groups. In RGs, the BAT score correlated positively with the serum resistin level (r = 0.35; p = 0.047). A stepwise multiple regression analysis showed that 40.8% of the variability in the BAT score was determined by resistin and BMI. The association of BIP with resistin values was observed only in RGs. In conclusion, our findings add to the increasing evidence that resistin may be a link between BIP and body composition, most likely through fat mass, in adolescent female RGs.

Development of Garments with Elastic Straps and Pressure Applicator (GESPA) and "GVcorrect" App to Follow the Changes in Lower-Extremity Alignment (Genu Valgum)-A Pilot Study.

BACKGROUND: There are non-invasive methods of correcting genu valgum (GV), but to date, there is no method to evaluate mechanotherapeutic intervention that does not restrict child's natural movements while the process is on-going so that timely decisions could be made on effectiveness of intervention. The aim of study was to develop and assess the comfortability of garments with elastic straps and pressure applicator (GESPA) and the reliability and user-friendliness of "GVcorrect" app, which aims to catch the elastic straps' pressure level (mN). METHODS: 6 children (5-7 y) with intermalleolar distance ≥5 cm wore GESPA daily for 3 months. Anthropometrical and goniometrical measurements were done according to standard technique; tone and biomechanical parameters of skeletal muscles determined with MyotonPRO; feedback about GESPA and "GVcorrect" collected via questionnaire. RESULTS: Based on feedback from children and parents, new, more comfortable and user-friendly GESPA were designed; several updates were made to "GVcorrect" app; new goals were set for the next phase of the study. CONCLUSIONS: GESPA and the "GVcorrect" app serve their purpose, but there are still a number of important limitations that need to be removed before the product can be marketed. The study continues with product development until a medical device certificate is obtained.

Serum sclerostin concentration is associated with specific adipose, muscle and bone tissue markers in lean adolescent females with increased physical activity.

OBJECTIVES: Sclerostin is an important regulator of bone mass involving the Wnt/ß-catenin signalling pathway. Relatively few studies have investigated the relationships of circulating sclerostin levels with adiposity-related and muscle-related biochemical factors in individuals with increased energy metabolism. The aim of this study was to investigate the associations of circulating sclerostin with adipokines, myokines, osteokines and body composition values in lean adolescent females with increased physical activity. METHODS: A total of 73 adolescent females who were physically active and aged 14-18 years old participated in the study. Sclerostin, leptin, resistin, tumour necrosis factor (TNF)-α, interleukin (IL)-6, irisin, osteocalcin, C-terminal telopeptide of type I collagen (CTx), insulin-like growth factor (IGF)-1 and insulin were obtained from fasting blood samples. Body composition was measured by dual-energy X-ray absorptiometry (DXA) and analyzed for body fat mass, lean body mass, bone mineral content and muscle mass. RESULTS: Serum sclerostin (117.9 ± 60.3 pg/mL) was correlated with age, age at menarche, body fat, muscle mass, training activity, leptin, TNF-α, irisin, osteocalcin, CTx and IGF-1. Multivariate linear regression analysis demonstrated that fat mass (ß = 0.434; p = 0.001), leptin (ß = -0.308; p = 0.015), irisin (ß = 0.227; p = 0.024) and CTx (ß = 0.290; p = 0.031) were the most important predictors of serum sclerostin concentration. CONCLUSIONS: Bone-derived sclerostin is associated with specific adipokine, myokine and osteokine values in lean adolescent females with increased physical activity. These results suggest that the interactions between bone, adipose and muscle tissues could also be associated with circulating sclerostin concentrations.

Body composition and inflammatory markers in pubertal girls: Comparison between athletes and non-athletic controls.

Various inflammation parameters are increased with childhood obesity, but few comparable data are found in lean growing athletes. This study aims to characterize differences in 12 simultaneously measured inflammatory parameters between pubertal rhythmic gymnasts (RG) and untrained controls (UC), and to examine the relationship between body composition and inflammatory markers. Sixty 10-12-year-old girls were divided into RG (n = 30) and UC (n = 30). Fat mass (FM) and fat free mass (FFM) were measured by dual-energy X-ray absorptiometry. Leptin and 12 inflammatory parameters (interleukin [IL]-2, IL-4, IL-6, IL-8, IL-10, vascular endothelial growth factor, interferon-gamma [IFN-γ], tumor necrosis factor-alpha, IL-1α, IL-1ß, monocyte chemotactic protein-1 and epidermal growth factor) were measured from fasting blood samples. No differences were seen in 12 inflammatory markers between studied groups. As expected, leptin (RG: 2.4 ± 1.1; UC: 7.6 ± 4.2 ng ml-1) and FM (RG: 7.3 ± 2.3; UC: 11.8 ± 5.1 kg) were lower (p < .05) in RG compared to UC. In the whole group of lean pubertal girls, 69.0% of the variability in body FM was determined by leptin, and 11.2% of the variability in body FFM was explained by IFN-γ. In conclusion, measured 12 inflammatory biomarkers were not different between RG and UC, despite lower leptin and FM in RG. In lean pubertal girls, IFN-γ was independently associated with FFM, and leptin with FM.