Nutritional aspects of immunosuppression in athletes

Sports Medicine

Volumn 28, Issue 3, 1999, Pages 151-176

  Bishop, Nicolette C ^a   Blannin, Andrew K ^a   Walsh, Neil P ^b   Robson, Paula J ^a   Gleeson, Michael ^a  

^a UNIVERSITY OF BIRMINGHAM   (United Kingdom)

^b LEEDS TRINITY UNIVERSITY   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

ATHLETE; DIET; HUMAN; IMMUNE DEFICIENCY; INFECTION RISK; NUTRITION; NUTRITIONAL DEFICIENCY; OPPORTUNISTIC INFECTION; PHYSICAL PERFORMANCE; PROTEIN INTAKE; REVIEW; TRAINING; WEIGHT REDUCTION;

DIET; DIET, FAT-RESTRICTED; DIET, PROTEIN-RESTRICTED; DIETARY CARBOHYDRATES; DIETARY FATS; DIETARY PROTEINS; IMMUNOSUPPRESSION; MINERALS; OPPORTUNISTIC INFECTIONS; SPORTS; SPORTS MEDICINE; VITAMINS;

EID: 0032757548     PISSN: 01121642     EISSN: None     Source Type: Journal    
DOI: 10.2165/00007256-199928030-00002     Document Type: Review

References (158)

1. Nieman DC, Johansen LM, Lee JW. Infectious episodes in runners before and after the Los Angeles Marathon. J Sports Med Phys Fitness 1990; 30: 316-28
2. Peters EM, Bateman ED. Ultramarathon running and URTI: an epidemiological survey. S Afr Med J 1983; 64: 582-4
3. Gleeson M, Bishop NC. Immunology. In: Maughan RJ, editor. Basic science for sports medicine. Oxford: Butterworth Heinemann. 1999: 199-236
4. Chandra RK. Nutrition and the immune system: an introduction. Am J Clin Nutr 1997; 66: S460-3
5. Richter EA, Kiens B, Raben A, et al. Immune parameters in male athletes after a lacto-ovo vegetarian diet and a mixed Western diet. Med Sci Sports Exerc 1991; 23 (5): 517-21
6. Kubena KS, McMurray DN. Nutrition and the immune system: a review of nutrient-nutrient interactions. J Am Diet Assoc 1996; 96 (11): 1156-64
7. Scrimshaw NS, SanGiovanni JP. Synergism of nutrition, infection and immunity: an overview. Am J Clin Nutr 1997; 66: S464-77
8. Cunningham-Rundles S. Effects of nutritional status immunological function. Am J Clin Nutr 1982; 35:1202-10
9. Devlin JT, Williams C. Foods, nutrition and sports performance: a final consensus statement. J Sports Sci 1991; 9 Suppl.: iii
10. Newsholme EA. Breaking Olympic records [editorial]. BMJ 1996; 313 (7052): 246
11. Shephard RJ, Shek PN. Heavy exercise, nutrition and immune function: is there a connection? Int J Sports Med 1995; 16 (8): 491-7
12. Beals KA, Manore MM. The prevalence and consequence of eating disorders in female athletes. Int J Sport Nutr 1994; 4 (2): 175-95
13. Coyle EF. Timing and method of increased carbohydrate intake to cope with heavy training, competition and recovery. In: Williams C, Devlin J, editors. Foods, nutrition and sports performance. London: E & FN Spon, 1992: 35-63
14. Christensen EH, Hanson O. Arbeitsfahigkeit and ernahrung. Scand Arch Physiol 1939; 81: 160-71
15. Bergstrom J, Hultman E. A study of the glycogen metabolism during exercise in man. Scand J Clin Lab Invest 1967; 19: 218-28
16. Hawley JA, Dennis SC, Lindsey EH, et al. Nutritional practices of athletes: are they sub-optimal? J Sports Sci 1995; 13: S75-81
17. Ardawi MSM, Newsholme EA. Glutamine metabolism in lymphocytes of the rat. Biochem J 1983; 212:835-42
18. Brand K. Glutamine and glucose metabolism during thymocyte proliferation. Biochem J 1985; 228: 353-61.
19. Ardawi MSM. Glutamine and glucose metabolism in human peripheral lymphocytes. Metabolism 1988; 37: 99-103
20. Hume DA, Weidemann MJ. Role and regulation of glucose in proliferating cells. J Natl Cancer Inst 1979; 62: 3-8
21. Calder PC. Fuel utilisation by cells of the immune system. Proc Nutr Soc 1995; 54 (1): 65-82
22. Newsholme P, Newsholme EA. Rates of utilisation of glucose, glutamine and olcate and formation of end products. Biochem J 1989; 261: 211-8
23. Hume DA, Radik JL, Ferber E, et al. Aerobic glycolysis and lymphocyte transformation. Biochem J 1978; 174; 703-9
24. Coyle EF, Hagberg JM, Hurkey BF, et al. Carbohydrate feeding during prolonged strenuous exercise can delay fatigue. J Appl Physiol 1983; 55: 230-5
25. Coggan AR. Plasma glucose metabolism during exercise in humans. Sports Med 1991; 11 (2); 102-24
26. Nehlsen-Cannarella SL, Fagoaga OR, Nieman DC, et al. Carbohydrate and the cytokine response to 2.5 h of running. J Appl Physiol 1997; 82 (5): 1662-7
27. Nieman DC, Fagoaga OR, Butterworth DE, et al. Carbohydrate supplementation affects blood granulocyte and monocyte trafficking but not function after 2.5 h running. Am J Clin Nutr 1997; 66: 153-9
28. Nieman DC, Henson DA, Garner EB, et al. Carbohydrate affects natural killer cell redistribution but not function after running. Med Sci Sports Exerc 1997; 29 (10): 1318-24
29. Gleeson M, Blannin AK, Walsh, NP et al. Effect of low- and high-carbohydrate diets on the plasma glutamine and circulating leukocyte responses to exercise. Int J Sport Nutr 1998; 8 (1): 49-59
30. Bishop NC, Blannin AK, Rand L, et al. Effects of carbohydrate and fluid intake on the blood leukocyte responses to prolonged cycling [abstract]. J Sports Sci 1999; 17: 26-7
31. Cupps TR, Fauci AS. Corticosteroid-mediated immunoregulation in man. Immunol Rev 1982; 65: 133-55
32. Nieman DC, Miller AR, Henson DA, et al. Effect of high-versus moderate-intensity exercise on lymphocyte subpopulations and proliferative response. Int J Sports Med 1994; 15 (4): 199-206
33. Kappel M, Tvede N, Galbo H, et al. Evidence that the effect of physical activity on natural killer cell activity is mediated by epinephrine. J Appl Physiol 1991; 70: 2530-4
34. Khansari DN, Murgo AJ, Faith RE. Effects of stress on the immune system. Immunol Today 1990; 11 (5): 170-5
35. Tsagarakis S, Grossman A. Corticotropin-releasing hormone: interactions with the immune system. Neuroimmunomodulation 1994; 1 (6): 329-34
36. Fox PC, van der Ven PF, Sonies BC et al. Xerostomia, evaluation of a symptom with increasing significance. J Am Dent Assoc 1985; 110: 519-25
37. Ullum H, Haahr PM, Diamant M, et al. Bicycle exercise enhances plasma IL-6 but does not change IL-1 α, IL-1 β, IL-6 or TNF-α pre-mRNA in BMNC. J Appl Physiol 1994; 77: 93-7
38. Bruunsgaard H, Galbo H, Halkjaer-Kristensen J, et al. Exercise-induced increase in serum interleukin-6 in humans is related to muscle damage. J Physiol 1997; 499 (3): 833-41
39. Singh A, Feilla ML, Deuster PA. Exercise-induced changes in immune function: effects of zinc supplementation. J Appl Physiol 1994; 76: 2298-303
40. Costill DL, Sharp RL, Sherman WM. A survey of the nutritional habits among collegiate athletes. Misconceptions in sports nutrition. Report I. Rosemont (IL); National Dairy Council, 1980: 7
41. Williams C. Macronutrients and performance. J Sports Sci 1995; 13: S1-10
42. Bjorntorp P. Importance of fat as a support nutrient for energy: metabolism of athletes. In: Williams C, Devlin J, editors. Foods, nutrition and sports performance. London; E & FN Spon, 1992: 87-94
43. Zurier RB. Fatty acids, inflammation and immune responses. Prostaglandins Leukot Essent Fully Acids 1993; 48 (1): 57-62
44. Calder PC, Newsholme EA. Polyunsaturated fatty acids suppress human peripheral lymphocyte proliferation and interleukin-2 production. Clin Sci 1992; 82: 695-700
45. Calder PC. Effects of fatty acids and dietary lipids on cells of the immune system. Proc Nutr Soc 1996; 53: 127-50
46. Yaqoob P, Newsholme EA, Calder PC. Fatty acid oxidation by lymphocytes [abstract]. Biochem Soc Trans 1994; 22: 116S
47. Ardawi MSM, Newsholme EA. Metabolism of ketone bodies, olcate and glucose in lymphocytes of the rat. Biochem J 1984; 221: 255-60
48. Gleeson M, Waring JJ. Influence of diet on the storage, mobilization and utilization of energy reserves in trained and untrained rats. Comp Biochem Physiol A 1986; 85 (3): 411-5
49. Costa Rosa LF, Safi DA, Guimaraes AR. The effect of N-3 PUFA rich diet upon macrophage and lymphocyte metabolism and function. Biochem Mol Biol Int 1996; 40 (4): 833-42
50. Barr SI. Women, nutrition and exercise: a review of athletes' intakes and a discussion of energy balance in active women. Prog Food Nutr Sci 1987; 11: 307-61
51. Di Chen J, Wang JF, Li KJ, et al. Nutritional problems and measures in elite and amatcur athletes. Am J Clin Nutr 1989; 49: 1084-9
52. Newsholme P, Curi R, Gordon S, et al. Metabolism of glucose, glutamine, long-chain fatty acids and ketone bodies by murine macrophages. Biochem J 1986; 239: 121-5
53. Kaplan DR. A novel method of immunosuppression mediated by ethanol. Cell Immunol 1996; 102: 1-9
54. Hughes DA, Pinder AC, Piper Z, et al. N-3 polyunsaturated fatty acids (PUFA) modulate the expression of functionally associated molecules on human monocytes. Biochem Soc Trans 1995; 23 (2): 303S
55. König D, Berg A, Weinstock C, et al. Essential fatty acids, immune function and exercise. Ex Immunol Rev 1997; 3: 1-31
56. Kunkel SL, Chensue SW, Phan SM. Prostaglandins as endogenous mediators of interleukin-1 production. J Immunol 1986; 136: 186-93
57. Stephan RN, Conrad PJ, Saizawa M, et al. Prostaglandin E2 depresses antigen-presenting cell function of peritoneal macorphages. J Surg Res 1988; 44: 733-9
58. Pedersen BK, Tvede N, Klarlund K, et al. Indomethacin in vitro and in vivo abolishes post-exercise suppression of natural killer cell activity in peripheral blood. Int J Sports Med 1990; 11: 127-31
59. Faist E, Markewitz A, Fuchs D, et al. Immunomodulatory therapy with thymopentin and indomethacin. Ann Surgery 1991; 215: 264-75
60. O'Leary MJ, Coakley JH. Nutrition and immunonutrition. Br J Anaesth 1996; 77 (1): 118-27
61. Shephard RJ, Shek PN. Potential impact of physical activity and sport an the immune system: a brief review. Can J Sports Sci 1994; 16; 169-85
62. Shephard RJ. Physical activity, training and the immune response, Carmel (IN): Cooper, 1997: 219-28
63. Espersen GT, Grunnet N, Lervang HH, et al. Decreased interleukin-1 beta levels in plasma rheumatoid arthritis patients after dietary supplementation with n-3 polyunsaturated fatty acids. Clin Rheumatol 1992; 11 (3): 393-5
64. Geusens P, Wouters C, Nijs J, et al. Long-term effect of omega-3 fatty acid supplementation in active rheumatoid arthritis: a 12-month, double blind, controlled study, Arthritis Rheum 1994; 37 (6): 824-9
65. Abbate R, Gori AM, Martini F, et al. n-3 PUFA supplementation, monocyte PCA expression and interleukin-6 production, Prostaglandins Leukot Essent Fatty Acids 1996; 54 (6): 439-44
66. Endres S, Meydani SN, Ghorbani R, et al. Dietary supplementation with n-3 fatty acids suppresses interleukin-2 production and mononuclear cell proliferation. J Leukoc Biol 1993; 54 (6): 599-603
67. Kramer TR, Schoene N, Douglass LW, et al. Increased vitamin E intake restores fish-oil-induced suppressed blastogenesis of mitogen-stimulated T lymphocytes. Am J Clin Nutr 1991; 54 (5): 896-902
68. Calder PC, Newsholme EA. Influence of antioxidant vitamins on fatty acid inhibition of lymphocyte proliferation. Biochem Mol Biol Int 1993; 29: 175-83
69. Lew H, Quintanilha A. Effects of endurance training and exercise on tissue antioxidative capacity and acetaminophen detoxification. Eur J Drug Metab Pharmacokinet 1991; 16: 59-68
70. Robertson JD, Maughan RJ, Duthie GG, et al. Increased blood antioxidant systems of runners in response to training load. Clin Sci 1991; 80: 611-8
71. 2 and endurance in runners. Med Sci Sports Exerc 1994; 26: 81-8
72. Venkatraman JT, Rowland JA, Denardin E, et al. Influence of the level of dietary lipid intake and maximal exercise on the immune status in runners. Med Sci Sports Exerc 1997; 29 (3): 333-44
73. Deakin V. Assessment of nutritional status of athletes. In: Burke L, Deakin V, editors, Clinical sports nutrition. Sydney: McGraw-Hill, 1994: 38-73
74. Lemon PWR. Effect of exercise on protein requirements. In: Williams C, Devlin J, editors. Foods, nutrition and sports performance. London: E & FN Spon, 1992: 65-86
75. Åstrand P-A, Rodahl K. Textbook of work physiology: physiological bases of exercise, 3rd ed. London: McGraw-Hill, 1986
76. Short SH, Short WR. Four-year study of university athlete's dietary intake. J Am Diet Assoc 1983; 82 (6): 632-45
77. Burke L, Inge K. Protein requirements for training and 'bulking up'. In: Burke L, Deakin V, editors. Clinical sports nutrition. Sydney: McGraw-Hill, 1994: 124-50
78. Ueda N, Kayashita J, Moriguchi S, et al. Effect of dietary protein levels on immune function in exercised rats. Nutr Res 1990; 10: 429-37
79. Daly JM, Reynolds J, Sigal RK, et al. Effect of dietary protein and amino acids on immune function. Crit Care Med 1990; 18 (2 Suppl.): S86-93
80. Rohde T, Ullum H, Rasmussen JP, et al. Effects of glutamine on the immune system: influence of muscular exercise and HIV infection. J Appl Physiol 1995; 79 (1): 146-50
81. Walsh NP, Blannin AK, Robson PJ, et al. Glutamine, exercise and immune function: links and possible mechanisms. Sports Med 1998; 26 (3): 177-91
82. Rowbottom DG, Keast D, Morton AR. The emerging role of glutamine as an indicator of exercise stress and overtraining. Sports Med 1996; 21 (2): 80-97
83. Parry-Billings M, Budgett R, Koutedakis Y, et al. Plasma amino acid concentrations in the overtraining syndrome: possible effects on the immune system. Med Sci Sports Exerc 1992; 24 (12): 1353-8
84. Rowbottom DG, Keast D, Goodman C, et al. The haematological, biochemical and immunological profile of athletes suffering from the overtraining syndrome. Eur J Appl Physiol 1995; 70: 502-9
85. Kingsbury KJ, Kay L, Hjelm M. Contrasting plasma free amino acid patterns in elite athletes: association with fatigue and infection. Br J Sports Med 1998; 32 (1): 25-32
86. Mackinnon LT, Hopper S. Plasma glutamine and upper respiratory tract infection during intensified training in swimmers. Med Sci Sports Exerc 1996; 28: 285-90
87. van der Schoor P, van Hall G, Saris WHM, et al. Ingestion of protein hydrolysate prevents the post-exercise reduction in plasma glutamate [abstract]. Int J Sports Med 1997; 18: S115
88. Castell LM, Poortmans JR, Newsholme EA. Does glutamine have a role in reducing infections in athletes? Eur J Appl Physiol 1996; 73: 488-90
89. Greenhaff PL, Gleeson M, Maughan RJ. The influence of an alteration in diet composition on plasma and muscle glutamine levels in man [abstract]. Clin Sci 1988; 74: 20P
90. Wagenmakers AJM, van Hall G. Effect of carbohydrate ingestion during prolonged intense exercise on the post-exercise reduction of plasma glutamine [abstract]. Int J Sports Med 1997; 18: S116
91. van der Beek EJ. Vitamin supplementation and physical exercise performance. In: Williams C, Devlin J, editors. Foods, nutrition and sports performance, London: E & FN Spon, 1992: 95-112
92. Packer L. Vitamin E, physical exercise and tissue damage. Med Biol 1984; 62: 105-9
93. Gleeson M, Robertson JD, Maughan RJ. Influence of exercise on ascorbic acid status in man. Clin Sci 1987; 73: 501-5
94. Peters EM, Goetzsche JM, Grobbelaar B, et al. Vitamin C supplementation reduces the incidence of post-race symptoms of upper respiratory tract in ultramarathon runners. Am J Clin Nutr 1993; 57: 170-4
95. Cannon JG. Exercise and resistance to infection. J Appl Physiol 1993; 74 (3): 973-81
96. Duthie GG, Jenkinson AM, Morrice PC., et al. Antioxidant adaptations to exercise. In: Maughan RJ, Sheriffs SM, editors. Biochemistry of exercise IX. Champaign (IL): Human Kinetics, 1996: 465-70
97. Peters EM. Exercise, immunology and upper respiratory tract infections. Int J Sports Med 1997; 18 Suppl. 1: S69-77
98. Beisel WR, Edelman R, Nauss K, et al. Single-nutrient effects on immunological functions, JAMA 1981; 245: 53-8
99. Chandra RK, Nutrition and immunity: lessons from the past and new insights into the future. Am J Clin Nutr 1991; 53: 1087-101
100. Dreisen S. Nutrition and the immone response: a review. Int J Vitamin Nutr Res 1978; 49: 220-8
101. Alexander M, Newmark H, Miller G. Oral beta-carotene can increase the number of CD4+ cells in human blood. Immunol Lett 1985; 9: 221-4
102. Watson RR, Prabhala RH, Plezia EM, et al. Effect of beta-carotene on lymphocyte subpopulation in elderly humans: evidence for a dose response relationship. Am J Clin Nutr 1991; 28: 225-32
103. Santos MS, Meydani SN, Leka L, et al. Natural killer cell activity in elderly men is enhanced by beta-carotene supplementation. Am J Clin Nutr 1996; 64: 772-7
104. Marieb EN. Human anatomy and physiology. Redwood City (CA): Benjamin Cummings, 1989
105. Yetiv J. Sense and nonsense in nutrition. London: Penguin, 1986
106. Peters EM, Campbell A, Pawley L. Vitamin A fails to increase resistance to upper respiratory infection in distance runners. S Afr J Sports Med 1992; 7: 3-7
107. American Dietetic Association. Position paper of the American Dietetic Association: vegetarian diets - technical support paper. J Am Diet Assoc 1988; 88 (3): 352-5
108. Hemilä H. Vitamin C and common cold incidence: a review of studies with subjects under heavy physical stress. Int J Sports Med 1996; 17: 379-83
109. Pauling L. The significance of the evidence about ascorbic acid and the common cold. Proc Nat Acad Sci U S A 1971; 68: 2678-81
110. Hemilä H. Vitamin C and the common cold. Br J Nutr 1992; 67: 3-16
111. Wilmore JH, Costill DL. Physiology of sport and exercise. Champaign (IL): Human Kinetics, 1994
112. Peters EM, Goetzsche JM, Joseph LE, et al. Vitamin C as effective as combination of anti-oxidant nutrients in reducing symptoms of URTI in ultramarathon runners. S Afr J Sports Med 1996; 4: 23-7
113. Goldfarb AH. Antioxidants: Role of supplementation to prevent exercise-induced oxidative stress. Med Sci Sports Exerc 1993; 25 (2): 232-6
114. Williams MH. Nutrition for fitness and sport. 4th ed. Dubuque (IA): Brown and Benchmark, 1995
115. Mertz W. The essential trace elements. Science 1981; 213: 1332-8
116. Sharman IM, Down MG, Sen RN, The effect of vitamin E and training on physiological function and athletic performance in adolescent swimmers. Br J Nutr 1971; 26: 265-76
117. Shephard RJ, Campbell R, Pimm P, et al. Vitamin E, exercise and the recovery from physical activity. Eur J Appl Physiol 1974; 33: 119-26
118. Watt T, Romet TT, McFarlene I, et al. Vitamin E and oxygen consumption. Lancet 1974; 2 (7876): 354-5
119. Tanaka J, Fujiwara H, Torisu M. Vitamin E and immune response. I. Enhancement of helper T-cell activity by dietary supplementation of vitamin E in mice. Immunology 1979; 38: 727-34
120. Prasad JS. Effect of vitamin E supplementation on leukocyte function. Am J Clin Nutr 1980; 33: 606-8
121. Cannon JG, Meydani SN, Fielding RA, et al. Acute phase response in exercise II: association between vitamin E, cytokines, and muscle proteolysis. Am J Physiol 1991; 260: R1235-40
122. Tengardy RP. The role of vitamin E in the immune response and disease resistance. Ann N Y Acad Sci 1990; 587: 24-33
123. Quintanitha AT, Packer L, Vitamin E, physical exercise and tissue oxidative damage, In: Porter R, Whelan J, editors, Biology of vitamin E, London: Pitman, 1983: 56-69
124. Packer L. Oxidants, antioxidants nutrients and the athlete. J Sports Sci 1997; 15: 353-63
125. Scrimshaw NS, Young VR. The requirements of human nutrition. Sci Am 1976; 235 (3): 50-64
126. Clarkson PM. Minerals: exercise performance and supplementation in athletes. In: Williams C, Devlin J, editors. Foods, nutrition and sports performance. London: E & FN Spon. 1992: 113-46
127. Sherman AR. Zinc, copper and iron nutriture and immunity. J Nutr 1992; 122: 604-9
128. Chvapil M, Stankova L, Zukoski 4th C, et al. Inhibition of some functions of polymorphonuclear leukocytes by in vitro zinc. J Lab Clin Med 1977; 89 (1): 135-46
129. Ogino K, Izumi Y, Segawa H, et al. Zinc hydroxide induced respiratory burst in rat neutrophils. Eur J Pharmacol 1994; 270: 73-8
130. Dressendorfer RH, Wade CE, Keen CL, et al. Plasma mineral levels in marathon runners during a 20-day road race. Physician Sports Med 1982; 10: 113-8
131. Anderson RA, Polansky MM, Bryden NA. Strenuous running: acute effects on chromium, copper, zinc and selected clinical variables in urine and serum of male runners. Biol Trace Elem Res 1984; 6: 327-36
132. Ohno H, Yamashita K, Doi R, et al. Exercise-induced changes in blood zinc and related proteins in humans. J Appl Physiol 1985; 58 (5): 1453-8
133. Deuster PA, Day BA, Singh A, et al. Zinc status of highly trained women runners and untrained runners. Am J Clin Nutr 1989; 49: 1295-301
134. Robson PJ, Blannin AK, Gleeson M, et al. The effects of intermittent high intensity exercise on blood zinc status and urinary zinc excretion [abstract]. J Sports Sci 1998; 16: 59-60
135. Deuster PA, Kyle SB, Moser PB, et al. Nutritional survey of highly trained women runners. Am J Clin Nutr 1986; 44: 954-62
136. Haralambie G. Serum zinc in athletes in training, Int J Sports Med 1981; 2: 135-8
137. Solomons NW. On the assessment of zinc and copper nutriture in man. Am J Clin Nutr 1979; 32: 856-71
138. Pilch SM, Senti FR. Analysis of zinc data from the second national health and nutrition examination survey (NHANES II). J Nutr 1985; 115: 1393-7
139. Chandra RK. Excessive intake of zinc impairs immune responses. JAMA 1984; 252: 1443-6
140. Sunzel B, Holm S, Reuterving C-O, et al. The effect of zinc on bacterial phagocytosis, killing and cytoprotection in human polymorphonuclear leukocytes. APMIS 1995; 102: 635-44
141. Kluger MJ, Ashton HA, Doshi JB, et al. Sports anaemia and iron supplements [letter]. Med Sci Sports Exerc 1993; 25 (2): 303-4
142. Goldblum SE, Cohen DA, Jay M, et al. Interleukin 1-induced depression of iron and zinc: role of granulocytes and lactoferrin. Am J Physiol 1987; 252: E27-32
143. Magazanik A, Weinstein Y, Dlin RA, et al. Iron deficiency caused by seven weeks of intensive physical exercise. Eur J Appl Physiol 1988; 57: 198-202
144. Pattini A, Schena F, Guidi GC, Serum ferritin and serum iron changes after cross-country and roller ski endurance races. Eur J Appl Physiol 1990; 61: 55-60
145. Galan P, Thibault H, Preziosi P, et al. Interleukin-2 production in iron-deficient children. Biol Trace Elem Res 1992; 32: 421-5
146. Puschmann M, Ganzoni AM. Increased resistance of iron-deficient mice to salmonella infection. Infect Immunol 1977; 17: 663-4
147. Helyar L, Sherman AR. Iron deficiency and interleukin 1 production by rat leukocytes. Am J Clin Nutr 1987; 46: 346-52
148. Dallman PR. Iron deficiency and the immune response. Am J Clin Nutr 1987; 46: 329-34
149. van Asbeck S, Marx JJM, Struyvenberg A, et al. Effect of iron (III) in the presence of various ligands on the phagocylic and metabolic activity of human polymorphonuclcar leukocytes. J Immunol 1994; 132: 851-6
150. Fricker P, Clark F, Telford R, et al. Sports anaemia and the 'at risk' athlete. Sports Sci Med Q 1985; 1 (3): 4-7
151. Eichner ER. Sports anaemia, iron supplements and blood doping. Med Sci Sports Exerc 1992; 24: S315-8
152. Synder AC, Dvorak LL, Roepke JB. Influence of dictary iron source on measures of iron status among female runners. Med Sci Sports Exerc 1989; 21: 7-10
153. Blum SM, Sherman AR, Boileau RA. The effects of fitness-type exercise on iron status in adult women. Am j Clin Nutr 1986; 43: 456-63
154. Ricci G, Masotti M, DePaoli Vitali E, et al. Effects of exercise on haematological parameters, serum iron, serum ferritin, red cell 2,3-diphosphoglycerate and creatine content, and serum erythropoietin in long-distance runners during basal training, Acta Haematol 1988; 80: 95-8
155. Deakin V. Iron deficiency in athletes: identification, prevention and dietary treatment. In: Burke L, Deakin V, editors, Clinical sports nutrition. Sydney: McGraw-Hill, 1994: 174-97
156. Haymes EM, Lamanca JJ. Iron loss in runners during exercise: implications and recommendations. Sports Med 1989; 7: 277-85
157. Lukasewycz OA, Prohaska JR. The immune response in copper deficiency. Ann N Y Acad Sci 1990; 587: 147-59
158. Gutteridge JM, Rowley DA, Halliwell B, et al. Copper and iron complexes catalytic for oxygen radical reactions in sweat from human athletes. Clin Chim Acta 1985; 145 (3): 267-73