Link Between Ferritin, Vitamin D, Performance, and Eating Attitudes in Female Athletes

ABSTRACT

Iron and vitamin D deficiencies can affect athletes’ health and performance. However, the epidemiology and associated risk factors remain unclear. Forty-three elite female athletics athletes (20.2±1.9 years) were included. A survey regarding the training schedule and Eating Attitudes Test-26, body composition, bone mineral density, and serum 25-hydroxyvitamin D (25(OH)D) and ferritin levels were assessed. Mean serum 25(OH)D and ferritin levels were 25.2±5.5 ng/mL and 29.0±13.2 ng/mL, respectively, and 83.7% and 41.9% of athletes had vitamin D and ferritin insufficiency, respectively. Serum 25(OH)D level was negatively correlated with the number of rest days per week (Coefficient,−6.19; 95% confidence interval [CI],−9.82–−2.57; p=0.002), and serum ferritin level was negatively correlated with body mass index (Coefficient,−3.87; 95% CI,−7.57–−0.16; p=0.041). Performance levels were positively correlated with serum vitamin D levels (Coefficients, 7.25; 95% CI, 0.25–14.25; p=0.043) and negatively correlated with EAT-26 scores (Coefficient,−7.30; 95% CI,−12.61–−1.98; p=0.009) and body fat percentage (Coefficient,−13.26; 95% CI,−24.66–−1.86; p=0.025). Vitamin D and ferritin insufficiencies are prevalent among Japanese female athletics athletes. Serum vitamin D level was related to performance level.

Keywords

athletics - anemia - iron-deficiency

Publication History

Received: 24 September 2024

Accepted after revision: 24 September 2024

Accepted Manuscript online:
24 September 2024

Article published online:
14 January 2025

• References

• 1 Coates A, Mountjoy M, Burr J. Incidence of Iron Deficiency and Iron Deficient Anemia in Elite Runners and Triathletes. Clin J Sport Med 2017; 27: 493-498
• 2 Malczewska J, Raczynski G, Stupnicki R. Iron status in female endurance athletes and in non-athletes. Int J Sport Nutr Exerc Metab 2000; 10: 260-276
• 3 Parks RB, Hetzel SJ, Brooks MA. Iron deficiency and anemia among collegiate athletes: A retrospective chart review. Med Sci Sports Exerc 2017; 49: 1711-1715
• 4 Tabata S, Tsukahara Y, Kamada H. et al. Prevalence of anemia and iron deficiency and its association with body mass index in elite Japanese high school long-distance runners. Phys Sportsmed 2024; 52: 360-368
• 5 Suedekum NA, Dimeff RJ. Iron and the athlete. Curr Sports Med Rep 2005; 4: 199-202
• 6 Hurrell R, Egli I. Iron bioavailability and dietary reference values. Am J Clin Nutr 2010; 91: 1461S-1467S
• 7 Cepeda-Lopez AC, Melse-Boonstra A, Zimmermann MB. et al. In overweight and obese women, dietary iron absorption is reduced and the enhancement of iron absorption by ascorbic acid is one-half that in normal-weight women. Am J Clin Nutr 2015; 102: 1389-1397
• 8 Torstveit MK, Ackerman KE, Constantini N. et al. Primary, secondary and tertiary prevention of Relative Energy Deficiency in Sport (REDs): A narrative review by a subgroup of the IOC consensus on REDs. Br J Sports Med 2023; 57: 1119-1126
• 9 Robinson JK. Sun exposure, sun protection, and vitamin D. JAMA 2005; 294: 1541-1543
• 10 Farrokhyar F, Tabasinejad R, Dao D. et al. Prevalence of vitamin D inadequacy in athletes: a systematic-review and meta-analysis. Sports Med 2015; 45: 365-378
• 11 Carswell AT, Oliver SJ, Wentz LM. et al. Influence of vitamin D supplementation by sunlight or oral D3 on exercise performance. Med Sci Sports Exerc 2018; 50: 2555-2564
• 12 Burgaz A, Åkesson A, Öster A. et al. Associations of diet, supplement use, and ultraviolet B radiation exposure with vitamin D status in Swedish women during winter. Am J Clin Nutr 2007; 86: 1399-1404
• 13 Atkinson MA, Melamed ML, Kumar J. et al. Vitamin D, race, and risk for anemia in children. J Pediatr 2014; 164: 153-158. e151
• 14 Liu T, Zhong S, Liu L. et al. Vitamin D deficiency and the risk of anemia: A meta-analysis of observational studies. Ren Fail 2015; 37: 929-934
• 15 Constantini NW, Arieli R, Chodick G. et al. High prevalence of vitamin D insufficiency in athletes and dancers. Clin J Sport Med 2010; 20: 368-371
• 16 Malczewska-Lenczowska J, Sitkowski D, Surała O. et al. The association between iron and vitamin D status in female elite athletes. Nutrients 2018; 10: 167
• 17 Blanco-Rojo R, Pérez-Granados AM, Toxqui L. et al. Relationship between vitamin D deficiency, bone remodelling and iron status in iron-deficient young women consuming an iron-fortified food. Eur J Nutr 2013; 52: 695-703
• 18 Goldstein ER, Fukuda DH. Connecting energy availability and iron deficiency with bone health: implications for the female athlete. Strength Cond J 2020; 42: 2-11
• 19 Calvo MS, Whiting SJ, Barton CN. Vitamin D intake: A global perspective of current status. J Nutr 2005; 135: 310-316
• 20 Tsukahara Y, Mason RA, Macznik A. Training and physiological characteristics of American and Japanese female track and field athletes. J Sports Med Phys Fitness 2022; 62: 1184-1190
• 21 Hirsch KR, Smith-Ryan AE, Trexlern ET. et al. Body composition and muscle characteristics of division I track and field athletes. J Strength Cond Res 2016; 30: 1231-1238
• 22 Harriss DJ, MacSween A, Atkinson G. Ethical Standards in Sport and Exercise Science Research: 2020 Update. Int J Sports Med 2019; 40: 813-817
• 23 McKay AKA, Stellingwerff T, Smith ES. et al. Defining Training and Performance Caliber: A Participant Classification Framework. Int J Sports Physiol Perform 2022; 17: 317-331
• 24 Spiriev B. IAAF scoring tables of athletics. IAAF; 2017. Internet https://www.worldathletics.org/news/iaaf-news/scoring-tables-2017 accessed on June 5, 2024
• 25 Tsukahara Y, Kamada H, Torii S. et al. Association between self-reported overtraining syndrome and symptoms in high school track and field athletes. Int J Sports Med 2023; 44: 138-144
• 26 Garner DM, Olmsted MP, Bohr Y. et al. The eating attitudes test: Psychometric features and clinical correlates. Psychol Med 1982; 12: 871-878
• 27 Kennel KA, Drake MT, Hurley DL. Vitamin D deficiency in adults: When to test and how to treat. In, mayo clinic proceedings. Elsevier; 2010. 85. 752-758
• 28 Holick MF. Vitamin D deficiency. N Engl J Med 2007; 357: 266-281
• 29 Płudowski P, Karczmarewicz E, Bayer M. et al. Practical guidelines for the supplementation of vitamin D and the treatment of deficits in Central Europe – recommended vitamin D intakes in the general population and groups at risk of vitamin D deficiency. Endokrynologia Polska 2013; 64: 319-327
• 30 Komatsu T, Yamasawa F, Dohi M. et al. The prevalence of anemia in Japanese Universiade athletes, detected with longitudinal preparticipation medical examinations. Journal of General and Family Medicine 2018; 19: 102-108
• 31 Haimi M, Kremer R. Vitamin D deficiency/insufficiency from childhood to adulthood: Insights from a sunny country. World J Clin Pediatr 2017; 6: 1-9
• 32 World Health Organization. Prevention and Management of Osteoporosis: Report of a WHO Scientific Group. Geneva: World Health Organization; . 2003
• 33 Hinrichs T, Chae E-H, Lehmann R. et al. Bone mineral density in athletes of different disciplines: A cross-sectional study. Open Sports Sci J 2010; 3: 129-133
• 34 Piasecki J, McPhee J, Hannam K. et al. Hip and spine bone mineral density are greater in master sprinters, but not endurance runners compared with non-athletic controls. Arch Osteoporos 2018; 13: 1-9
• 35 Macdonald HM. Contributions of sunlight and diet to vitamin D status. Calcif Tissue Int 2013; 92: 163-176
• 36 Chatard J-C, Mujika I, Guy C. et al. Anaemia and iron deficiency in athletes: Practical recommendations for treatment. Sports Med 1999; 27: 229-240
• 37 Sim M, Garvican-Lewis LA, Cox GR. et al. Iron considerations for the athlete: A narrative review. Eur J Appl Physiol 2019; 119: 1463-1478
• 38 Mayer C, Barker MK, Dirk P. et al. Menstrual blood losses and body mass index are associated with serum ferritin concentrations among female varsity athletes. Appl Physiol Nutr Metab 2020; 45: 723-730
• 39 Tsukahara Y, Torii S, Yamasawa F. et al. Changes in Body Composition and Its Relationship to Performance in Elite Female Track and Field Athletes Transitioning to the Senior Division. Sports (Basel) 2020; 8: 115
• 40 Gilsanz V, Kremer A, Mo AO. et al. Vitamin D status and its relation to muscle mass and muscle fat in young women. J Clin Endocrinol Metab 2010; 95: 1595-1601
• 41 Degoutte F, Jouanel P, Bègue R. et al. Food restriction, performance, biochemical, psychological, and endocrine changes in judo athletes. Int J Sports Med 2006; 27: 9-18