Diabetes polygenic risk scores and maternal characteristics in Hoosier Moms Cohort participants.

As the standard of competitive sport continues to rise, athletes are exposed to greater physical demands during training and competition, more stringent recovery requirements, and increasingly congested competition schedules [,]. To enhance athletic performance, delay fatigue, and accelerate physiological recovery, sports supplements have been widely incorporated into athletes’ daily training and competition routines and have gradually become an important component of sports nutrition support []. Athletes represent the primary users of sports supplements, with prevalence rates substantially higher than those observed in the general population, typically ranging from 40% to 80%; among elite athletes, supplement use may even exceed 90% [,,]. These findings indicate that the use of sports supplements has become an integral part of routine athletic training. Multiple studies have demonstrated that athletes’ motivations for using sports supplements are multifaceted, encompassing various objectives such as improving health status, enhancing athletic performance, accelerating post-exercise recovery, and modulating immune function [,,,]. Among these, health improvement and performance enhancement represent the primary motivations reported across most studies; however, their relative importance is influenced by multiple factors, including geographic region, competitive level, and sex, resulting in substantial heterogeneity across athlete populations [,,,]. Notably, athletes with disabilities exhibit distinct physiological characteristics and nutritional requirements due to variations in disability types and functional status, leading to considerable inter-individual heterogeneity in their needs for sports supplementation [,,]. A study by Madden et al. in elite Paralympic athletes revealed that the primary motivations for sports supplement use in this population were health maintenance, energy provision, and medical-related needs. Although the overall pattern of motivations was comparable to that observed in able-bodied athletes, medical considerations exerted a more prominent influence []. Furthermore, supplement use among athletes is not solely driven by individual decision-making; social and environmental factors, including recommendations from coaches and behaviors modeled by peers, also play important roles. These findings suggest that sports supplement use represents the interplay between individual needs and social influences []. Collectively, these diverse motivations highlight that sports supplements have become deeply integrated into the contemporary training and competitive practices of athletes. However, although sports supplements may offer potential benefits for improving performance and promoting recovery, their safety remains insufficiently supported by robust evidence []. Previous studies have shown that long-term or high-dose use of certain sports supplements may exert adverse effects on multiple organ systems, particularly key target organs such as the cardiovascular system, liver, and kidneys []. For the purposes of this review, long-term supplementation was operationally defined as continuous or repeated intake for at least 8 weeks, or supplementation sustained over a complete training cycle or competitive season []. High-dose supplementation was defined as an intake exceeding one or more established reference thresholds, including recommended daily intake levels, tolerable upper intake levels (ULs), evidence-based ergogenic doses, or manufacturer-recommended dosages [,]. Such damage may not only compromise athletic performance but also negatively affect athletes’ long-term health and quality of life []. Nevertheless, most athletes still have relatively limited awareness of the potential health risks associated with sports supplements. At the same time, misleading commercial claims and marketing messages have contributed to the increasingly common irrational use and even misuse of these products [,]. In this context, for athletes who use sports supplements over prolonged periods, insufficient understanding of the potential harms associated with inappropriate use may prevent them from achieving the intended benefits and may instead adversely affect their health []. For example, long-term or high-dose intake of exogenous antioxidants such as vitamin C or vitamin E may disrupt the dynamic balance between free radicals and endogenous antioxidant defense systems, thereby promoting lipid peroxidation and inflammatory responses and exacerbating oxidative stress-related injury. In addition, excessive antioxidant supplementation may inhibit the activation of reactive oxygen species (ROS)-mediated exercise-adaptive signaling pathways, attenuating exercise-induced adaptive responses and altering the expression of adaptation-related genes and protein synthesis, ultimately impairing skeletal muscle function and cardiovascular health []. Therefore, the use of sports supplements should not be considered solely