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Background. Higher protein diets are promoted for effective weight loss. Striated tissues in omnivorous diets contain high-quality protein, but limited data exist regarding their effects on bone. Methods. To examine the effects of energy restriction--induced weight loss with higher protein omnivorous diets versus lower protein vegetarian diets on bone mineral density in overweight postmenopausal women, two randomized controlled feeding studies were conducted. In Study 1.28 women consumed 750 kcal/day energy deficit diets with 18% energy from protein via lacto-ovo vegetarian sources (normal protein, n = 15) or 30% energy from protein with 40% of protein from lean pork (higher protein, n = 13, omnivorous) for 12 weeks. In Study 2, 54 women consumed their habitual diet (control, n = 11) or 1,250 kcal/day diets with 16% energy from nonmeat protein sources (n = 14) or 26% energy from protein, including chicken (n = 15) or beef (n = 14) for 9 weeks. Results. Study I: With weight loss (normal protein -11.2%, higher protein -10.1%), bone mineral density was not significantly changed in normal protein (-0.003 [+ or -] 0.003 g/[cm.sup.2], -0.3 %) but decreased in higher protein (- 0.0167 [+ or -] 0.004 g/[cm.sup.2], -1.4%, group-by-time p < .05). Study 2: The control, nonmeat, chicken, and beef groups lost 1.5%, 7.7%, 10.4%, and 8.1% weight and 0.0%, 0.4%, 1.1%, and 1.4% bone mineral density, respectively. The change of bone mineral density was significant for chicken and beef compared with the control (group-by-time, p < .05). Markers of calcium metabolism and bone homeostasis in blood and urine were not changed over time or differentially affected by diet. Conclusion. Consumption of higher protein omnivorous diets promoted decreased bone mineral density after weight loss in overweight postmenopausal women. Key Words: Protein--Weight loss--Bone mineral density. doi: 10.1093/geron/glq083

Background. Chronic inflammation has been implicated in the development of cardiovascular disease, diabetes mellitus, cachexia, and osteoporosis. Regular physical activity has been purported to possess 'anti-inflammatory' properties which may limit chronic inflammation. Recently, we hypothesized that toll-like receptor 4 (TLR4) may play a role in activity-induced modulation of inflammation. Therefore, the purpose of this study was to determine the association between age, physical activity status, biomarkers of inflammation, and TLR4. Methods. Male and female participants (n = 84) were recruited to fill one of the following groups: young (18-30 years), active; young, inactive; old (60-80 years), active; or old, inactive. To assess physical activity status, participants completed a Paffenbarger Physical Activity Questionnaire and a modified Balke submaximal treadmill test. After grouping and screening, participants were given a standard mixed diet to consume 24 hours prior to arriving at the laboratory. Participants were instructed to consume all food by 10 PM the night prior to blood sampling (8-hour fast). Following 30 minutes of seated rest in a quiet room, venous blood samples were collected. Lipopolysaccharide-stimulated inflammatory cytokine production and plasma high-sensitivity C-reactive protein (hsCRP) were determined by enzyme-linked immunosorbent assay, and TLR4 expression was determined by flow cytometry. Results. Lipopolysaccharide-stimulated interleukin-6, interleukin-l [beta], and tumor necrosis factor-[alpha] production, TLR4 expression, and hsCRP were significantly lower in active compared to inactive participants (p < .05). Also, older participants had significantly higher hsCRP than young participants had (p < .05). Conclusions. The findings of the present study support previous reports which infer that acute exercise or a physically active lifestyle may possess anti-inflammatory properties. Also this study, along with previous work from our laboratory, suggests that TLR4 may play a role in regulating the link between inflammatory cytokine production and a physically active lifestyle.

Background. For elderly women, insufficient data exist to assess the accuracy of the assumed mean protein requirement of 0.6 g of protein * [kg.sup.-1] * [day.sup.-1], and the adequacy of the current Recommended Dietary Allowance (RDA) of 0.8 g of protein * [kg.sup.-1] * [day.sup.-1]. The aims of this study were to assess the mean protein requirement and suggested safe and adequate protein intake (protein allowance) of elderly women using a shorter-term nitrogen balance protocol. Methods. During three separate 18-day trials, 11 elderly women (age range, 70-81 years) were randomly fed eucaloric diets designed to provide either 0.50, 0.75, or 1.00 g of protein * [kg.sup.-1] * [day.sup.-1]. Nitrogen balance was determined at Weeks 2 and 3 (Days 7-10 and 14-17, respectively) of each trial using data from total nitrogen analyses of duplicate food composites, 24-hour urine collections, and stool collections. The mean protein requirement was calculated using linear regression of individual women's data from all three trials and inverse prediction. Results. At protein intakes of 0.53 [+ or -] 0.02, 0.76 [+ or -] 0.02, or 1.06 [+ or -] 0.05 g of protein * [kg.sup.-1] * [day.sup.-1], net nitrogen balances during Week 2 were -14.5 [+ or -] 3.1, 3.8 [+ or -] 2.5 and 23.4 [+ or -] 3.3 mg of nitrogen * [kg.sup.-1] * [day.sup.-1], respectively, for these body weight- and body composition-stable women. At Week 3, the net nitrogen balances were -0.1 [+ or -] 2.7, 8.5 [+ or -] 3.6 and 42.0 [+ or -] 3.0 mg of nitrogen * [kg.sup.-1] * [day.sup.-1]. From Week 2 to Week 3, shifts to more positive nitrogen balances occurred due to decreases in urinary nitrogen excretion. The mean protein requirement at Week 2 was calculated to be 0.70 [+ or -] 0.09 g of protein, * [kg.sup.-1] * [day.sup.-1] (coefficient of variation [CV] = 13%) and at Week 3 was calculated to be 0.56 [+ or -] 0.09 g of protein * [kg.sup.-1] * [day.sup.-1] (CV = 17%). From these data, an adequate protein allowance was estimated to be greater than the RDA at Week 2 (0.90 g of protein * [kg.sup.-1] * day [[d].sup.-1]), and not different than the RDA at Week 3 (0.76 g of protein * [kg.sup.-1] * [day.sup.-1]). Conclusions. The decrease over time in urinary nitrogen excretion from Week 2 to Week 3 suggests that these elderly women did not achieve a metabolic steady state during this shorter-term nitrogen balance study. Collectively, these data suggest that the total protein needs of elderly women are at or above the current RDA for protein. However, the results of this study indicate that shorter-term nitrogen balance protocols are insufficient to firmly establish the RDA for protein of elderly women, and further research is required using alternative criteria measures.

Effects of a 10-week progressive strength training program composed of a mixture of exercises for increasing muscle mass, maximal peak force, and explosive strength (rapid force production) were examined in 8 young (YM) (29 [+ or -] 5 yrs) and 10 old (OM) (61 [+ or -] 4 yrs) men. Electromyographic activity, maximal bilateral isometric peak force, and maximal rate of force development (RFD) of the knee extensors, muscle cross-sectional area (CSA) of the quadriceps femoris (QF), muscle fiber proportion, and fiber areas of types I, IIa, IIb, and IIab of the vastus lateralis were evaluated. Maximal and explosive strength values remained unaltered in both groups during a 3-week control period with no training preceding the strength training. After the 10-week training period, maximal isometric peak force increased from 1311 [+ or -] 123 N by 15.6% (p < .05) in YM and from 976 [+ or -] 168 N by 16.5% (p < .01) in OM. The pretraining RFD values of 4049 [+ or -] 791 N*[s.sup.-1] in YM and 2526 [+ or -] 1197 N*[s.sup.-1] in OM remained unaltered. Both groups showed significant increases (p < .05) in the averaged maximum IEMGs of the vastus muscles. The CSA of the QF increased from 90.3 [+ or -] 7.9 [cm.sup.2] in YM by 12.2% (p < .05) and from 74.7 [+ or -] 7.8 [cm.sup.2] in OM by 8.5% (p < .001). No changes occurred in the muscle fiber distribution of type I during the training, whereas the proportion of subtype IIab increased from 2% to 6% (p < .05) in YM and that of type lib decreased in both YM from 25% to 16% (p < .01) and in OM from 15% to 6% (p < .05). The mean fiber area of type I increased after the 10-week training in YM (p < .001) and OM (p < .05) as well as that of type IIa in both YM (p < .01) and OM (p < .01). The individual percentage values for type I fibers were inversely correlated with the individual changes recorded during the training in the muscle CSA of the QF (r = -.56, p < .05). The present results suggest that both neural adaptations and the capacity of the skeletal muscle to undergo training. induced hypertrophy even in older people explain the gains observed in maximal force in older men, while rapid force production capacity recorded during the isometric knee extension action remained unaltered during the present mixed strength training program.

Background. Inadequate dietary protein intake results in loss of skeletal muscle mass. Some shorter-term nitrogen balance studies suggest that the Recommended Dietary Allowance (RDA) of protein may not be adequate for older people. The aim of this study was to assess the adequacy of the RDA of protein for older people by examining longer-term responses in urinary nitrogen excretion, whole-body protein metabolism, whole-body composition, and mid-thigh muscle area. Methods. This was a 14-week precisely controlled diet study. Ten healthy, ambulatory men and women, aged 55 to 77 years, were provided eucaloric diets that contained 0.8 g protein [multiplied by] [kg.sup.-1] [multiplied by] [day.sup.-1]. The study was conducted at a General Clinical Research Center using an outpatient setting for 11 weeks and an inpatient setting for 3 weeks. The main outcome measures included urinary nitrogen excretion, postabsorptive and postprandial whole-body leucine kinetics via infusion of L-[1-[sup.13]C]-leucine, whole-body density via hydrostatic weighing, total body water via deuterium oxide dilution, and mid-thigh muscle area via computed tomography scans. Results. Mean urinary nitrogen excretion decreased over time from Weeks 2 to 8 to 14 (p = .025). At Week 14, compared with Week 2, there were no changes in postabsorptive or postprandial leucine kinetics (turnover, oxidation, incorporation into protein via synthesis, release via breakdown, or balance). Whole-body composition (% body fat, fat-free mass, and protein + mineral mass) did not change over time in these weight-stable subjects. Mid-thigh muscle area was decreased by - 1.7 [+ or -] 0.6 [cm.sup.2] (p = .019) at Week 14 compared with Week 2. The loss of mid-thigh muscle area was associated with the decrease in urinary nitrogen excretion (Spearman r = .83, p = .010). Conclusions. The maintenance of whole-body leucine metabolism and whole-body composition is generally consistent with a successful adaptation to the RDA for protein. However, the decrease in mid-thigh muscle area and the association with decreased urinary nitrogen excretion are consistent with a metabolic accommodation. These results suggest that the RDA for protein may not be adequate to completely meet the metabolic and physiological needs of virtually all older people.

Background: Emerging research suggests that redistributing total protein intake from 1 high-protein meal/d to multiple moderately high-protein meals improves 24-h muscle protein synthesis. Over time, this may promote positive changes in body composition. Objective: We sought to assess the effects of within-day protein intake distribution on changes in body composition during dietary energy restriction and resistance training. Design: In a randomized parallel-design study, 41 men and women [mean ± SEM age: 35 ± 2 y; body mass index (in kg/m²): 31.5 ± 0.5] consumed an energy-restricted diet (750 kcal/d below the requirement) for 16 wk while performing resistance training 3 d/wk. Subjects consumed 90 g protein/d (1.0 ± 0.03 g ⋅ kg-1 ⋅ d-1, 125% of the Recommended Dietary Allowance, at intervention week 1) in either a skewed (10 g at breakfast, 20 g at lunch, and 60 g at dinner; n = 20) or even (30 g each at breakfast, lunch, and dinner; n = 21) distribution pattern. Body composition was measured pre- and postintervention. Results: Over time, whole-body mass (least-squares mean ± SE: -7.9 ± 0.6 kg), whole-body lean mass ( - 1.0 ± 0.2 kg), whole-body fat mass (-6.9 ± 0.5 kg), appendicular lean mass (-0.7 ± 0.1 kg), and appendicular fat mass (-2.6 ± 0.2 kg) each decreased. The midthigh muscle area (0 ± 1 cm²) did not change over time, whereas the midcalf muscle area decreased (-3 ± 1 cm²). Within-day protein distribution did not differentially affect these body-composition responses. Conclusion: The effectiveness of dietary energy restriction combined with resistance training to improve body composition is not influenced by the within-day distribution of protein when adequate total protein is consumed. This trial was registered at clinicaltrials. gov as NCT02066948. [ABSTRACT FROM AUTHOR]

Background: In the United States, 17% of children are currently obese. Increasing feelings of fullness may prevent excessive energy intake, lead to better diet quality, and promote long-term maintenance of healthy weight.Objective: The purpose of this study was to develop a fullness-rating tool (aim 1) and to determine whether a high-protein (HP), high-fiber (HF), and combined HP and HF (HPHF) breakfast increases preschoolers' feelings of fullness before (pre) and after (post) breakfast and pre-lunch, as well as their diet quality, as measured by using a composite diet quality assessment tool, the Revised Children's Diet Quality Index (aim 2).Methods: Children aged 4 and 5 y (n = 41; 22 girls and 19 boys) from local Head Start centers participated in this randomized intervention trial. Sixteen percent of boys and 32% of girls were overweight or obese. After the baseline week, children rotated through four 1-wk periods of consuming ad libitum HP (19-20 g protein), HF (10-11 g fiber), HPHF (19-21 g protein, 10-12 g fiber), or usual (control) breakfasts. Food intake at breakfast was estimated daily, and for breakfast, lunch, and snack on day 3 of each study week Student's t tests and ANOVA were used to determine statistical differences.Results: Children's post-breakfast and pre-lunch fullness ratings were ≥1 point higher than those of pre-breakfast (aim 1). Although children consumed, on average, 65 kcal less energy during the intervention breakfasts (P < 0.007) than during the control breakfast, fullness ratings did not differ (P = 0.76). Relative to the control breakfast, improved diet quality (12%) was calculated for the HP and HF breakfasts (P < 0.027) but not for the HPHF breakfast (aim 2).Conclusions: Post-breakfast fullness ratings were not affected by the intervention breakfasts relative to the control breakfast. HP and HF breakfasts resulted in higher diet quality. Serving HP or HF breakfasts may be valuable in improving diet quality without lowering feelings of satiation or satiety. This trial was registered at clinicaltrials.gov as NCT02122224. [ABSTRACT FROM AUTHOR]

Research suggests that subclinical hypothyroidism (SHT) influences insulin sensitivity and glucose tolerance. Reductions in thyroid stimulating hormone (TSH) concentrations are associated with exercise training (ExTr), which improves insulin sensitivity and glucose uptake.Purpose:A secondary analysis of previously published data was conducted to examine the relationship between SHT, TSH and glucose homeostatic control at baseline and to assess the impact of ExTr on thyroid status and how SHT affects changes in insulin sensitivity after ExTr.Materials and methods:Data were obtained from a 36-week ExTr and whey protein supplementation intervention trial. Subjects (n= 304, 48 ± 7 years, females = 186) were randomized to a specific whey protein group (0, 20, 40, or 60 g per day) and all subjects participated in a resistance (2 d/wk) and aerobic (1 d/wk) training program. Testing was conducted at baseline and post-intervention.Results:At baseline, 36% (n= 110) and 12% (n= 35) of subjects were classified with SHT based on the TSH ≥ 3 µIU/L or TSH ≥ 4.5 µIU/L cut-offs, respectively. No association was found between baseline TSH and baseline measures of glucose homeostatic control. Whey protein supplementation did not influence intervention outcomes. Post-intervention (n= 164), no change was observed in TSH. SHT did not affect changes in insulin sensitivity following ExTr.Conclusion:These results support that the health benefits of ExTr for the management of insulin resistance (IR) are not blunted by SHT. [ABSTRACT FROM PUBLISHER]

Our understanding of the potential benefits and challenges of optimizing dietary protein intake in older adults continues to evolve. An overarching hypothesis generated during Protein Summit 2.0 was that consuming an adequate amount of high-quality protein at each meal, in combination with physical activity, may delay the onset of sarcopenia, slow its progression, reduce the magnitude of its functional consequences, or all of these. The potential benefits of young and middle-aged adults adopting a diet pattern whereby adequate protein is consumed at each meal as a countermeasure to sarcopenia are presented and discussed. For example, meeting a protein threshold (~25-30 g/meal) represents a promising, yet still largely unexplored dietary strategy to help maintain muscle mass and function. For many older adults, breakfast is a carbohydrate-dominated lower-protein meal and represents an opportunity to improve and more evenly distribute daily protein intake. Although both animal and plant-based proteins can provide the required essential amino acids for health, animal proteins generally have a higher proportion of the amino acid leucine. Leucine plays a key role in stimulating translation initiation and muscle protein anabolism and is the focus of ongoing research. Protein requirements should be assessed in the light of habitual physical activity. An evenly distributed protein diet provides a framework that allows older adults to benefit from the synergistic anabolic effect of protein and physical activity. To fully understand the role of dietary protein intake in healthy aging, greater efforts are needed to coordinate and integrate research design and data acquisition and interpretation from a variety of disciplines. [ABSTRACT FROM AUTHOR]

We investigated whether inadequate dietary protein would result in increased serum parathyroid hormone (PTH) concentration, consistent with secondary hyperparathyroidism. Data from 2 controlled feeding studies were utilized. In study 1, 26 healthy women (15 young, 21-46 y, and 11 elderly, 70-81 y) consumed for 12 d each in separate trials 3 levels of protein, 1.00, 0.75, and 0.50 g protein/(kg. d). Blood was drawn from fasting subjects on d 12 of each trial. In study 2, 24 persons (54-80 y) were fed diets with either 1.20 g protein/(kg. d) for 2 wk (HPro, n = 11, 6 men, 5 women) or 1.2 g protein/(kg. d) for 1 wk and then 0.50 g protein/(kg. d) for a 2nd week (IPro, n = 13, 6 men, 7 women). Blood was obtained from fasting subjects after wk 1 and 2. Consistent with altered protein metabolism, urinary total nitrogen excretion and blood urea nitrogen fell progressively with decreasing protein intake in study 1; in study 2, the values decreased from wk 1 to 2 in the IPro group only. Serum intact PTH concentrations did not differ among the 3 protein intakes in study 1, or between the HPro and IPro groups in study 2. These findings do not support the hypothesis that the short-term ingestion of inadequate dietary protein increases serum PTH concentration. [ABSTRACT FROM AUTHOR]

In this review article, nutritional considerations of the aging athlete are discussed. The focuses of the review include energy, carbohydrate, protein, selected vitamins and minerals, and fluids. Age-associated changes in body composition, resting energy expenditure, and volume and intensity of training, may decrease the need for dietary energy and the intakes of macro- and micronutrients and fluids. The older athlete should monitor nutrient intakes to insure adequacy, especially regarding carbohydrate to promote glucose storage and use as an energy source during exercise, and protein to promote strength-training-induced muscle hypertrophy. Emphasis should also be placed on the dietary intakes of certain micronutrients, as well as the potential need for supplementation of certain vitamins and minerals, including the vitamins B2, B6, B12, D, E, and folate, and the minerals calcium and iron. Age-associated changes in thermoregulation and an increased susceptibility to dehydration underscore the critical importance to the older athlete of adequate fluid intake to sustain health and performance. Nutrition is a tool that the older athlete should use to enhance exercise performance and health. [Copyright &y& Elsevier]

Unhealthy Western-style eating patterns (WSEP) predominate, adversely affecting health. Resistance to improving dietary patterns prompts interest to incorporate a potentially health-promoting ingredient into typical WSEP foods and beverages. We assessed the effect of incorporating isocalorically matched carbohydrates versus milk protein isolate (MPI) into a WSEP on weight loss-induced changes in cardiometabolic health and body composition. In a randomized, double-blind, parallel-design study, 44 participants (age 52 ± 1 years, body mass index (BMI) 31.4 ± 0.5 kg/m2, mean ± standard error) consumed a weight maintenance WSEP (0.8 g total protein/kg/day) for 3 weeks (baseline). After, participants consumed an energy-restricted (750 kcal/day below estimated requirement) WSEP for 16 weeks, randomly assigned to contain either an additional 0.7 g carbohydrate/kg/d (CON: n = 23, 0.8 g total protein/kg/day) or 0.7 g protein/kg/d from MPI (MPI: n = 21, 1.5 g total protein/kg/day) incorporated into foods and beverages. Compared to CON, the MPI favored reductions in average 24 h and sleeping systolic and diastolic blood pressures (BP), waking hours systolic BP, and fasting plasma triglyceride concentrations. Reductions in fasting plasma insulin, glucose, total cholesterol, and low-density lipoprotein cholesterol concentrations were not different between groups. Among all participants, whole body mass, lean mass, fat mass, and thigh muscle area, each decreased over time. For adults finding it difficult to deviate from a WSEP, replacing a portion of their carbohydrate with foods and beverages containing MPI may be an effective dietary strategy to reduce BP after weight loss. [ABSTRACT FROM AUTHOR]

The article discusses the effects of exercise and calcium supplementation on calcium homeostasis in sportswomen. The section aims to examine the effects of moderate-intensity exercise on dermal calcium losses during abstinence from exercise versus strenuous exercise in the context of overall daily calcium retention, and to determine the role of calcium supplementation on calcium homeostasis in premenopausal physically active sportswomen. According to the study, calcium supplementation can correct for negative calcium balance attributable to low calcium dietary intake and additional dermal losses from exercise.

Abstract: Objective: This controlled feeding study examined the effects of exercise on daily water intake (particularly ad libitum water intake), water output, whole-body water balance, and hydration status in physically active, premenopausal women. Design: The randomized crossover design consisted of three 8-day trials: placebo and no exercise, placebo and exercise (1-hour cycling bout per day at 65%-70% of heart rate reserve), and 800 mg calcium supplementation and exercise. During each trial, controlled quantities of the same foods and beverages were provided and ad libitum water intake was quantified. Water input included measured water from foods and beverages, measured ad libitum intake, and estimated metabolic production. Water output included measured losses in urine and stool, and estimated insensible losses from respiration and non-sweating perspiration (insensible diffusion through the skin). Subjects: Participants were 26 women, age 25±5 years, body mass index 22±2, and VO2peak 43±6 mL×kg−1×min−1 (mean±standard deviation). Results: Ad libitum water intake was 363 g/day more (P<0.05) for the placebo and exercise (1,940±654 g/day) and calcium supplementation and exercise (1,935±668 g/day) trials, compared with placebo and no exercise trial (1,575±667 g/day), and total water input was correspondingly higher in placebo and exercise and calcium supplementation and exercise trials compared with the placebo and no exercise trial. Urine, stool, and total water outputs were not different among trials. Apparent net water balance (representative of sweat water output) was 367 g/day more (P<0.05) in placebo and exercise (679±427 g/day) and calcium supplementation and exercise (641±519 g/day) trials compared with placebo and no exercise trial (293±419 g/day). Hydration status was clinically normal during all three trials. Calcium supplementation did not influence water balance. Conclusion: These results support that young, physically active women can completely compensate for exercise-induced sweat losses by increasing ad libitum water intake, and not decreasing non-sweat water outputs or impairing hydration status. [Copyright &y& Elsevier]

Objective To test the hypothesis that older men who consumed a vegetarian (lacto-ovo) diet would develop a lower iron status compared with older men who consumed a beef-containing diet during a period of resistive training (RT). Design Experimental, repeated measures study. Subjects Twenty-one healthy men aged 59 to 78 years, with a BMI range of 24 to 33 kg/m2, completed the study. Intervention All men consumed a vegetarian diet for 2 weeks (baseline). After this, the men were randomly assigned to one of two dietary groups. Eleven men consumed a beef-containing diet, and 10 men continued to consume a vegetarian diet for 12 weeks. During this time all subjects participated in RT three days per week, designated as RT1 to RT12. Main outcome measures Serum ferritin and serum iron concentrations, transferrin saturation, transferrin receptor, total iron binding capacity, and selected hematological variables, as well as selected nutrient intakes and estimated iron bioavailability from three-day diet records, were determined at baseline, RT5, and RT12. Statistical analyses A general linear model repeated-measures ANOVA was used to examine the effects of group, time, and group×time interactions for iron status and dietary data. Results Total iron intake was not different between the two groups; however, the beef group had a three to four times greater intake of bioavailable iron (P<.01) than the vegetarian group. Serum iron, total iron binding capacity, transferrin saturation, and transferrin receptor were not significantly different between the beef and vegetarian groups, or changed over time with RT. Serum ferritin decreased over time in both the beef and vegetarian groups during RT (P<.01). Re-introduction of beef into the diets of the beef group increased hemoglobin concentration and hematocrit compared with the vegetarian group during the 12 weeks of RT (group×time, P<.05). These changes were within clinically normal limits. Applications/Conclusions Older men who consume a beef-containing, higher-bioavailable-iron diet, compared with a vegetarian, lower-bioavailable-iron diet, have an increased hematological profile during a 12-week period of RT. Older men who consume either a beef-containing or a vegetarian diet maintain a hematological profile within clinically normal limits during 12 weeks of RT. J Am Diet Assoc. 2003;103:594-601. [Copyright &y& Elsevier]