












































MANUSCRIPT TYPE


EVIDENCE-TO-PRACTICE REVIEW  

 

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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                     Volume 6 – Issue 2 – September 2023 

The Influences of the Religious Tradition of Ramadan on Dietary 
Intake and Body Composition in Adolescent Athletes: An Evidence-to-
Practice Review 
Regina A. Duncan, MS, SCAT, ATC*; Shannon E. Ryan, MS, SCAT ATC‡; Erin M. Watlington MS, ATC†; Nancy A. Uriegas, MS, 
SCAT, ATC§; Zachary K. Winkelmann, PhD, SCAT, ATC, CHSE§ 
*Prisma Health Orthopedics, Columbia, SC; ‡Cintas, Albany, NY; †QuarterLine, Joint Base Lewis-McChord, WA; §University of 
South Carolina, Columbia, SC  
 

 
ABSTRACT 
When participating in the religious tradition of Ramadan, the body is subject to changes that adjust an athlete's regimented dietary 
intake. The guiding systematic review and meta-analysis were conducted to gather the results of the limited research on the effect 
of Ramadan observance on body mass, body composition, and dietary intake in adolescent athletes. Data were extracted from two 
different databases, and a search through several journals exploring body mass and/or body composition and/or dietary intake 
was conducted. The methodological quality of each study was assessed via QualSyst. No significant differences were found when 
comparing the body mass, body composition, body fat percentage, lean mass, and dietary intake pre-Ramadan and throughout 
Ramadan. Body mass remained unchanged from pre-Ramadan to the first week of Ramadan, from pre-Ramadan to the second 
week of Ramadan, or from pre-Ramadan to the fourth week. Body composition did not change from pre-Ramadan to the first week 
of Ramadan or from pre-Ramadan to the fourth week of Ramadan. Body fat percentage did not change from pre-Ramadan to the 
second week of Ramadan or from pre-Ramadan to the fourth week of Ramadan. Lean body mass was unchanged from pre-Ramadan 
to the fourth week of Ramadan. Finally, the dietary intake of total energy, fat, protein, carbohydrates, and water did not change 
throughout Ramadan. Therefore, adolescent athletes continuing to train throughout the duration of Ramadan observance has no 
effect on body mass or composition and dietary intake. 
Content Focus: Health Care Competency  
 
Correspondence 
Dr. Zachary Winkelmann, 1300 Wheat Street, Columbia, SC 29208. 
E-mail: winkelz@mailbox.sc.edu   
Twitter: @zachwinkelmann 
 
Full Citation 
Duncan RA, Ryan SE, Watlington EM Uriegas NA, Winkelmann ZK. The influences of the religious tradition of Ramadan on 
dietary intake and body composition in adolescent athletes: An evidence-to-practice review. Clin Pract Athl Train. 2023;6(2): 
21-27. https://doi.org/10.31622/2023/0006.02.3 
 

 
ORIGINAL REFERENCE 
Trabelsi, K, Ammar A, Boukhris O, et al. Effects of Ramadan Observance on Dietary Intake and Body 
Composition of Adolescent Athletes: Systematic Review and Meta-Analysis. Nutrients, 2020;12(6): 1574. 
 
SUMMARY 
 
CLINICAL PROBLEM AND QUESTION 
 
Athletic success is often defined as an athlete’s performance on the field; however, several other factors 
contribute to one’s success. Many athletes look to elevate their performance by turning to controllable and 
manipulatable factors such as body mass and composition. Body composition is the percentage of fat, bone, 
and muscle in one’s body, whereas body mass index is a representation of one’s weight and height.1 These 
factors have been linked to a possible increase in performance outcomes when maintaining a low-fat mass 
and a high value of lean mass in athletic performance.1 Therefore, optimizing intake, type, quantity, and 
timing of specific foods, fluids, and supplements is widely used across the athletic population to improve 
performance outcomes.1 However, these variables need to be highly individualized from athlete to athlete 
while maintaining positive dietary behaviors. Not only does each sport have specific demands, but each 
athlete does as well. Therefore, their own optimal body composition and mass will need to reflect these 

mailto:winkelz@mailbox.sc.edu


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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                     Volume 6 – Issue 2 – September 2023 
  

individual factors. Recognizing this need between athletes and being able to adjust body mass and 
composition in accordance with proper dietary intake is a significant factor in athletic success.  
 
Ramadan, observed during the 9th month of the Islamic calendar, is a Muslim tradition that requires anyone 
in observance to abstain from eating, drinking, and sexual activity from sunrise to sunset over a 29–30-day 
period.1,14,15 The observance is in commemoration of Muhammad’s first revelation and is regarded as one 
of the five Pillars of Islam.1 During the observance of Ramadan, an individual’s body may go through several 
changes to adjust to the new dietary demands. The known bodily change is significant to note in pubescent 
athletes who are under higher-than-normal physical demands during their sports training. Therefore, these 
athletes may experience difficulty in performance training adaptations during Ramadan due to less-than-
optimal training conditions.1 This period of change can impact dietary intake, body composition, and physical 
performance due to diet modifications to accommodate late-night training.1  
 
Additionally, pubescent athletes at this stage in life often rely on others for the purchase and preparation 
of foods due to their young age and lack of nutritional knowledge, which may lead to unhealthy eating 
habits placing an increased emphasis on the importance of monitoring changes during the observable period 
of Ramadan.1,18-22 The evaluation of the effects of Ramadan observance on the adolescent athlete’s body 
mass, body composition, and dietary intake is essential to note for athletic trainers working with youth and 
pediatric patients. Therefore, the primary clinical question of the guiding systematic review and analysis was 
to evaluate the effects of Ramadan observance on body mass, body composition, and dietary intake in 
adolescent athletes.1 
 
SUMMARY OF LITERATURE 
 
Existing literature included in the guiding systematic review was chosen based on predetermined criteria to 
encompass the scope of the clinical question best. Inclusion criteria were defined as studies 1) written in 
English and French languages, 2) published or accepted for publication in peer-reviewed journals, 3) 
investigated athletes continuing to train during Ramadan observance, 4) included athletes 10-19 years old, 
and 5) were observed during the entire month of Ramadan.1 Exclusion criteria were defined as descriptive 
or review articles, conference proceedings, and articles based on sedentary or obese individuals. Included 
articles must have assessed dietary intake made by a nutritionist and body mass and/or body composition. 
An initial search of electronic databases, PubMed, and Web of Science resulted in 40 potential studies. 
Following the literature search, 45 articles were identified, including five additional sources cited in the 40 
identified initially. Once duplicate articles were removed, 36 remained. After screening the full texts and 
related citations, 12 studies were included in the guiding systematic review, totaling 192 male athletes 
ranging from 13 to 19 years old. The authors examined the methodological quality of the twelve quantitative 
studies using the QualSyst assessment tool. The guiding systematic review was the first to analyze the effects 
of Ramadan observance on body mass, body composition, and dietary intake in adolescent athletes.  
 
SUMMARY OF OUTCOMES 
 
The authors from the guiding systematic review and meta-analysis examined the effects the religious month 
of Ramadan has on body mass, body composition, and dietary intake in adolescent athletes between the 
ages of 10 and 19.1 Of the twelve studies included in the systematic review and meta-analysis, eight studies 
reported data for body mass and seven studies reported data for body composition.2-13 Body fat was 
measured in one study6 using a foot-to-foot bioelectric impedance analyzer and the remaining studies used 
a skinfold caliper.4-7,10,13  
 
Of the twelve studies included in the systematic review and meta-analysis, ten studies assessed dietary intake 
by assessing at least one component of the participant's dietary diary (Table 1).3-8,10,11,13,14 Components that 
were considered for assessment were caloric intake, proteins, fat, carbohydrate, and water intake. Overall, 



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three studies examined caloric intake only,6,11,14 one study assessed caloric intake and water intake,5 two 
studies examined caloric intake, proteins, fat, and carbohydrate intake,7,8 and four studies examined caloric 
intake, proteins, fat, carbohydrate, and water intake.3,4,10,12 Dietary diaries were used to record dietary 
intake for all participants in the ten studies.3-8,10,11,13,14 Two studies used a 2-day dietary diary without an 
interview by a trained nutritionist,6,11 Two studies used a 3-day dietary diary with an interview by a trained 
nutritionist,10,12 Two studies used a 3-day dietary diary without an interview by a trained nutritionist,3,14 and 
four studies used a 7-day dietary diary without an interview by a trained nutritionist.4,5,7,8  
 
 
Table 1. Participant Dietary Diary Outcomes 

Studies Dietary Intake Assessed Dietary Diary / Interview with Nutritionist 
Aziz et al.2   
Aziz et al.3 Caloric, proteins, fat, 

carbohydrate, water 
3-day dietary diary & no interview 

Bouhlel et al.4 Caloric, proteins, fat, 
carbohydrate, water 

7-day dietary diary & no interview 

Bouhlel et al.5 Caloric, water 7-day dietary diary & no interview 
Güvenç6 Caloric 2-day dietary diary & no interview 
Hammouda et al.7 Caloric, proteins, fat, 

carbohydrate 
7-day dietary diary & no interview 

Hammouda et al.8 Caloric, proteins, fat, 
carbohydrate 

7-day dietary diary & no interview 

Maughan et al.10 Caloric, proteins, fat, 
carbohydrate, water 

3-day dietary diary & interview 

Meckel et al.11 Caloric 2-day dietary diary & no interview 
Zarrouk et al.12 Caloric, proteins, fat, 

carbohydrate, water 
3-day dietary diary & interview 

Zarrouk et al.13   
Aloui et al.14 Caloric 3-day dietary diary & no interview 

 
 
FINDINGS AND CLINICAL APPLICATION 
 
A total of twelve studies were included, with participants residing in Tunisia, Turkey, Singapore, Morocco, 
and Israel. Furthermore, the mean age for the participants of the studies ranged from 15 to 19 years, and 
they predominately participated in soccer (n=6)3,6,7,9-11and Karate (n=4),5,8,12,13 Other sports included were 
boxing,4 martial arts,2 running,9 and basketball.3 The number of training sessions ranged from 3-7 across the 
studies, the duration was between 1-2 hours, and not all studies reported the time of day of training of those 
who did two reported training before breaking the fast3,10 and four trained after breaking the fast.6,7,12,13 
Overall, four outcomes were measured to examine the effects Ramadan has on the human body over the 
course of participating in the observance of Ramadan. The outcomes examined were body mass, body 
composition (i.e., fat mass, fat percentage), lean mass, and dietary intake (i.e., total caloric intake, 
macronutrient intake, fluid intake).1  
  
Outcome 1 – Body Mass  
The body mass of a varying number of participants was assessed before the start of Ramadan and after 
either one, two, or four weeks of fasting. There were no significant changes to body mass from before 
Ramadan to the first week of Ramadan fasting.1 At one week, body mass was reported to have no changes 
in five studies,3,5,6,9,12 a decrease in one study,5 and an increase in one study.9 When comparing the effects 
of body mass before Ramadan fasting to the second week of Ramadan fasting, there were no significant 
changes in body mass.1 Body mass was recorded to have no changes in three studies,3,9,10 a decrease in two 



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All rights reserved. ISSN Online 2577-8188                                                                     Volume 6 – Issue 2 – September 2023 
  

studies,7,8 and an increase in one study at two weeks.9 Studies that compared body mass before Ramadan 
fasting to after four weeks of Ramadan fasting concluded there were no significant differences between the 
two.1 Eight studies2,3,5,6,9-12 concluded no change in body mass, three studies4,7,8 reported a decrease in body 
mass, and one study9 showed an increase in body mass from before the start of Ramadan fasting to after 
four weeks of Ramadan fasting  
 
Outcome 2 – Body Composition 
Fat Mass  
The body composition of a varying number of participants was assessed before the start of Ramadan and 
after either one or four weeks of Ramadan fasting. Body fat mass was measured in kilograms for body 
composition.1 There was no significant change in body composition one week after Ramadan fasting 
compared to before Ramadan.1 All three studies concluded there were no changes to body fat mass at one 
week.4,5,13 When comparing the effects of before Ramadan fasting to the fourth week of Ramadan fasting, 
there were no significant changes in body composition.1 Body fat mass did not change in three 
studies4,5,13 and decreased in one study at four weeks.8  
 
Body Fat Percentage  
The body fat percentage of a varying number of participants was assessed before the start of Ramadan 
and after either two or four weeks of Ramadan fasting. There were no changes in the two studies that 
examined the effects on body fat percentage before Ramadan and after two weeks of Ramadan 
fasting.7,10 After reviewing these two studies, it was determined that there was no significant change in body 
fat percentage from before Ramadan to after two weeks of Ramadan fasting.1 From before the fourth week 
of Ramadan fasting, there was no significant change in body fat percentage.1 One study concluded a 
decrease in body fat percentage7 and two studies concluded no change in body fat percentage at four 
weeks.6,10  
 
Outcome 3 – Lean Mass  
The lean mass of a varying number of participants was calculated in kilograms before the start of Ramadan 
and after four weeks of Ramadan fasting.1 There was no significant change in lean mass from the two 
studies.1 Both studies reported no change in lean mass from before Ramadan to after four weeks of 
Ramadan fasting.7,13   
  
Outcome 4 – Dietary Intake  
The dietary intake of a varying number of participants was recorded before the start of Ramadan 
and during Ramadan fasting. Components of dietary intake that were examined over the twelve studies 
include total energy, protein, fat, carbohydrate, and total water intake. Total energy intake was reported 
to have no change in four studies,3,6,11,14 an increase in two studies,10,12 and a decrease in four studies 
throughout Ramadan.4,5,7,8 The findings from these studies conclude that Ramadan fasting had no significant 
effect on total energy intake.1  Ramadan fasting was shown to have no significant effect on protein 
consumption.1 Throughout Ramadan, protein intake did not change in three studies,7,8 increased in one 
study,10 and decreased in one study.4 Fat intake had no significant change reported throughout 
Ramadan.1 There was no change in fat intake reported in one study,10 an increase in one study,12 
and a decrease in three studies.4,7,8 Carbohydrate intake was also shown to have no significant effect from 
before to during Ramadan.1  Four studies noted no change,7,8,10,12 and one study noted an increase in 
carbohydrate intake throughout Ramadan.4  there was no significant effect on total water intake from 
before to during Ramadan.1  Total water intake had no change in two studies,3,10 increased in one study,12 
and decreased in two studies.4,5 
 
 
 
 



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CLINICAL BOTTOM LINE 
 
As of 2017, an estimated 3.5 million Americans 
practice the religion of Islam.15 As this number 
continues to grow, one can only expect the 
prevalence of Muslim adolescent athletes to 
increase. Due to the physiological strain that 
fasting can have on the body, especially during 
adolescence, the guiding systematic review 
sought to describe the effects of Ramadan 
observance on factors such as body mass, body 
composition, and dietary intake in adolescent 
athletes.1 Following the analysis, it was 
determined that there were no statistically 
significant effects of Ramadan observance on 
body mass, body composition, and dietary 
intake. Muslim athletes may continue to train at 
least three times/week during this month.1 
 
To provide the best patient-centered care, the 
sports medicine team must be culturally 
competent with the spiritual and religious 
practices of the athletes they provide care for.16 
This means understanding the practices of the 
religion and how observing traditions such as 
Ramadan may affect the health and well-being 
of the athlete. Although the guiding systematic 
review did not find any significant effects on 
body mass, body composition, or dietary intake, 
this does not mean that every athlete will fit this 
trend.1 In that case, the athletic trainer should be 
prepared to provide patient-centered care by 
recognizing and addressing the many other 
factors that may affect an athlete during 
Ramadan.  
 
Body composition is the term used to describe the 
components of the human body, which include 
lean mass, fat mass, body water, and bone mass. 
Overall, the authors in the studies observed no 
changes in overall body composition. One reason 
for observing no changes is that there were also 
no changes to the dietary intake and fluid intake 
in participants of their studies. It is important to 
note that changes in overall body composition 
(i.e., body mass, percent body fat, lean mass) are 
also impacted by changes in exercise, something 
that was not objectively measured in these 
studies. It would be important to consider the 
effects of Ramadan fasting on energy 
availability, that is, the amount of dietary energy Figure 1. Dietary Recommendations 



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remaining for physiological mechanisms of the body after exercise.17 Measuring using this method would 
utilize both dietary energy intake and exercise energy expenditure, and changes can be related to two 
other components of the Athlete Triad: menstrual/reproductive function and bone mineral density.17,18 
Moreover, one should note that the newer “gold standard for body composition assessment” is Dual-Energy 
X-ray Absorptiometry (DXA or DEXA), which was not done by any of the studies included. Therefore, the 
results should account for errors in the measures used (bioelectrical impedance and skinfolds).  
 
For adolescents who may not be solely responsible for the food available, it may be beneficial to include 
their legal guardians in conversations regarding the amount and quality of food consumed during Ramadan. 
It could also prove useful to facilitate open discussions with athletes and coaches regarding accommodations 
to training schedules and expectations for performance during this time. In addition to the data’s 
recommendation of training three times a week during Ramadan observance, scheduling these training times 
to accommodate the adolescent's fasting schedule may improve the performance outcomes.16,17 

 
To support the health and well-being of young athletes during their observance of Ramadan, there are three 
main recommendations for athletic trainers to consider. These involve the timing of events, minimizing sleep 
deprivation, and optimizing nutrient uptake and hydration.19,20 More details regarding these 
recommendations can be found in the attached infographic (Figure 1). In addition to the previous 
recommendations, it is also vital to consider the accommodations that may be necessary in the instance of a 
medical emergency. This could include allowing access to cooling towels and/or cooling tubs to assist 
temperature regulation without the intake of fluids.20 If a medical emergency is believed to be caused by 
dehydration and/or heat stroke, the athlete should be provided with fluids, and the emergency action plan 
should be activated. In summation, adolescent athletes observing the religious tradition of Ramadan can still 
compete without adverse effects, provided they continue a typical training pattern, ensure adequate sleep 
each night, and maintain their intake of energy and fluids.19,20  
 
REFERENCES 
 
1. Trabelsi K, Ammar A, Boukhris O, et al. Effects of Ramadan Observance on Dietary Intake and Body 

Composition of Adolescent Athletes: Systematic Review and Meta-Analysis. Nutrients. 2020;12(6):1574. 
https://doi.org/10.3390%2Fnu12061574.  

2. Aziz AR, Chia MYH, Low CY, Slater GJ, Png W, Teh KC. Conducting an acute intense interval exercise 
session during the Ramadan fasting month: What is the optimal time of the day? Chronobiol Int. 
2012;29(8):1139-1150. https://doi.org/10.3109/07420528.2012.708375.  

3. Aziz AR, Slater GJ, Chia MYH, Teh KC. Effects of Ramadan fasting on training induced adaptations to 
a seven-week high-intensity interval exercise programme. Sci Sports. 2012;27(1):31-38. 
https://doi.org/10.1016/j.scispo.2011.03.004.  

4. Bouhlel H, Bogdanis G, Hamila A, et al. Effects of Ramadan observance on repeated cycle ergometer 
sprinting and associated inflammatory and oxidative stress responses in trained young men. JNFH. 
2016;4(1):39-47. https://doi.org/10.22038/jfh.2016.6890.  

5. Bouhlel H, Latiri I, Zarrrouk N, et al. Effet du jeûne du Ramadan et de l’exercice maximal sur le temps 
de réaction simple et de choix chez des sujets entraînés. Science & sports. 2014;29(3):131-137. 
https://doi.org/10.1016/j.scispo.2014.02.002.  

6. Güvenç A. Effects of Ramadan fasting on body composition, aerobic performance and lactate, heart 
rate and perceptual responses in young soccer players. J Hum Kinet. 2011;29:79-91. 
https://doi.org/10.2478/v10078-011-0042-9.  

7. Hammouda O, Chtourou H, Aloui A, et al. Concomitant effects of Ramadan fasting and time-of-day on 
apolipoprotein AI, B, Lp-a and homocysteine responses during aerobic exercise in Tunisian soccer 
players. PLoS One. 2013;8(11):e79873. https://doi.org/10.1371/journal.pone.0079873.  

https://doi.org/10.3390%2Fnu12061574
https://doi.org/10.3109/07420528.2012.708375
https://doi.org/10.1016/j.scispo.2011.03.004
https://doi.org/10.22038/jfh.2016.6890
https://doi.org/10.1016/j.scispo.2014.02.002
https://doi.org/10.2478/v10078-011-0042-9
https://doi.org/10.1371/journal.pone.0079873


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8. Hammouda O, Chtourou H, Aloui A, et al. Does Ramadan fasting affect the diurnal variations in metabolic 
responses and total antioxidant capacity during exercise in young soccer players? Sport Sciences for 
Health. 2014;10(2):97-104. https://doi.org/10.1007/s11332-014-0179-8.  

9. Lotfi S, Madani M, Tazi A, Zerdani I, Boumahmaza M, Talbi M. Effets du jeûne de Ramadan sur les 
performances physiques et la VO2 max chez les coureurs de demi-fond et les footballeurs. Revue Sci 
Staps. 2010;17:27-37. 

10. Maughan RJ, Bartagi Z, Dvorak J, Zerguini Y. Dietary intake and body composition of football players 
during the holy month of Ramadan. J Sports Sci. 2008;26(sup3):S29-S38. 
https://doi.org/10.1080/02640410802409675.  
 

11. Meckel Y, Ismaeel A, Eliakim A. The effect of the Ramadan fast on physical performance and dietary 
habits in adolescent soccer players. Eur J Appl Physiol. 2008;102(6):651-657. 
https://doi.org/10.1007/s00421-007-0633-2.  

12. Zarrouk N, Hammouda O, Latiri I, et al. Ramadan fasting does not adversely affect neuromuscular 
performances and reaction times in trained karate athletes. J Int Soc Sports Nutr. 2016;13(1):1-10. 
https://doi.org/10.1186/s12970-016-0130-2.  

13. Zarrouk N, Hug F, Hammouda O, et al. Effect of Ramadan intermittent fasting on body composition and 
neuromuscular performance in young athletes: a pilot study. Biol Rhythm Res. 2013;44(5):697-709. 
https://doi.org/10.5812%2Fasjsm.34754.  

14. Aloui A, Chtourou H, Hammouda O, et al. Effects of Ramadan on the diurnal variations of physical 
performance and perceived exertion in adolescent soccer players. Biological Rhythm Research. 
2013;44(6):869-875. https://doi.org/10.1080/09291016.2013.780697.  

15. Mohamed B. New estimates show U.S. Muslim population continues to grow. Pew Research Center. May 
30, 2020. Accessed August 22, 2023. https://www.pewresearch.org/short-reads/2018/01/03/new-
estimates-show-u-s-muslim-population-continues-to-grow/.  

16. Jayadevappa R, Chhatre S. Patient centered care-a conceptual model and review of the state of the 
art. Open Health Serv and Policy J. 2011;4(1). http://dx.doi.org/10.2174/1874924001104010015.  

17. Nattiv A, Loucks AB, Manore MM, et al. American College of Sports Medicine position stand. The female 
athlete triad. Med Sci Sports Exerc. 2007;39(10):1867-1882. 
https://doi.org/10.1249/mss.0b013e318149f111.  

18. Nattiv A, De Souza MJ, Koltun KJ, et al. The Male Athlete Triad-A Consensus Statement From the Female 
and Male Athlete Triad Coalition Part 1: Definition and Scientific Basis. Clin J Sport Med. 
2021;31(4):345-353. https://doi.org/10.1097/jsm.0000000000000946.  

19. Maughan RJ, Zerguini Y, Chalabi H, Dvorak J. Achieving optimum sports performance during Ramadan: 
some practical recommendations. J Sports Sci. 2012;30 Suppl 1:S109-S117. 
https://doi.org/10.1080/02640414.2012.696205.  

20. Shephard RJ. The impact of Ramadan observance upon athletic performance. Nutrients. 2012;4(6):491-
505. https://doi.org/10.3390%2Fnu4060491.  

https://doi.org/10.1007/s11332-014-0179-8
https://doi.org/10.1080/02640410802409675
https://doi.org/10.1007/s00421-007-0633-2
https://doi.org/10.1186/s12970-016-0130-2
https://doi.org/10.5812%2Fasjsm.34754
https://doi.org/10.1080/09291016.2013.780697
http://dx.doi.org/10.2174/1874924001104010015
https://doi.org/10.1249/mss.0b013e318149f111
https://doi.org/10.1097/jsm.0000000000000946
https://doi.org/10.1080/02640414.2012.696205
https://doi.org/10.3390%2Fnu4060491

	ABSTRACT

