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Iron considerations for the athlete: a narrative review

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Abstract

Iron plays a significant role in the body, and is specifically important to athletes, since it is a dominant feature in processes such as oxygen transport and energy metabolism. Despite its importance, athlete populations, especially females and endurance athletes, are commonly diagnosed with iron deficiency, suggesting an association between sport performance and iron regulation. Although iron deficiency is most common in female athletes (~ 15–35% athlete cohorts deficient), approximately 5–11% of male athlete cohorts also present with this issue. Furthermore, interest has grown in the mechanisms that influence iron absorption in athletes over the last decade, with the link between iron regulation and exercise becoming a research focus. Specifically, exercise-induced increases in the master iron regulatory hormone, hepcidin, has been highlighted as a contributing factor towards altered iron metabolism in athletes. To date, a plethora of research has been conducted, including investigation into the impact that sex hormones, diet (e.g. macronutrient manipulation), training and environmental stress (e.g. hypoxia due to altitude training) have on an athlete’s iron status, with numerous recommendations proposed for consideration. This review summarises the current state of research with respect to the aforementioned factors, drawing conclusions and recommendations for future work.

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Abbreviations

ΔHbmass:

Change in haemoglobin mass

DMT-1:

Divalent metal transporter 1

DCytB:

Duodenal cytochrome b

ERFE:

Erythroferrone

EPO:

Erythropoietin

FSH:

Follicle stimulating hormone

GI:

Gastro-intestinal

Hb:

Haemoglobin

Hbmass :

Haemoglobin mass

HIF:

Hypoxia-inducible factor

IL-6:

Interleukin-6

IV:

Intravenous

Fe:

Iron

ID:

Iron deficiency

IDA:

Iron deficiency anaemia

IDNA:

Iron deficient non-anaemia

LHTL:

Live high, train low

LCHF:

Low carbohydrate, high fat

LEA:

Low energy availability

LH:

Luteinising hormone

VO2max :

Maximal oxygen uptake

mRNA:

Messenger ribonucleic acid

OCC:

Oral contraceptive cycle

OCP:

Oral contraceptive pill

RDI:

Recommended dietary intake

RED-S:

Relative energy deficiency in sport

sTfR:

Soluble transferrin receptor

TfR:

Transferrin receptor

TfR-2:

Transferrin receptor-2

vVO2peak :

Velocity at peak oxygen uptake

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All authors on this review contributed to each section equitably. The literature search, idea development, writing, reviewing and editing for each section were completed as a collective. Furthermore, all authors have provided specific insight on key aspects relevant to each sub-heading.

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Sim, M., Garvican-Lewis, L.A., Cox, G.R. et al. Iron considerations for the athlete: a narrative review. Eur J Appl Physiol 119, 1463–1478 (2019). https://doi.org/10.1007/s00421-019-04157-y

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