Importance: Underserved pregnant individuals experience the highest risk of aberrant pregnancy weight gain and adverse perinatal outcomes. The Women, Infants, and Children (WIC) federal program assists underserved pregnant individuals and is therefore positioned to offer equitable access to interventions to enhance gestational weight gain in accordance with clinical guidelines. Objective: Test effectiveness of a pragmatic, fully remote lifestyle intervention co-developed with WIC participants on the incidence of gestational weight gain guideline attainment and perinatal outcomes. Design: The SmartMoms in WIC trial was a single blind randomized clinical trial conducted from July 2019 to May 2024. Setting: Louisiana WIC Program pregnant participants across 31 participating WIC clinics. Participants: 1300 individuals were recruited from Louisiana WIC; 756 were excluded via phone call and 544 were screened in person; 351 were enrolled. Randomization was stratified by geographical region and BMI class. Intervention: A high intensity multicomponent e-health intervention (Healthy Beginnings) for gestational weight gain management or usual care between 10 to 16 weeks gestation and until delivery (approximately 24 weeks). Main Outcome(s) and Measure(s): The primary outcome was assessed at participants WIC clinic and included gestational weight gain guideline attainment with total observed weight gain, weight gain per week and deviation from guidelines as secondary outcomes. Perinatal outcomes from birth certificates were exploratory. Results: The study sample (179 Intervention; 172 Usual Care) was diverse: 39% with obesity; 57% non-Hispanic Black. The incidence of guideline attainment was not different between groups. Study observed total (adjusted mean difference, -1.4 kg; 95% CI, -2.8 to -0.1), and rate of weight gain (adjusted mean difference -0.07 kg/wk; 95% CI, -0.13 to -0.01) and the deviation from guidelines was lower in the Intervention Group compared to Usual Care. There were 43 cases (16/172 Intervention, 27/171 Usual Care) of preterm birth and 30 NICU admissions (12/172 Intervention, 18/171 Usual Care) equating to an adjusted relative risk reduction of 36.9% and 28.6%, respectively. Conclusions and Relevance: A fully remote lifestyle intervention concomitant with WIC clinical care lowered gestational weight gain and reduced the risk of preterm birth and NICU admission. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial ClinicalTrials.gov [NCT04028843][1] ### Funding Statement This research was supported by funding from the National Institute of Nursing Research (5R01NR017644), the Louisiana/Pennington Nutrition and Obesity Research Center (NORC) of the National Institutes of Diabetes, Digestive and Kidney Diseases (P30DK072476) and the Louisiana Clinical and Translational Sciences Center (U54 GM104940). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethical approval for this was was given by the institutional review boards of Pennington Biomedical Research Center and the Louisiana Department of Health. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes A deidentified dataset will be made publicly available in the Pennington/Louisiana NORCBiorepository at http://doi.org/10.17616/R31NJN8P [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04028843&atom=%2Fmedrxiv%2Fearly%2F2025%2F01%2F31%2F2025.01.29.25321347.atom

Introduction In pregnancy, people with obesity or excess adiposity are prone to excess gestational weight gain (GWG) and have the highest risks for multiple maternal morbidities. Epidemiological studies suggest that the lowest incidence of adverse maternal and infant outcomes occurs with GWG lower than current recommendations (<5 kg) and with gestational weight maintenance, resulting in fat mass loss, in those with obesity. Data from randomised clinical trials are needed to evaluate the efficacy of a fat mass loss intervention on pregnancy outcomes. The objective of this proof-of-principle randomised controlled trial is to test the effect of a gestational fat mass loss intervention in pregnant individuals with obesity on changes in weight, fat mass and cardiometabolic disease risk factors.Methods and analysis In this two-site randomised parallel group, 100 women (30% black; 30% Hispanic) with pre-existing obesity (31.0≤body mass index≤55.0 kg/m2) are randomised to usual care (Provider Directed Group) or usual care plus a fat mass loss intervention with food provision (Weight Maintenance Group). The primary outcomes of the trial (Healthy Mamas/Mamis Saludables) are weight, fat mass (via three-compartment model) and cardiometabolic disease risk factors (ie, blood pressure, lipids, glucose, insulin) from baseline (~13 weeks gestation) to ~35 weeks gestation and at 2 weeks postpartum. Secondary aims evaluate the safety of the fat mass loss intervention during pregnancy and test the hypotheses that compared with usual care, the intervention will have no significant adverse effect on fetal growth, neonatal size, infant body composition and other adverse events. Mediators (eg, eating, activity) and moderators (eg, parity, obesity grade, race/ethnicity) of intervention effects are also examined. Finally, the study will explore the effect of prenatal fat mass loss on reducing the incidence of adverse obstetrical outcomes, including non-elective caesarean delivery, gestational diabetes, hypertension and pre-eclampsia.Ethics and dissemination The trial has been approved by the Pennington Biomedical Research Center Institutional Review Board, is monitored by an independent data and safety monitoring board and will be conducted in agreement with the Declaration of Helsinki. All results, positive, negative and inconclusive, will be disseminated at national and/or international scientific meetings and in peer-reviewed scientific journals.Trial registration number NCT04731688.

Background: Women can spend up to 40% of their lives in the postmenopausal state. As women begin to transition into menopause, known as perimenopause, changes in hormonal concentrations and body composition dramatically increase overall cardiometabolic risk. Dietary patterns and interventions can be utilized to prevent and treat cardiovascular disease (CVD) and some dietary patterns over others may be more beneficial due to their specific effects on the health aspects of menopause. In this narrative review, we summarize key cardiovascular alterations that occur during the menopause transition and explore current dietary recommendations to address CVD risk as well as explore the new frontier of precision nutrition and the implications for nutrition prescription during menopause. Summary: Popular dietary interventions for CVD such as the Dietary Approaches to Stop Hypertension (DASH) diet and the Mediterranean Diet (MED) have limited data in women following menopause. However, both diets improve CVD risk biomarkers of total cholesterol and low-density lipoprotein cholesterol as well as lower oxidative stress and inflammation and improve endothelial function. As the menopause transition increases the risk for developing metabolic syndrome, insulin insensitivity, and dyslipidemia, the DASH and MED diets may be impactful dietary strategies for mediating CVD risk in menopausal women. However, these are “one-size-fits-all” approaches that neglect individual characteristics such as genetic predisposition and environmental factors. Precision nutrition considers individual factors for nutrition prescription, spanning from evaluating food intake preferences and behaviors to deep phenotyping. Data from a large-scale investigation of the menopause transition suggests nutritional strategies that address postprandial glycemic responses, and the gut microbiome may attenuate some of the unfavorable effects of menopause on CVD risk factors. Key Messages: Considering menopause, women are a clinical population that would greatly benefit from precision nutrition. Future research should explore the use of machine learning and artificial intelligence in a precision nutrition framework to modify the DASH and MED diets to address adverse effects that occur during the menopause transition are vital for supporting women’s health as they age.

Obesity is a highly prevalent chronic disease that impacts >40% of reproductive-aged females. The pathophysiology of obesity is complex and can be understood simply as a chronic energy imbalance whereby caloric intake exceeds caloric expenditure with an energy surplus stored in adipose tissue. Obesity may be categorized into degrees of severity as well as different phenotypes on the basis of metabolic health and underlying pathophysiology. Obesity and excess adiposity have a significant impact on fertility and reproductive health, with direct effects on the hypothalamic-pituitary-ovarian axis, the ovary and oocyte, and the endometrium. There are significant adverse pregnancy outcomes related to obesity, and excess weight gain before, during, and after pregnancy that can alter the lifelong risk for metabolically unhealthy obesity. Given the high prevalence and pervasive impact of obesity on reproductive health, there is a need for better and individualized care for reproductive-aged females that considers obesity phenotype, underlying pathophysiology, and effective and sustainable interventions to treat obesity and manage weight gain before, during, and after pregnancy.

The purpose of this study was to evaluate change in bone mineral density (BMD), BMD percentile (BMDp), lean mass (LM), fat-free mass index, body fat percentage (BF%), and muscle size (mCSA) and quality (EI) in collegiate female gymnasts over a competitive season and characterize the impact of menarche on changes. Twenty gymnasts completed a validated survey to assess age of menarche. Body composition was assessed via whole-body dual-energy X-ray absorptiometry scans at pre- and postseason. mCSA and EI were determined from a panoramic ultrasound scan of the vastus lateralis. Pre- to postseason changes were evaluated using paired sample t tests, and strength of relationships between were analyzed via bivariate correlations and linear regression. Significant losses in body fat percentage (Δ -1.1 ± 1.9%; p = .022) and EI (Δ -5.0 ± 5.8 a.u.; p = .002) were observed. No significant changes were observed in BMDp, mCSA, BMD, LM, or fat-free mass index (p = .310–.869). Age of menarche (15.4 ± 1.5 years) was negatively correlated with Δ BMDp (r = −.454; p = .044) and Δ mCSA (r = −.658; p = .002), explaining 21% and 43% of variation in Δ BMDp and Δ mCSA, respectively. Positive outcomes of gymnastics training, such as gains in LM and mCSA, may be attenuated by delayed menarche, suggested by increased EI and decreased body fat percentage, despite no changes in mCSA or overall LM. These findings may indicate a higher priority of fat utilization within the muscle over muscle and bone growth. Considering menarche as a significant predictor for Δ mCSA, this lack of increase (despite improved EI), may signify increased injury risk resulting from team-specific training style or insufficient energy intake to support appropriate muscle growth.

The effects of female sex hormones on optimal performance have been increasingly recognized as an important consideration in exercise and sport science research. This narrative review explores the findings of studies evaluating the effects of menstrual cycle phase in eumenorrheic women and the use of hormonal contraception (oral contraceptives and hormonal intrauterine devices) on metabolism, muscular strength, and recovery in active females. Ovarian hormones are known to influence metabolism because estrogen is a master regulator of bioenergetics. Importantly, the menstrual cycle may impact protein synthesis, impacting skeletal muscle quality and strength. Studies investigating muscular strength in eumenorrheic women report equivocal findings between the follicular phase and luteal phase with no differences compared to oral contraceptive users. Studies examining recovery measures (using biomarkers, blood lactate, and blood flow) do not report clear or consistent effects of the impact of the menstrual cycle or hormonal contraception use on recovery. Overall, the current literature may be limited by the evaluation of only one menstrual cycle and the use of group means for statistical significance. Hence, to optimize training and performance in females, regardless of hormonal contraception use, there is a need for future research to quantify the intra-individual impact of the menstrual cycle phases and hormonal contraceptive use in active females.

OBJECTIVE:This study characterized the impact of physical activity (light, moderate, and vigorous [VIG] active minutes per day) and body composition (percent body fat [%BF] and fat-free mass index) on total menopausal symptoms (TMSs) in 72 premenopausal, perimenopausal (PERI), or postmenopausal women.METHODS:Activity minutes were collected from wearable fitness trackers. Body composition was evaluated using a whole-body dual-energy x-ray absorptiometry scan. TMSs were quantified using The North American Menopause Society Questionnaire.RESULTS:Significant associations were observed between TMSs and %BF ( r = 0.464, P < 0.001) and VIG ( r = -0.245, P = 0.038). %BF and VIG were significant predictors for TMSs across groups ( R2 = 0.146 and R2 = 0.092, respectively), but only %BF maintained for PERI ( R2 = 0.421, P < 0.001).CONCLUSIONS:%BF predicted nearly half of the variance in PERI TMSs, whereas VIG predicted 9% of the sample variance, demonstrating an important influence of body fat accumulation and intense physical activity in the menopause transition. High-intensity exercise interventions to alleviate body composition changes may also reduce menopausal-related symptoms for PERI women.

ABSTRACT:Cabre, HE, Ladan, AN, Moore, SR, Joniak, KE, Blue, MNM, Pietrosimone, BG, Hackney, AC, and Smith-Ryan, AE. Effects of hormonal contraception and the menstrual cycle on fatigability and recovery from an anaerobic exercise test. J Strength Cond Res 38(7): 1256-1265, 2024-This study sought to evaluate the effects of oral contraceptive (OC) and hormonal intrauterine device (H-IUD) use, compared with a eumenorrheic (EUM) cycle, on fatigability and recovery between hormone the phases. Peak power (PP), average power (AP), fatigue index (FI), blood lactate, vessel diameter, and blood flow (BF) were measured from a repeated sprint cycle test (10 × 6 seconds) in 60, healthy, active women (mean ± SD ; age: 26.5 ± 7.0 years, BMI: 22.5 ± 3.7 kg·m -2 ) who used monophasic OC (≥6 months; n = 21), had a H-IUD (≥6 months; n = 20), or had regular naturally occurring menstrual cycle (≥3 months) or had a nonhormonal IUD (EUM; n = 19). Subjects were randomly assigned to begin in either the low-hormone phase (LHP) or high-hormone phase (HHP) and were tested once in each phase. Separate univariate analyses of covariances assessed the change from HHP to LHP between the groups, covaried for progesterone, with significance set at p ≤ 0.05. All groups demonstrated similar changes in PP, AP, FI, blood lactate, vessel diameter, and BF between the phases ( p > 0.05). Although not significant, AP was higher in LHP for OC (Δ -248.2 ± 1,301.4 W) and EUM (Δ -19.5 ± 977.7 W) and higher in HHP for H-IUD (Δ 369.3 ± 1,123.0 W). Oral contraceptive group exhibited a higher FI (Δ 2.0%) and reduced blood lactate clearance (Δ 2.5%) in HHP. In recreationally active women, hormonal contraception and hormone phases may minimally impact fatigue and recovery. Individual elite female athletes may benefit from understanding hormonal contraception type as performance and recovery may slightly vary across the cycle.

Objective: Nearly all females use some form of contraception in their lifetimes, making hormonal contraception (HC) a prevalent hormonal landscape. The purpose of this survey was to characterize the prevalence of HC use and the associated perceived side effects in active U.S. adult females. Study Design: Six hundred seventy active adult females between ages 18 and 52 years living in the United States (age = 30.7 ± 8.1 years; body mass index = 25.4 ± 5.5 kg/m2) completed an online questionnaire based on previously validated assessments to characterize menstrual cycle, prevalence of HC use, perceived side effects, and physical activity. Physical activity was reported in minutes over 7 days and converted into metabolic equivalent-minutes per week. Data are reported as descriptive statistics and proportions; Pearson’s chi-squared analyses were used to examine the relationships between categorical variables. Results: Overall, 65.2% of females reported using HC. Combined oral contraceptives were most commonly used (48.3%), followed by intrauterine devices (40.7%). Compared with non-HC users, HC users reported a significantly lower occurrence of premenstrual syndrome (65.7% vs. 54.0%, respectively; p = .004). Compared with the prevalence of perceived negative side effects, HC users reported a higher prevalence of perceived positive side effects. Progestin-only HC users reported significantly more perceived negative side effects than combination HC users (58.2% vs. 48.5%, respectively; p = .042). The physical activity level did not appear to influence perceived side effects. Conclusions: HC use in females remains very high. HC users reported a higher number of perceived positive side effects compared with perceived negative side effects; the type of HC method may impact the perceived side effects.

INTRODUCTION:To evaluate the effects of oral contraceptive (OC) and hormonal intrauterine device (H-IUD) use, compared with an eumenorrheic (EUM) cycle, on maximal strength and power between hormone phases. METHODS:One-repetition maximum (1RM) leg press and bench press, peak force from knee extension and upright row isometric dynamometry, and power from vertical jump height and reactive strength index (cm·s -1 ) were measured in 60 healthy, active women (mean ± SD; age: 26.5 ± 7.0 yr, body mass index: 23.8 ± 3.0 kg·m -2 ) who were monophasic OC users for ≥6 months ( n = 21), had an H-IUD for ≥6 months ( n = 20), or had regularly naturally occurring menstrual cycle for ≥3 months or were using a nonhormonal IUD (EUM; n = 19). Participants were randomly assigned to begin in the follicular phase/placebo pill (low hormone phase (LHP)) or in the luteal phase/active pill (high hormone phase (HHP)) and were tested once in each phase. Estimates of total lean mass (LM), leg LM, and arm LM were measured via dual energy x-ray absorptiometry. Separate univariate ANCOVAs were used to assess the change from HHP to LHP between groups, with LM and progesterone as covariates. RESULTS:Leg press 1RM was significantly different across phases between groups ( P = 0.037), with higher leg press 1RM in the HHP for the OC group (mean difference [∆ HHP - LHP] ± standard error: ∆ 7.4 ± 15.9 kg; P = 0.043) compared with the H-IUD group (∆ -8.9 ± 23.8 kg; P = 0.043). All groups demonstrated similar bench press 1RM, peak force, vertical jump height, and reactive strength index between phases ( P > 0.05). CONCLUSIONS:Lower body strength was greater in the HHP for OC users (5.6% increase) suggesting that lower body maximal strength outcomes may be influenced by hormonal contraception type.

Entering pregnancy with obesity increases the risk of adverse health outcomes for parent and child. As such, research interventions are largely focused on limiting excess gestational weight gain during pregnancy, especially in those with obesity. Yet, while many lifestyle interventions are successful in reducing GWG, few affect pregnancy outcomes. Here we review work targeting the metabolic milieu instead of focusing solely on weight. Work done in non-pregnant populations suggests that specifically targeting glucose, triglyceride, and leptin levels or inflammatory makers improves the metabolic milieu and overall health. We posit that precision interventions that include strategies such as time restricted eating, following the 24 h movement guidelines, or reducing sedentary behavior during pregnancy can be successful approaches benefiting the maternal metabolic milieu and minimize the risk of adverse pregnancy outcomes. Personalized tools such as continuous glucose monitors or community-based approaches play an important role in pre-conception health and should be extrapolated to pregnancy interventions to directly benefit the metabolic milieu optimizing health outcomes for both parent and child.

Introduction Chronic pain affects 19% of adults in the United States, with increasing prevalence in active and aging populations. Pain can limit physical activity and activities of daily living (ADLs), resulting in declined mental and social health. Nutritional interventions for pain currently target inflammation or joint health, but few influence both. Collagen, the most abundant protein in the human body and constituent of the extra cellular matrix, is such a nutraceutical. While there have been reports of reductions in pain with short-term collagen peptide (CP) supplementation, there are no long-term studies specifically in healthy middle-aged active adults. Purpose To determine the effects of daily CP consumption over 3, 6, and 9 months on survey measures of pain, function, and physical and mental health using The Knee Injury & Osteoarthritis Outcomes Score (KOOS) and Veterans Rand 12 (VR-12) in middle-aged active adults. Methods This study was a double-blind randomized control trial with three treatment groups (Placebo, 10 g/d CP, and 20 g/d CP). Results Improvements in ADLs (p = .031, & eta;(p) (2) = .096) and pain (p = .037, & eta;(p) (2) = .164) were observed with 10 g/d CP over 6 months, although pain only improved in high frequency exercisers (>180 min/week). Additionally, VR-12 mental component scores (MCS) improved with 10 g/d of CP over 3-9 months (p = .017, & eta;(p) (2) = .309), while physical component scores (PCS) improved with 20 g/d of CP over 3-9 months, but only in females (p = .013, & eta;(p) (2)= .582). Conclusion These findings suggest 10 to 20 g/d of CP supplementation over 6 to 9 months may improve ADLs, pain, MCS, and PCS in middle-aged active adults.

Fat-free mass index (FFMI, kg/m2) and regional muscle characteristics may provide direct insight into athletic performance and injury prevention. Underutilized and often misunderstood, FFMI specifies individual potential to accumulate fat-free mass (FFM; lean mass and bone mineral content) relative to height. FFMI has been shown to be useful for tracking changes in FFM and monitoring return to play from injury, particularly in females. PURPOSE: The purpose of this study was to evaluate the relationship between total and regional body composition and muscle characteristics with aerobic capacity, speed, power, and agility performance in Division I female soccer players. METHODS: Eighteen female soccer players (mean ± SD; Height = 165.3 ± 5.1 cm; Weight = 63.6 ± 7.3 kg; FFMI = 18.4 ± 1.2 kg/m2; %fat = 22.9 ± 4.9 kg) completed a total body dual-energy x-ray absorptiometry scan to determine total body percent fat (%fat), FFM, and right and left leg lean mass (RLM and LLM, respectively). FFMI was determined as FFM/height (m2). A panoramic ultrasound scan of the right vastus lateralis muscle was used to determine cross-sectional area (mCSA) and echo intensity (EI) of the vastus lateralis. Performance testing included vertical jump (VJ; cm), beep test (BT, m), 10 m and 30 m dash (s), and right and left Illinois agility tests (ILR and ILL, respectively; s). Pearson product moment correlations were utilized to evaluate these relationships. RESULTS: FFMI was significantly positively associated with VJ (r = 0.681; p = 0.002). EI had a significant positive association with BT (r = 0.471; p = 0.048). %fat was significantly negatively associated with VJ (r = -0.667; p = 0.002), BT (r = -0.538; p = 0.021), and positively associated with 30 m (r = 0.491; p = 0.039), ILR (r = 0.578; p = 0.012), and ILL (r = 0.668; p = 0.002) tests. mCSA, FFM, RLM, and LLM were not significantly related to any performance metrics. CONCLUSION: FFMI and %fat may influence power-based movements where greater FFMI and lower %fat benefited VJ. EI may positively impact aerobic performance, while %fat may negatively affect aerobic capacity. Measuring FFMI, EI, and %fat can inform nutrition and training interventions to achieve body composition goals benefiting performance and return to play.

PURPOSE: Sleep disturbances are a core symptom of menopause. Understanding sleep changes during the menopause transition may mitigate disruptions to overall health and quality of life. The purpose of this study was to evaluate sleep quantity and quality and the relationship with menopausal symptoms in pre-, peri-, and post-menopausal women. METHODS: 72 healthy women (mean ± SD; Age = 48.0 ± 7.2 years, Ht = 163.0 ± 6.3 cm, Wt = 69.0 ± 14.2 kg) were stratified as pre-menopausal (PRE; n = 24) who were eumenorrheic, peri-menopausal (PERI; n = 24) who had irregular cycle lengths, and post-menopausal (POST; n = 24) who had no period for 12 consecutive months prior to their visit. Overall self-reported sleep quality was quantified by The Pittsburgh Sleep Quality Index (PSQI) to calculate a global score (GS) and reported as minutes asleep per night (RM, min). Participants wore a wrist tracker for at least six consecutive days to evaluate minutes asleep (MA, min), Rapid Eye Movement minutes (REM), and light and deep sleep averages per night. The validated Menopause Health Questionnaire from the North American Menopause Society was used to characterize total number of menopausal symptoms. RESULTS: A one-way ANOVA revealed no significant difference between groups in GS, RM or MA (p > 0.05). POST had less REM sleep than PRE [mean difference (MD) ± standard error: -14.82 ± 6.07 min; p = 0.052]. PERI had more light (MD: 29.21 ± 9.79 min; p = 0.012) and less deep sleep (MD:-10.19 ± 4.20 min; p = 0.054) than PRE. PERI experienced more hot flashes (MD: 0.75 ± 0.18; p = 0.001), night sweats (MD: 0.92 ± 0.21; p = 0.001), and tiredness (MD: 0.63 ± 0.22; p = 0.020) than PRE. PERI experienced a greater total number of menopausal symptoms (MD: 6.58 ± 1.51; p = 0.001) than PRE. GS was significantly positively related to total number of symptoms (R = 0.323, p = 0.006). There was no significant correlation between REM, light, deep, or MA and total number of symptoms. CONCLUSION: Perimenopausal women may experience more sleep disruptive menopausal symptoms that contribute to poor sleep quality. Targeting sleep remediation for perimenopause may be important for improving their health and quality of life.

Background Citrulline may amplify the effects of L-arginine and nitric oxide concentration, which may augment vasodilation and blood flow, thereby enhancing aerobic exercise performance. The purpose of this randomized, double-blind, placebo-controlled crossover study was to investigate effects of L-citrulline + Glutathione on aerobic exercise performance and blood flow in well-trained men.Methods Twenty-five males (Mean ± SD; Age: 22.2 ± 2.4 yrs; Height: 177.0 ± 4.8 cm; Weight: 75.3 ± 6.9 kg) were randomly assigned to the L-citrulline + Glutathione (Setria Performance Blend: SPB; L-citrulline [2 g] + glutathione [200 mg], 6 capsules) or placebo (PL; 3.1 g cellulose, 6 capsules) group. Participants performed a maximal oxygen consumption treadmill test to determine peak velocity (PV) and returned after eight days of ingesting either PL or SPB. Three timed treadmill runs to exhaustion (TTE) were performed at 90%, 100%, and 110% PV. Brachial artery blood flow and vessel diameter were assessed using ultrasound at 1-hr prior to exercise (1hrPrEX), after each exercise bout, immediately post-exercise (immediate PEX), and 30 minutes post exercise (30minPEX) at visits 2 and 4. Blood analytes were assessed via venous blood draws at visit 1, visit 3, and 1hrPEX, immediate PEX, and 30minPEX at visits 2 and 4. After a 14-day washout, participants repeated the same procedures, ingesting the opposite treatment. Separate repeated measures ANOVAs were performed for TTE, vessel diameter, blood flow, and blood analytes.Results Blood flow was significantly augmented 30minPEX (p = 0.04) with SPB in comparison with PL. L-citrulline and L-arginine plasma concentrations were significantly elevated immediately PEX (p = 0.001) and 30-minPEX (p = 0.001) following SPB in comparison to PL.Conclusion Acute ingestion of SPB after eight days may enhance blood flow, L-citrulline, and L-arginine plasma concentrations after high-intensity exercise, which may enhance performance.Clinical Trial Registration [https://clinicaltrials.gov/ct2/show/nct04090138], identifier [NCT04090138].

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ABSTRACT Introduction The menopause transition yields significant physiological alterations. The purpose was to characterize lean soft tissue (LST), muscle size (muscle cross-sectional area (mCSA)), muscle quality (echo intensity (EI)), and strength across the menopause transition. A secondary aim was to evaluate whole-body protein turnover in a subsample of women. Methods Seventy-two healthy women were enrolled in this cross-sectional study based on menopause stage (PRE: n = 24; PERI: n = 24; POST: n = 24). Whole-body LST was measured via dual-energy x-ray absorptiometry, and muscle characteristics (mCSA and EI) were measured via B-mode ultrasound of the vastus lateralis. Maximal voluntary contractions (N·m) of the knee extensors were evaluated. Physical activity (in minutes per day) was accounted for using the International Physical Activity Questionnaire. A subsample of women (n = 27) ingested 2.0 g of 15N-alanine to determine whole-body net protein balance (NB; in grams per kilogram of body mass per day). Results Significant differences were evident in LST (P = 0.022), leg LST (P = 0.05), and EI (P = 0.018) between menopause stages. Bonferroni post-hoc comparisons revealed greater LST in PRE versus PERI (mean difference (MD) ± SE, 3.8 ± 1.5 kg; P = 0.048) and POST (3.9 ± 1.5 lb; P = 0.049). Similarly, EI was significantly higher in PERI PRE (MD, 18.3 ± 7.1 a.u.; P = 0.036). There was no significant difference in mCSA (P = 0.082) or in maximal voluntary contraction (P = 0.167). NB was significantly different across groups (P = 0.026); NB was greater in PRE compared with PERI (MD, 0.39 ± 0.17 g·kg−1; P = 0.090), and from PRE to POST (MD, 0.46 ± 0.17 g·kg−1; P = 0.042). Physical activity was not significantly different across groups but demonstrated a linear increase from PRE to POST. Conclusions The current findings suggest that LST, muscle quality, and protein balance may be negatively influenced by the menopause transition.

This study examined the effects of creatine (Cr) loading on body mass (BM) and fluid markers of total body water (TBW), extra-cellular fluid (ECF), and intra-cellular fluid (ICF) across the menstrual cycle (MC). Thirty moderately active females, either naturally-menstruating (NM) or using hormonal contraceptives (HC), were randomized to Cr (Cr; 4 × 5 g/day of creatine monohydrate for 5 days; n = 15) or a non-caloric placebo (PL; n = 15) using a double-blind, placebo-controlled design, with a menstrual phase crossover. BM, TBW, ECF, and ICF were measured at pre- and post-supplementation in randomized order of follicular phase (FP; NM: MC days 0–8, HC: inactive pill days) or luteal phase (LP; NM: ≤15 days from next projected cycle start date, HC: active pill days) using bioelectrical impedance spectroscopy. Acute hydration status and salivary estrogen were used as covariates. Change in BM was not different between groups across MC ([PL-Cr] Δ 0.40 ± 0.50 kg; p = 0.427) or between MC phase across groups ([FP-LP] Δ 0.31 ± 0.48 kg; p = 0.528). TBW (p = 0.802), ECF (p = 0.373), and ICF (p = 0.795) were not different between supplement groups at pre-supplementation/FP time points. There were no significant differences between the NM and HC subjects at any time point, for any outcome (p > 0.05). Following LP supplementation, significant changes were observed in TBW (Cr: Δ 0.83 ± 0.38 L, PL: Δ −0.62 ± 0.38 L; p = 0.021), ECF (Cr: Δ 0.46 ± 0.15 L, PL: Δ −0.19 ± 0.15 L; p = 0.013), and ICF (Cr: Δ 0.74 ± 0.23 L, PL: Δ −0.02 ± 0.23 L; p = 0.041). These data demonstrate an increase in all fluid compartments in the LP following Cr loading, without observed alterations in body weight for females.