Assessing psychological and nutritional impact of suspected orthorexia nervosa: a cross-sectional pilot study.

BACKGROUND: To date, research on the dietary patterns of individuals with potential orthorexic symptoms is lacking. This cross-sectional pilot study aimed to explore the feasibility of assessing dietary patterns with psychological traits and states of individuals with possible orthorexic tendencies. METHODS: Dietary intakes of 10 individuals (two males and eight females) were assessed using 24-h recall. Mean age of participants was 28.3 years; mean body mass index was 21.2 kg m-2 . Nutrient intakes were compared with current dietary guidelines and the Eatwell Guide (Public Health England, 2016). Participants completed the ORTO-15, the Eating Attitude Test (EAT-26), the Obsessive-Compulsive Inventory-Revised edition (OCI-R), Paulhus's Spheres of Control (SoC), the Rosenberg's Self-Esteem Scale (RSES) and the Multidimensional Body-Self Relations Questionnaire (MBSRQ). RESULTS: High levels of disparity across participants' psychometric scores and 24-h recall results were observed. There was no single pattern of self-imposed dietary restrictions among participants. Described dietary practices failed to meet the guidelines for several nutrients. CONCLUSIONS: The results of this pilot study suggest that an extensive investigation of the diets of individuals with possible orthorexic tendencies in a large-scale study would contribute to the understanding of this condition. In addition, the use of multiple psychometric instruments is recommended for diagnosing orthorexic nervosa.

Health benefits and consequences of the Eastern Orthodox fasting in monks of Mount Athos: a cross-sectional study.

BACKGROUND/OBJECTIVES: Greek Orthodox fasting (OF), which involves 180-200 days of fasting per year, is dictated by the Christian Orthodox religion. For the first time, this cross-sectional study examines the characteristics and the effects of OF on anthropometry, cardiometabolic markers and calcium homeostasis in Athonian monks (AMs). SUBJECTS/METHODS: Daily intakes of energy, macro- and micronutrients of a day during a weekend of Nativity Fast, defined as non-restrictive day (NRD), and a weekday during Great Lent, labeled as restrictive day (RD) were recorded. RESULTS: The daily energy intake of 70 AM (age=38.8±9.7 years) was low during both RD and NRD (1265.9±84.5 vs 1660±81 kcal, respectively, P<0.001). Paired samples t-test showed statistically significant difference between daily intakes in RD and NRD: carbohydrates (159.6±21.8 vs 294.3±23.4 g, P<0.0001) and saturated fat (12.7±0.0 vs 16.4±0.0 g, P<0.0001) were lower, whereas protein (89.2±1.3 vs 72.35±1.3 g, P<0.001) was higher during RD. A subsample of 50 monks (age=38.7±10.6 years) formed a study cohort for cardiometabolic and calcium homeostasis assessment. Body weight (74.3±12.9 kg) and body mass index (BMI; 23.8±4.1 kg/m2) were independent of level of physical activity. Optimal profiles for lipid and glucose parameters (total cholesterol: 183.4±41.7 mg/dl, LDL: 120.6±37.6 mg/dl, triglycerides: 72.2±31.3 mg/dl, HDL: 48.5±14.2 mg/dl and homeostasis model assessment of insulin resistance (HOMA-IR) 1.02±0.40) were found. Profound hypovitaminosis D (8.8±6.2 ng/ml), high parathyroid hormone (PTH): 115.5±48.0 pg/ml with normal serum calcium levels (8.9±3.2 mg/dl) was observed. CONCLUSIONS: Unaffected by variation in lifestyle factors, the results of this unique study offers clear evidence for the health benefits of the strict Athonian OF through optimal lipid and glucose homeostasis.

Vitamin D during pregnancy: why observational studies suggest deficiency and interventional studies show no improvement in clinical outcomes? A narrative review.

A considerable number of studies have examined vitamin D status during pregnancy. Although data from observational studies denote vitamin D hypovitaminosis (deficiency or insufficiency) during pregnancy is associated with a plethora of adverse maternal and neonatal outcomes, data from interventional (supplementation) trials fail to reveal a significant impact on maternal and offspring health. The aim of this narrative review was to critically appraise the methodology of the most representative published randomized controlled trials in an attempt to explain the difference between observational and supplementation results. We found that this difference could be attributed to a variety of factors, namely: (i) study design (lack of a specific outcome in conjunction with timing of supplementation, enrolment of participants with heterogeneous vitamin D status); (ii) pitfalls in the interpretation of vitamin D equilibrium (lack of determination of plasma half-life); (iii) supplementation regimen (administration of a wide range of regimens, in terms of dose, bolus and form); (iv) geographical characteristics (vitamin D needs could vary significantly within a country, particularly in areas with a wide range of latitude gradient); (v) adaptations of vitamin D metabolism during pregnancy (vitamin D and calcium equilibrium are changed during pregnancy compared with the non-pregnant state) and (vi) supplementation of populations with low baseline 25(OH)D values would likely manifest beneficial effects. All these parameters should be taken into consideration in the design of future vitamin D supplementation trials.

Using the prototype willingness model to predict doping in sport.

To enable preventive measures to be designed, it is important to identify modifiable distal and proximal factors underlying doping behavior. This study investigated aspects of the prototype willingness model in relation to doping. A cross-sectional study was conducted involving 729 competitive athletes. Following ethical approval, athletes (mean age = 28.8 ± 10.1 years; 63% male) completed an online questionnaire, which assessed doping-related attitudes, norms, prototype perceptions, outcome expectancies, and behavioral willingness. Using hierarchical multiple regression analysis, 54.4% of the total variance in willingness to dope was explained. Specifically, past doping, attitudes, and favorability of performance enhancing substance user prototypes were the strongest unique predictors of willingness to dope. Athletes appeared most willing to dope if they were to suffer an injury, a dip in performance, or think others are doping and getting away with it. National-level athletes displayed significantly greater willingness to dope (Kruskal-Wallis γ2 = 35.9, P < 0.001) and perceived themselves as significantly more similar to a doper (Kruskal-Wallis γ2 = 13.4, P = 0.004) than athletes competing at any other level. The findings highlight the importance of extending anti-doping provision beyond elite-level sport and the need to target athletes' doping-related perceptions.

Maternal vitamin D status during pregnancy: the Mediterranean reality.

Vitamin D status during pregnancy is linked to bone mineralization of developing fetus, which justifies targeting sufficient levels of vitamin D in pregnant women. Despite high level of sunshine in the Mediterranean regions, maternal hypovitaminosis D remain common in these countries. The aim of this narrative review was to provide potential explanations for this phenomenon in an effort to guide future public health policies and vitamin D intakes during pregnancy. We searched Medline for publications regarding hypovitaminosis D during pregnancy in the Mediterranean region. Available studies confirmed the high prevalence of hypovitaminosis D among pregnant women in the Mediterranean regions (50-65% in most studies), resulting in severe skeletal and nonskeletal health events among the offspring. Reasons for this may rely on maternal darker skin pigmentation, poor dietary vitamin D intake, veiled clothing and reduced sunshine exposure, health policies and increased prevalence of obesity. Public health organizations should be aware of this phenomenon and develop specific policies to prevent hypovitaminosis D and its adverse outcomes in maternal and neonatal health.

Maternal vitamin D status in pregnancy and offspring bone development: the unmet needs of vitamin D era.

Data from animal and human studies implicate maternal vitamin D deficiency during pregnancy as a significant risk factor for several adverse outcomes affecting maternal, fetal, and child health. The possible associations of maternal vitamin D status and offspring bone development comprise a significant public health issue. Evidence from randomized trials regarding maternal vitamin D supplementation for optimization of offspring bone mass is lacking. In the same field, data from observational studies suggest that vitamin D supplementation is not indicated. Conversely, supplementation studies provided evidence that vitamin D has beneficial effects on neonatal calcium homeostasis. Nevertheless, a series of issues, such as technical difficulties of current vitamin D assays and functional interplay among vitamin D analytes, prohibit arrival at safe conclusions. Future studies would benefit from adoption of a gold standard assay, which would unravel the functions of vitamin D analytes. This narrative review summarizes and discusses data from both observational and supplementation studies regarding maternal vitamin D status during pregnancy and offspring bone development.

Gateway to doping? Supplement use in the context of preferred competitive situations, doping attitude, beliefs, and norms.

Nutritional supplement (NS) use is widespread in sport. This study applied an integrated social cognitive approach to examine doping attitudes, beliefs, and self-reported doping use behavior across NS users (n = 96) and nonusers (n = 116). Following ethical approval, 212 competitive athletes (age mean = 21.4, s = 4.5; 137 males) completed self-reported measures of doping-related social cognitions and behaviors, presented in an online format where completion implied consent. Significantly more NS users (22.9%) reported doping compared with nonusers (6.0%; U = 4628.0, P < 0.05). NS users presented significantly more positive attitudes toward doping (U = 3152.0, P < 0.05) and expressed a significantly greater belief that doping is effective (U = 3152.0, P < 0.05). When presented with the scenario that performance-enhancing substances are effective and increase the possibility of winning, NS users were significantly more in favor of competing in situations that allow doping (U = 3504.5, P < 0.05). In sum, doping use is three-and-a-half times more prevalent in NS users compared with nonusers. This finding is accompanied by significant differences in doping attitudes, norms, and beliefs. Thus, this article offers support for the gateway hypothesis; athletes who engage in legal performance enhancement practices appear to embody an "at-risk" group for transition toward doping. Education should be appropriately targeted.

Doping and supplementation: the attitudes of talented young athletes.

There is evidence of a small but significant proportion of adolescents engaging in doping practices. Young athletes face very specific pressures to achieve results as they strive for a career at an elite level. This study used an anonymized questionnaire to survey 403 (12-21 years old) talented young athletes' attitudes toward performance-enhancing substances and supplements. Two-thirds of the sample comprised males. Athletes were generally against the use of doping substances to enhance sporting performance. Within this generally unfavorable view, males tended to express a more permissive attitude toward performance-enhancing methods than females. Those convinced of the necessity of supplementation for sporting success were also more likely to express permissive attitudes. When asked whether they would take a "magic" drug that, while undetectable, would significantly enhance performance, the overwhelming majority of athletes said "no," but many thought others would take the substance. Interestingly, there was a significant association between the projected use of the hypothetical drug by competitors and the individual respondent's willingness to take the hypothetically "magic" substance. The study offers an insight into young athletes' attitudes toward specific forms of performance enhancement, and the strength of their beliefs in the face of a tempting hypothetical scenario.

Prediction of response to antiretroviral therapy by human experts and by the EuResist data-driven expert system (the EVE study).

OBJECTIVES: The EuResist expert system is a novel data-driven online system for computing the probability of 8-week success for any given pair of HIV-1 genotype and combination antiretroviral therapy regimen plus optional patient information. The objective of this study was to compare the EuResist system vs. human experts (EVE) for the ability to predict response to treatment. METHODS: The EuResist system was compared with 10 HIV-1 drug resistance experts for the ability to predict 8-week response to 25 treatment cases derived from the EuResist database validation data set. All current and past patient data were made available to simulate clinical practice. The experts were asked to provide a qualitative and quantitative estimate of the probability of treatment success. RESULTS: There were 15 treatment successes and 10 treatment failures. In the classification task, the number of mislabelled cases was six for EuResist and 6-13 for the human experts [mean±standard deviation (SD) 9.1±1.9]. The accuracy of EuResist was higher than the average for the experts (0.76 vs. 0.64, respectively). The quantitative estimates computed by EuResist were significantly correlated (Pearson r=0.695, P<0.0001) with the mean quantitative estimates provided by the experts. However, the agreement among experts was only moderate (for the classification task, inter-rater κ=0.355; for the quantitative estimation, mean±SD coefficient of variation=55.9±22.4%). CONCLUSIONS: With this limited data set, the EuResist engine performed comparably to or better than human experts. The system warrants further investigation as a treatment-decision support tool in clinical practice.

Self-admitted behavior and perceived use of performance-enhancing vs psychoactive drugs among competitive athletes.

The relationships between projected use, self-reported behavior and attitudes to performance-enhancing (PED) and recreational (RD) drugs were investigated among 82 competitive Hungarian athletes, with 14.6% admitting using PED and 31.7% using RD. Both the observed doping estimations (even those made by non-users) and self-admitted use were considerably higher than the average rate of positive doping tests (2% of all tests). The notable overestimation by PED users (34.6% vs 16.9%) was in keeping with the false consensus effect. A prediction model with attitude and projection to the likelihood of PED use suggested at least a 70% chance of self-involvement of athletes, with responses at or above the median scores (Performance Enhancement Attitude Scale ≥ 60 and estimation ≥ 50%) on the two independent measures. Users overestimated the prevalence of doping in their sport (P=0.007) but not RD use, with the converse holding for RD users' views of doping (P=0.029). PED users also showed a significantly more lenient attitude toward doping (P<0.001). This domain-specific characteristic adds new information to the ongoing research effort in understanding drug-doping co-morbidity. The reasons for elevated in-group projection are discussed, along with the potential application of this phenomenon in doping epidemiology studies.

Mission impossible? Regulatory and enforcement issues to ensure safety of dietary supplements.

Dietary supplements are widely used across all ages and user groups and constitute a considerable business sector in most developed countries. Hazards relating to concentration, composition, individual contaminants and supplement interactions present an increasing public health concern. The aim of this paper is to review the literature for reported supplement contaminations (occurs in ca 25% of supplements, with anabolic steroids being the most common) and complement these findings with notifications logged in the EU's Rapid Alert System for Food and Feed (RASFF) through imports or market surveillance, typically logged for poor quality control issues. Notifications in the RASFF have steadily increased by sixfold for supplements in the past 7 years with the USA and China being the major transgressors. Finland and Italy lead in detections, mainly notifying unpermitted substances and contaminants in sexual-enhancing or weight-loss supplements. This paper highlights the paucity of enforcement. Regulating supplements as a foodstuff and not a medicine, coupled with the fact that a significant proportion of the supplement market is distributed via the Internet (hence absent from routine border control and surveillance), make ensuring and enforcing safety a very challenging task. The need for better quality control, compliance and public awareness is evident.

Gate keepers of EU food safety: four states lead on notification patterns and effectiveness.

The EU RASFF database has been used to provide information on trends in food notifications. The major focus of previous reports has been on either the health hazards arising from various contaminants found in foodstuff or producers of these faulty products. To complement these analyses, the aim of this paper is to examine the food notifications, recorded via the RASFF between 2000 and 2009, from the detectors' point of view and to compare and contrast detecting activities of those playing a key role in guarding food safety and security in the EU. Data were scrutinized using network analysis to capture underlying pattern in the EU context and detailed descriptive statistics to generate an in-depth view. The results revealed that 60% of the notifications were made by Italy, Germany, the UK and Spain, with the remaining 40% shared among 26 other countries and Commission Services. A distinct reporting pattern was observed between these key countries with the Netherlands showing vigilance above and beyond that expected based on its population, suggesting that countries with major ports might secure food safety in their own country as well as guarding the EU's food market. The ethnic composition may also influence the detection patterns.

Popular drugs in sport: descriptive analysis of the enquiries made via the Drug Information Database (DID).

OBJECTIVE: To analyse enquiries made in the Drug Information Database (DID) to develop a better understanding of athletes' interests and concerns regarding the prohibited status of available substances. SETTING: Retrospective analyses of anonymous enquiries recorded in the DID in 2006 and 2007. PARTICIPANTS: Athletes and supporting personnel. RESULTS: The DID recorded 223 717 enquiries with 200 of the >6000 UK licensed pharmaceutical products receiving over 100 enquiries each. The majority (79.2%) of these enquiries were in the pharmaceutical product category, followed by recreational drugs (10.4%). A variety of common medications were subject to enquiry, with anti-inflammatory agents, decongestants and bronchodilators being most common; a trend in keeping with reported medication use by athletes. Of all enquiries, 42% were not found owing to misspelled words or enquiries about unregulated substances. The proportion of enquiries about substances not listed in the database is relatively high and has increased over the 24 month observation period. CONCLUSION: The DID is a well-used information resource with some 10 000 enquiries being made each month. Of the c. 60% of successful enquiries, the major focus was on pharmaceutical products. With some 73% of enquiries being made by the athletes themselves, further investigations are warranted to explore enquiry patterns in relation to specific sports. Of the unsuccessful enquiries, a large number were related to nutritional supplements, which warrants further investigation. The DID database appears to be a valid mirror of athletes' chemically assisted practices and may be successfully used to inform health professionals as well as antidoping prevention programmes.

Mercury, cadmium and lead contamination in seafood: a comparative study to evaluate the usefulness of Target Hazard Quotients.

The aim of this paper is to explore the applicability of Target Hazard Quotient (THQ) estimations to inform on seafood hazards through metal contamination. The food recall data set was collated by the Laboratory of the Government Chemist (LGC, UK) over the period from January to November 2007. Pearson chi-square goodness of fit test, nonparametric correlation (Kendall tau) and Kruskal-Wallis test were used. Descriptive statistics and statistical analyses were computed by using Excel and SPSS 15.0. The vast majority of food alerts/recalls owing to metal contamination occur in seafood and during the summer months. Only swordfish and shark containing produce received over 10 recalls which were mainly for mercury contamination. Seafood produce originating from only 3 countries had over 10 recalls owing to metal contamination (Spain 50; France 11 and Indonesia 11). Based upon the food alert/recall system, the application of THQ estimations of risk in cases of metal contamination of seafood is questionable as THQ implies frequent if not daily exposure over a lifetime. Infrequent recalls owing to metal contamination and the absence of patterns make it highly unlikely that an individual would be subject to multiple exposures to significant levels of metal ions in seafood.

Towards an empirical model of performance enhancing supplement use: a pilot study among high performance UK athletes.

This paper addressed a gap in the literature of empirically derived models of performance enhancing supplement use by developing a demographic and psychosocially based model of athlete supplement use. Selected questions were used from a larger survey conducted by UK Sport into British athletes' experiences, knowledge, attitudes and opinions in relation to anti-doping activities. Forward conditional step wise logistic regression was employed on data from n=757 athletes to develop a model that discriminated supplement non-users from users. The model identified that British athletes most likely to use supplements were younger (under 23) males who were more likely to see doping as a problem in their sport and were more knowledgeable about testing procedures than their non-user counterparts. Post hoc analysis reinforced that non-users saw doping as less of a problem in their sport and were less knowledgeable about drug testing procedures relative to those using supplements. The pattern of results indicated gender-specific interventions on supplement use for young male athletes may yield significant benefits. The relationship between supplement use and perception of a doping problem suggested more work is needed to understand supplement use culture within sports. The relationship between knowledge of testing procedures and supplement use suggested further research is needed to see whether this is a positive or negative effect of detection-based doping deterrence activity.