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Article

Relationship of Vitamin D Status with Biomarkers of Muscle Damage and Body Composition in Spanish Elite Female Football Players: A Cross-Sectional Study

by
Agustin Mora-Fernandez
1,
Julia Peinado Rojas
1,
Nuria Gimenez-Blasi
2,
Javier Conde-Pipó
1,
Jose Antonio Latorre
3 and
Miguel Mariscal-Arcas
1,4,*
1
Health Science and Nutrition Research (HSNR-CTS1118), Department of Nutrition and Food Science, School of Pharmacy, University of Granada, 18071 Granada, Spain
2
Department of Health Sciences, Catholic University of Avila, 05005 Avila, Spain
3
Department of Food Technology, Nutrition and Food Science, Campus of Lorca, University of Murcia, 30800 Murcia, Spain
4
Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain
*
Author to whom correspondence should be addressed.
Appl. Sci. 2024, 14(14), 6349; https://doi.org/10.3390/app14146349
Submission received: 17 May 2024 / Revised: 9 July 2024 / Accepted: 17 July 2024 / Published: 21 July 2024
(This article belongs to the Special Issue Effects of Physical Training on Exercise Performance—2nd Edition)
Browse Figure
Versions Notes

Abstract

:
Recently, there has been a growing interest in relation to the female athlete, especially in widespread disciplines such as football. Concerns about vitamin D deficiency status have recently been considered due to its effects on the performance and health status of female footballers. However, its relationship to body composition and muscle damage in female football athletes remains unclear to date. The purpose of the present study was to analyse the association of the vitamin D status of Spanish elite female football players with anthropometric variables and markers of muscle damage. Ethical consent was obtained from a total of 21 players from a Spanish elite women’s football team (20–33 years). Anthropometric analysis was carried out according to the standardised protocol of the International Society for the Advancement of Kineanthropometry (ISAK). The clinical analyses, based on urine and blood samples, were carried out by the club’s medical staff at the start of the season in the early morning in a fasting state. The athletes were also asked about the regularity of their menstrual cycle and some dietary habits. Thirty-three percent of the female athletes had vitamin D levels below the reference values. Significantly higher FM values were observed in athletes with low vitamin D status (p < 0.05), as well as statistically significant negative correlations between vitamin D levels and FM (p < 0.05) in the group of female players with vitamin D levels below the baseline values. No significant associations were observed between markers of muscle damage and the other variables. Complementing an assessment of body composition with a biochemical analysis of vitamin D levels may be an interesting strategy in the process of monitoring the elite female football player throughout the season.

1. Introduction

Concern in the scientific field for the figure of the female athlete has shown an overwhelming increase in recent years; this is reflected in the 2095 results available in the year 2000 when entering the term “female athlete” in the PubMed search engine, compared to the 11,406 available in the year 2020. In turn, this increased development of research on the female athlete is one of the key elements in the rapid evolution and progress that women’s sport is experiencing at present [1,2].
Within this research boom, concern for the nutritional status of the female athlete and its influence on her health and sporting performance has recently received special attention [3,4,5,6]. The unique physiological conditions and hormonal profiles of this athlete population pose specific nutritional challenges and problems that may compromise the athlete’s performance and health, such as the well-known “female athlete triad” [3,7,8].
This added risk for female athletes, who may suffer from different clinical conditions at the bone, reproductive, and multisystemic levels, with negative consequences for their future, makes nutritional care a key aspect of the female athlete’s daily life [8,9].
This interest has notably reached widespread team sports such as football, where groups of experts from different sports federations and organizations have specifically addressed the female football player, proposing recommendations and specific nutritional support in different consensuses [10,11].
Among these concerns, the presence of vitamin D deficiency states in football athletes has generated particular interest because of its impact on the health and sporting performance of these athletes [12,13]. This problem has also reached the national level in Spain [14], making the analysis of vitamin D levels a fundamental aspect in the process of the nutritional assessment of female football players [15].
On the other hand, the higher fat content in female football athletes could be an added risk factor in the development of vitamin D-deficient states in this group of athletes [16,17]. These alterations in vitamin D levels could compromise the recovery process and alter markers of muscle damage in female athletes [18,19], especially in female football athletes where the nature of the sport significantly compromises the athletes’ recovery process [20]. However, in clinical settings the relationship between markers of muscle damage and fat mass and vitamin D levels currently remains unclear in female football athletes.
Given the impact that an inadequate vitamin D status may have on the recovery status and, consequently, the sports performance and nutritional status of female football athletes, as well as the need to know the influence of body fat mass on the risk of vitamin D deficiency, the purpose of the present study was to study the association of the vitamin D status of Spanish elite female football players with markers of muscle damage and body composition based on biochemical and anthropometric assessments.

2. Materials and Methods

The reporting of this study complies with the STROBE statement [21].

2.1. Design

A cross-sectional study was carried out in which a biochemical and anthropometric evaluation was carried out during the first phase of the season in the women’s first team of the Granada Football Club, which belongs to the lower part of the first Spanish national league.

2.2. Ethics Statement

This study was approved by the Ethics Committee of the Universitat Oberta de Catalunya (UOC) and the Ethics Committee of the Research Project of the University of Murcia (n° OTRI-1117) and strictly complies with data protection regulations and the Helsinki protocol.

2.3. Participants

The sample consisted of 23 female players in the first team squad, aged 20–35 years. Informed consent was collected from the athletes before the start of the study. Those participants who did not want to fill it in were excluded from the study (n = 2); so, the total sample was reduced to 21 players.
The coaches and technical staff were also asked about the usual positions of each player; the players were grouped into 4 specific positions: goalkeeper, defender, midfielder, and forward.
The only exclusion criterion was the use of drugs or dietary supplements that could influence or modify biomarker values during the study phase.

2.4. Procedure

2.4.1. Anthropometric Measurements

Body weights were taken using a Tanita BC-545N electronic scale (Tanita, Tokyo, Japan).
For height, a SECA (Hamburg, Germany) portable detachable stadiometer measuring tape with a range of 205 centimetres and 1 mm divisions was used. This measurement was taken during the course of an inspiration meeting with the subjects positioned in the Frankfort plane [22].
The rest of the anthropometric data were taken with a Cescorf tape measure (Porto Alegre, Brazil, accuracy 1 mm, range 2 m) and a Harpenden plicometer (Harpenden, UK, accuracy 0.2 mm and range 0–80 mm) for the measurement of skinfolds (triceps, subscapular, biceps, iliac crest, supraspinal, abdominal, thigh, and calf).
Anthropometric assessment of body composition was performed using the International Society for the Advancement of Kineanthropometry (ISAK) restricted profile by an ISAK level 2 (Full-Profile Anthropometrist) certified practitioner [23]. Two measurements were taken for each measurement, with the mean value reported if the technical error of measurement was <5%. If the technical error of measurement was >5%, a third measurement was taken reporting the median of the 3 values. All these anthropometric measurements were carried out at the start of the season prior to a morning training session in a fasted state.
The sum of 6 skinfolds (triceps, subscapular, supraspinal, abdominal, thigh, and calf) was estimated for its application in sports nutrition and its association with the individual adiposity index of each athlete [22,24].
Carter’s (1982) equation was used with the sum of the 6 skinfolds for the estimation of the fat mass percentage because of its good correlation with dual-energy X-ray absorptiometry (DXA) in football athletes [25]. The percentage fat mass (%FM) values obtained were used to indirectly estimate the kilograms of fat-free mass (FFM) and fat mass (FM).

2.4.2. Biochemical Analysis

The biochemical evaluation of blood and urine samples was carried out; the samples were taken by the club’s medical service from fasting players during the month of August at the start of the season. Blood samples were taken from the median ulnar and cephalic (upper forearm) veins, while for the urine sample, each player was asked to take the first urine sample of the day. Serum values of vitamin D (ng/mL), CK (IU/L), magnesium (mg/dL), testosterone (ng/dL), free testosterone (pg/mL), serotonin (ng/mL), haemoglobin (g/dL), creatinine (mg/dL), total cholesterol (mg/dL), ferritin (ng/mL), iron (µg/dL), transferrin (mg/dL), and TSI (saturation index, %), as well as basal urinary cortisol values (µg/dL), were determined.
The values obtained for the different variables were then compared with reference values for healthy adult women, thus classifying the athletes into three groups: “below recommended values”, “within recommended values”, “above recommended values”. The athletes were classified into two groups according to the vitamin D values obtained: athletes with vitamin D values below the reference values and athletes with vitamin D values within or above the reference values (30–80 ng/mL).

2.4.3. Menstrual Cycle

On the other hand, the participants were asked in person whether they had a regular menstrual cycle during the study period. A regular menstrual cycle was defined as monthly bleeding within a time range of 21 to 35 days with a duration of 2 to 7 days. The participants who did not meet these conditions were classified as having non-regular menses.

2.4.4. Dietary Habits

The players were also asked about different dietary habits that could have an impact on their post-exercise recovery [26]. Thus, dichotomous questions were used to ask the athletes whether they prioritized foods rich in carbohydrates or proteins before and after training, respectively, and whether they had their post-training intake during the two hours after exercise or over a longer period of time.

2.5. Statistical Analysis

The post hoc power of the test was estimated from the G*Power v.3.1.9.7 program [27] at 0.10, including an effect size of 0.25, and the sample provided by the team consisting of 21 participants.
Statistical analysis was performed with the SPSS v.25 statistical software. Normality was analysed using the Shapiro–Wilk test. Medians, minimum and maximum values, interquartile range (IQR), frequencies, and percentages (%) were used for the basic description. For rank comparisons of the different independent variables by playing positions, the non-parametric Kruskal–Wallis H-test was used for more than two groups, given the small sample size (n < 30) of the study [28,29]. To analyse the differences between the 2 groups of players according to their vitamin D levels, as well as the post hoc statistical test for the Kruskal–Wallis test, the non-parametric Mann–Whitney U test was used. Pearson’s chi-square test was also used for the contrast between two nominal variables. For the calculation of the correlation coefficient (r) between the different variables, the non-parametric Spearman correlation coefficient test (r) was also used. The level of correlation was classified as strong (≥0.8), moderate (0.8–0.2), and weak (≤0.2). Logistic regression analysis was used to establish the likelihood of elevated muscle damage levels as a function of the players’ vitamin D status, post-training dietary habits, body fat values, and menstrual cycle. The level of statistical significance for all the tests was set at 95%.

3. Results

Table 1 summarises the age, body composition, and vitamin D levels of the 21 athletes finally included in the study of players distinguished by playing position. Despite the different physical demands of the different playing positions in the sport of football, no significant differences were observed in any anthropometric variable or vitamin D levels or in the age of the players according to their playing position.
Figure 1 illustrates the percentage of players outside the reference values for the different biomarkers analysed. Magnesium, ferritin, basal cortisol, and free testosterone did not show results outside the reference values in any of the athletes. Of the total of 21 athletes, 9 of them (42.3%) showed CK values above the reference values, and 33.3% (n = 7) and 23.8% (n = 5) showed values of vitamin D and TSI, transferrin, and serum iron below the reference values, respectively.
Table 2 shows the differences in anthropometric measurements, biochemical variables, and regularity of the menstrual cycle between vitamin D-deficient athletes and those who had vitamin D levels within the reference ranges. Significant differences in FM values in kilograms were only observed between athletes with optimal or deficient vitamin D levels (p < 0.05).
Table 3 shows the bivariate correlations between the variables of age, body composition, and biomarkers of muscle damage in the groups of players with insufficient and normal vitamin D status. Correlations were observed between age and vitamin D levels, both in the group of players with values within the reference ranges (r = 0.657, p = 0.011) and in those with deficient vitamin D levels (r = −0.873, p = 0.010). Significant moderate negative correlations were also observed in the low vitamin D subgroup for vitamin D levels and FM values in kilograms (r = −0.786, p = 0.036).
Table 4 shows the binary logistic regression analysis of the odds of having elevated levels of muscle damage (CK) as a function of vitamin D status, menstrual cycle, body fat, and dietary habits. No significant relationships were observed between any of the variables.

4. Discussion

The present study aimed to study the relationship between vitamin D status and body composition and markers of muscle damage in Spanish national elite female football players. To the knowledge of the present research group, this is the first study to relate the vitamin D status of elite female football players to markers of muscle damage and their body composition. These findings allow us to offer a different practical approach to the etiology of vitamin D deficiency in athletes and to address this common problem in athletes from the point of view of their body composition. It therefore highlights the need to analyse vitamin D levels in conjunction with the body composition of female football athletes in order to provide a more complete picture of their clinical, nutritional, and sporting situation, as well as their lifestyle habits.
It is well known that defined lifestyles are closely linked to various metabolic disorders and associated comorbidities. The presence of specific dietary patterns or levels of physical activity may have an impact on the development of different health problems in elite female football players [4,10], such as alterations in vitamin D status and/or imbalances in body composition [30,31]. It is remarkably important to consider the day-to-day habits and lifestyles of female athletes as being essential factors in the prevention of such nutritional and anthropometric alterations.
In the first part of the study, the influence of body composition on the vitamin D status of the players was evaluated. Deficient vitamin D levels may compromise optimal muscle function and may be a risk factor in the development of stress fractures, musculoskeletal pain, and common diseases [31,32]. In the analysis, statistically significant correlations between vitamin D levels and FM (r = −0.786, p < 0.05) were observed in the group of athletes with vitamin D levels below the reference values, although these were not significant in the group of football players with adequate vitamin D values (r = 0.213, p > 0.05).
This association is in line with previous studies in athletes and the general population [16,17,33] and could be due to the sequestration of fat-soluble vitamins within adipose tissue or the effect of volume dilution in individuals with larger body size [16]. These findings highlight the importance of considering body composition as a complementary analysis to serum vitamin D results, as well as other relevant variables, such as the athlete’s sun exposure or the sport disciplines performed among others [14].
Although no significant differences were observed between the different playing positions in each of the anthropometric variables, in line with previous studies of elite female football players [34,35,36], the previous studies show that there is a tendency for defenders and goalkeepers to have higher levels of adiposity and body size [37,38]. Therefore, it would be prudent to monitor the vitamin D status of the types of players with a tendency to present higher adiposity levels, as well as to perform repeated biochemical and anthropometric evaluations during different phases of the season given the body evolution presented by the athletes during the course of the season [39]. These facts highlight the importance of considering the time of the season at which the assessment is made when contrasting these results and the possibility that the players in the present study showed higher anthropometric values as the season progressed, especially those players of pubertal age [39].
On the other hand, inverse correlations were observed between athlete age and vitamin D levels in the athlete group. Although it is well known that the risk of developing vitamin D deficiency in older athletes is increased by lower sun exposure, reduced physical activity, or higher levels of adiposity [40,41], the inclusion of adult athletes only and the absence of significant differences in the ages of the vitamin D status subgroups may mean that the age of the players is not a determining factor in the observed differences in vitamin D levels in the sample of the present study. However, it is worth noting the importance of the further monitoring of body composition and vitamin D levels in older female football players given their added risk of developing vitamin D deficiency states [42].
The second part of the study sought to analyse the relationship between the vitamin D levels of female football players and their markers of muscle damage. Although a large number of players showed markedly elevated levels of muscle damage, no associations were observed between vitamin D levels and markers of muscle damage in female football players. Although vitamin D appears to play a key role in muscle function and recovery from post-exercise muscle damage [32,43], its effects on markers of muscle damage are contradictory [19,44]. More studies assessing the relationship of vitamin D status with different biomarkers of muscle damage are required.
On the other hand, no associations were observed between body fat values and muscle damage in female players. Although no significant correlations were observed between muscle damage values, previous studies show that athlete fat mass could be a potent factor for the variability of muscle damage markers such as CK [45,46]. Therefore, it might be a prudent strategy to improve the body composition of those athletes with high adiposity levels as a possible implication for vitamin D levels and muscle damage in athletes, especially in those playing positions or times of the season with higher exertion load [47,48].
Finally, bivariate regression analysis showed no relationship between the dietary habits of the players and the risk of suffering higher levels of muscle damage. The use of specific dietary and nutritional strategies, such as the use of certain supplements or post-exercise protein intake, may be of interest in improving recovery and decreasing muscle damage in those players with elevated values in markers related to muscle damage [49]. However, more studies with a larger sample size are needed to analyse the relationship between markers of muscle damage, dietary habits, and vitamin D levels, as well as the influence of the mutual interaction between vitamin D levels and the body fat of female football players in different phases of the season.
In relation to the limitations of this study, the small sample size of the study stands out. This aspect could explain the lack of differences found between some of the study variables. Although the study offers a momentary and cross-sectional perspective of the situation of female football players in an elite team of the Spanish top national league during the early stages of the season, it could be interesting to contrast these values with different phases of the competitive season or to monitor the athletes throughout the season. Other limitations of the work include the lack of standardised gold standard methods, such as X-ray absorptiometry in the assessment of body composition or the use of quantitative analysis in the dietary assessment of female athletes [15], as well as the lack of measurement of possible confounding variables of interest according to the objectives of the study (e.g., sun exposure, ethnicity...).

5. Conclusions

A total of 33.3% of the athletes had vitamin D values below the reference values. The body fat levels of female football athletes are shown to be a relevant factor in the etiology of vitamin D deficiency. Significant differences in FM values in kilograms were observed between the different subgroups according to the vitamin D levels (p < 0.05), as well as moderate significant correlations between the FM values and vitamin D levels in the vitamin D-deficient group (p < 0.05). No significant relationships between vitamin D levels, dietary habits, and body fat-related parameters with elevated values of biomarkers of muscle damage were observed.
Body composition analysis may be an important tool in the monitoring of female football players at risk of vitamin D deficiency.
Studies with a larger sample size that analyse the relationship between markers of muscle damage, dietary habits, and vitamin D levels are needed.

Author Contributions

Conceptualization, A.M.-F., J.C.-P., J.A.L. and M.M.-A.; Methodology, J.P.R., J.C.-P., J.A.L. and M.M.-A.; Software, N.G.-B. and J.A.L.; Validation, N.G.-B. and J.A.L.; Formal analysis, A.M.-F., J.P.R., N.G.-B., J.A.L. and M.M.-A.; Investigation, J.P.R., J.A.L. and M.M.-A.; Resources, M.M.-A.; Writing—original draft, A.M.-F., J.P.R., J.C.-P. and J.A.L.; Writing—review & editing, J.A.L. and M.M.-A.; Supervision, M.M.-A.; Project administration, M.M.-A.; Funding acquisition, J.A.L. and M.M.-A. All authors have read and agreed to the published version of the manuscript.

Funding

The funding sponsors had no role in the design of the study, in the collection, analyses, or interpretation of the data; in the writing of the manuscript; or in the decision to publish the results. This study was funded by the Research Project of the University of Murcia (n° OTRI-1117 “Seguimiento y asesoramiento nutricional del Granada CF) and the High Council for Sports (CSD), Spanish Ministry of Culture and Sport, through the NESA NETWORK “Spanish Network of Sports Care at Altitude (RADA)” Ref. 19/UPB/23. This work was carried out thanks to the support of the University of Granada (Own Research Plan—P. 10) for research stays granted to MM-A at the University of Murcia under the responsibility and supervision of JA-L.

Institutional Review Board Statement

This study was approved by the Ethics Committee of the Universitat Oberta de Catalunya (UOC) and the Ethics Committee of the Research Project of the University of Murcia (n° OTRI-1117), and strictly complies with data protection regulations and the Helsinki protocol. The reporting of this study complies with the STROBE statement.

Informed Consent Statement

Informed consent was obtained from all the subjects involved in the study.

Data Availability Statement

There are restrictions on the availability of data for this trial, due to the signed consent agreements around data sharing, which only allow access to external researchers for studies following the project’s purposes. Requestors wishing to access the trial data used in this study can make a request to [email protected].

Acknowledgments

The authors thank Granada Football Club for their support. This paper will be part of Agustin Mora-Fernandez’s doctoral thesis, which is being completed as part of the “Nutrition and Food Sciences Program” at the University of Granada, Spain.

Conflicts of Interest

The authors declare no conflicts of interest.

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Applsci 14 06349 g001
Figure 1. Distribution of abnormal biomarkers (above and below reference values). * The reference values correspond to the standardized values for Spanish Andalusian women up to 101 years of age. ** They correspond to the reference values for adult women aged 20–60 years. *** Correspond to reference values for adult women aged 15–40 years. CK: Creatine Kinase; Mg: Magnesium; T.S.I.: Transferrin Saturation Index.
Figure 1. Distribution of abnormal biomarkers (above and below reference values). * The reference values correspond to the standardized values for Spanish Andalusian women up to 101 years of age. ** They correspond to the reference values for adult women aged 20–60 years. *** Correspond to reference values for adult women aged 15–40 years. CK: Creatine Kinase; Mg: Magnesium; T.S.I.: Transferrin Saturation Index.
Applsci 14 06349 g001
Table 1. Sample characteristics and differences by playing position.
Table 1. Sample characteristics and differences by playing position.
Total (n = 21)Goalkeeper (n = 2)Defender (n = 6)Midfielder (n = 8)Forward (n = 5)Kruskal–Wallis Test
M (Min–Max, IQR)M (Min–Max)M (Min–Max)M (Min–Max)M (Min–Max)Hp
Age24 (20–33, 4)24.50 (21–28)24.50 (21.00–29.00)22 (20–30)25.00 (23.00–33.00)3.9090.271
Weight
(kg)		62.00 (53.70–80.60, 12.00)69.80 (62.00–77.60)65.05 (56.30–70.30)56.65 (53.70–74.50)60.80 (54.20–80.60)4.2920.232
Height (m)1.67 (1.55–1.81, 0.10)1.69 (1.63–1.74)1.69 (1.64–1.75)1.64 (1.55–1.81)1.69 (1.64–1.79)2.6740.445
BMI (kg/m2)22.37 (18.98–25.63, 1.92)24.48 (23.34–25.63)22.43 (20.93–24.91)21.54 (20.21–22.81)22.06 (18.98–25.16)5.3240.150
% Fat Mass Carter16.32 (12.87–26.14, 4.71)21.42 (21.03–21.81)16.38 (12.87–18.63)16.81 (13.86–26.14)15.03 (13.71–16.82)6.3450.096
FFM (kg)51.18 (44.24–68.48, 8.62)54.82 (48.96–60.68)54.05 (49.06–60.75)47.37 (44.24–55.03)52.01 (46.77–68.48)6.6140.085
FM (kg)10.46 (7.24–19.47, 2.74)14.98 (13.04–16.92)10.60 (7.24–11.72)9.81 (7.46–19.47)9.25 (7.43–12.12)4.3490.226
Vitamin D (ng/mL)35.80 (18.70–63.80, 13.85)35.75 (24.80–46.70)31.65 (23.40–37.50)34.80 (18.70–45.80)39.50 (22.60–63.80)1.1450.766
M: Median; Min: Minimum; Max: Maximum; IQR: Interquartile Range; BMI: Body Mass Index; FFM: Fat-Free Mass; FM: Fat Mass.
Table 2. Anthropometric, biochemical, and menstrual differences according to the vitamin D levels.
Table 2. Anthropometric, biochemical, and menstrual differences according to the vitamin D levels.
Vitamin D Deficiency * (n = 7)Adequate Vitamin D * (n = 14)Mann–Whitney Test
M (Min–Max, IQR)M (Min–Max, IQR)Up
Age23.00 (20.00–29.00, 3.00)25.00 (20.00–33.00, 4.50)30.000.153
Anthropometric variables
% Fat Mass Carter16.76 (15.03–26.14, 5.48)15.71 (12.87–21.03, 3.93)26.000.086
FM (kg)11.72 (8.95–19.47, 5.66)9.40 (7.24–13.04, 3.41)15.000.011
FFM (kg)55.94 (45.85–68.48)49.05 (44.24–60.75, 6.17)24.000.062
Biochemical variables (reference values *)
Haemoglobin
(12.0–16.5 g/dL)		13.20 (11.80–14.50, 1.70)13.30 (12.10–14.20, 0.82)45.000.765
Creatinine
(0.55–1.02 mg/dL)		0.91 (0.76–1.18, 0.27)0.94 (0.61–11.18, 0.19)42.000.601
Magnesium
(1.60–2.6 mg/dL **)		2.11 (1.83–2.16, 0.14)2.07 (1.90–2.30, 0.13)45.000.765
CK (26–192 UI/L)158.00 (67.60–307.00, 90.00)190.00 (93.70–290.00, 80.75)43.000.654
Total Cholesterol
(140–240 mg/dL)		157.00 (119.00–177.00, 43.00)160.00 (114.00–204.00, 20.50)36.000.331
Ferritin
(8–252 ng/mL)		62.10 (13.80–123.00, 82.00)75.55 (12.40–181.00, 62.33)46.000.823
Serum iron
(50–170 µg/dL)		65.00 (40.00–147.00, 48.00)83.50 (32.00–168.00, 44.50)38.000.412
Transferrin
(215–365 mg/dL)		248.00 (208.00–361.00, 64.00)243.50 (195.00–337.00, 54.25)43.500.681
TSI
(15–50%)		18.81 (7.90–35.68, 11.21)22.50 (8.08–51.36, 19.63)35.000.296
Basal Cortisol
(10–26 µg/dL)		19.90 (16.90–22.80, 1.70)17.85 (14.20–21.70, 4.78)24.000.062
Testosterone
(12–59 ng/dL)		32.26 (23.76–51.39, 17.96)39.97 (10.40–71.41, 22.86)46.000.823
Free Testosterone
(0.02–4.6 pg/mL ***)		1.10 (0.80–1.80, 0.80)1.30 (0.70–2.50, 0.83)42.000.599
Serotonin (0–200 ng/mL)93.00 (70.00–241.00, 49.00)124.50 (58.00–178.00, 59.50)35.000.322
Regular menstrual cycle (%)85.778.6 0.694 #
Min: Minimum; Max: Maximum; IQR: Interquartile Range; FM: Fat Mass; FFM: Fat-Free Mass; CK: Creatine Kinase; TSI: Transferrin Saturation Index. * The reference values corresponding to the standardized values for Spanish Andalusian women up to 101 years of age. ** They correspond to the reference values for adult women aged 20–60 years. *** Correspond to reference values for adult women aged 15–40 years. # Obtained from Pearson’s chi-square test.
Table 3. Correlations between age, body composition, and biomarkers of muscle damage in players with insufficient and normal vitamin D status.
Table 3. Correlations between age, body composition, and biomarkers of muscle damage in players with insufficient and normal vitamin D status.
Vit D lowVit D adeAgeCreatinineCK
Vit D lowR −0.873 *0.036−0.571
Vit D adeR 0.657 *0.2270.222
WeightR−0.4640.058−0.2100.294−0.165
HeightR−0.5360.115−0.2210.405−0.078
BMIR−0.5000.026−0.1160.044−0.082
% FM CarterR−0.2860.328−0.133−0.048−0.325
FFM (kg)R−0.071−0.172−0.1760.358−0.142
FM (kg)R−0.786 *0.213−0.2250.109−0.245
Vit D low: Vitamin D levels in the athlete group below reference values; Vit D ade: Vitamin D levels in the athlete group within reference levels; BMI: Body Mass Index; FFM: Fat-Free Mass; FM: Fat Mass; CK: Creatine Kinase; * p < 0.05 by Spearman’s rho correlation test.
Table 4. Influencing factors in the presence of elevated CK levels.
Table 4. Influencing factors in the presence of elevated CK levels.
BpOR95% CI
LowerUpper
Vitamin D deficiency−0.0300.7060.9700.8291.136
Irregular menstrual cycle0.1880.8931.2070.07718.853
No exclusive consumption of carbohydrate-rich foods before training−2.2600.1200.1040.0061.809
No consumption of protein-rich foods after training only1.3830.3893.9860.17292.554
>2 h in post-exercise ingestion0.3950.8101.4850.05937.450
%FM0.33680.4921.4450.5054.136
FM (kg)0.3030.6791.3540.3225.704
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Mora-Fernandez, A.; Rojas, J.P.; Gimenez-Blasi, N.; Conde-Pipó, J.; Latorre, J.A.; Mariscal-Arcas, M. Relationship of Vitamin D Status with Biomarkers of Muscle Damage and Body Composition in Spanish Elite Female Football Players: A Cross-Sectional Study. Appl. Sci. 2024, 14, 6349. https://doi.org/10.3390/app14146349

AMA Style

Mora-Fernandez A, Rojas JP, Gimenez-Blasi N, Conde-Pipó J, Latorre JA, Mariscal-Arcas M. Relationship of Vitamin D Status with Biomarkers of Muscle Damage and Body Composition in Spanish Elite Female Football Players: A Cross-Sectional Study. Applied Sciences. 2024; 14(14):6349. https://doi.org/10.3390/app14146349

Chicago/Turabian Style

Mora-Fernandez, Agustin, Julia Peinado Rojas, Nuria Gimenez-Blasi, Javier Conde-Pipó, Jose Antonio Latorre, and Miguel Mariscal-Arcas. 2024. "Relationship of Vitamin D Status with Biomarkers of Muscle Damage and Body Composition in Spanish Elite Female Football Players: A Cross-Sectional Study" Applied Sciences 14, no. 14: 6349. https://doi.org/10.3390/app14146349

APA Style

Mora-Fernandez, A., Rojas, J. P., Gimenez-Blasi, N., Conde-Pipó, J., Latorre, J. A., & Mariscal-Arcas, M. (2024). Relationship of Vitamin D Status with Biomarkers of Muscle Damage and Body Composition in Spanish Elite Female Football Players: A Cross-Sectional Study. Applied Sciences, 14(14), 6349. https://doi.org/10.3390/app14146349

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