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Background & aims: Adequate energy availability is essential for the body to maintain its physiological functions and achieve optimal health, especially among athletes. Unfortunately, low energy availability (LEA) is common among athletes, and it has been associated with impairments in health and performance. In contrast, an energy-restricted diet has been linked to longevity, but it is unclear how LEA affects athletes’ lifespans. The goal of the present study was to assess the impact of LEA thermodynamically on the lifespan of athletes. Methods: Data from seven healthy young endurance-trained athletes (24 ± 4 years) who underwent short-term low energy availability (125 (kJ/day) per kg FFM) once with low protein content (LEA-LP; 0.8 g/kg) and with high protein content (LEA-HP; 125 (kJ/day) per kg FFM, 1.7 g/kg), as well as a control diet (CON; 230 (kJ/day) per kg FFM, 1.7 g/kg), were used in the calculations. The athletes followed each diet for five days and expended 67.5 (kJ/day) per kg FFM. entropy generation-based thermodynamic calculations were performed based on the metabolic activity of the athletes, which was determined from oxygen consumption and carbon dioxide production rates. Results: Low energy availability was successfully induced during LEA-LP (62 ± 8 (kJ/day) per kg FFM; 95%Cl: 53–70) and LEA-HP (64 ± 8 (kJ/day) per kg FFM; 95%Cl: 56–71) diets. Despite of achieving energy deficit of −6658 ± 2110 kJ/day (95%Cl: 8609-(−) 4707) (LEA-LP), −5781 ± 623 (95%Cl: 26591-(−)4707) (LEA-HP) and excessive energy of 772 ± 1915 (95%Cl: 845-2388) (CON) statistical analyses revealed no significant differences in lifespan estimations among diets (CON: 72 ± 8 years (95%Cl: 65–79), LEA-LP: 74 ± 7 years (95%Cl: 68–80), and LEA-HP: 73 ± 11 (95%Cl: 62–83)). Conclusions: This study suggests valuable insights into the intricate relationship between energy availability, entropy generation, and lifespan among athletes. Whereas entropy generation levels and the lifespan of athletes remained stable depending on diets, the distinguished differences in energy deficiency and energy availability underline the need for a profounder investigation of underlying physiological mechanisms to improve the health and performance of athletes.

Objective This cross-sectional study aimed to investigate the role of low energy availability (LEA) in the interplay between depression and disordered eating/eating disorders (DE/EDs) among female athletes. The International Olympic Committee consensus statement on Relative Energy Deficiency in Sport (REDs) identified depression as both an outcome of LEA and a secondary risk factor for REDs. However, the direct link between LEA and depression has yet to be fully established.Methods We assessed 57 female athletes participating in weight-sensitive sports at different levels of competition training at least four times a week. Assessment was conducted using laboratory analyses, clinical interviews and the Patient Health Questionnaire-9 questionnaire. Participants were recruited through various channels, including German sports clubs, Olympic training centres, social media platforms and the distribution of flyers at competitions. Indicators of LEA were defined if at least two of the following three physiological indicators were present: menstrual disturbances, suppressed resting metabolic rate and suppressed thyroid hormones. Logistic and linear regression analysis were used to examine the relationship between LEA, depression and DE/ED.Results The lifetime prevalence of depressive disorders was 29.6%. 19% of the participants were diagnosed with an ED, and an additional 22.6% exhibited DE.LEA was not significantly associated with either lifetime prevalence of depressive disorders or current depressive symptoms. However, a significant association was found between depression and DE/ED in terms of both lifetime prevalence and current depressive symptoms. DE/ED increased the probability of lifetime prevalence of depressive disorders by 34% (19%–49%) compared with normal eating behaviour.Conclusion We found no evidence that LEA is an independent factor for depression in female athletes. Its association with LEA and REDs appears to occur primarily in the presence of DE/ED.

Abstract Background Age-related accumulation of highly differentiated CD8+ effector memory re-expressing CD45RA (EMRA) T-cells and disruption of the kynurenine (KYN) pathway are associated with chronic inflammation and the development of insulin resistance. In this study the aim was to investigate the effects of 12-week combined strength and endurance exercise on CD8+ T-cell differentiation and KYN pathway metabolites. Ninety-six elderly subjects (f/m, aged 50—70) were randomized to a control (CON) or exercise (EX) group. The EX group completed combined strength and endurance training twice weekly for one hour each time at an intensity of 60% of the one-repetition maximum for strength exercises and a perceived exertion of 15/20 for endurance exercises. The EX group was also randomly subdivided into two groups with or without a concomitant balanced diet intervention in order to examine additional effects besides exercise alone. Before and after the intervention phase, the proportions of CD8+ T-cell subsets and levels of KYN pathway metabolites in peripheral blood were determined. Results The CD8+ EMRA T-cell subsets increased in the CON group but remained almost unchanged in the EX group (p = .02). Plasma levels of kynurenic acid (KA) increased in the EX group and decreased in the CON group (p = .03). Concomitant nutritional intervention resulted in lower levels of quinolinic acid (QA) compared with exercise alone (p = .03). Overall, there was a slight increase in the QA/KA ratio in the CON group, whereas it decreased in the EX group (p > .05). Conclusions Combined strength and endurance training seems to be a suitable approach to attenuate CD8+ T-cell differentiation in the elderly and to redirect the KYN pathway towards KA. The clinical relevance of these effects needs further investigation.

Female endurance athletes are at high risk for developing Relative Energy Deficiency in Sport (REDs), resulting in symptoms such as menstrual dysfunction and gastrointestinal (GI) problems. The primary aim of this study was to investigate effects of the FUEL (Food and nUtrition for Endurance athletes—a Learning program) intervention consisting of weekly online lectures combined with individual athlete-centered nutrition counseling every other week for sixteen weeks on REDs related symptoms in female endurance athletes at risk of low energy availability [Low Energy Availability in Females Questionnaire (LEAF-Q) score ≥8]. Female endurance athletes from Norway (n = 60), Sweden (n = 84), Ireland (n = 17), and Germany (n = 47) were recruited. Fifty athletes with risk of REDs (LEAF-Q score ≥8) and with low risk of eating disorders [Eating Disorder Examination Questionnaire (EDE-Q) global score

Relative energy deficiency in sport (RED-S) is a complex syndrome describing health and performance consequences of low energy availability (LEA) and is common among female endurance athletes. Various underlying causes of LEA have been reported, including disordered eating behavior (DE), but studies investigating the association with exercise addiction and food intolerances are lacking. Therefore, the aim of this cross-sectional study was to investigate the association between DE, exercise addiction and food intolerances in athletes at risk of LEA compared to those with low risk. Female endurance athletes, 18–35 years, training ≥5 times/week were recruited in Norway, Sweden, Ireland, and Germany. Participants completed an online-survey comprising the LEA in Females Questionnaire (LEAF-Q), Exercise Addiction Inventory (EAI), Eating Disorder Examination Questionnaire (EDE-Q), and questions regarding food intolerances. Of the 202 participants who met the inclusion criteria and completed the online survey, 65% were at risk of LEA, 23% were at risk of exercise addiction, and 21% had DE. Athletes at risk of LEA had higher EDE-Q and EAI scores compared to athletes with low risk. EAI score remained higher in athletes with risk of LEA after excluding athletes with DE. Athletes at risk of LEA did not report more food intolerances (17 vs. 10%, P = 0.198), but were more frequently reported by athletes with DE (28 vs. 11%, P = 0.004). In conclusion, these athletes had a high risk of LEA, exercise addiction, and DE. Exercise addiction should be considered as an additional risk factor in the prevention, early detection, and targeted treatment of RED-S among female endurance athletes.

Abstract Background The number of people preferring plant-based nutrition is growing continuously in the western world. Vegetarianism and veganism are also becoming increasingly popular among individuals participating in sport. However, whether recreationally active vegetarian and vegan populations can meet their nutritional needs is not clear. Methods The purpose of this cross-sectional study was to compare the nutrient intake of omnivorous (OMN, n = 27), lacto-ovo vegetarian (LOV, n = 25) and vegan (VEG, n = 27) recreational runners (two to five training sessions per week) with intake recommendations of the German, Austrian and Swiss Nutrition Societies (Deutsche, Österreichische und Schweizerische Gesellschaften für Ernährung, D-A-CH) for the general population. Lifestyle factors and supplement intake were examined via questionnaires; dietary habits and nutrient intake were determined based on 3-day dietary records. Results More than half of each group did not reach the recommended energy intake (OMN: 10.4, 8.70–12.1; LOV: 9.67, 8.55–10.8; VEG: 10.2, 9.12–11.3 MJ). Carbohydrate intake was slightly below the recommendations of > 50 EN% in OMN (46.7, 43.6–49.8 EN%), while LOV (49.4, 45.5–53.3 EN%) and VEG (55.2, 51.4–59.0 EN%) consumed adequate amounts (p = 0.003). The recommended protein intake of 0.8 g/kg body weight (D-A-CH) was exceeded in all three groups (OMN: 1.50, 1.27–1.66; LOV: 1.34, 1.09–1.56; VEG: 1.25; 1.07–1.42 g/kg BW; p = 0.047). Only VEG (26.3, 22.7–29.8 EN%) did not achieve the recommended fat intake of 30 EN%. The supply of micronutrients, such as vitamin D and cobalamin, was dependent on supplement intake. Additionally, female OMN and LOV achieved the recommended daily intake of 15 mg iron only after supplementation, while VEG consumed adequate amounts solely via food. Conclusion All three groups were sufficiently supplied with most nutrients despite the exceptions mentioned above. The VEG group even showed advantages in nutrient intake (e.g. carbohydrates, fiber and iron) in comparison to the other groups. However, the demand for energy and several macro- and micronutrients might be higher for athletes. Thus, it is also necessary to analyze the endogenous status of nutrients to evaluate the influence of a vegetarian and vegan diet on the nutrient supply of athletes. Trial registration German Clinical Trial Register (DRKS00012377), registered on April 28, 2017.

Background: The ‘Western diet’ typically consumed in industrialized countries is characterized by high amounts of processed cereal grains and animal products while being low in vegetables, tubers, and fruits. This dietary behavior leads to imbalances of acid–base status in favor of the acids and may cause low-grade metabolic acidosis (LGMA) that is associated with negative effects on health in the long run, including urolithiasis, bone loss, and even cardiometabolic diseases. Therefore, it has become of great interest to find dietary strategies that can be used to neutralize the acid load associated with Western diets. Objective: The aim of this study was to investigate whether the diet-dependent net acid load can be reduced by the daily consumption of mineral waters with different bicarbonate content and different potential renal acid load (PRAL). Methods: A single-centered, randomized trial including 129 healthy men and women aged from 18 to 75 years was conducted. Participants consumed 1,500–2,000 mL of one of four mineral waters with different bicarbonate content and different PRAL values daily for 4 weeks: low bicarbonate, high PRAL (LBHP, HCO3−: 403.0 mg/L, PRAL: 10.7); medium-high bicarbonate, medium PRAL (MBMP, HCO3− : 1816.0 mg/L, PRAL: −10.8); high bicarbonate, low PRAL (HBLP, HCO3−: 2451.0 mg/L, PRAL: −19.3); medium-high bicarbonate, low PRAL (MBLP, HCO3−: 1846.0 mg/L, PRAL: −22.1). Throughout the study, participants were asked to maintain their usual dietary habits. The primary outcome was the net acid excretion (NAE) measured in the 24-h urine output. Results: Consumption of the three mineral waters: MBMP, HBLP, and MBLP led to a significant decrease in NAE values. Within the MBMP group, the NAE could be reduced by 48% (P = 0.001), while consumption of HBLP led to a reduction of 68% (P < 0.001) and MBLP to a reduction of 53% (P = 0.001). Moreover, a slight increase in serum bicarbonate could also be observed in the groups that drank HBLP (P = 0.057) and MBLP (P = 0.001). Conclusion: Daily consumption of at least 1,500–2,000 mL of mineral water rich in bicarbonate (>1800.0 mg/L) with medium or low PRAL (

The vegetable watercress (Nasturtium officinale R.Br.) is, besides being a generally nutritious food, a rich source of glucosinolates. Gluconasturtiin, the predominant glucosinolate in watercress, has been shown to have several health beneficial properties through its bioactive breakdown product phenethyl isothiocyanate. Little is known about the immunoregulatory effects of watercress. Moreover, anti-inflammatory effects have mostly been shown in in vitro or in animal models. Hence, we conducted a proof-of-concept study to investigate the effects of watercress on the human immune system. In a cross-over intervention study, 19 healthy subjects (26.5 ± 4.3 years; 14 males, 5 females) were given a single dose (85 g) of fresh self-grown watercress or a control meal. Two hours later, a 30 min high-intensity workout was conducted to promote exercise-induced inflammation. Blood samples were drawn before, 5 min after, and 3 h after the exercise unit. Inflammatory blood markers (IL-1β, IL-6, IL-10, TNF-α, MCP-1, MMP-9) were analyzed in whole blood cultures after ex vivo immune cell stimulation via lipopolysaccharides. A mild pro-inflammatory reaction was observed after watercress consumption indicated by an increase in IL-1β, IL-6, and TNF-α, whereas the immune response was more pronounced for both pro-inflammatory and anti-inflammatory markers (IL-1β, IL-6, IL-10, TNF-α) after the exercise unit compared to the control meal. During the recovery phase, watercress consumption led to a stronger anti-inflammatory downregulation of the pro-inflammatory cytokines IL-6 and TNF-α. In conclusion, we propose that watercress causes a stronger pro-inflammatory response and anti-inflammatory counter-regulation during and after exercise. The clinical relevance of these changes should be verified in future studies.

Watercress, Nasturtium officinale R. Br., is a native water or semiaquatic plant that has a high nutrient density. Physiologically relevant are the various glucosinolates, which possess positive health effects in form of their thio- and isothiocyanates. In an interdisciplinary project, we aim to develop a hydroponic, and finally an aquaponic, circulatory cultivation system and to study the health effects of watercress. In humans, there is a lack of data-based knowledge on potential beneficial health effects of watercress. Growth of watercress was followed during one season in an open-door hydroponic system. Watercress was also cultivated in the greenhouse in different substrates with different concentrations of nutrients and salt. The biomass production is strongly dependent on the temperature. The glucosinolate contents differ significantly during the growing season, especially during flowering. Watercress naturally grows in nutrient rich fresh waters, however, when cultivated at NaCl concentrations of up to 120 mM the gain in biomass is still high. In a human proof of-concept study, indications for antioxidant and anti-inflammatory effects of fresh watercress were observed already after a single dose intake of fresh watercress (85 g). Further in vivo and in vitro studies are planned to study health beneficial effects of watercress and its metabolic activity.

Background In search of the right nutrition for the athlete, numerous nutritional strategies and diets were discussed over time. However, the influence of plant-based diets, especially veganism, on exercise capacity has not been clarified. Methods We conducted a cross-sectional study to compare the exercise capacity of vegan (VEG, n = 24), lacto-ovo-vegetarian (LOV, n = 26) and omnivorous (OMN, n = 26) recreational runners. To determine maximal exercise capacity, participants performed an incremental exercise test on a bicycle ergometer until voluntary exhaustion. During the test capillary blood samples were taken at several time points for the measurement of arterial lactate [lac] and glucose [glc] concentrations. To determine nutrient intake, a 24 h dietary recall was conducted. Results The groups showed comparable training habits in terms of training frequency (mean 3.08 ± 0.90 time/wk., p = 0.735), time (mean 2.93 ± 1.34 h/wk., p = 0.079) and running distance (mean 29.5 ± 14.3 km/wk., p = 0.054). Moreover, similar maximum power output (PmaxBW) was observed in all three groups (OMN: 4.15 ± 0.48 W/kg, LOV: 4.20 ± 0.47 W/kg, VEG: 4.16 ± 0.55 W/kg; p = 0.917) and no differences regarding [lac] throughout the exercise test and maximum lactate could be observed between the groups (OMN: 11.3 ± 2.19 mmol/l, LOV: 11.0 ± 2.59 mmol/l, VEG: 11.9 ± 1.98 mmol/l; p = 0.648). Conclusion The data indicate that each examined diet has neither advantages nor disadvantages with regard to exercise capacity. These results suggest that a vegan diet can be a suitable alternative for ambitious recreational runners. Trial registration German Clinical Trials Register (DRKS00012377). Registered on 28 April 2017

Aging and overweight increase the risk of developing type 2 diabetes mellitus. In this cross-sectional study, we aimed to investigate the potential mediating role of T-EMRA cells and inflammatory markers in the development of a decreased insulin sensitivity. A total of 134 healthy older volunteers were recruited (age 59.2 (SD 5.6) years). T cell subpopulations were analyzed by flow cytometry. Furthermore, body composition, HOMA-IR, plasma tryptophan (Trp) metabolites, as well as cytokines and adipokines were determined. Using subgroup and covariance analyses, the influence of BMI on the parameters was evaluated. Moreover, correlation, multiple regression, and mediation analyses were performed. In the subgroup of participants with obesity, an increased proportion of CD8+EMRA cells and elevated concentrations of plasma kynurenine (KYN) were found compared to the lower-weight subgroups. Linear regression analysis revealed that an elevated HOMA-IR could be predicted by a higher proportion of CD8+EMRA cells and KYN levels. A mediation analysis showed a robust indirect effect of the Waist-to-hip ratio on HOMA-IR mediated by CD8+EMRA cells. Thus, the deleterious effects of abdominal obesity on glucose metabolism might be mediated by CD8+EMRA cells in the elderly. Longitudinal studies should validate this assumption and analyze the suitability of CD8+EMRA cells as early predictors of incipient prediabetes.