Nutrients — Open Access Journal

The present study was undertaken to provide a better insight into the relationship between different levels of body mass index (BMI) and changing risk for hypertension, using an unselected sample of participants assessed during the Longevity Check-up 7+ (Lookup7+) project. Lookup7+ is an ongoing cross-sectional survey started in June 2015 and conducted in unconventional settings (i.e., exhibitions, malls, and health promotion campaigns) across Italy. Candidate participants are eligible for enrolment if they are at least 18 years of age and provide written informed consent. Specific health metrics are assessed through a brief questionnaire and direct measurement of standing height, body weight, blood glucose, total blood cholesterol, and blood pressure. The present analyses were conducted in 7907 community-living adults. According to the BMI cutoffs recommended by the World Health Organization, overweight status was observed among 2896 (38%) participants; the obesity status was identified in 1135 participants (15%), with 893 (11.8%) participants in class I, 186 (2.5%) in class II, and 56 (0.7%) in class III. Among enrollees with a normal BMI, the prevalence of hypertension was 45% compared with 67% among overweight participants, 79% in obesity class I and II, and up to 87% among participants with obesity class III (p for trend < 0.001). After adjusting for age, significantly different distributions of systolic and diastolic blood pressure across BMI levels were consistent. Overall, the average systolic blood pressure and diastolic blood pressure increased significantly and linearly across BMI levels. In conclusion, we found a gradient of increasing blood pressure with higher levels of BMI. The fact that this gradient is present even in the fully adjusted analyses suggests that BMI may cause a direct effect on blood pressure, independent of other clinical risk factors. Full article

Infant colic is a common condition of unknown pathogenesis that brings frustration to families seeking for effective management. Accumulating evidence suggests that some single strains of lactobacilli may play a positive dietary role in attenuation of colic in exclusively breastfed infants. The objective of this study was to evaluate a mixture of two Lactobacillus strains in decreasing infant cry and fuss in this population. Infants aged 4–12 weeks received L. rhamnosus 19070-2 and L. reuteri 12246 in a daily dose of 250 × 10⁶ CFU, 3.33 mg of fructooligosaccharide, and 200 IU of vitamin D₃ (84 infants, probiotic group) or just vitamin D₃ (84 infants, control group) for 28 days. Cry and fuss time were measured with validated Baby’s Day Diary on days 0 and 28. At baseline, mean (SD) duration of cry and fuss time was comparable in the probiotic and control groups: 305 (81) vs. 315 (90) min., respectively (p = 0.450). On day 28, mean cry and fuss time became statistically different: 142 (89) vs. 199 (72), respectively (p < 0.05). Mean change in cry and fuss time from day 0 through day 28 was −163 (99) minutes in the probiotic and −116 (94) minutes in the control group (p = 0.019). Our findings confirm that lactobacilli decrease cry and fuss time and provide a dietary support in exclusively breastfed infants with colic. Full article

Because supermarkets are a critical part of the community food environment, the purpose of this paper is to examine the association between accessibility to the supermarket where participants were surveyed, frequency of shopping at the supermarket, and self-reported and objectively-assessed fruit and vegetable consumption. Accessibility was assessed using Geographic Information Systems (GIS) measured distance and multiple versions of the modified Retail Food Environment Index (mRFEI), including a localized road network buffer version. Frequency of shopping was assessed using self-report. The National Cancer Institute Fruit and Vegetable screener was used to calculate daily servings of fruits and vegetables. Skin carotenoids were assessed using the “Veggie Meter™” which utilizes reflection spectroscopy to non-invasively assess skin carotenoids as an objective measure of fruit and vegetable consumption. Bivariate and multivariable statistics were used to examine the associations in RStudio. There was a positive association between skin carotenoids and the Special Supplemental Nutrition Program for Women Infants and Children (WIC) and mRFEI scores, suggesting that WIC participation and a healthier food environment were associated with objectively-assessed fruit and vegetable consumption (skin carotenoids). Future research should examine these associations using longitudinal study designs and larger sample sizes. Full article

In general, fermented foods (FFs) are considered as functional foods. Since the awareness about the health benefits of FFs has increased, the consumption of FF also improved significantly in recent decades. Diabetes is one of the leading threats of the health span of an individual. The present manuscript details the general methods of the production of FFs, and the results of various studies (in vitro, in vivo, and clinical studies) on the antidiabetic properties of FFs. The fermentation method and the active microbes involved in the process play a crucial role in the functional properties of FFs. Several in vitro and in vivo studies have been reported on the health-promoting properties of FFs, such as anti-inflammation, anticancer, antioxidant properties, improved cognitive function and gastrointestinal health, and the reduced presence of metabolic disorders. The studies on the functional properties of FFs by randomized controlled clinical trials using human volunteers are very limited for several reasons, including ethical reasons, safety concerns, approval from the government, etc. Several scientific teams are working on the development of complementary and alternative medicines to improve the treatment strategies for hyperglycemia. Full article

Ageing, sarcopenia, and malnutrition are associated with quantitative and qualitative changes of body composition. There are several imaging modalities, including magnetic resonance imaging (MRI), for the assessment of trunk muscle tissue composition. In this study, we investigated the gender- and age-related changes in trunk muscle composition using chemical shift encoding-based water–fat MRI. A total of 79 healthy volunteers (26 men: 38.9 ± 10.4 years; 53 women: 39.5 ± 15.0 years) underwent 3T axial MRI using a six-echo multi-echo 3D spoiled gradient echo sequence, allowing for the calculation of the proton density fat fraction (PDFF) in the trunk muscles. PDFF of the abdominal, psoas, and erector spinae muscles were determined. We detected significant positive correlations for abdominal muscle PDFF with age (r = 0.638, p = 0.0001) in men, and for abdominal muscle PDFF (r = 0.709, p = 0.0001) and erector spinae muscle PDFF (r = 0.674, p = 0.0001) with age in women. After adjustment for body mass index (BMI), only the correlation of age and abdominal muscle PDFF in women remained significant (r = 0.631, p = 0.0001). The findings of this study suggest that an increasing fat deposition in muscle is driven primarily by age, rather than BMI, in women. These results further support that PDFF can be considered a valid imaging biomarker of trunk muscle composition. Full article

There is a mechanistic link between the gut-derived metabolite trimethylamine-N-oxide (TMAO) and obesity-related diseases, suggesting that the TMAO pathway may also be linked to the pathogenesis of obesity. The Visceral Adiposity Index (VAI), a gender-specific indicator of adipose dysfunction, and the Fatty Liver Index (FLI), a predictor of non-alcoholic fatty liver disease (NAFLD), are early predictors of metabolic syndrome (MetS). In this cross-sectional observational study, we investigated TMAO levels in adults stratified according to Body Mass Index (BMI) and the association of TMAO with VAI and FLI. One hundred and thirty-seven adult subjects (59 males; 21–56 years) were enrolled. TMAO levels were detected using HPLC/MS analysis. Homeostatic Model Assessment of Insulin Resistance (HoMA-IR), VAI and FLI were included as cardio-metabolic indices. TMAO levels increased along with BMI and were positively associated with VAI and FLI, independently, on common potential covariates. The most sensitive and specific cut-offs for circulating levels of TMAO to predict the presence of NAFLD-FLI and MetS were ≥8.02 µM and ≥8.74 µM, respectively. These findings allow us to hypothesize a role of TMAO as an early biomarker of adipose dysfunction and NAFLD-FLI in all borderline conditions in which overt MetS is not present, and suggest that a specific cut-off of TMAO might help in identifying subjects at high risk of NAFLD. Full article

Biofortification aims to improve the micronutrient concentration and bioavailability in staple food crops. Unlike other strategies utilized to alleviate Fe deficiency, studies of the gut microbiota in the context of Fe biofortification are scarce. In this study, we performed a 6-week feeding trial in Gallus gallus (n = 15), aimed to investigate the Fe status and the alterations in the gut microbiome following the administration of Fe-biofortified carioca bean based diet (BC) versus a Fe-standard carioca bean based diet (SC). The tested diets were designed based on the Brazilian food consumption survey. Two primary outcomes were observed: (1) a significant increase in total body Hb-Fe values in the group receiving the Fe-biofortified carioca bean based diet; and (2) changes in the gut microbiome composition and function were observed, specifically, significant changes in phylogenetic diversity between treatment groups, as there was increased abundance of bacteria linked to phenolic catabolism, and increased abundance of beneficial SCFA-producing bacteria in the BC group. The BC group also presented a higher intestinal villi height compared to the SC group. Our results demonstrate that the Fe-biofortified carioca bean variety was able to moderately improve Fe status and to positively affect the intestinal functionality and bacterial populations. Full article

Excessive dietary sodium is associated with elevated blood pressure (EBP). Bread products are identified as one of the main sources of daily sodium intake. The objective of this cross-sectional study was to evaluate the association between bread and others cereal products consumption with EBP. Frequency intake of a standard serving of bread and other cereal products was recorded and categorized as: ≤3 times/month or never (reference category group) and ≥ once/week. EBP was defined as systolic blood pressure (SBP) ≥120 mmHg and/or diastolic blood pressure (DBP) ≥80 mmHg. Raw and adjusted odds ratios (OR) for the association between consumption of the studied food products and blood pressure status were estimated. Overall, 2011 participants aged 37.3 ± 9.1 years old were included. In the models adjusted for relevant covariates, consumption of one piece of bolillo or telera (OR = 1.39; 95% CI = 1.01–1.89) ≥ once/week was associated with an increased risk of EBP, compared to the reference category. Also, participants consuming one bowl of high-fiber breakfast cereal once/week were less likely to have EBP (OR = 0.73; 95% CI = 0.53–0.98). Initiatives to reduce sodium levels in bread products such as bolillo and telera are needed in Mexico to help manage the cardiovascular risk at the population level. Full article

Introduction: Deficient levels of 25-hydroxyvitamin D (25(OH)D) (<30 ng/mL) may compromise health and athletic performance. Supplementation with oral vitamin D can favor the state of iron metabolism, and testosterone and cortisol as an indicator of muscle recovery of the athlete with a deficiency. The main aim of this study was to evaluate the influence of eight weeks of supplementation with 3000 IU/day of vitamin D on the hematological and iron metabolism profile, as well as on the analytical values of testosterone and cortisol on elite male traditional rowers. The secondary aim was to examine if serum 25(OH)D is a predictor of testosterone and cortisol levels. Material and Methods: Thirty-six elite male rowers (27 ± 6 years) were assigned to one of the two groups randomly: 1) Control group (CG, n = 18, height: 181.05 ± 3.39 cm and body mass: 77.02 ± 7.55 kg), 2) Group treated with 3,000 IU of vitamin D3/day (VD3G, s = 18, height: 179.70 ± 9.07 cm and body mass: 76.19 ± 10.07 kg). The rowers were subjected to blood tests at the beginning of the study (T1) and after eight weeks of treatment (T2), for the analysis of hematological and hormonal values. Repeated-measures ANOVA with group factor (GC and GVD3) were used to examine if the interaction of the different values was the same or different between the groups throughout the study (time × group) after vitamin D3 treatment. To analyze if 25(OH)D was a good predictor of testosterone, cortisol, and testosterone/cortisol ratio a stepwise regression model was performed. Results: Statistically significant and different increases were observed in the group-by-time interaction of 25(OH)D in VD3G in respect to CG during the study (p < 0.001; VD3G (T1: 26.24 ± 8.18 ng/mL vs. T2: 48.12 ± 10.88 ng/mL) vs CG (T1: 30.76 ± 6.95 ng/mL vs. T2: 35.14 ± 7.96 ng/mL). Likewise, significant differences between groups were observed throughout the study in the group-by-time interaction and changes of hemoglobin (GC: −2.89 ± 2.29% vs. VD3G: 0.71 ± 1.91%; p = 0.009), hematocrit (CG: −1.57 ± 2.49% vs. VD3G: 1.16 ± 1.81%; p = 0.019) and transferrin (CG: 0.67 ± 4.88% vs. VD3G: 6.51 ± 4.36%; p = 0.007). However, no differences between groups were observed in the group-by-time interaction of the hormonal parameters (p > 0.05). Regression multivariate analysis showed that cortisol and testosterone levels were associated with 25(OH)D levels (p < 0.05). Conclusion: Oral supplementation with 3000 IU/day of vitamin D3 during eight weeks showed to be sufficient to prevent a decline in hematological levels of hemoglobin and hematocrit, and improve transferrin of 25(OH)D levels. However, although it was not sufficient to enhance muscle recovery observed by testosterone and cortisol responses, it was observed that serum 25(OH)D levels could be a predictor of anabolic and catabolic hormones. Full article

Objective: To pilot test the effectiveness of “MyNutriCart”, a smartphone application (app) that generates healthy grocery lists, on diet and weight. Methods: A pilot randomized trial was conducted to test the efficacy of using the “MyNutriCart” app compared to one face-to-face counseling session (Traditional group) in Hispanic overweight and obese adults. Household food purchasing behavior, three 24-h food recalls, Tucker’s semi-quantitative food frequency questionnaire (FFQ), and weight were assessed at baseline and after 8 weeks. Statistical analyses included t tests, a Poisson regression model, and analysis of covariance (ANCOVA) using STATA. Results: 24 participants in the Traditional group and 27 in the App group completed the study. Most participants were women (>88%), with a mean age of 35.3 years, more than a high school education (>80%), a family composition of at least three members, and a mean baseline body mass index (BMI) of 34.5 kg/m². There were significant improvements in household purchasing of vegetables and whole grains, in individual intakes of refined grains, healthy proteins, whole-fat dairies, legumes, 100% fruit juices, and sweets and snacks; and in the individual frequency of intake of fruits and cold cuts/cured meats within the intervention group (p < 0.05). However, no significant differences were found between groups. No changes were detected in weight. Conclusions: “MyNutriCart” app use led to significant improvements in food-related behaviors compared to baseline, with no significant differences when compared to the Traditional group. Cost and resource savings of using the app compared to face-to-face counseling may make it a good option for interventionists. Full article

Given the links between parental obesity and eating psychopathology in their children, it is important to understand the mechanisms via which unhealthy relationships with eating are passed from generation to generation. The aim was to review research focusing on food-related parenting practices (FPPs) used by parents with overweight/obesity. Web of Science, PubMed and PsycINFO were searched. Studies that included a measure of FPPs were considered eligible and were required to have examined FPPs by parental weight status. Twenty studies were included. Single studies suggest differences between parents with healthy-weight vs. overweight/obesity with respect to; food accessibility, food availability and modelling. Multiple studies suggest that several parenting strategies do not differ according to parental weight status (child involvement, praise, use of food to control negative emotions, use of food-based threats and bribes, pressure, restriction, meal and snack routines, monitoring, and rules and limits). There was inconclusive evidence with respect to differences in parental control, encouragement and use of unstructured FPPs among parents with healthy-weight vs. overweight/obesity. The findings of this review imply some differences between parents with overweight/obesity and healthy-weight and the use of some food-related parenting practices, however, they should be interpreted with caution since research remains limited and is generally methodologically weak. The review highlights opportunities for further research, and suggests improvements to current measures of FPPs. Full article

As the population ages, the risk of becoming malnourished increases. Research has shown that poor oral health can be a risk factor for malnutrition in institutionalized elderly. However, it remains unclear whether oral health problems, edentulousness and health-related quality of life also pose a risk for malnutrition in community-dwelling older adults. In this cross-sectional observational study, 1325 community-living elderly (≥75 years) were asked to complete questionnaires regarding nutritional status, oral status (edentulous, remaining teeth, or implant-supported overdentures), oral health problems, health-related quality of life (HRQoL), frailty, activities of daily living (ADL) and complexity of care needs. Univariate and multivariate logistic regression analyses were performed with nutritional status as dependent variable. Of the respondents, 51% (n = 521) were edentulous, 38.8% (n = 397) had remaining teeth and 10.2% (n = 104) had an implant-supported overdenture. Elderly with complex care needs were malnourished most frequently, followed by frail and robust elderly (10%, 4.5% and 2.9%, respectively). Malnourished elderly reported more frequent problems with chewing and speech when compared with well-nourished elderly (univariate analysis). However, multivariate analysis did not show an association between malnutrition and oral health problems and edentulousness, although HRQoL was associated with malnutrition (odds ratio (OR) 0.972, confidence interval (CI) 0.951–0.955). Based on the results of this cross-sectional study, it can be concluded that poor HRQoL is significantly associated with malnutrition; however, edentulousness and oral health problems are not. Full article

The study evaluated the symptoms, acceptance, and digestibility of bread made from transgenic low-gliadin wheat, in comparison with gluten free bread, in Non-coeliac gluten sensitivity (NCGS) patients, considering clinical/sensory parameters and gut microbiota composition. This study was performed in two phases of seven days each, comprising a basal phase with gluten free bread and an E82 phase with low-gliadin bread. Gastrointestinal clinical symptoms were evaluated using the Gastrointestinal Symptom Rating Scale (GSRS) questionnaire, and stool samples were collected for gluten immunogenic peptides (GIP) determination and the extraction of gut microbial DNA. For the basal and E82 phases, seven and five patients, respectively, showed undetectable GIPs content. The bacterial 16S rRNA gene V1-V2 hypervariable regions were sequenced using the Illumina MiSeq platform and downstream analysis was done using a Quantitative Insights into Microbial Ecology (QIIME) pipeline. No significant differences in the GSRS questionnaires were observed between the two phases. However, we observed a significantly lower abundance of some gut genera Oscillospira, Dorea, Blautia, Bacteroides, Coprococcus, and Collinsella, and a significantly higher abundance of Roseburia and Faecalibacterium genera during the E82 phase compared with the basal phase. The consumption of low-gliadin bread E82 by NCGS subjects induced potentially positive changes in the gut microbiota composition, increasing the butyrate-producing bacteria and favoring a microbial profile that is suggested to have a key role in the maintenance or improvement of gut permeability. Full article

Dietary fat intake is associated with the risk of colorectal cancer (CRC); however, the results of epidemiological studies on this are controversial. Therefore, this study aimed to summarize the available scientific evidence regarding the association between dietary fat and the risk of CRC. We conducted a systematic search of PubMed, Web of Science, and the Cochrane library for articles related to dietary fat and the risk of CRC. The summary relative risks with 95% confidence intervals (CI) were calculated via a random effect model. Begg’s test was used to detect publication bias. A total of 18 articles were identified. The pooled relative risk with 95% CI for the risk of CRC were 1.00 (95% CI: 0.90–1.12), 0.97 (95% CI: 0.86–1.10), 1.08 (95% CI: 0.92–1.26), and 0.99 (95% CI: 0.93–1.04) for total fat, saturated fatty acid, monounsaturated fatty acid, and polyunsaturated fatty acid, respectively. No significant associations were found in subgroup analyses. Begg’s test for all exposures revealed no publication bias (total fat, p = 0.3; saturated fatty acid, p = 0.1; monounsaturated fatty acid, p = 0.08; polyunsaturated fatty acid, p = 0.2). The studies included in this review and meta-analysis revealed that dietary fats and fatty acids had no effects on the risk of CRC. Full article

Myricetin is a biologically active natural polyphenol with beneficial effects on metabolic health. This study aimed to examine the effects of myricetin on the expression levels of genes involved in lipolysis and mitochondrial respiration in adipocytes and the anti-obesity potential of myricetin. The results indicated that myricetin reduced triglyceride (TG) content and increased mitochondrial content and oxygen consumption rate (OCR) in adipocytes in vitro. To determine anti-obesity effect of myricetin, C57BL6/J mice were fed a high-fat diet (HFD) for eight weeks and then treated with myricetin (10 mg/kg) for 2 weeks. The in vivo treatment of myricetin reduced body weight by 11%. Furthermore, it improved the glucose tolerance, and increased fatty acid consumption of HFD-fed mice. Myricetin treatment increased Sirt3 expression and reduced the acetylation of mitochondrial proteins in adipose tissue. Finally, the knockdown of Sirt3 in adipocytes reduced the myricetin-induced increase in mitochondrial oxygen consumption rate by about 27% compared to controls. Our results indicated that myricetin exerted anti-obesity effects through the upregulation of Sirt3 expression and mitochondrial metabolism in adipose tissue. Full article

Citrus fruits are often employed as ingredients for functional drinks. Among Citrus, the variety, “Lempso”, a typical hybrid of the Calabria region (Southern Italy), has been reported to possess superior antioxidant activity when compared to other common Citrus varieties. For these reasons, the aim of this study is to investigatein vitro the nutraceutical value of the Tarocco clone, “Lempso”, highlighting its anti-inflammatory and antioxidant potential. A post-column 2,2′-diphenyl-1-picrylhydrazyl (DPPH•) radical scavenging assay for the screening of antioxidant compounds in these complex matrices was developed. Subsequently, polyphenolic extract was tested on a murine macrophage cell line under inflammatory conditions. The extract resulted was able to significantly inhibit nitric oxide (NO) and cytokine release and inducible nitric oxide synthase (iNOS) and cycloxygenase-2 (COX-2) expression. The inhibition of these pro-inflammatory factors was associated to Nuclear factor-kB (NF-kB) inhibition. Our results also indicate an anti-oxidant potential of the extract as evidenced by the inhibition of reactive oxygen species (ROS) release and by the activation of the nuclear factor E2-related factor-2 (Nrf-2) pathway in macrophages. The obtained results highlight the anti-inflammatory and antioxidant potential of Lempso extract and its potential use, as a new ingredient for the formulation of functional beverages with high nutraceutical value, providing health benefits to consumers. Full article

Background: Evidence shows that diet is associated with physical activity. However, there has been a lack of studies addressing it in a population of older adults. Therefore, the main purpose of this study was to explore associations between various frequencies of dietary intake and physical activity in older adults. Methods: In this cross-sectional study, the participants were 810 older adults aged ≥85. Frequency of dietary intake and the level of physical activity were assessed using the Elderly Diet Index score and International Physical Activity questionnaire. Mutual associations were examined using generalized estimating equations with a logistic regression model. Results: ”Optimal” intake of fish and seafood (OR (odds ratio) = 1.40; 95% CI (95 percent confidence interval) 1.01 to 2.00), fruits (OR = 2.10; 95% CI 1.45 to 3.02), legumes (OR = 1.73; 95% CI 1.19 to 2.50), olive oil (OR = 1.83; 95% CI 1.09 to 3.08) and bread (OR = 4.62; 95% CI 3.05 to 6.99) and the total Elderly Diet Index score (OR = 4.99; 95% CI 3.20 to 7.70) were associated with ”sufficient” physical activity. When all dietary components were entered simultaneously into the model, ”optimal” intakes of meat (OR = 1.73; 95% CI 1.10 to 2.71), fish and seafood (OR = 2.26; 95% CI 1.46 to 3.51), cereals (OR = 1.75; 95% CI 1.02 to 3.25), fruits (OR = 1.52; 95% CI 1.02 to 2.26), legumes (OR = 1.48; 95% CI 1.10 to 1.93), and bread (OR = 5.14; 95% CI 3.24 to 8.15) were associated with ”sufficient” physical activity. Conclusions: Our study shows that the total Elderly Diet Index score is the strongest predictor associated with ”sufficient” physical activity in a population of older adults. Thus, policies aiming to improve overall diet in order to achieve higher levels of physical activity are warranted. Full article

Iron plays a key role in many physiological processes; cells need a very exact quantity of iron. In patients with inflammatory bowel disease, anaemia is a unique example of multifactorial origins, frequently being the result of a combination of iron deficiency and anaemia of chronic disease. The main cause of iron deficiency is the activity of the disease. Therefore, the first aim should be to reach complete clinical remission. The iron supplementation route should be determined according to symptoms, severity of anaemia and taking into account comorbidities and individual risks. Oral iron can only be used in patients with mild anaemia, whose disease is inactive and who have not been previously intolerant to oral iron. Intravenous iron should be the first line treatment in patients with moderate-severe anaemia, in patients with active disease, in patients with poor tolerance to oral iron and when erythropoietin agents or a fast response is needed. Erythropoietin is used in a few patients with anaemia to overcome functional iron deficiency, and blood transfusion is being restricted to refractory cases or acute life-threatening situations. Full article

Wheelchair rugby is a rapidly growing Paralympic sport; however, research remains predominantly in the realms of physiology and biomechanics. Currently, there is little investigation into nutrition and dietary supplement use among wheelchair rugby athletes (WRA). The aim of this study was to assess the types of dietary supplements (DS) used, the prevalence of usage, and the reasons for use among WRA. The secondary aim was to report utilized and preferred sources of nutritional information among this population. A valid, reliable Dietary Supplement Questionnaire was used to report supplement use and reasons for use. Male (n = 33) and female (n = 9) WRA were recruited at a national tournament and through emailing coaches of various Canadian teams. Dietary supplement usage was prevalent as 90.9% of males and 77.8% of females reported usage within the past three months with the most regularly used supplements being vitamin D (26.2%), electrolytes (19.5%), and protein powder (19.5%). The most common reason for usage was performance. The top sources of nutrition information were dietitian/nutritionist and the internet. Further investigation into DS use is needed to help create nutritional guidelines that are accessible to WRA and athletes with disabilities in general. Full article