Emerging Trends in Sports Cardiology: The Role of Micronutrients in Cardiovascular Health and Performance
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Abstract
Micronutrients are critical components of an athlete’s diet, affecting both performance and cardiovascular health. This review summarizes current studies on the importance of micronutrients in sports cardiology, focusing on their effects on energy metabolism, antioxidant defense, and cardiac function. Key findings emphasize the relevance of micronutrient sufficiency in improving athletic performance and avoiding long-term health issues linked to strenuous training programs. Micronutrients like B vitamins help energy generation pathways, while antioxidants like C and E reduce exercise-induced oxidative damage. Minerals like magnesium and iron are important for muscle function and oxygen delivery, which are required for endurance and recovery. Effective nutritional practices include balancing food intake and, if required, supplementing under medical supervision to address individual needs and enhance performance results. Future research paths will focus on individualized nutrition techniques based on genetic and metabolic profiles, allowing for more precise food recommendations for athletes. Collaboration between sports medicine and nutrition disciplines is critical for establishing evidence-based practices and improving cardiovascular health in athletes.
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Baggish AL, Battle RW, Beckerman JG, Bove AA, Lampert RJ, Levine BD, et al. Sports Cardiology. J Am Coll Cardiol. 2017;70(15):1902-1918. Available from: https://doi.org/10.1016/j.jacc.2017.08.055
Borjesson M, Urhausen A, Kouidi E, Dugmore D, Sharma S, Halle M, et al. Cardiovascular evaluation of middle-aged/ senior individuals engaged in leisure-time sport activities: position stand from the sections of exercise physiology and sports cardiology of the European Association of Cardiovascular Prevention and Rehabilitation. Eur J Cardiovasc Prev Rehabil. 2011;18(3):446-58. Available from: https://doi.org/10.1097/hjr.0b013e32833bo969
Harmon KG, Zigman M, Drezner JA. The effectiveness of screening history, physical exam, and ECG to detect potentially lethal cardiac disorders in athletes: A systematic review/meta-analysis. J Electrocardiol. 2015;48(3):329-338. Available from: https://doi.org/10.1016/j.jelectrocard.2015.02.001
Rakhit D, Marwick TH, Prior DL, La Gerche A. Sports cardiology – a bona fide sub-specialty. Heart Lung Circ. 2018;27:1034-1036. Available from: https://lirias.kuleuven.be/2036282?limo=0
Battle RW. Sports cardiology: a discipline emerged. Clin Sports Med. 2015;34 Available from: https://doi.org/10.1016/j.csm.2015.04.002
Dineen EH, Peritz DC. What is Sports Cardiology? American College of Cardiology. Available at: Available from: https://www.acc.org/Latest-in-Cardiology/Articles/2019/03/20/12/33/What-is-Sports-Cardiology. Accessed 2019 May 23.
Sharma S, Drezner JA, Baggish A, Papadakis M, Wilson MG, Prutkin JM, et al. International recommendations for electrocardiographic interpretation in athletes. Eur Heart J. 2017;39(16):1466-1480. Available from: https://doi.org/10.1093/eurheartj/ehw631
Wilson MG, Basavarajaiah S, Whyte GP, Cox S, Loosemore M, Sharma S. Efficacy of personal symptom and family history questionnaires when screening for inherited cardiac pathologies: the role of electrocardiography. Br J Sports Med. 2007;42(3):207-211. Available from: https://doi.org/10.1136/bjsm.2007.039420
Zorzi A, Perazzolo Marra M, Rigato I, De Lazzari M, Susana A, Niero A, et al. Nonischemic left ventricular scar as a substrate of life-threatening ventricular arrhythmias and sudden cardiac death in competitive athletes. Circ Arrhythm Electrophysiol. 2016;9(7). Available from: https://doi.org/10.1161/circep.116.004229
Pelliccia A, Sharma S, Gati S, Bäck M, Börjesson M, Caselli S, et al. ESC Scientific Document Group. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. Eur Heart J. 2021 Jan 1;42(1):17-96. Available from: https://doi.org/10.1093/eurheartj/ehaa605
Powers SK, Howley ET. Exercise physiology: Theory and Application to Fitness and Performance. 10th ed. New York: McGraw-Hill Education; 2018. Available from: https://accessphysiotherapy.mhmedical.com/content.aspx?bookid=2460§ionid=193998798
Garba DL, Jacobsen AP, Blumenthal RS, Martinez MW, Ndumele CE, Coslick AM, et al. Assessing athletes beyond routine screening: Incorporating essential factors to optimize cardiovascular health and performance. Am Heart J Plus: Cardiol Res Pract. 2024;44:100413. Available from: https://doi.org/10.1016/j.ahjo.2024.100413
Cavigli L, Olivotto I, Fattirolli F, Mochi N, Favilli S, Mondillo S, et al. Prescribing, dosing and titrating exercise in patients with hypertrophic cardiomyopathy for prevention of comorbidities: Ready for prime time. Eur J Prev Cardiol. 2021 Aug 23;28(10):1093-1099. Available from: https://doi.org/10.1177/2047487320928654
D'Ascenzi F, Ragazzoni GL, Boncompagni A, Cavigli L. Sports cardiology: A glorious past, a well-defined present, a bright future. Clin Cardiol. 2023 Sep;46(9):1015-1020. Available from: https://doi.org/10.1002/clc.24112
Ames BN. Micronutrient deficiencies: a major cause of DNA damage. Ann NY Acad Sci. 1999;889(1):87-106. Available from: https://doi.org/10.1111/j.1749-6632.1999.tb08727.x
Rosanoff A, Weaver CM, Rude RK. Suboptimal magnesium status in the United States: are the health consequences underestimated? Nutr Rev. 2012;70(3):153-164. Available from: https://doi.org/10.1111/j.1753-4887.2011.00465.x
Lobo V, Patil A, Phatak A, Chandra N. Free radicals, antioxidants and functional foods: Impact on human health. Pharmacogn Rev. 2010;4(8):118. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3249911/
Ashor AW, Lara J, Mathers JC, Siervo M. Effect of vitamin C on endothelial function in health and disease: A systematic review and meta-analysis of randomised controlled trials. Atherosclerosis. 2014;235(1):9-20. Available from: https://doi.org/10.1016/j.atherosclerosis.2014.04.004
Kunadian V, Ford GA, Bawamia B, Qiu W, Manson JE. Vitamin D deficiency and coronary artery disease: A review of the evidence. Am Heart J. 2014;167(3):283-291. Available from: https://doi.org/10.1016/j.ahj.2013.11.012
Wierzbicki AS. Homocysteine and cardiovascular disease: a review of the evidence. Diabetes Vasc Dis Res. 2007;4(2):143-149. Available from: https://doi.org/10.3132/dvdr.2007.033
Williams M. Dietary supplements and sports performance: amino acids. J Int Soc Sports Nutr. 2022;2(2). doi: 10.1186/1550-2783-2-2-63. Available from: https://jissn.biomedcentral.com/articles/10.1186/1550-2783-2-2-63
Convertino VA, Armstrong LE, Coyle EF, Mack GW, Sawka MN, Senay LC, Sherman WM. Exercise and fluid replacement. Med Sci Sports Exerc. 1996;28(1). Available from: https://doi.org/10.1097/00005768-199610000-00045
Beard J, Tobin B. Iron status and exercise. Am J Clin Nutr. 2000;72(2):594S-597S. Available from: https://doi.org/10.1093/ajcn/72.2.594s
Nielsen FH, Lukaski HC. Update on the relationship between magnesium and exercise. PubMed. 2006;19(3):180-189. Available from: https://pubmed.ncbi.nlm.nih.gov/17172008.
Braakhuis AJ. Effect of vitamin C supplements on physical performance. Curr Sports Med Rep. 2012;11(4):180-184. Available from: https://doi.org/10.1249/jsr.0b013e31825e19cd
McAnulty SR, Nieman DC, McAnulty LS, Lynch WS, Jin F, Henson DA. Effect of mixed flavonoids, n-3 fatty acids, and vitamin C on oxidative stress and antioxidant capacity before and after intense cycling. Int J Sport Nutr Exerc Metab. 2011;21(4):328-337. Available from: https://doi.org/10.1123/ijsnem.21.4.328
Rayman MP. Selenium and human health. Lancet. 2012;379(9822):1256-1268. Available from: https://doi.org/10.1016/s0140-6736(11)61452-9
Cao G, Zuo J, Wu B, Wu Y. Polyphenol supplementation boosts aerobic endurance in athletes: systematic review. Front Physiol. 2024;15. Available from: https://doi.org/10.3389/fphys.2024.1369174
Al-Qurashi TM, Aljaloud KS, Aldayel A, Alsharif YR, Alaqil AI, Alshuwaier GO. Effect of rehydration with mineral water on cardiorespiratory fitness following exercise-induced dehydration in athletes. J Men’s Health. 2022;18:206. Available from: https://oss.jomh.org/files/article/20221109-208/pdf/jomh1810206.pdf
Marley A, Grant MC, Babraj J. Weekly vitamin D3 supplementation improves aerobic performance in combat sport athletes. Eur J Sport Sci. 2020;21:379-387. Available from: https://onlinelibrary.wiley.com/doi/10.1080/17461391.2020.1744736
Ksiażek A, Zagrodna A, Słowińska-Lisowska M, Lombardi G. Relationship between metabolites of vitamin D, free 25-(OH)D, and physical performance in indoor and outdoor athletes. Front Physiol. 2022;13:1211. Available from: Available from: https://doi.org/10.3389/fphys.2022.909086
Jordan SL, Albracht-Schulte K, Robert-McComb JJ. Micronutrient deficiency in athletes and inefficiency of supplementation: Is low energy availability a culprit? PharmaNutrition. 2020;14:100229. Available from: https://doi.org/10.1016/j.phanu.2020.100229
Mesquita EDL, Exupério IN, Agostinete RR, Luiz-de-Marco R, da Silva JCM, Maillane-Vanegas S, et al. The Combined Relationship of Vitamin D and Weight-Bearing Sports Participation on Areal Bone Density and Geometry Among Adolescents: ABCD - Growth Study. J Clin Densitom. 2022;25(4):674-681. Available from: https://doi.org/10.1016/j.jocd.2022.09.001
Brzezianski M, Pastuszak-Lewandoska D, Migdalska-Sek M, Jastrzebski Z, Radziminski L, Jastrzebska J, et al. Effect of Vitamin D3 Supplementation on Interleukin 6 and C-Reactive Protein Profile in Athletes. J Nutr Sci Vitaminol (Tokyo). 2022;68(5):359-367. Available from: https://doi.org/10.3177/jnsv.68.359
Chen LY, Wang CW, Chen LA, Fang SH, Wang SC, He CS. Low vitamin D status relates to the poor response of peripheral pulse wave velocity following acute maximal exercise in healthy young men. Nutrients. 2022;14:3074. Available from: https://doi.org/10.3390/nu14153074
Kurnatowska I, et al. Effect of vitamin K. Pol Arch Med Wewn. 2015;125:631-640. Available from: https://doi.org/10.20452/pamw.3041
Fraser A, Williams D, Lawlor DA. Associations of serum 25-hydroxyvitamin D, parathyroid hormone and calcium with cardiovascular risk factors: analysis of 3 NHANES cycles (2001-2006). PLoS One. 2010;5(11):e13882. Available from: https://doi.org/10.1371/journal.pone.0013882
Giovannucci E. 25-hydroxyvitamin D and risk of myocardial infarction in men: a prospective study. Arch Intern Med. 2008;168(11):1174-1180. Available from: https://doi.org/10.1001/archinte.168.11.1174
Lee JH, O'Keefe JH, Bell D, Morrow JD, Winters C, Lee H, et al. Vitamin D deficiency: An important, common, and easily treatable cardiovascular risk factor? J Am Coll Cardiol. 2008;52(24):1949-1956. Available from: https://doi.org/10.1016/j.jacc.2008.08.050
Kendrick J, Targher G, Smits G, Chonchol M. 25-Hydroxyvitamin D deficiency is independently associated with cardiovascular disease in the Third National Health and Nutrition Examination Survey. Atherosclerosis. 2009;205(1):255-60. Available from: https://doi.org/10.1016/j.atherosclerosis.2008.10.033
Forman JP, Giovannucci E, Holmes MD, Bischoff-Ferrari HA, Tworoger SS, Willett WC, et al. Plasma 25-hydroxyvitamin D levels and risk of incident hypertension. Hypertension. 2007;49(5):1063-9. Available from: https://doi.org/10.1161/hypertensionaha.107.087288
Rowe S, Carr AC. Global vitamin C status and prevalence of deficiency: A cause for concern? Nutrients. 2020;12:2008. Available from: https://doi.org/10.3390/nu12072008
Higgins MR, Izadi A, Kaviani M. Antioxidants and exercise performance: With a focus on vitamin E and C supplementation. Int J Environ Res Public Health. 2020;17:8452. Available from: https://doi.org/10.3390/ijerph17228452
Chauhan RC. Calcium as a boon or bane for athletes: A review. Asian J Res Mark. 2022;11:1-8.
Kunstel K. Calcium requirements for athletes. Curr Sports Med Rep. 2005;4:203-206. Available from: https://doi.org/10.1097/01.csmr.0000306208.56939.01
Song J, She J, Chen D, Pan F. Latest research advances on magnesium and magnesium alloys worldwide. J Magnes Alloy. 2020;8:1-41. Available from: https://doi.org/10.1016/j.jma.2020.02.003
Carlsohn A, Müller J, Dapp C. Position of the working group sports nutrition of the German Nutrition Society (DGE): Minerals and vitamins in sports nutrition. Dtsch Z Sportmed. 2020;71:208-215.
Maret W, Sandstead HH. Zinc requirements and the risks and benefits of zinc supplementation. J Trace Elem Med Biol. 2006;20:3-18. Available from: https://doi.org/10.1016/j.jtemb.2006.01.006
Michalak M, Pierzak M, Kręcisz B, Suliga E. Bioactive compounds for skin health: A review. Nutrients. 2021;13:203. Available from: https://doi.org/10.3390/nu13010203
Maughan RJ. Nutritional ergogenic aids and exercise performance. Nutr Res Rev. 1999;12(2):255-280. Available from: https://doi.org/10.1079/095442299108728956
Trushina EN, Mustafina OK, Nikitiuk DB, Kuznetsov VD. Immune dysfunction in highly skilled athletes and nutritional rehabilitation. Vopr Pitaniia. 2012;81(2):73-80. Available from: https://pubmed.ncbi.nlm.nih.gov/22774482/
Hider RC, Kong X. Iron: effect of overload and deficiency. In: Interrelations between Essential Metal Ions and Human Diseases. 2013;229-294. Available from: https://doi.org/10.1007/978-94-007-7500-8_8
McDowell LA, Kudaravalli P, Chen RJ, et al. Iron Overload. [Updated 2024 Jan 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526131/
Knez M, Glibetic M. Zinc as a biomarker of cardiovascular health. Front Nutr. 2021;8:686078. Available from: https://doi.org/10.3389/fnut.2021.686078
Kitala K, Tanski D, Godlewski J, Krajewska-Włodarczyk M, Gromadziński L, et al. Copper and zinc particles as regulators of cardiovascular system function - A review. Nutrients. 2023;15(13):3040. Available from: https://doi.org/10.3390/nu15133040
Ware M. Why do we need magnesium? [Internet]. Medical News Today. 2023. Available from: Available from: https://www.medicalnewstoday.com/articles/286839
DiNicolantonio JJ, Liu J, O'Keefe JH. Magnesium for the prevention and treatment of cardiovascular disease. Open Heart. 2018;5:e000775. Available from: https://doi.org/10.1136/openhrt-2018-000775
Reid IR, Birstow SM, Bolland MJ. Calcium and cardiovascular disease. Endocrinol Metab (Seoul). 2017;32(3):339-349. Available from: https://doi.org/10.3803/enm.2017.32.3.339
imon LV, Hashmi MF, Farrell MW. Hyperkalemia. [Updated 2023 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470284/
de la Guía-Galipienso F, Pérez-Gómez J, García-Prieto A, et al. Vitamin D and cardiovascular health. Clin Nutr. 2021;40(5):2946-2957. Available from: https://doi.org/10.1016/j.clnu.2020.12.025
Owen KN, Dewald O. Vitamin E Toxicity. [Updated 2023 Feb 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK564373/
O’Mary L. Excess vitamin B3 linked to increased risk of heart disease. [Internet]. WebMD. 2024 Feb 20. Available from: Available from: https://www.webmd.com/heart-disease/news/20240220/excess-vitamin-b3-linked-increased-risk-of-heart-disease
Abdullah M, Jamil RT, Attia FN. Vitamin C (Ascorbic Acid). [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499877/
Larson-Meyer DE, Willis KS. Vitamin D and athletes. Curr Sports Med Rep. 2010;9(4):220-226. Available from: https://doi.org/10.1249/jsr.0b013e3181e7dd45
Da Boit M, Hunter AM, Gray SR. Fit with good fat? The role of n-3 polyunsaturated fatty acids on exercise performance. Metabolism. 2017;66:45–54. Available from: https://doi.org/10.1016/j.metabol.2016.10.007
Powers SK, Jackson MJ. Exercise-induced oxidative stress: cellular mechanisms and impact on muscle force production. Physiol Rev. 2008;88(4):1243-1276. Available from: https://doi.org/10.1152/physrev.00031.2007
Guest NS, Horne J, Vanderhout S, El-Sohemy A. Sport nutrigenomics: Personalized nutrition for athletic performance. Front Nutr. 2019;6:8. Available from: https://doi.org/10.3389/fnut.2019.00008
Brown MA, Stevenson EJ, Howatson G. Whey protein hydrolysate supplementation accelerates recovery from exercise-induced muscle damage in females. Appl Physiol Nutr Metab. 2018;43(4):324-330. Available from: https://doi.org/10.1139/apnm-2017-0412
Soares MJ, Satyanarayana K, Bamji MS, Jacob CM, Ramana YV, Rao SS. The effect of exercise on the riboflavin status of adult men. Br J Nutr. 1993;69(4):541-551. Available from: https://doi.org/10.1079/bjn19930054
Suboticanec K, Stavljenic A, Schalch W, Buzina R. Effects of pyridoxine and riboflavin supplementation on physical fitness in young adolescents. Int J Vitam Nutr Res. 1990;60:81-88. Available from: https://pubmed.ncbi.nlm.nih.gov/2387675/
van der Beek EJ, van Dokkum W, Schrijver J, Wedel M, Gaillard AW, Wesstra A, et al. Thiamin, riboflavin, and vitamins B-6 and C: impact of combined restricted intake on functional performance in man. Am J Clin Nutr. 1988;48(6):1451-62. Available from: https://doi.org/10.1093/ajcn/48.6.1451
van der Beek EJ, van Dokkum W, Wedel M, Schrijver J, van den Berg H. Thiamin, riboflavin, and vitamin B6: impact of restricted intake on physical performance in man. J Am Coll Nutr. 1994;13:629-640. Available from: https://doi.org/10.1080/07315724.1994.10718459
Powers HJ, Bates CJ, Lamb WH, Singh J, Gelman W, Webb E. Effects of a multivitamin and iron supplement on running performance in Gambian children. Hum Nutr Clin Nutr. 1985;39C:427-437. Available from: https://pubmed.ncbi.nlm.nih.gov/4077578/
Tauler P, Ferrer MD, Sureda A, Pujol P, Drobnic F, et al. Supplementation with an antioxidant cocktail containing coenzyme Q prevents plasma oxidative damage induced by soccer. Eur J Appl Physiol. 2008;104(5):777-85. Available from: https://doi.org/10.1007/s00421-008-0831-6
Bryer SC, Goldfarb AH. Effect of high dose vitamin C supplementation on muscle soreness, damage, function, and oxidative stress to eccentric exercise. Int J Sport Nutr Exerc Metab. 2006;16(3):270-80. Available from: https://doi.org/10.1123/ijsnem.16.3.270
Luden ND, Saunders MJ, Todd MK. Postexercise carbohydrate-protein- antioxidant ingestion decreases plasma creatine kinase and muscle soreness. Int J Sport Nutr Exerc Metab. 2007;17(1):109-23. Available from: https://doi.org/10.1123/ijsnem.17.1.109
Ceglia L. Vitamin D and skeletal muscle tissue and function. Mol Aspects Med. 2008;29(6):407-414. https://doi.org/10.1016/j.mam.2008.07.002
Williams MH. Dietary supplements and sports performance: minerals. J Int Soc Sports Nutr. 2005;2(1):43-49. https://doi.org/10.1186/1550-2783-2-1-43
Otten JJ, Hellwig JP, Meyers LD, editors. Dietary Reference Intakes: The Essential Guide to Nutrient Requirements. 1st ed. Washington, DC: National Academies Press; 2009.
Lukaski HC. Vitamin and mineral status: effects on physical performance. Nutr. 2004;20(7-8):632-644. Available from: https://doi.org/10.1016/j.nut.2004.04.001
Lee M, Hsu Y, Shen S, Ho C, Huang C. A functional evaluation of anti-fatigue and exercise performance improvement following vitamin B complex supplementation in healthy humans: a randomized double-blind trial. Int J Med Sci. 2023;20(10):1272-1281. Available from: https://doi.org/10.7150/ijms.86738
Micha R, Peñalvo JL, Cudhea F, Imamura F, Rehm CD, Mozaffarian D. Association between dietary factors and mortality from heart disease, stroke, and Type 2 diabetes in the United States. JAMA. 2017b;317(9):912-924. Available from: https://doi.org/10.1001/jama.2017.0947
Clemente-Suárez VJ, Bustamante-Sanchez Á, Mielgo-Ayuso J, Martínez-Guardado I, Martín-Rodríguez A, Tornero-Aguilera JF. Antioxidants and Sports Performance. Nutrients. 2023;15(10):2371. Available from: https://doi.org/10.3390/nu15102371
Sawka MN, Burke LM, Eichner ER, Maughan RJ, Montain SJ, Stachenfeld NS. American College of Sports Medicine position stand: exercise and fluid replacement. Med Sci Sports Exerc. 2007;39(2):377-390. Available from: https://doi.org/10.1249/mss.0b013e31802ca597
Jeukendrup AE, Killer SC. The myths surrounding pre-exercise carbohydrate feeding. Ann Nutr Metab. 2010;57(Suppl 2):18-25. Available from: https://doi.org/10.1159/000322698
Ghazzawi HA, Hussain MA, Raziq KM, Alsendi KK, Alaamer RO, Jaradat M, et al. Exploring the Relationship between Micronutrients and Athletic Performance: A Comprehensive Scientific Systematic Review of the Literature in Sports Medicine. Sports (Basel). 2023;11(6):109. Available from: https://doi.org/10.3390/sports11060109
Reilly T, Waterhouse J, Burke LM, Alonso JM. Nutrition for travel. J Sports Sci. 2007;25(sup1):S125-34. Available from: https://doi.org/10.1080/02640410701607445
Heikura IA, Uusitalo AL, Stellingwerff T, Bergland D, Mero AA, Burke LM. Low energy availability is difficult to assess but outcomes have large impact on bone injury rates in elite distance athletes. Int J Sport Nutr Exerc Metab. 2018;28(4):403-411. Available from: https://doi.org/10.1123/ijsnem.2017-0313
Petróczi A, Naughton DP. Supplement use in sport: is there a potentially dangerous incongruence between rationale and practice? J Occup Med Toxicol. 2007;2(1):4. Available from: https://doi.org/10.1186/1745-6673-2-4
German JB, Zivkovic AM, Dallas DC, Smilowitz JT. Nutrigenomics and personalized diets: what will they mean for food? Annu Rev Food Sci Technol. 2011;2(1):97-123. Available from: https://doi.org/10.1146/annurev.food.102308.124147
Mullins VA, Bresette W, Johnstone L, Hallmark B, Chilton FH. Genomics in personalized nutrition: can you “eat for your genes”? Nutrients. 2020;12(10):3118. Available from: https://doi.org/10.3390/nu12103118
Li Q, Zhou J. The microbiota–gut–brain axis and its potential therapeutic role in autism spectrum disorder. Neuroscience. 2016;324:131-139. Available from: https://doi.org/10.1016/j.neuroscience.2016.03.013
Fiorini S, De Cassya Lopes Neri L, Guglielmetti M, Pedrolini E, Tagliabue A, Quatromoni PA, Ferraris C. Nutritional counseling in athletes: a systematic review. Front Nutr. 2023;10:1250567. Available from: https://doi.org/10.3389/fnut.2023.1250567