High prevalence of iron deficiency and anemia in female military recruits.

Iron deficiency anemia has long been known to impair physical and mental performance. Iron deficiency itself, even without anemia, may also cause such an effect. Similar to female athletes, women in active military units may have increased risks for iron deficiency and its detrimental effects. Female recruits were screened for anemia and iron store status, and a questionnaire on lifestyle habits and menstruation was completed. Iron depletion (serum ferritin level of <20 microg/L) was found for 77% of study participants. Iron deficiency (ferritin level of <12 microg/L and transferrin saturation of <15%) was found for 15% of study participants. Anemia was found for 24% of subjects, and iron deficiency anemia was found for 10% of subjects. High prevalence of iron depletion, iron deficiency, anemia, and iron deficiency anemia was found among female recruits intended for active military duty. Therefore, a recommendation can be made to screen such female recruits for anemia and iron stores.

[Exercise prescription for diabetics: more than a general recommendation].

Physical activity (PA) offers numerous benefits in diabetes prevention and management. These include better glycemic control, reduction of co-morbidities such as hypertension, dyslipidemia and cardiovascular disease, decreased mortality and improved quality of life. Many caretakers are unaware of the specific recommendations and restrictions regarding PA in diabetic patients. This may result in the withholding of an important therapeutic tool from patients, the unnecessary limitation of PA in patients keen to undertake it, or, on the other hand, in adverse reactions to exercise which may be prevented. This review presents PA recommendations in both type 1 and 2 diabetics, which include aerobic activity and strength training. Several safety points before commencing or increasing the intensity of a PA program are also addressed; assessment of the cardiovascular response to exercise, the presence of retinopathy, neuropathy, nephropathy, and proper foot care, are essential.

The menstrual cycle and sport performance.

The female sex steroid hormones estrogen and progesterone have potential effects on exercise capacity and performance through numerous mechanisms, such as substrate metabolism, cardiorespiratory function, thermoregulation, psychologic factors, and injuries. Consequently, hormone level changes may theoretically lead to either improved or decreased performance at various times throughout the menstrual cycle. Numerous methodological issues and a paucity of studies have precluded evidence-based conclusions in almost every area of research in this field. In addition, there appears to be a great degree of inter- and intraindividual variability in these hormonal responses. Using oral contraceptives may be advantageous for female athletes who are negatively affected by their menstrual cycle, as they may provide a stable yet controllable hormonal milieu for training and competition.

AlphaMUPA mice: a transgenic model for longevity induced by caloric restriction.

Caloric restriction (CR) is currently the only therapeutic intervention known to attenuate aging in mammals, but the underlying mechanisms of this phenomenon are still poorly understood. To get more insight into these mechanisms, we took advantage of the alphaMUPA transgenic mice that previously were reported to spontaneously eat less and live longer compared with their wild-type control mice. Currently, two transgenic lines that eat less are available, thus implicating the transgenic enzyme, i.e. the urokinase-type plasminogen activator (uPA), in causing the reduced appetite. This phenotypic change could have resulted from the ectopic transgenic expression that we detected in the adult alphaMUPA brain, or alternatively, from a transgenic interference in brain development. Here, we have summarized similarities and differences so far found between alphaMUPA and calorically restricted mice. Recently, we noted several changes in the alphaMUPA liver, at the mitochondrial and cellular level, which consistently pointed to an enhanced capacity to induce apoptosis. In addition, alphaMUPA mice showed a reduced level of serum IGF-1 and a reduced incidence of spontaneously occurring or carcinogen-induced tumors in several tissues. In contrast, alphaMUPA did not differ from wild type mice in the levels of low molecular weight antioxidants when compared in several tissues at a young or an old age. Overall, the alphaMUPA model suggests that fine-tuning of the threshold for apoptosis, possibly linked in part to modulation of serum IGF-1 and mitochondrial functions, could play a role in the attenuation of aging in calorically restricted mice.

Omega-6 fatty acids and coronary artery disease: the pros and cons.

Polyunsaturated fatty acids have long been recommended as a beneficial substitute for atherogenic saturated fat. The connection between dietary lipids and blood cholesterol is still under debate, as is the connection between dietary fat and coronary artery disease. Thus, the lipid hypothesis is still a hypothesis. The major dietary polyunsaturated fatty acid, linoleic acid of the omega-6 family, has several properties that render it hyperinsulinemic and atherogenic. The potential benefits of linoleic acid intake regarding coronary artery disease, and its possible harms, are discussed.

Prevalence of iron depletion and anemia in top-level basketball players.

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

Polyunsaturated Fatty acids, insulin resistance, and atherosclerosis: is inflammation the connecting link?

We discuss the concept that the two essential (not produced by the body and obtained exclusively through the diet) polyunsaturated fatty acid families-n-6 and n-3-may play a role in the pathogenesis of insulin resistance through inflammatory pathways. Linoleic acid, the major n-6 fatty acid, is metabolized into pro-inflammatory arachidonic acid, which, in turn, gives rise to leukotrienes and protaglandins. N-3 fatty acids, found in plants and in fish, reduce the levels of arachidonic acid, thereby lowering inflammatory mediator concentrations and increasing insulin sensitization. We discuss these findings and their implications for insulin resistance and their possible effect on coronary heart disease.

[Iron deficiency and anemia in female athletes--causes and risks].

Iron deficiency is probably the most common nutrient deficiency in the western world. Low levels of iron in the body are caused by several mechanisms, and become symptomatic with the onset of iron deficiency anemia. Athletes are a special group with additional reasons for iron or blood loss, such as plasma expansion, increase perspiration, 'foot strike hemolysis, and occasionally--malnutrition. Female athletes have yet another source of blood loss--menstruation. However, the most common cause for low hemoglobin levels in an athlete is dilutional pseudoanemia, which is caused by exercise-induced fluid retention. Athletes are more sensitive to the effects of anemia and iron deficiency, as exercise performance depends on maximal oxygen carrying capacity to the active muscle, and efficient oxygen utilization. Iron deficiency without anemia can also reduce athletic performance. Diagnosis is ultimately made by a blood count and red blood cell parameters, with ferritin serving as an index of body iron stores. Treatment requires iron supplements, as it is nearly impossible to refill the iron stores through diet alone.

Weight control and the management of obesity after menopause: the role of physical activity.

BACKGROUND: Postmenopausal women have an increased tendency for gaining weight. The declines of endogenous estrogen, together with physical inactivity, are probably the major causes of this phenomenon. Postmenopausal overweight and obesity leads to increased rates of hypertension, diabetes mellitus, coronary artery disease, and all cause mortality. Additional consequences may include hormone-dependent cancer, gallstones, nephrolithiasis, and osteoarthritis. Weight loss can reverse many of these complications, reduce the number and dosages of medications used, and improve longevity. This difficult task requires lifestyle modification. OBJECTIVES: To review the current information about the effects of physical activity on postmenopausal weight gain and its consequences and to provide basic strategies to treat obesity during the menopause transition. METHODS: A Medline search together with a manual search of selected articles. CONCLUSION: Several options for weight loss are available, yet lifestyle modification is essential in managing postmenopausal obesity and overweight. While this demands dietary and behavioral changes, a major element of this modification is regular physical activity, which reduces obesity-related morbidity and mortality. The amendment to a healthier lifestyle is achievable at the postmenopausal years. All medical personnel should advocate against overweight and obesity and provide tools for their management.

Effect of an Indo-Mediterranean diet on progression of coronary artery disease in high risk patients (Indo-Mediterranean Diet Heart Study): a randomised single-blind trial.

BACKGROUND: The rapid emergence of coronary artery disease (CAD) in south Asian people is not explained by conventional risk factors. In view of cardioprotective effects of a Mediterranean style diet rich in alpha-linolenic acid, we assessed the benefits of this diet for patients at high risk of CAD. METHODS: We did a randomised, single-blind trial in 1000 patients with angina pectoris, myocardial infarction, or surrogate risk factors for CAD. 499 patients were allocated to a diet rich in whole grains, fruits, vegetables, walnuts, and almonds. 501 controls consumed a local diet similar to the step I National Cholesterol Education Program (NCEP) prudent diet. FINDINGS: The intervention group consumed more fruits, vegetables, legumes, walnuts, and almonds than did controls (573 g [SD 127] vs 231 g [19] per day p<0.001). The intervention group had an increased intake of whole grains and mustard or soy bean oil. The mean intake of alpha-linolenic acid was two-fold greater in the intervention group (1.8 g [SD 0.4] vs 0.8 g [0.2] per day, p<0.001). Total cardiac end points were significantly fewer in the intervention group than the controls (39 vs 76 events, p<0.001). Sudden cardiac deaths were also reduced (6 vs 16, p=0.015), as were non-fatal myocardial infarctions (21 vs 43, p<0.001). We noted a significant reduction in serum cholesterol concentration and other risk factors in both groups, but especially in the intervention diet group. In the treatment group, patients with pre-existing CAD had significantly greater benefits compared with such patients in the control group. INTERPRETATION: An Indo-Mediterranean diet that is rich in alpha-linolenic acid might be more effective in primary and secondary prevention of CAD than the conventional step I NCEP prudent diet.