Effects of curcumin supplementation on sport and physical exercise: a systematic review

Abstract

Curcumin is the main phenolic compound in turmeric. It has been investigated recently due to its numerous medicinal properties and health benefits. However, few studies assessed the effects of curcumin supplementation on physical activity practice. Therefore, the purpose of this review is to assess the available evidences with human beings about the potential effects of curcumin supplementation on sport and physical exercise. This systematic review was conducted within the period from January to February, 2019, following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines. The LILACS, Medline, SciELO and PubMed databases were used for the search, with no publication date limit. The following terms, with the respective Boolean operators, were searched: “curcumin” AND sports; “curcumin” AND exercise; curcumin AND “aerobic exercise”; “curcumin” AND “resistance exercise”; “curcumin” AND “endurance exercise”; “curcumin” AND “strength exercise”. Eleven papers were selected for this review. Most of the studies displayed positive effects of the curcumin supplementation for athletes and physical exercise practitioners, and no side effects were reported. Participants supplemented with curcumin displayed reduced inflammation and oxidative stress, decreased pain and muscle damage, superior recovery and muscle performance, better psychological and physiological responses (thermal and cardiovascular) during training and improved gastrointestinal function. Curcumin supplementation appears to be safe and beneficial for sport and physical exercise in human beings. PROSPERO (CRD42019126763).

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Effects of curcumin supplementation on sport and
physical exercise: a systematic review
Lara Gomes Suhett, Rodrigo de Miranda Monteiro Santos, Brenda Kelly
Souza Silveira, Arieta Carla Gualandi Leal, Alice Divina Melo de Brito, Juliana
Farias de Novaes & Ceres Mattos Della Lucia
To cite this article: Lara Gomes Suhett, Rodrigo de Miranda Monteiro Santos, Brenda Kelly
Souza Silveira, Arieta Carla Gualandi Leal, Alice Divina Melo de Brito, Juliana Farias de
Novaes & Ceres Mattos Della Lucia (2020): Effects of curcumin supplementation on sport and
physical exercise: a systematic review, Critical Reviews in Food Science and Nutrition, DOI:
10.1080/10408398.2020.1749025
To link to this article: https://doi.org/10.1080/10408398.2020.1749025
Published online: 13 Apr 2020.
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REVIEW
Effects of curcumin supplementation on sport and physical exercise:
a systematic review
Lara Gomes Suhett
a
, Rodrigo de Miranda Monteiro Santos
b
, Brenda Kelly Souza Silveira
a
,
Arieta Carla Gualandi Leal
a
, Alice Divina Melo de Brito
a
, Juliana Farias de Novaes
a
, and
Ceres Mattos Della Lucia
a
a
Department of Nutrition and Health, Universidade Federal de Vic¸osa (UFV), Vic¸osa, Minas Gerais, Brazil;
b
Department of Physical Education,
Universidade Federal de Vic¸osa (UFV), Vic¸osa, Minas Gerais, Brazil
ABSTRACT
Curcumin is the main phenolic compound in turmeric. It has been investigated recently due to its
numerous medicinal properties and health benefits. However, few studies assessed the effects of
curcumin supplementation on physical activity practice. Therefore, the purpose of this review is to
assess the available evidences with human beings about the potential effects of curcumin supple-
mentation on sport and physical exercise. This systematic review was conducted within the period
from January to February, 2019, following the recommendations of the Preferred Reporting Items
for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines. The LILACS, Medline, SciELO and
PubMed databases were used for the search, with no publication date limit. The following terms,
with the respective Boolean operators, were searched: “curcumin”AND sports; “curcumin”AND
exercise; curcumin AND “aerobic exercise”;“curcumin”AND “resistance exercise”;“curcumin”AND
“endurance exercise”;“curcumin”AND “strength exercise”. Eleven papers were selected for this
review. Most of the studies displayed positive effects of the curcumin supplementation for athletes
and physical exercise practitioners, and no side effects were reported. Participants supplemented
with curcumin displayed reduced inflammation and oxidative stress, decreased pain and muscle
damage, superior recovery and muscle performance, better psychological and physiological
responses (thermal and cardiovascular) during training and improved gastrointestinal function.
Curcumin supplementation appears to be safe and beneficial for sport and physical exercise
in human beings. PROSPERO (CRD42019126763).
KEYWORDS
Turmeric; antioxidant;
exercise; nutritional
supplements; sports
Introduction
The turmeric (Curcuma longa L.) is an oriental spice
of yellowish color from the ginger (Zingiberaceae) family
(Ammon and Wahl 1991; Hewlings et al. 2017; Priyadarsini
2014). This spice is widely grown in tropical regions, with
India being its main producer (Ammon and Wahl 1991). In
Asian countries, turmeric is frequently used as a medicinal
herb as well as in cooking due to its pleasant odor and
slightly spicy and bitter taste (Ammon and Wahl 1991;
Hewlings et al. 2017; Salehi et al. 2019). Its composition
includes three curcuminoids: curcumin (60–70%), demetoxi-
curcumin (20–27%) and bisdemetoxicurcumin (10–15%),
besides other components such as volatile oils (turmerone,
atlantone and zingiberene), proteins, sugars and resins
(Jurenka 2009; Nelson et al. 2017).
Curcumin (1.7-bis (4-hidroxi-3 methoxyphenol)-1.6
heptadiene-3.5-diona), also known as diferuloylmethane, is
the main phenolic compound from the turmeric. This com-
pound was isolated from the rhizomes of the turmeric in
1865 by Vogel and Pelletier (1815) and had its structure
characterized by MiłobeRdzka, Kostanecki, and Lampe (1910).
Curcumin has recently drawn worldwide attention of
researchers (Salehi et al. 2019), who conducted studies that
indicated that its medicinal properties are associated with
the reduction of pain (Karlapudi et al. 2018; Sun et al.
2018), anti-inflammatory effects (Ghandadi and Sahebkar
2017; Mollazadeh et al. 2019), besides prevention and treat-
ment of cardiovascular (Li et al. 2020; Momtazi-Borojeni
et al. 2019) and gastrointestinal (GI) diseases (Ghosh et al.
2018; Mazieiro et al. 2018), cancer (Kunnumakkara et al.
2017; Mizumoto et al. 2019; Talib et al. 2018) and other
chronic diseases (Kunwar and Priyadarsini 2016; Prasad
et al. 2014; Salehi et al. 2019; Sharan Patel et al. 2019).
Also, studies that employed animal models reported
positive results of curcumin supplementation for physical
activity and sport performance (Huang et al. 2015), thus
supporting muscle recovery and reduction of inflammation
(Davis et al. 2007), improvement of mitochondrial biogen-
esis (Ray Hamidie et al. 2015), reduction of oxidative stress
(Kawanishi et al. 2013), prevention of fatigue and muscle
damage (Huang et al. 2015; Sahin et al. 2016). However,
there is lack of studies conducted with humans that assessed
CONTACT Lara Gomes Suhett nutrilarasuhett@gmail.com Nutrition Postgraduation Program. Department of Nutrition and Health, Universidade Federal de
Vic¸osa (UFV), Av. P.H. Rolfs s/n, Campus Universit
ario, CEP 36570-000, Vic¸osa –Minas Gerais, Brazil.
ß2020 Taylor & Francis Group, LLC
CRITICAL REVIEWS IN FOOD SCIENCE AND NUTRITION
https://doi.org/10.1080/10408398.2020.1749025

the effects of curcumin supplementation on physical exer-
cise. There is still no consensus in literature about the min-
imal dose for obtention of benefits for sports and exercise.
Therefore, this review aimed to assess the currently available
evidence about the potential effects of curcumin supplemen-
tation on humans in sports and physical exercise.
Materials and methods
Identification and selection of studies
This systematic review focused on the following research
question: “Is curcumin supplementation advantageous for
sports practice in humans?”The present paper was designed
within the period from January to February 2019, based
on the PRISMA (Preferred Reporting Items for Systematic
Reviews and Meta-Analyzes) guidelines and registered
in PROSPERO (CRD42019126763).
The following databases were searched: dados Latin-
American and Caribbean System on Health Sciences
Information (LILACS), Medical Literature Analysis and
Retrieval System Online (Medline), Scientific Electronic
Library Online (SciELO) e National Library of Medicine,
Bethesda, MD (PubMed), with no publication date limit.The
following search strategy was carried out using the combin-
ation of important words related to curcumin and exercise,
as well as the descriptors from the Medical Subject Headings
(MeSH) index with the respective Boolean operators:
“curcumin”AND “sports”;“curcumin”AND “exercise”;
“curcumin”AND “aerobic exercise”;“curcumin”AND
“resistance exercise”;“curcumin”AND “endurance exercise”;
“curcumin”AND “strength exercise”. The search was
restricted to papers written in English language.
A protocol for identification and selection of original
studies was defined by the authors (Figure 1). The papers
were analyzed and selected manually, independently and
simultaneously by two authors (L.G.S. and B.K.S.S). As for
the cases that raised doubt, the reviewers jointly assessed the
paper, in order to achieve an agreement. Initially, 346 papers
were identified, and subsequently screened by their title and
abstract. After the assessment of the eligibility criteria, 11
papers were selected for the present review.
Eligibility criteria
1. Inclusion: Published intervention studies with human
beings, which assessed the effects of curcumin supple-
mentation on sports and exercise performance.
2. Exclusion: Studies conducted with animals or in vitro;
review papers; book chapters; books; abstracts; studies
unrelated to curcumin supplementation; studies involv-
ing factors other than sports and physical exercise (e.g.,
osteoarthritis, depression, cardiovascular diseases, fibro-
sis, cancer); unpublished paper; monographs; thesis; dis-
sertation; duplicated papers; studies whose authors have
stated conflicts of interest.
Data extraction
Data gathered about the selected papers were: author; year of
publication; country; study design; sample (n); sample age; dos-
age used; duration of the intervention; kind of physical exercise;
outcome variables; main findings related to the effects of curcu-
min; presence of significant result and side effects.
Risk of bias
To assess the risk of bias of the studies included in this
review, the Cochrane Collaboration tool was used (Higgins
and Green 2008). The studies were assessed according to 3
levels of bias: high risk, low risk and unclear (insufficient
information for an appropriate judgment). The following
kinds of bias were considered: random sequence generation
(selection bias); allocation concealment (selection bias); blind-
ing of participants and personnel (performance bias); blinding
of outcome assessment (detection bias); incomplete outcomes
(friction bias); selective outcome reporting (reporting bias);
and finally, other sources of bias (Higgins and Green 2008).
Results
Selection and description of the studies
A total of 346 papers were identified through the combined
descriptors. From these, 11 original papers were eligible and
were included in this review (Figure 1). All the selected studies
are mostly randomized (n ¼8) and crossover (n ¼8) clinical
trials, conducted with adult participants, whereas samples were
comprised of male individuals (n ¼8). Sample size and time of
intervention varied from 8 to 47 participants and from 1 day to
3 months, respectively. The used curcumin dosages varied from
0.01 g to 6 g/day, and curcumin was administered either in iso-
lation, or associated to other compounds (piperine; Boswellia
extract). The kinds of exercises performed varied between aer-
obic (n ¼7) and resistance (n ¼4) (Table 1).
Other characteristics of the studies, such as author and
year of publication, study location, are describe in Table 1.
Table 2, in turn, displays the information about the outcome
variables (curcumin’s serum concentration, inflammation,
muscle soreness and damage, recovery and muscle perform-
ance, oxidative stress markers, psychological and physio-
logical parameters (thermal and cardiovascular) and GI
function), besides the description of the main results and
the presence of side effects reported in the studies.
Curcumin’s serum concentration
Curcumin’s serum concentration was assessed in less than
half of the papers (n ¼3) (Takahashi et al. 2013; Tanabe,
Chino, Ohnishi, et al. 2019; Tanabe, Chino, Sagayama, et al.
2019). Significant differences were observed in curcumin’s
serum concentration, whereas in baseline the group supple-
mented before the resistance exercise (180 mg/day –7 days)
displayed higher values in comparison to the placebo and
the group supplemented with curcumin after the exercise
(180 mg/day –4 days). Between 1 and 4 days after the
2 L. G. SUHETT ET AL.

exercise, the curcumin’s serum concentration was higher in
the group supplemented after the exercise (Tanabe, Chino,
Sagayama, et al. 2019). Another study also assessed the effects
of the curcumin supplementation (180 mg/day –7days)
through two experiments, which analyzed the curcumin’s
serum concentration after performing resistance exercise. In
experiment 1, curcumin supplementation was performed 7 days
prior to the exercise, and a significant reduction in plasmatic
concentration was observed, in comparison to the baseline.
However, in experiment 2, curcumin supplementation was car-
ried out during 7 days after the exercise, and a significant
increase was observed for the curcumin’s serum concentration
1 day after the exercise, compared to the baseline, and has
remained as such in the 3, 5 and 7 subsequent days (Tanabe,
Chino, Ohnishi, et al. 2019).
In turn, Sciberras et al. (2015) carried out curcumin sup-
plementation before the aerobic exercise in the cycle
ergometer (500 mg/day for 3 days þ500 mg pre-exercise)
and assessed the curcumin’s plasmatic concentration after
the exercise and reported an average of 79.7 ± 26.3 mg/ml in
the supplemented group, whilst no curcumin concentration
was observed in the control group’s plasma. Takahashi et al.
(2013) supplemented curcumin 2 h prior to the aerobic exer-
cise in the treadmill (group 1: 90 mg and group 2: 90 mg þ
90 mg pre-exercise) and observed a significant increase
of their serum concentrations in the baseline, immediately
after, and 2 h after the exercise, in both supplemented
groups, when compared to the placebo group.
Inflammation
Curcumin supplementation displayed significant reduction
of inflammation derived from the physical exercise
(Table 2). Szymanski et al. (2018), in their study with 8
Figure 1. Protocol for identification and selection of eligible studies for the systematic review on the effects of curcumin supplementation on exercise.
CRITICAL REVIEWS IN FOOD SCIENCE AND NUTRITION 3

Table 1. Characteristics of the studies included.
Author/year Country Study design Sample (n) Age Intervention Duration Exercise test
Tanabe, Chino, Sagayama,
et al. (2019)
Japan Randomized single-
blind
parallel clinical trial
24 Healthy young
individuals
(20 M)
Group 1: 28.8 ± 3.6
years
Group 2: 29.8 ± 3.4
years
Group 3: 28 ± 3.2 years
Group 1: 180 mg/day of
curcumin Theracurmin.
Group 2: 180 mg/day of
curcumin Theracurmin.
Group 3: Placebo.
Group 1: 7 days before
the exercise.
Group 2: 4 days after
the exercise.
Group 3: 4 days after
the exercise
Resistance exercise:
30 maximal eccentric
isokinetic (120
o
/s)
contractions of elbow flexors.
Tanabe, Chino, Ohnishi,
et al. (2019)
Japan Double-blind crossover
clinical trial
20 Healthy individuals
(20 M)
Experiment 1:
28.5 ± 3.4 years
Experiment 1:
Group 1: 180 mg/day of
Theracurmin curcumin.
Group 2: Placebo (starch).
Experiment 1:
7 days before the
exercise.
Resistance exercise:
30 maximal eccentric
isokinetic (120
o
/s)
contractions of elbow flexors.
Tanabe, Chino, Ohnishi,
et al. (2019)
Japan Double-blind crossover
clinical trial
20 Healthy individuals
(20 M)
Experiment 2:
29 ± 3.9 years
Experiment 2:
Group 1: 180 mg/day of
Theracurmin curcumin.
Group 2: Placebo (starch).
Experiment 2:
7 days after the
exercise.
Resistance exercise:
30 maximal eccentric
isokinetic (120
o
/s)
contractions of elbow flexors.
Szymanski et al. (2018)USA Double-blind crossover
clinical trial
8 Healthy and
physically active
individuals
(6 M and 2 W)
19 ± 1 years Group 1: 500 mg/day of
Meriva
V
R
curcumin.
Group 2: Placebo.
3 days before
the exercise.
1h of aerobic exercise
(treadmill running) at 65%
VO2 max.
Falgiano et al. (2018)USA Double-blind crossover
clinical trial
8 Healthy and
physically active
individuals
(6 M and 2 W)
19 ± 1 years Group 1: 500 mg/day of
Meriva
V
R
curcumin.
Group 2: Placebo.
3 days before
the exercise.
1 h of aerobic exercise
(treadmill running) at 65%
VO2 max.
McAllister et al. (2018)USA Randomized double-
blind crossover
clinical trial
14 Apparently healthy
and physically
active individuals
(14 M)
21–30 years Group 1: 1.5g/day of
curcumin.
Group 2: Placebo (cellulose).
3 days before
the exercise.
35 min of steady-state aerobic
exercise (cycling) at 60%
VO2 max with mental
stress challenges.
Delecroix et al. (2017)France Randomized single-
blind crossover
clinical trial
10 Elite rugby players
(10 M)
20.7 ± 1.4 years Group 1: 6 g of curcumin þ
60 mg of piperine/day.
Group 2: Placebo (glucose).
4 days (2 days before
and 2 days
post-exercise)
25 repetitions over 25 m of
one leg jumps on a 8%
downhill slope with 90-
second interval between
them, covering 25m as fast
as possible and stopping in
a pre-defined zone of 3.5m
at the end of the 25
m slope.
McFarlin et al. (2016)
USA
Randomized double-
blind clinical trial
28 Individuals
(10 M and 18 W) Group 1:
20 ± 1 yearsGroup 2:
19 ± 2 years
Group 1: 400 mg/day of
Longvida
V
R
curcumin.
Group 2: Placebo (rice flour).
7 days (2 days before,
on the day and 4
days after
the exercise)
Resistance exercise:
6 series of 10 repetitions of
eccentric exercise (leg press)
with initial load set at 110%
of the estimated 1RM
Chilelli et al. 2016 Italy Controlled randomized
parallel clinical trial
47 Cyclists
(47 M)
Group 1:
45 ± 9 yearsGroup 2:
46 ± 8 years
Group 1: Mediterranean diet
þ50 mg Phytome
V
R
turmeric (10 mg of
curcumin) þ140 mg of
Boswellia extract (105 mg
of boswellic acid.)
Group 2: Control
(Mediterranean diet).
3 months. Aerobic exercise (cycling),
around 200 km weekly.
4 L. G. SUHETT ET AL.

physically active individuals, reported that the serum con-
centration of the interleukin receptor antagonist (IL1-RA)
displayed higher elevation for the placebo group than for
the curcumin group (CG) (500 mg/day –3 days) after aer-
obic exercise (1 h of treadmill running), when compared to
pre-exercise moment. After the exercise, the alpha tumor
necrosis factor (TNF-a) increased in the placebo group
(immediately after: 19% and 1 h after: 24%; p ¼0.01), as well
as interleukin-10 (IL-10) (immediately after: 61% and 1 h
after: 42%; p <0.01). However, such an increase was not
observed for the CG (p >0.05). Another study, carried out
in Japan with 20 healthy males (Tanabe, Chino, Ohnishi,
et al. 2019), reported that interleukin-8 serum concentration
(IL-8) 12 h after the resistance exercise was lower for the CG
in experiment 1 (180 mg/day –7 days prior the exercise),
compared to the placebo group. In a clinical trial performed
in the USA with 28 individuals (McFarlin et al. 2016), the
magnitude of the increases was significantly lower in the CG
(400 mg/day –7 days) for TNF-a(25%; p ¼0.028) and IL-
8(21%; p ¼0.030) after resistance exercise-induced muscle
damage, in comparison to the placebo. Likewise, in a study
carried out in New Zealand with 17 physically active males
(Nicol et al. 2015), the authors observed that the CG (5 g/
day –5 days) displayed lower interleukin-6 (IL-6) concentra-
tion 24 h after the exercise (20%; ±18%), compared to the
moment immediately after the performance of resistance
exercise. However, other studies did not report significant
differences between the groups with respect to the inflam-
matory markers assessed (Chilelli et al. 2016; Falgiano et al.
2018; Sciberras et al. 2015).
Pain and muscle damage
Despite some inconclusive findings, in general, curcumin
supplementation appears to be benefic for decreased pain
and also muscle damage by decreasing serum CK (Table 2).
Reduced muscle pain was observed on the 3
rd
day post-
resistance exercise for the post-exercise CG (180 mg/day –
4 days) compared to the placebo group and the group sup-
plemented 7 days prior to the exercise. However, there were
no differences in relation to creatine kinase’s (CK) serum
concentration between groups (Tanabe, Chino, Sagayama,
et al. 2019). Another study observed that the score for
muscle pain was lower for the CG (180 mg/day –7 days
after the exercise) 3–6 days after the exercise when compared
to the placebo group. In addition, CK serum concentrations
were lower for the CG 5–7 days after the exercise in com-
parison to the placebo group (Tanabe, Chino, Ohnishi, et al.
2019). Similar findings were reported by Nicol et al. (2015),
in which individuals supplemented with curcumin (5 g/day –
5 days) displayed reduced muscle pain and lower CK serum
concentration CK (22–29%; ± 21–22%) 24- and 48-hours
post-resistance exercise.
Despite having observed significantly lower CK increases
(48%; p ¼0.035) for the CG, McFarlin et al. did not report
significant differences in quadriceps muscle pain between
the groups after 6 series of 10 leg press repetitions with
approximate load of 110% 1RM (repetition maximum).
Nicol et al. (2015)New Zealand Controlled Randomized
double-blind
crossover clinical
trial
17 Physically active
individuals
(17 M)
33.8 ± 5.4 years
Group 1: 5 g/day of curcumin
Group 2: Placebo (Avicel 105).
5 days (2.5 days
before and 2.5 days
after the exercise)
Resistance exercise:
5 sets of 10 repetitions at
120% 1RM þ2 sets of 10
repetitions at 100% 1RM of
eccentric exercise (single-
leg press).
Sciberras et al. (2015)United Kingdom Randomized double-
blind crossover
clinical trial
11 Aerobic exercise
athletes
(11 M)
35.5 ± 5.7 years Group 1: 500 mg/day of
Meriva
V
R
curcumin.
Group 2: Placebo.
Group 3: No supplementation.
4 days (3 days before
þ500 mg prior
to exercise).
2 h of aerobic exercise (cycle
ergometer –70 rpm) at
95% power from
lactate threshold.
Takahashi et al. (2013) Japan Randomized double-
blind placebo-
controlled crossover
clinical trial
10 Healthy individuals
(10 M)
26.8 ± 2 years Group 1: 90 mg of curcumin
2 h before the exercise.
Group 2: (180 mg/day) 90 mg
of curcumin 2h before þ
90 mg immediately after the
exercise.
Group 3: Placebo.
1 day. 2 h of aerobic exercise
(treadmill walking or
running)
at 65% VO2 max.
g, grams; M, men; mg, milligrams; mg/day, milligrams per day; RM, repetition maximum; VO2 max, maximum rate of oxygen consumption; W, women.
CRITICAL REVIEWS IN FOOD SCIENCE AND NUTRITION 5

Table 2. Outcome variables, main results and side effects.
Author/year Outcome variables Main results Side effects? (yes/no)
Tanabe, Chino, Sagayama,
et al. (2019)
Before, immediately after, and 1–4 d after:
Curcumin’s plasmatic concentration;
MVC of elbow flexors; ROM of elbow
joint; Muscle pain; CK.
Following resistance exercise, ROM was higher 3–4 days after
the exercise for group 2 (curcumin supplementation after
the exercise) compared to placebo. The score for muscle
pain was lower for group 2–3 days after the exercise
(p <0.05).
–
Tanabe, Chino, Ohnishi,
et al. (2019)
Before, immediately after, and 1–7 d after:
Curcumin’s plasmatic concentration;
MVC of elbow flexors; ROM of elbow
joint; Muscle pain; CK; IL-8; TNF-a;d-
ROMs; BAP.
In experiment 1, IL-8 was lower 12h after the exercise for the
CG, compared to placebo.
–
Tanabe, Chino, Ohnishi,
et al. (2019)
Before, immediately after, and 1–7 d after:
Curcumin’s plasmatic concentration;
MVC of elbow flexors; ROM of elbow
joint; Muscle pain; CK; IL-8; TNF-a;d-
ROMs; BAP.
In experiment 2, MVC and ROM were improved 3–7 days and
2–7 days after the exercise, respectively. Muscle soreness
and CK were lower 3–6 days and 5–7 days after the exercise,
respectively, for the CG compared to placebo.
–
Szymanski et al. (2018)Before, immediately after, 1hr and 4hrs
after:
Physiological parameters (VE, VO2,
VCO2, RER, PSI, Hydration, Heart rate,
skin temperature, body temperature
and internal temperature); I-FABP;
Inflammation markers (MCP-1, IL-6, IL1-
RA, IL-10, TNF-a).
I-FABP (after exercise: 87% vs. 58%; 1h after exercise: 33% vs.
18%), IL1-RA (1h after exercise: 153% vs. 77%) increased
more after the exercise for the placebo group than the CG.
TNF-a(after exercise: 19% and 1h after exercise: 24%;
p¼0.01) and IL-10 (after exercise: 61% e 1h after exercise:
42%; p <0.01) increased for the placebo group, but not for
the CG (p >0.05) after the exercise. The absolute increase of
internal temperature (2.42 ± 0.26 C vs. 2.13 ± 0.30 C;
p¼0.019), average body temperature (2.38 ± 0.24 C vs.
2.12 ± 0.28 C; p ¼0.049), heart rate (39 ± 5 bpm vs. 30 ± 7
bpm; p ¼0.012) and PSI (9.76 ± 0.57 vs. 8.73 ± 0.76;
p¼0.047) were higher for the placebo compared to the CG
over the 60min exercise. The risk of insolation was lower for
the CG after 40-60 min of exercise (p <0.01).
No
Falgiano et al. (2018)Before, immediately after, 1hr and 4hrs
after:
TLR4; MyD88; pNF-jB; NF-jB; SIRT1; p-
AMPK; pHSF-1; HSP70,
Compared to placebo, CG did not change protein expression in
PBMC (p >0.05) after exercise-induced exertional heat stress.
However, reductions in the placebo and CGs were observed
1h after the exercise, in TLR4 (22.8 and -19.8%; p¼0.03),
HSP70 (15.7% and -6.3%; p¼0.04), pAMPK (52.7% and
-44.3%; p<0.01) and SIRT1 (49.5% and -46.1%; p<0.01).
The pNF-jB - NF-jB ratio increased in both conditions
(þ57.4% and þ93.4%; p¼0.02).
No
McAllister et al. (2018)Before, immediately after, 30 min and 1 hr
after:
Heart rate; GSH; SOD; H2O2; AOPP.
Curcumin ingestion did not result in significant impact on
oxidative stress markers after exposure to double stress
(mental and physical) for trained males. –
Delecroix et al. (2017)Immediately after, 24 hrs, 48 hrs and
72 hrs after:
Concentric and isometric torque peak
for knee extensor; 6-second one-leg
sprint performance; Jumping
performance; CK; Muscle soreness.
Effects on recovery of some aspects of muscle function 24h
after physical activity. Decreased loss of mean power during
sprint for the CG (1.77 ± 7.25%; 1277 ± 153W), compared to
placebo (13.6 ± 13.0%; 1130 ± 241W) (Effect size ¼1.12;
CI 90% ¼-1.86 - 0.29).
–
McFarlin et al. (2016)Before, 1 d, 2 d, 3 and 4 d after:
Muscle soreness; CK; Inflammatory
cytokines (IL-6, TNF-a, IL-8, IL-10).
Significantly lower increases of CK (48%; p ¼0.035), TNF-a
(25%; p ¼0.028), and IL-8 (21%; p ¼0.030) for the CG,
after exercise-induced muscle damage, compared to placebo. No
Chilelli et al. (2016)Before and 3 months later:
IL-6; TNF-a; CRP; AGE; sRAGE; MDA;
PPFA; NEFA.
Significant reduction in the accumulation of total AGEs
(11.59 ± 12.49 vs. 0.15 ± 2.30; p <0.001) and MDA
(0.10 ± 0.006 vs. 0.07 ± 0.03; p <0.02) for the CG,
compared to control group.
No
Nicol et al. (2015)Before, immediately after, 24hrs and 48hrs
after:
Muscle pain and swelling; Muscle
sensitivity; Jumping performance; CK;
IL-6; TNF-a.
Curcumin supplementation reduced single-leg muscle pain
symptoms in several locations 24 and 48 h after the exercise.
CG also displayed lower CK concentration 24 and 48 h after
the exercise (22–29 %; ± 21–22 %) and lower IL-6 24h
following the exercise (20 %; ±18 %). No significant
differences in TNF-a. Improved muscle performance
(determined by the increased height of the single-leg 1st
jump) 24 and 48 h after the resistance exercise (15 %; 90
%CL ± 12 %).
No
Sciberras et al. (2015)Before, immediately after and 1hr after:
Curcumin’s plasmatic concentration; IL-
6; TNF-a; IL1-RA; IL-10; Cortisol; CRP.
Before:
Psychological stress.
CG reported higher amount of “better than usual”results, with
respect to training stress, when compared to placebo and
control groups. No
(continued)
6 L. G. SUHETT ET AL.

Another clinical trial carried out in France, with 10 rugby
players supplemented with curcumin þpiperine (6 g/day þ
60 mg/day –4 days), also displayed no effects on the reduc-
tion of pain or muscle damage (Delecroix et al. 2017).
Muscle recovery and performance
After curcumin supplementation there was a significant
improvement in some aspects of muscle recovery and per-
formance in exercise (Table 2). Curcumin supplementation
post-resistance exercise (180 mg/day –4 days) improved the
range of movement (ROM) 3–4 days following the exercise
in comparison to the placebo group (Tanabe, Chino,
Sagayama, et al. 2019), thus substantiating the findings of
Tanabe, Chino, Ohnishi, et al. (2019), which suggests that
post-exercise supplementation contributed to muscle recov-
ery. Another study (Delecroix et al. 2017) reported lower
average loss of power in sprints for the CG (6 g curcumin þ
60 mg piperine/day –4 days) (1.77 ± 7.25%; 1277 ± 153 W)
when compared to the placebo (13.6 ± 13.0%;
1130 ± 241 W). Nicol et al. (2015) observed improved muscle
performance (determined by the increase in the 1st jump
height) 24- and 48-hours after resistance exercise (15%; 90%
CL ± 12%) in individuals supplemented with curcumin (5 g/
day –5 days). However, no significant difference was
observed in relation to perceived exertion between curcumin
and placebo groups (Takahashi et al. 2013).
Oxidative stress
With respect to oxidative stress, Chilelli et al. (2016), in
their study carried out in Italy with 47 cyclists, showed that
the group supplemented with curcumin þBoswellia serrata
(10 mg/day þ105 mg/day –3 months) displayed higher
reduction of endogenous advanced glycation end products
(AGEs) (11.59 ± 12.49 vs. 0.15 ± 2.30; p <0.001) and
malondialdehyde (MDA) (0.10 ± 0.006 vs. 0.07 ± 0.03;
p<0.02) compared to the control group. Takahashi et al.
(2013), by their part, in a clinical trial conducted in Japan
with 10 males, observed that the groups supplemented with
curcumin (90 mg/day and 180 mg/day –1 day) displayed
lower serum concentration of derivatives of reactive oxygen
metabolites (d-ROMs) (p ¼0.023) and thioredoxin-1 (TRX-
1) (p ¼0.047), besides higher values of biological antioxidant
potential (BAP) (p <0.01) and reduced glutathione (GSH)
(p ¼0.037) compared to placebo after aerobic exercise
(treadmill walking or running at 65% VO2 max). The pla-
cebo group, displayed lower values of glutathione reductase
(GR) immediately after the exercise, than pre-exercise
(p <0.05) and displayed higher values of glutathione perox-
idase (GPX) 2 h following the exercise (p <0.05) (Takahashi
et al. 2013). In contrast, other studies did not report signifi-
cant differences between groups in the assessed oxidative
stress markers (McAllister et al. 2018; Tanabe, Chino,
Ohnishi, et al. 2019)(Table 2).
Psychological and physiological parameters
Curcumin supplementation is also related to beneficial
effects in psychological and physiological parameters (ther-
mal and cardiovascular) (Table 2). A double-blind clinical
trial conducted in the United Kingdom with 11 practitioners
of aerobic physical activity (cycle ergometer) displayed,
through a subjective assessment, that the CG (500 mg/day –
4 days) displayed more frequently a “better than usual”
result with respect to the psychological stress during train-
ing, compared to the placebo and control groups (Sciberras
et al. 2015).
Szymanski et al. (2018) observed that the absolute
increase of the internal temperature (2.42 ± 0.26 C vs.
2.13 ± 0.30 C; p ¼0.019), average body temperature
(2.38 ± 0.24 C vs. 2.12 ± 0.28 C; p ¼0.049), heart rate
(39 ± 5 bpm vs. 30 ± 7 bpm; p ¼0.012) and Physiological
Strain Index (PSI) (9.76 ± 0.57 vs. 8.73 ± 0.76; p ¼0.047)
were higher during aerobic exercise in the placebo group,
compared to the curcumin supplemented group (500 mg/day
–3 days), although findings are controversial with respect to
heart rate (McAllister et al. 2018; Sciberras et al. 2015;
Takahashi et al. 2013).
Table 2. Continued.
Author/year Outcome variables Main results Side effects? (yes/no)
Takahashi et al. (2013)Immediately after:
Curcumin’s plasmatic concentration;
Heart rate; Perceived exertion; d-ROMs;
TRX-1; BAP; GSH; TBARS; GSSG; SOD;
CAT; GPX; GR.
CGs displayed lower serum concentrations of d-ROMs
(p ¼0.023) and TRX-1 (p ¼0.047), and also higher BAP
(p <0.01) and GSH (p ¼0.037) values, compared to the
placebo, after the exercise. Immediately after the exercise,
the placebo group displayed lower GR values (5.6 ± 0.6),
compared to pre-exercise (9.0 ± 1.1) (p <0.05). 2h after the
exercise, the placebo group displayed higher GPX values
(269.3 ± 9.3), compared to pre-exercise
(197.3 ± 36.9) (p <0.05).
-
AGE, advanced glycation end-products; AOPP, advanced oxidation protein products; BAP, biological antioxidant potential; CAT, catalase; CG, curcumin group; CK,
creatine kinase; CRP, c reactive protein; d-ROMs, derivatives of reactive oxygen metabolites; FRAP, Ferric Reducing Antioxidant Power; GPX, glutathione peroxid-
ase; GR, glutathione reductase; GSH, reduced glutathione; GSSG, oxidized glutathione; H2O2; hydrogen peroxide; HSP 70, heat shock protein 70; I-FABP, intes-
tinal fatty acid binding protein; IŒB, inhibitor of kappa beta; IL1-RA, interleukin 1 receptor antagonist; IL-6, interleukin 6; IL-8, interleukin 8; IL-10, interleukin
10; MCP-1, monocyte chemoattractant protein-1; MDA, malondayldehyde; MyD88, myeloid differentiation protein 88; MVC, maximal voluntary contraction; NF-
jB, nuclear factor kappa beta; NEFA, composition and non-esterified fatty acid; pAMPK, phosphorylated 5-AMP-activated protein kinase; PBMC, peripheral blood
mononuclear cell; pHSF1, p-Heat shock factor 1; pNF-ŒB, p-Nuclear factor kappa beta; PPFA, plasma phospholipid fatty acid; PSI, physiological strain index; RER,
respiratory exchange ratio; ROM, range of motion; SIRT1, sirtuin-1; sRAGE, soluble receptor for AGE; TBARS, thiobarbituric acid reactive substances; TNF-a, tumor
necrosis factor alpha; TLR4, toll-like receptor 4; TRX-1, thioredoxin-1; SOD, superoxide dismutase; VCO2, carbon dioxide production; VE, minute ventilation; VO2,
oxygen consumption.
CRITICAL REVIEWS IN FOOD SCIENCE AND NUTRITION 7

No significant differences were observed for minute ven-
tilation (VE), maximum oxygen uptake (VO
2
), carbon diox-
ide production (VCO
2
), respiratory exchange ratio (RER),
hydration and skin temperature (Szymanski et al. 2018).
Gastrointestinal function (GI)
Only one study assessed the effect of curcumin supplemen-
tation on the improvement of GI function during exercise-
induced exertional heat stress (Table 2). In the study by
Szymanski et al. (2018), the fatty acid binding protein (I-
FABP, GI barrier damage marker) displayed higher elevation
after aerobic exercise for the placebo group (after exercise:
87% vs. 58%; 1 h after exercise: 33% vs. 18%) than for the
CG (500 mg/day –3 days).
Side effects
More than half of the studies (n ¼6) assessed the presence
of side effects in relation to curcumin supplementation and
no adverse symptoms or injury to health were reported for
the used dosages (Chilelli et al. 2016; Falgiano et al. 2018;
McFarlin et al. 2016; Nicol et al. 2015; Sciberras et al. 2015;
Szymanski et al. 2018)(Table 2).
Assessment of risk of bias
Although most of the studies were randomized, many did
not include the description of the method employed to gen-
erate the random sequence, thus hampering the assessment
(Delecroix et al. 2017; Falgiano et al. 2018; McAllister et al.
2018; McFarlin et al. 2016; Sciberras et al. 2015; Szymanski
et al. 2018; Takahashi et al. 2013; Tanabe, Chino, Ohnishi,
et al. 2019; Tanabe, Chino, Sagayama, et al. 2019). Most
studies displayed low risk of bias in relation to allocation
concealment. With respect to the blinding of participants
and personnel, most of the studies were double-blind, thus
displaying low risk for this bias, except for Delecroix et al.
and Chilelli et al., who did not detail the data about the
blinding and were assessed as unclear in this regard. As for
the blinding of the outcome evaluators, three studies were
classified as unclear (Chilelli et al. 2016; Delecroix et al.
2017; Tanabe, Chino, Sagayama, et al. 2019). All studies
were classified as unclear for selective outcome reporting
bias, due to insufficient information about the studies’pro-
tocols for judgment (Figure 2).
Discussion
This systematic review, according to our knowledge, is the
first to gather the available evidence about the effects of cur-
cumin supplementation in sport and exercise in human
beings, indicating reduction of inflammation, oxidative
stress, muscle pain and damage; improved muscle recovery,
sport performance, psychological and physiological
responses (thermal and cardiovascular) during training, as
well as GI function (Figure 3).
Regular physical activity has many health benefits
(Grazioli et al. 2017; Warburton and Bredin 2017).
However, high intensity, long duration and short-rest time
exercises may lead to severe inflammation, muscle damage
and consequently muscle pain (Clarkson, Nosaka, and
Braun 1992; Powers et al. 2010; Wagner, Reichhold, and
Neubauer 2011), as well as influence immunological
response (Walsh et al. 2011), thus enabling the activation of
transition factors, increasing the serum concentration of
pro-inflammation cytokines and production of extracellular
reactive oxygen species (EROs) (Garcia-Lopez et al. 2007).
Although exercise-induced moderate inflammatory
responses and EROs are essential for physiological adapta-
tions and muscle regeneration (Clarkson, Nosaka, and
Braun 1992; Ferraro et al. 2014; Garcia-Lopez et al. 2007), if
not controlled, may lead to delayed onset muscle soreness
(DOMS) and decreased sport performance (Powers et al.
2010; Wagner, Reichhold, and Neubauer 2011). Therefore, it
is important to resort to strategies to control or minimize
muscle damage and inflammatory responses, allowing for
fast recovery, particularly for athletes and individuals with
intense exercise routine.
There are evidences that curcumin supplementation plays
an important role on reduced post-exercise inflammation
(McFarlin et al. 2016; Nicol et al. 2015; Szymanski et al.
2018; Tanabe, Chino, Ohnishi, et al. 2019). One of the
mechanisms involved is based on its capacity to inhibit tran-
scription factors, such as nuclear kappa B (NF-kB) and acti-
vator protein-1 (AP-1), responsible for inducing enzyme
expression and secretion (cyclooxygenase-2 (COX-2) and 5-
lipoxygenase (LOX-5)) and cytokines (TNF-aand proin-
flammatory interleukins as IL-1, IL-6, IL-8) activators of the
immunological system (Khalaf, Jass, and Olsson 2010; Singh
and Aggarwal 1995; Thaloor et al. 1999). However, literature
is still controversial with respect to the anti-inflammatory
effects of curcumin on physical exercise (Chilelli et al. 2016;
Falgiano et al. 2018; Sciberras et al. 2015), and more experi-
mental studies are necessary to clarify this relation.
Recent research, with protocols that used between 0.01
and 6 g/day curcumin, has also shown benefits of the sup-
plementation on the reduction of pain and muscle damage
(decreasing serum CK) (Nicol et al. 2015; Tanabe, Chino,
Ohnishi, et al. 2019; Tanabe, Chino, Sagayama, et al. 2019),
speeding recovery and enhancing sport performance
(Delecroix et al. 2017; Tanabe, Chino, Ohnishi, et al. 2019;
Tanabe, Chino, Sagayama, et al. 2019). Curcumin, through
the modulation of NF-kB activity, an important factor of the
inflammatory cascade and regulator of the myogenesis, may
support the cellular proliferation and differentiation of myo-
blasts, enabling the increase of strength and muscle repair
(Mourkioti et al. 2006; Thaloor et al. 1999). Thus, it is likely
that curcumin has positive therapeutic applications in ath-
letes and physical activity practitioners, either through its
anti-inflammatory action or its role in muscle regeneration
(Tanabe, Chino, Ohnishi, et al. 2019).
The supplementation of different kinds of antioxidants,
including curcumin (Chilelli et al. 2016; Takahashi et al.
2013), has been pointed out as a positive strategy for
8 L. G. SUHETT ET AL.

preventing oxidative stress and improving sport perform-
ance (Antonioni et al. 2019; Takami et al. 2019). The anti-
oxidant effect of curcumin is related to its capacity of
sequestering EROs, precluding lipidic peroxidation and cel-
lular damage, in addition to chelating free radical gener-
ator ions (Itokawa et al. 2008). Curcumin is also involved
in the modulation of the activity of the GPX enzymes,
catalase (CAT) and superoxide dismutase (SOD) in the
neutralization of free radicals (Manikandan et al. 2004). In
addition, curcumin can suppress the NF-kB metabolism
and, consequently, inhibit EROs-generator enzymes, such
as COX-2, LOX-5, and xanthine-hydrogenase/oxidase
(Khalaf, Jass, and Olsson 2010; Marchiani et al. 2014;
Singh and Aggarwal 1995).
McAllister et al. (2018), in their study carried out in the
USA with trained males exposed to double stress (mental
and physical), did not observe significant effects of curcumin
supplementation on the oxidative stress markers after the
exercise, just as Tanabe et al. (Tanabe, Chino, Ohnishi, et al.
2019). However, the authors highlighted that their protocol
did not induce oxidative stress in their sample, even after
exhaustive training, which might explain the absence of
treatment effects and, therefore, supplementation would not
be necessary.
Another likely justification for the absence of significant
results after curcumin supplementation in physical exercise
is its low bioavailability, which happens to be a major disad-
vantage for its clinical application (Anand et al. 2007;
Figure 2. Risk of bias summary: Authors’judgments about each possible risk of bias of the studies included in the review. þ, low risk; ?, unclear.
CRITICAL REVIEWS IN FOOD SCIENCE AND NUTRITION 9

Nelson et al. 2017). Some reasons for its low availability are:
reduced absorption, low water solubility, quick metabolism,
chemical instability and fast systemic elimination (Anand
et al. 2007). Hence, it is important that future studies assess
previously whether curcumin’s serum concentration has suf-
ficiently increased after supplementation so as to produce
biological effects, in addition to resorting to methods which
are being developed with the purpose of increasing bioavail-
ability, such as the association of curcumin and piperine,
use of nanoparticles, phospholipid complexes and curcu-
min’s structural analogs (safflower oil) (Anand et al. 2007;
Prasad et al. 2014; Siviero et al. 2015).
As for the physiological aspects, Szymanski et al.
observed lower increase of heart rate in the curcumin-sup-
plemented group during exercise-induced thermal stress.
The remaining studies that did not report significant results
have resorted to physical exercises in normal thermal condi-
tions (McAllister et al. 2018; Sciberras et al. 2015; Takahashi
et al. 2013). It is possible that the reduced heart rate is asso-
ciated with the action of curcumin in the improvement of
endothelial function (Santos-Parker et al. 2017; Szymanski
et al. 2018), although the mechanisms have not been com-
pletely clarified.
Literature indicates that intense and prolonged physical
exercises may lead to disorders in the immune system and
in the GI tract (Dokladny, Zuhl, and Moseley 2016; Lim and
Mackinnon 2006). These disorders, such as the increased
macrophages activity, due to muscle damage, increased pro-
inflammatory circulating cytokines, increased intestinal per-
meability, allowing the passage of gram-negative bacteria
and translocation of lipopolysaccharides (LPS) (cell wall
component endotoxin of the gram-negative bacteria) for
systemic circulation, may enable the development of endo-
toxemia and hyperthermia (Lim and Mackinnon 2006). In
this context, the effects of curcumin supplementation on the
reduction of internal and body temperature, on PSI and on
the reduction of risk of insolation appear to be secondary to
its action in the improvement of GI function, in addition to
its anti-inflammatory action (Szymanski et al. 2018).
The existence of investigations addressing the advantages
of curcumin supplementation for the health of the GI tract
(Ghosh et al. 2018; Lopresti 2018) has raised the hypothesis
that the phenolic compound could help reducing gastro-
intestinal symptoms and intercurrences during training, thus
improving sport performance. Szymanski et al. (2018)
observed an improvement in the GI function after 3 days of
curcumin supplementation. Some of the proposed mecha-
nisms are related to the curcumin’s capacity of significantly
reduce LPS plasmatic concentration, as well as interleukin-
1b(IL-1b) production by the intestinal epithelial cells and
reduce the mitogen-activated protein kinase (p38 MAPK),
helping the reduction of the disfunction of the intestinal
barrier and inflammatory process (Wang, Ghosh, and
Ghosh 2017).
In addition to the aforementioned effects, curcumin supple-
mentation seems to be beneficial for neuropsychiatric changes
and cognitive functions (Lopresti 2018;Ngetal.2017;Zhuetal.
2019). However, little is known about its effects during physical
exercise. Sciberras et al., after applying the Daily Analysis of Life
Demands on Athletes (DALDA) questionnaire, observed that,
after supplementation, participants reported feeling better with
respect to the causes and symptoms of psychological stress, when
compared to the place group. This result paves the way for future
Figure 3. Potential positive effects and molecular targets of curcumin supplementation in exercise. AGE, advanced glycation end-products; BAP, biological antioxi-
dant potential; CK, creatine kinase; d-ROMs, derivatives of reactive oxygen metabolites; GSH, reduced glutathione; I-FABP, intestinal fatty acid binding protein; IL1-
RA, interleukin 1 receptor antagonist; IL-6, interleukin 6; IL-8, interleukin 8; MDA, malondayldehyde; MVC, maximal voluntary contraction; PSI, physiological strain
index; ROM, range of motion; TNF-a, tumor necrosis factor alpha; TRX-1, thioredoxin-1.
10 L. G. SUHETT ET AL.

investigations on the use of this polyphenol to improve psycho-
logical parameters in sport and exercise.
Curcumin has already been approved and listed as
“Generally Recognized As Safe”(GRAS) by the US Food and
Drug Administration (FDA) (Gupta, Patchva, and Aggarwal
2013). Also, clinical trials assessed its safety and tolerability,
by indicating that doses up to 12 g/day are safe for human
consumption for a 3-month period (Gupta, Patchva, and
Aggarwal 2013; Lao et al. 2006). Among the studies included
in the present review, no side effects of curcumin supplemen-
tation were reported, and the doses applied were considered
safe and tolerable for sport practitioners and athletes.
In this study, some strengths may be highlighted, such as
its systematic approach, based on the PRISMA method,
peer-review and assessment of the risk of bias through the
Cochrane Collaboration tool (Higgins and Green 2008).
However, it was not possible to carry out a meta-analysis of
the data due to the heterogeneity of the studies. The reduced
amount of papers included may also be regarded as a limita-
tion to ensure the benefits of curcumin supplementation in
sport and physical exercise in human beings. Nevertheless,
this review adds new information to literature and empha-
sizes the need for further studies on this subject with the
purpose of examining the acute and chronic effects of cur-
cumin supplementation in different populations and sports,
elucidating the mechanisms involved and establish recom-
mended curcumin dosages in sport.
In conclusion, the evidences presented indicate that cur-
cumin supplementation in human beings is likely safe and
beneficial for sport and physical activity, due to the reduc-
tion of inflammation and oxidative stress, reduction of pain
and muscle damage, improved muscle recovery, sport per-
formance, psychological and physiological responses (ther-
mal and cardiovascular) during training, as well as the GI
function. However, curcumin is not yet considered a sports
supplement with level A of evidence, therefore, more studies
are still needed to confirm the results and establish a safe
and effective dosage of supplementation.
Disclosure statement
The authors declare no conflict of interests.
Funding
This study was financed by the Coordenac¸~
ao de Aperfeic¸oamento de
Pessoal de N
ıvel Superior - Brazil (CAPES) - Finance Code 001,
through PhD grants to L.G.S, B.K.S.S, and R.M.M.S.
ORCID
Lara Gomes Suhett http://orcid.org/0000-0002-2497-1587
Rodrigo de Miranda Monteiro Santos http://orcid.org/0000-0003-
0499-8966
Brenda Kelly Souza Silveira http://orcid.org/0000-0003-3339-3747
Arieta Carla Gualandi Leal http://orcid.org/0000-0003-3113-8590
Alice Divina Melo de Brito http://orcid.org/0000-0002-6698-4802
Juliana Farias de Novaes http://orcid.org/0000-0003-3616-5096
Ceres Mattos Della Lucia http://orcid.org/0000-0002-6731-5694
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