Joint Position Statement: nutrition and athletic performance. American College of Sports Medicine, American Dietetic Association, and Dietitians of Canada

Circadian rhythm in sportspersons and athletic performance: A mini review

Circadian rhythms in the physiological and behavioral processes of humans play a crucial role in the quality of living and also in the magnitude of success and failure in various endeavors including competitive sports. The rhythmic activities of the body and performance in sportspersons do have a massive impact on their every cutthroat competition. It is essential to schedule sports activities and training of players according to their circadian typology and time of peak performance for improved performance and achievement. In this review, the focus is on circadian rhythms and diurnal variations in peak athletic performance in sportspersons. Accuracy and temporal variability in peak performance in an individual could be attributed to various factors, namely chronotype, time of the day, body temperature, jetlag, hormones, and prior light exposure. Circadian rhythm of mood, alertness, T-core, and ultimately athletic performance is not only affected by sleep but also by circadian variations in hormones, such as cortisol, testosterone, and melatonin. There are, however, a few reports that are not consistent with the conclusions drawn in this review. Nevertheless, circadian rhythm and performance among sportspersons and athletes are important areas of research. This review might be useful to the managers and policymakers associated with competitive sports and athletic events.

Low and high carbohydrate isocaloric diets on performance, fat oxidation, glucose and cardiometabolic health in middle age males

High carbohydrate, low fat (HCLF) diets have been the predominant nutrition strategy for athletic performance, but recent evidence following multi-week habituation has challenged the superiority of HCLF over low carbohydrate, high fat (LCHF) diets, along with growing interest in the potential health and disease implications of dietary choice. Highly trained competitive middle-aged athletes underwent two 31-day isocaloric diets (HCLF or LCHF) in a randomized, counterbalanced, and crossover design while controlling calories and training load. Performance, body composition, substrate oxidation, cardiometabolic, and 31-day minute-by-minute glucose (CGM) biomarkers were assessed. We demonstrated: (i) equivalent high-intensity performance (@∼85%VO2max), fasting insulin, hsCRP, and HbA1c without significant body composition changes across groups; (ii) record high peak fat oxidation rates (LCHF:1.58 ± 0.33g/min @ 86.40 ± 6.24%VO2max; 30% subjects > 1.85 g/min); (iii) higher total, LDL, and HDL cholesterol on LCHF; (iv) reduced glucose mean/median and variability on LCHF. We also found that the 31-day mean glucose on HCLF predicted 31-day glucose reductions on LCHF, and the 31-day glucose reduction on LCHF predicted LCHF peak fat oxidation rates. Interestingly, 30% of athletes had 31-day mean, median and fasting glucose > 100 mg/dL on HCLF (range: 111.68-115.19 mg/dL; consistent with pre-diabetes), also had the largest glycemic and fat oxidation response to carbohydrate restriction. These results: (i) challenge whether higher carbohydrate intake is superior for athletic performance, even during shorter-duration, higher-intensity exercise; (ii) demonstrate that lower carbohydrate intake may be a therapeutic strategy to independently improve glycemic control, particularly in those at risk for diabetes; (iii) demonstrate a unique relationship between continuous glycemic parameters and systemic metabolism.

Nutritional Habits of Professional Cyclists during Pre-Season

The first aim of the present study was to assess the dietary intake of professional cyclists during pre-season. The second aim was to assess the dietary habits of this population during a complete season. Fifteen elite male (age: 23.2 ± 5.4 years) and twenty-three elite female (age: 20.1 ± 7.0 years) cyclists volunteered to participate in the study. Dietary nutrient intake during pre-season was assessed using a 72 h dietary recall interview, and a 136-item food frequency questionnaire was used to assess dietary habits during the year. Protein intake exceeded the PRI’s recommendation of 0.83 g/kg/day for all cycling groups. Fat exceeded RI recommendations in females in both road (43.3%) and CXO (39.8%) cycling groups, whilst males were found to follow recommendations for fat intake. CHO intake was below recommendations in all groups. Intake of all vitamins exceeded recommendations, with the exception of B9 in female road cyclists (77.8% RDA) and vitamin D in all groups. With regards to mineral intake, consumption exceeded RDA/AI recommendations in all groups except for iodine in male XCO cyclists (61.6%), female road cyclists (61.6%), and female XCO cyclists (58%) and potassium in female road cyclists (74.6%). Males consumed greater amounts of eggs and non-processed foods than females. Road cyclists consumed greater amounts of fish and seafood and had a lower intake of coffee and tea than XCO cyclists. Better knowledge of food guidelines in terms of serving and food variety is important for professional cyclists at may impact health and performance.

Evaluation of a randomized nutrition intervention combining nutrition education and cooking workshops on dietary intakes and psychosocial determinants of performance in university football athletes

Although nutrition influences performance, many athletes, including football players, do not meet nutritional requirements for their sport. The objective of this study was to determine the impact of a nutrition intervention combining nutrition education and cooking workshops on nutrition knowledge, intention, and perceived behavioral control in the preparation of healthy meals, dietary intakes, and diet quality in male university football players. Athletes ( n = 23; age: 22 ± 1 year) were randomly assigned to an intervention (2 h/week) ( n = 13) or control group ( n = 10) over three weeks. Questionnaires were completed before (pre), immediately after (post 1), and two months after the intervention (post 2). Dietary intakes and diet quality were evaluated from three web-based 24-h dietary recalls per visit. Mixed linear models for repeated measures with Tukey’s post hoc test were performed to determine the effects of the intervention on all outcomes. There was a group by time interaction for nutrition knowledge ( p = 0.002) that was higher immediately after and two months after the intervention compared to the control group. No differences on other outcomes were observed. Combining nutrition education and cooking workshops improved nutrition knowledge, but did not affect intention and perceived behavioral control in the preparation of healthy meals, dietary intakes, and diet quality in male university football athletes.

An Overview on How Exercise with Green Tea Consumption Can Prevent the Production of Reactive Oxygen Species and Improve Sports Performance

Free radicals are reactive products that have multiple effects on the human body. Endogenous and exogenous antioxidants manage the overproduction of free radicals. However, an imbalance between free radicals and antioxidant factors causes oxidative stress. Exercise and physical activity are factors that increase oxidative stress and disrupts the body’s homeostasis. Intensity and duration of training, training characteristics, and fitness level can have positive or negative effects on oxidative stress. Green tea consumption is recommended for the prevention of a variety of diseases, health maintenance, and weight loss. The effectiveness of green tea is primarily due to the presence of catechins and polyphenols, specifically (–)-epigallocatechin-3-gallate, which has antioxidant and anti-inflammatory properties based on clinical and animal studies. This review investigates the effect of green tea exercise and their interactive effects on free radicals and sports improvement.

Profiles for identifying problematic dietary habits in a sample of recreational Spanish cyclists and triathletes

There is a lack of sufficient information on the dietary intake and nutritional supplementation of recreational endurance athletes throughout the year. The present observational study sought to assess the dietary intake and nutritional supplementation habits of recreational cyclists and triathletes from Spain. 4,037 cyclists and triathletes completed self-report measures. Nutritional profiles were developed and differences were examined according to sporting discipline and gender. Differences between groups were compared using the Mann-Whitney U or chi-squared test. Next, micro- and macro-nutrients were grouped according to whether or not guideline intake amounts were met. The clustering of dietary habits was then examined via K-means cluster analysis. Triathletes took more supplements than cyclists (X2 = 36.489; p value = .000) and females took more supplements than males (X2 = 5.920; p value = .017). Females and triathletes reported greater protein and CHO consumption than males and cyclists, respectively. Triathletes also reported a higher consumption of total fat, MUFA, PUFA, EPA, DHA and fibre. Females and triathletes tended to consume more vitamins and minerals than males and cyclists, respectively. Two main dietary habit clusters emerged which may be used to inform nutritional interventions targeting recreational athletes not meeting nutritional requirements. There is an imbalance in the main nutrients making up the diet of recreational Spanish athletes, characterised by insufficient CHO and excessive protein.

The Impact of a Nutritional Intervention Program on Eating Behaviors in Italian Athletes

A balanced diet is a fundamental component of athletes’ health, training, and performance. The majority of athletes choose adequate quantities of macronutrients but, at the same time, do not respect World Health Organization dietary guidelines, eating a lot of discretionary food and not drinking enough water. Athletes need more nutritional education to improve the quality of their food choice. By modifying their eating habits, they could also enhance their performance. Our study aimed to evaluate the impact of nutritional intervention on eating habits in a group of Northern Italian athletes. A sample of 87 athletes (41 males and 46 females) aged 16.5 ± 2.9 was enrolled. We organized meetings and detected eating habits (before and after the meetings) using a food frequencies questionnaire. We found that nutritional intervention positively affected participants consumption of vegetables (p < 0.05), nuts (p < 0.001), legumes (p < 0.001), and fish (p < 0.05). Other aspects of the athletes’ eating habits were not significantly improved. Some gender differences were found; males increased their consumption of vegetables (p < 0.05) and nuts (p < 0.001), while females increased their intake of legumes (p < 0.001). Our finding suggested that nutritional intervention could promote healthy eating habits among athletes. If sports nutrition experts, coaches, personal trainers, sports medicine experts, and athletes cooperated, they could guarantee athletes’ health status.

Factors that affect menarche in Japanese national-level track-and-field athletes

OBJECTIVES

The minimum body mass index (BMI) required to menarche and the relationship between the training onset age of sports and menarche is not fully understood. The aim of this study is to elucidate the minimum BMI required to attain menarche in female adolescent athletes competing at a national level, and to determine how the occurrence of menarche is associated with training onset age in track-and-field athletes.

METHODS

Overall, 134 sprinters and 44 long-distance (LD) runners of ninth-grade females at a national level were enrolled and an anonymous questionnaire was administered.

RESULTS

As BMI increased, the proportion of athletes who had attained menarche increased. The BMI cutoff values for menarche were 17.3 and 17.1 kg/m² for sprinters and LD runners, respectively. Menarche had not occurred in almost 50% of the LD runners who began training at elementary school, and among LD runners, those who began training at elementary school had 18.4 higher odds of not attaining menarche until the age of 15 years as opposed to those who started training after elementary school.

CONCLUSIONS

The BMI cutoff values could be an indicator for menarche in sprinters and LD runners. For LD runners, starting to compete at elementary school could be a risk factor for delayed menarche.

The Influence of the Trainer's Social Behaviors on the Resilience, Anxiety, Stress, Depression and Eating Habits of Athletes

During their sporting lives, athletes must face multiple difficulties that can have consequences for their mental health and changes in their eating patterns. Therefore, the present study aims to analyze how social skills of the trainer influence the coping capacity, psychological well-being, and eating habits of the athlete, elements that are key to achieving success during competition. This study involved 1547 athletes and 127 trainer. In order to achieve the objective, the mean, standard deviation, bivariate correlations, reliability analysis and a structural equation model were analysed. The results showed that prosocial behaviours were positively related to resilience, while antisocial behaviours were negatively related. Resilience was negatively related to anxiety, stress and depression. Finally, anxiety, stress and depression were negatively related to healthy eating and positively related to unhealthy eating. These results highlight the importance of creating a positive social climate to develop coping strategies that promote mental health and healthy eating habits of athletes.

Seaweed's Bioactive Candidate Compounds to Food Industry and Global Food Security

The world population is continuously growing, so it is important to keep producing food in a sustainable way, especially in a way that is nutritious and in a sufficient quantity to overcome global needs. Seaweed grows, and can be cultivated, in seawater and generally does not compete for arable land and freshwater. Thus, the coastal areas of the planet are the most suitable for seaweed production, which can be an alternative to traditional agriculture and can thus contribute to a reduced carbon footprint. There are evolving studies that characterize seaweed's nutritional value and policies that recognize them as food, and identify the potential benefits and negative factors that may be produced or accumulated by seaweed, which are, or can be, dangerous for human health. Seaweeds have a high nutritional value along with a low caloric input and with the presence of fibers, proteins, omega 3 and 6 unsaturated fatty acids, vitamins, and minerals. Moreover, several seaweed sub-products have interesting features to the food industry. Therefore, the focus of this review is in the performance of seaweed as a potential alternative and as a safe food source. Here described is the nutritional value and concerns relating to seaweed consumption, and also how seaweed-derived compounds are already commercially explored and available in the food industry and the usage restrictions to safeguard them as safe food additives for human consumption.

Effect of carbohydrate-electrolyte consumption on insulin, cortisol hormones and blood glucose after high-intensity exercise

Objective: This study aimed to examine the effect of CHO-E consumption after high-intensity exercise on insulin, cortisol hormones and blood glucose responses, which is important for performance and recovery in athletes. Methods: Sixteen volunteers, male athletes, participated into this study. Athletes were divided into two groups as experiment (CHO-E) and placebo (PLA). Blood was taken from the athletes three times as basal, post-exercise (PE) and 2 h after ingestion of supplement (PS). Results: When inter-group comparisons, insulin was significantly higher in the CHO-E group than the PLA group at the PS phase (p < .05). Cortisol significantly decreased in the CHO-E group at the PS compared to the PE (p < .05). Conclusions: Carbohydrate-electrolyte consumption after high-intensity exercise, accelerates the recovery process by providing optimal recovery, and enable the metabolism to remain in the anabolic state by preventing it from entering in the catabolic process as well as provides hormonal balance in metabolism.

Serum 25-hydroxyvitamin D fluctuations in military personnel during 6-month summer operational deployments in Afghanistan

Soldier operational performance is determined by their fitness, nutritional status, quality of rest/recovery, and remaining injury/illness free. Understanding large fluctuations in nutritional status during operations is critical to safeguarding health and well-being. There are limited data world-wide describing the effect of extreme climate change on nutrient profiles. This study investigated the effect of hot-dry deployments on vitamin D status (assessed from 25-hydroxyvitamin D (25(OH)D) concentration) of young, male, military volunteers. Two data sets are presented (pilot study, n 37; main study, n 98), examining serum 25(OH)D concentrations before and during 6-month summer operational deployments to Afghanistan (March to October/November). Body mass, percentage of body fat, dietary intake and serum 25(OH)D concentrations were measured. In addition, parathyroid hormone (PTH), adjusted Ca and albumin concentrations were measured in the main study to better understand 25(OH)D fluctuations. Body mass and fat mass (FM) losses were greater for early (pre- to mid-) deployment compared with late (mid- to post-) deployment (P<0·05). Dietary intake was well-maintained despite high rates of energy expenditure. A pronounced increase in 25(OH)D was observed between pre- (March) and mid-deployment (June) (pilot study: 51 (sd 20) v. 212 (sd 85) nmol/l, P<0·05; main study: 55 (sd 22) v. 167 (sd 71) nmol/l, P<0·05) and remained elevated post-deployment (October/November). In contrast, PTH was highest pre-deployment, decreasing thereafter (main study: 4·45 (sd 2·20) v. 3·79 (sd 1·50) pmol/l, P<0·05). The typical seasonal cycling of vitamin D appeared exaggerated in this active male population undertaking an arduous summer deployment. Further research is warranted, where such large seasonal vitamin D fluctuations may be detrimental to bone health in the longer-term.

Ingestion of carbohydrate or carbohydrate plus protein does not enhance performance during endurance exercise: a randomized crossover placebo-controlled clinical trial

A beverage containing protein (PRO) and carbohydrate (CHO) may have an ergogenic effect on endurance performance. However, evidence regarding its efficacy on similar conditions to athletes' race day is still lacking. The objective of this study was to compare the effects of 3 different nutritional supplementation strategies on performance and muscle recovery in a duathlon protocol. Thirteen male athletes (29.7 ± 7.7 years) participated in 3 simulated Olympic-distance duathlon trials (SDTs) under 3 different, randomly assigned supplementation regimens: CHO drink (75 g CHO), isocaloric CHO plus PRO drink (60.5 g CHO and 14.5 g PRO), and placebo drink (PLA). Supplements were offered during the cycling bout. Blood samples were collected before, immediately after, and 24 h after each SDT for creatine kinase (CK) analysis. Isometric peak torque (PT) was measured before and 24 h after each SDT. The primary outcome measure was the time to complete the 5-km running section (t_5km) at a self-selected pace. There was no difference in t_5km between CHO (1270.3 ± 130.5 s), CHO+PRO (1267.2 ± 138.9 s), and PLA (1275.4 ± 120 s); p = 0.87, effect size (ES) ≤ 0.1. Pre-post changes for PT and CK were not significant for any of the 3 conditions (PT: p = 0.24, ES ≤ 0.4; CK: p = 0.32, ES = 0.3-1.04). For endurance sports lasting up to 2 h, with a pre-exercise meal containing CHO at 1.5 g·kg^-1, supplementation with CHO or CHO+PRO does not offer additional benefits for performance and muscle recovery when compared with PLA.

Effects of deployment on diet quality and nutritional status markers of elite U.S. Army special operations forces soldiers

Background

Special Operations Forces (SOF) Soldiers deploy frequently and require high levels of physical and cognitive performance. Nutritional status is linked to cognitive and physical performance. Studies evaluating dietary intake and nutritional status in deployed environments are lacking. Therefore, this study assessed the effects of combat deployment on diet quality and serum concentrations of nutritional status markers, including iron, vitamin D, parathyroid hormone (PTH), glucose, and lipids, among elite United States (U.S.) Army SOF Soldiers.

Methods

Changes from baseline to post-deployment were determined with a repeated measure within-subjects design for Healthy Eating Index-2010 (HEI-2010) scores, intake of foods, food groups, key nutrients, and serum nutritional status markers. Dietary intake was assessed with a Block Food Frequency Questionnaire. The association between post-deployment serum 25-hydroxy vitamin D (25-OH vitamin D) and PTH was determined. Analyses of serum markers were completed on 50 participants and analyses of dietary intake were completed on 33 participants.

Results

In response to deployment, HEI-2010 scores decreased for total HEI-2010 (70.3 ± 9.1 vs. 62.9 ± 11.1), total fruit (4.4 ± 1.1 vs. 3.7 ± 1.5), whole fruit (4.6 ± 1.0 vs. 4.2 ± 1.4), dairy (6.2 ± 2.7 vs. 4.8 ± 2.4), and empty calories (14.3 ± 3.2 vs. 11.1 ± 4.5) (P ≤ 0.05). Average daily intakes of foods and food groups that decreased included total dairy (P < 0.01), milk (P < 0.01), and non-juice fruit (P = 0.03). Dietary intake of calcium (P = 0.05) and vitamin D (P = 0.03) decreased. PTH increased from baseline (3.4 ± 1.6 vs. 3.8 ± 1.4 pmol/L, P = 0.04), while there was no change in 25-OH vitamin D. Ferritin decreased (385 ± 173 vs. 354 ± 161 pmol/L, P = 0.03) and soluble transferrin receptor increased (16.3 ± 3.7 vs. 17.1 ± 3.5 nmol/L, P = 0.01). There were no changes in glucose or lipids. Post-deployment, serum 25-OH vitamin D was inversely associated with PTH (r = −0.43, P < 0.01).

Conclusions

HEI-2010 scores and dietary intake of milk, calcium, and vitamin D decreased following deployment. Serum PTH increased and iron stores were degraded. No Soldiers were iron deficient. Personnel that deploy frequently should maintain a high diet quality in the U.S. and while deployed by avoiding empty calories and consuming fruits, vegetables, and adequate sources of calcium, vitamin D, and iron. Improving availability and quality of perishable food during deployment may improve diet quality.

Higher protein intake is associated with improved muscle strength in elite senior athletes

OBJECTIVE

The optimal protein intake for elderly individuals who exercise regularly has not yet been clearly defined. The aim of this study was to test the hypothesis that protein intake level is associated with muscle strength in elderly elite athletes.

METHODS

We evaluated 50 elite senior athletes (38 men and 12 women) participating in the European Master Games 2011 in an observational cross-sectional study. Participants were divided into two groups-lower (LPI) or higher (HPI) protein intake-according to the median value of their ratio of urinary urea nitrogen to urinary creatinine (i.e., 8.8 g/L), as a marker of protein intake. A dietary interview confirmed differences in protein consumption between the LPI and HPI groups. We also evaluated body composition (bioimpedance), muscle strength, and hematochemical indices.

RESULTS

LPI and HPI groups were homogeneous for age (72 [68-74] and 71 [68-74] y, respectively), fat-free mass index (18.4 [17-19.4] and 18.2 [17-19.1] kg/m²), body fat (18.3% [12.3-20.7%] and 16.6% [13.6-21.2%]), and glomerular filtration rate (57.7 [53.8-64.9] and 62.7 [56.1-69.3] mL/min/1.73 m²). The HPI group showed greater leg and trunk muscle strength (N) compared with the LPI group (left leg extension, 339 [238-369] versus 454 [273-561], respectively, P < 0.05; right leg extension, 319 [249-417] versus 432 [334-635], P ≤ 0.05; trunk extension, 435 [370-467] versus 464 [390-568], P ≤ 0.05).

CONCLUSIONS

Higher protein intake in elite senior athletes is associated with a greater muscle strength.

Design of a randomized trial to determine the optimum protein intake to preserve lean body mass and to optimize response to a promyogenic anabolic agent in older men with physical functional limitation

The dietary protein allowance for older men to maintain lean body mass and muscle strength and to accrue optimal anabolic responses to promyogenic stimuli is poorly characterized. The OPTIMEN trial was designed to assess in older men with moderate physical dysfunction and insufficient habitual protein intake (<recommended dietary allowance, RDA, 0.8g·kg^-1·d^-1) the efficacy of consuming diets containing 163% RDA (1.3g·kg^-1·d^-1) for protein, compared to RDA, to increase lean mass, muscle performance, and physical function. A second aim was to determine whether increasing protein intake to 1.3 versus 0.8g·kg^-1·d^-1 would augment anabolic responses to a promyogenic agent, testosterone. For this randomized, double-blind, placebo-controlled six-month intervention trial, 92 men, 65years or older, with Short Physical Performance Battery scores 3-10, and habitual protein intakes <RDA, were assigned to one of four groups: 100% RDA plus placebo intramuscular injections weekly; 100% RDA plus weekly intramuscular injections of 100mg testosterone enanthate; 163% RDA plus placebo injections; or 163% RDA plus testosterone injections. All participants received portion-controlled packaged meals and group-specific dietary supplements containing either mixtures of casein and whey or carbohydrate, with identical appearance. The primary outcome was change in lean body mass assessed using dual energy X-ray absorptiometry. Secondary outcomes included maximal voluntary strength and power in leg press and chest press exercises, 6-minute walking distance, stair climbing power, and self-reported physical function. Results of the OPTIMEN trial have important implications for dietary protein guidance and policy, and efficacy of promyogenic drugs.

Algal Proteins: Extraction, Application, and Challenges Concerning Production

Population growth combined with increasingly limited resources of arable land and fresh water has resulted in a need for alternative protein sources. Macroalgae (seaweed) and microalgae are examples of under-exploited "crops". Algae do not compete with traditional food crops for space and resources. This review details the characteristics of commonly consumed algae, as well as their potential for use as a protein source based on their protein quality, amino acid composition, and digestibility. Protein extraction methods applied to algae to date, including enzymatic hydrolysis, physical processes, and chemical extraction and novel methods such as ultrasound-assisted extraction, pulsed electric field, and microwave-assisted extraction are discussed. Moreover, existing protein enrichment methods used in the dairy industry and the potential of these methods to generate high value ingredients from algae, such as bioactive peptides and functional ingredients are discussed. Applications of algae in human nutrition, animal feed, and aquaculture are examined.

Repeated sprint ability is not enhanced by caffeine, arginine, and branched-chain amino acids in moderately trained soccer players

The aim was to investigate the effect of a dietary supplementation on the repeated sprint ability (RSA) performance in recreationally trained team sports athletes. Twelve young men underwent a RSA exercise protocol in five trials, in which participants ingested carbohydrates (CHO) plus caffeine (Caf), CHO plus arginine (Arg), CHO plus branched-chain amino acids (BCAA), CHO plus Caf, Arg, and BCAA (ALL), and CHO only. Heart rate, oxygen saturation, hematic lactate, ratings of perceived exertion, average sprint time, total time, best sprint time, peak power, and average power were taken. Data revealed no significant effects neither on physiological nor performance parameters with any of the supplements.

Novel Tools in Determining the Physiological Demands and Nutritional Practices of Ontario FireRangers during Fire Deployments

INTRODUCTION

The seasonal profession of wildland fire fighting in Canada requires individuals to work in harsh environmental conditions that are physically demanding. The purpose of this study was to use novel technologies to evaluate the physiological demands and nutritional practices of Canadian FireRangers during fire deployments.

METHODS

Participants (n = 21) from a northern Ontario Fire Base volunteered for this study and data collection occurred during the 2014 fire season and included Initial Attack (IA), Project Fire (P), and Fire Base (B) deployments. Deployment-specific energy demands and physiological responses were measured using heart-rate variability (HRV) monitoring devices (Zephyr BioHarness3 units). Food consumption behaviour and nutrient quantity and quality were captured using audio-video food logs on iPod Touches and analyzed by NutriBase Pro 11 software.

RESULTS

Insufficient kilocalories were consumed relative to expenditure for all deployment types. Average daily kilocalories consumed: IA: 3758 (80% consumption rate); P: 2945±888.8; B: 2433±570.8. Average daily kilocalorie expenditure: IA: 4538±106.3; P: 4012±1164.8; B: 2842±649.9. The Average Macronutrient Distribution Range (AMDR) for protein was acceptable: 22-25% (across deployment types). Whereas the AMDR for fat and carbohydrates were high: 40-50%; and low: 27-37% respectively, across deployment types.

CONCLUSIONS

This study is the first to use the described methodology to simultaneously evaluate energy expenditures and nutritional practices in an occupational setting. The results support the use of HRV monitoring and video-food capture, in occupational field settings, to assess job demands. FireRangers expended the most energy during IA, and the least during B deployments. These results indicate the need to develop strategies centered on maintaining physical fitness and improving food practices.

Hydration in the Pediatric Athlete - How to Guide Your Patients

Hydration is arguably among the foremost priorities youth athletes, parents, and coaches habitually consider as vital for sports. Insufficient hydration and a resultant measurable sweat-induced body water deficit can negatively affect performance and, in some athletic scenarios, can be a danger to a young athlete's health and safety, especially during vigorous physical activity in a warm-to-hot environment. Accordingly, it is essential to be well hydrated prior to practice, training, and competition and minimize total body water deficits incurred while being mindful of the greater sweat losses and hydration needs/challenges that accompany physical growth and maturation. Informed clinicians can play a key role as trusted resources in providing the most effective guidelines and making the best overall individual recommendations regarding hydration for youth athletes.

Effect of taking dietary supplement on hematological and biochemical parameters in male bodybuilders an equation model

Background:

The improved physical action following administration of supplements to bodybuilders was supported by changes in laboratory parameters. Despite the fact that these supplements are sometimes associated both advantage and side effects, this study were conducted for the purpose of evaluating the possible effects of some commonly used supplements in bodybuilders on the hematological and biochemical parameters.

Materials and Methods:

In this study, we included 40 male bodybuilders as cases and 40 controls in the age group of 20-40 years. They used different kinds of supplements for 1 year. In general, all the supplements used were classified into two groups: hormonal and non-hormonal. Laboratory tests were requested for evaluation of hematological and biochemical parameters.

Results:

In an equation model, we found that weight (P = 0.024), duration of bodybuilding (P < 0.001), and duration of hormone supplement consumption (P < 0.001) were loaded significantly on the latent variables, demographic and dietary supplement, respectively. The relationship between dietary supplement and biochemical and hematological parameters was significant (P = 0.01) and some of these parameters including creatinine (P = 0.023), blood aspartate aminotransferase (AST) (P < 0.001), alanine aminotransferase (ALT) (P < 0.001), and red blood cell distribution (RDW) (P = 0.046) had a significant role than others. In a multivariate regression model, we found that WBC (P < 0.001), platelets (P < 0.001), blood urea nitrogen (BUN; P < 0.001), creatinine (P < 0.001), AST (P = 0.005), and ALT (P = 0.001) were higher in athletes than in controls.

Conclusions:

It is strongly advised that there should be some concerns about possible supplement-induced changes in the laboratory exams for bodybuilders. The available supplements are unchecked and not approved by the US Food and Drug Administration (FDA). More studies should be designed for a better and precise administration of each supplement in athletes.

Nutritional behaviour and beliefs of ski-mountaineers: a semi-quantitative and qualitative study

BACKGROUND

Endurance athletes are advised to optimize nutrition prior to races. Little is known about actual athletes' beliefs, knowledge and nutritional behaviour. We monitored nutritional behaviour of amateur ski-mountaineering athletes during 4 days prior to a major competition to compare it with official recommendations and with the athletes' beliefs.

METHODS

Participants to the two routes of the 'Patrouille des Glaciers' were recruited (A, 26 km, ascent 1881 m, descent 2341 m, max altitude 3160 m; Z, 53 km, ascent 3994 m, descent 4090 m, max altitude 3650 m). Dietary intake diaries of 40 athletes (21 A, 19 Z) were analysed for energy, carbohydrate, fat, protein and liquid; ten were interviewed about their pre-race nutritional beliefs and behaviour.

RESULTS

Despite belief that pre-race carbohydrate, energy and fluid intake should be increased, energy consumption was 2416 ± 696 (mean ± SD) kcal · day(-1), 83 ± 17% of recommended intake, carbohydrate intake was only 46 ± 13% of minimal recommended (10 g · kg(-1) · day(-1)) and fluid intake only 2.7 ± 1.0 l · day(-1).

CONCLUSIONS

Our sample of endurance athletes did not comply with pre-race nutritional recommendations despite elementary knowledge and belief to be compliant. In these athletes a clear and reflective nutritional strategy was lacking. This suggests a potential for improving knowledge and compliance with recommendations. Alternatively, some recommendations may be unrealistic.

Comparison of availability and plasma clearance rates of β-hydroxy-β-methylbutyrate delivery in the free acid and calcium salt forms

β-Hydroxy-β-methylbutyrate (HMB), a leucine metabolite, has long been supplemented as a Ca salt (Ca-HMB) to increase strength and performance gains with exercise and to reduce recovery time. Recently, the free acid form of HMB (HMB-FA) has become commercially available in capsule form (gelcap). The current study was conducted to compare the bioavailability of HMB using the two commercially available capsule forms of HMB-FA and Ca-HMB. We also compared the pharmacokinetics of each form when administered mixed in water. Ten human subjects (five male and five female) were studied in a randomised crossover design. There was no significant sex by treatment interaction for any of the pharmacokinetic parameters measured. HMB-FA administered in capsules was more efficient than Ca-HMB capsule at HMB delivery with a 37 % increase in plasma clearance rate (74·8 (sem 4·0) v. 54·5 (sem 3·2) ml/min, P<0·0001) and a 76 % increase in peak plasma HMB concentration (270·2 (sem 17·8) v. 153·9 (sem 17·9) μmol/l, P<0·006), which was reached in one-third the time (P<0·009). When HMB-FA and Ca-HMB were administered in water, the differences still favoured HMB-FA, albeit to a lesser degree. Plasma HMB with HMB-FA administered in water was greater during the early phase of absorption (up to 45 min postadministration, P<0·05); this resulted in increased AUC during the first 60 min after administration, when compared with Ca-HMB mixed in water (P<0·03). In conclusion, HMB-FA in capsule form improves clearance rate and availability of HMB compared with Ca-HMB in capsule form.

Nutritional Considerations for Performance in Young Athletes

Nutrition is an integral component to any athletes training and performance program. In adults the balance between energy intake and energy demands is crucial in training, recovery, and performance. In young athletes the demands for training and performance remain but should be a secondary focus behind the demands associated with maintaining the proper growth and maturation. Research interventions imposing significant physiological loads and diet manipulation are limited in youth due to the ethical considerations related to potential negative impacts on the growth and maturation processes associated with younger individuals. This necessary limitation results in practitioners providing nutritional guidance to young athletes to rely on exercise nutrition recommendations intended for adults. While many of the recommendations can appropriately be repurposed for the younger athlete attention needs to be taken towards the differences in metabolic needs and physiological differences.

Dietary intake habits and controlled training on body composition and strength in elite female volleyball players during the season

The purpose of this study was to assess dietary intake of elite female volleyball players (EFVPs, n = 22) during the first 11 weeks of the competitive season. Further, we compared findings for total energy intake and specific macronutrient distribution with the established recommendations for high-intensity athletes. Subjects also engaged in periodized training and we assessed changes in body composition (BC) and strength. Twenty-two EFVPs had dietary intake (7-day dietary recall and food-frequency questionnaire), BC (body mass index (BMI), body fat percentage, fat mass, muscle mass), and 1-repetition maximum (1RM) strength (bench press, military press, back squat, power clean, clean and jerk, pull-over) assessed at baseline (T0, before preseason) and 11 weeks later (T11). Athletes consumed less total kilocalories and carbohydrates (CHO) compared with established recommendations (total kilocalories: 40.7 ± 5.2 kcal/(kg · day)(-1) vs.

RECOMMENDATIONS

50-80 kcal/(kg · day)(-1); CHO: 4.3 ± 0.6 g/(kg · day)(-1) vs.

RECOMMENDATIONS

5-8 g/(kg · day)(-1)). Further, subjects consumed greater protein (2.1 ± 0.4 g/(kg · day)(-1)) compared with recommendations (1.6-1.8 g/(kg · day)(-1)) and greater fat (36.1 ± 4.6% of total kilocalories) than recommendations (20%-35% of total kilocalories). There were improvements (p < 0.05) in BC from T0-T11 (body fat percentage: 17.9% ± 4.2%-16.8% ± 3.6%, -4.7% ± 7.4%; fat mass: 12.7 ± 4.2-11.9 ± 3.8 kg, -4.0% ± 9.2%; muscle mass: 42.8% ± 3.4%-43.3% ± 3.0%, +1.3 ± 3.1%) and 1RM strength (bench press: 39.1 ± 4.5-43.4 ± 4.9 kg; +11.4% ± 9.3%; clean and jerk: 29.7 ± 6.3-34 ± 5.8 kg; +17.7% ± 23.8%); however, there was no change (p > 0.05) in BMI or military press and pull-over. Back squat (p = 0.054; +33.0% ± 83.7%) and power clean (p = 0.056; +26.2% ± 49.0%) increases approached significance. Our findings indicate that EFVPs improved BC and strength despite a dietary intake different from recommendations. This is possibly due to different substrate utilization during exercise in females versus males, thus new recommendations should be considered for high-intensity athletes, which are sex-specific.

Roles of physical activity and cardiorespiratory fitness on sex difference in insulin resistance in late elementary years

PURPOSE

Little is known about the potential role of lifestyle factors in sex differences in insulin resistance in late elementary school children.

METHODS

In this cross-sectional study, we compared sex differences in Tanner scales, body fat, physical activity (PA) and fitness, and insulin resistance markers in elementary school children (boys, n = 69 and girls, n = 81) aged 12-13 years. Body composition was assessed with a standardized protocol. Cardiorespiratory fitness was measured as oxygen consumption during an incremental treadmill exercise. Fasting blood samples were collected for blood chemistry assays including lipids, glucose, insulin and homeostasis model assessment for insulin resistance (HOMA-IR), leptin, and adiponectin. Daily PA was measured with an accelerometer for 7 consecutive days, and they were classified as low-, moderate-, and vigorous-PA. Independent t-tests were used to compare mean differences in the measured variables between boys and girls. There were significant sex differences in Tanner scales, body mass index, percent body fat, and waist circumference (WC).

RESULTS

Girls had significantly higher values in Tanner scales (p < 0.001) and percent body fat (p < 0.001) than boys. Boys had significantly higher values in body mass index (p = 0.019) and waist circumference (p < 0.001) than girls. Boys also had significantly higher values in VO2max (p < 0.001) and low (p < 0.001), moderate (p < 0.001), and vigorous (p < 0.001) PAs. With respect to metabolic risk factors, girls had significantly higher serum levels of triglycerides (p = 0.005), insulin (p < 0.001), and HOMA-IR (p < 0.001) and significantly lower high-density lipoprotein cholesterol (p = 0.015) than boys.

CONCLUSION

In summary, the current findings of the study showed that the increased risk for insulin resistance in girls over boys is associated with higher Tanner scale and percent body fat in conjunction with poor cardiorespiratory fitness and physical inactivity, suggesting that exercise intervention to promote physical activity and fitness is imperative for general health promotion of school children, with a special focus on girls.

Acute nutritional ketosis: implications for exercise performance and metabolism

Ketone bodies acetoacetate (AcAc) and D-β-hydroxybutyrate (βHB) may provide an alternative carbon source to fuel exercise when delivered acutely in nutritional form. The metabolic actions of ketone bodies are based on sound evolutionary principles to prolong survival during caloric deprivation. By harnessing the potential of these metabolic actions during exercise, athletic performance could be influenced, providing a useful model for the application of ketosis in therapeutic conditions. This article examines the energetic implications of ketone body utilisation with particular reference to exercise metabolism and substrate energetics.

Dietary advice for muscularity, leanness and weight control in Men's Health magazine: a content analysis

BACKGROUND

The dietary content of advice in men's lifestyle magazines has not been closely scrutinised.

METHODS

We carried out an analysis of such content in all 2009 issues (n = 11) of Men's Health (MH) focusing on muscularity, leanness and weight control.

RESULTS

Promotion of a mesomorphic body image underpinned advice to affect muscle building and control weight. Diet advice was underpinned by a strong pseudo-scientific discourse, with citation of expert sources widely used to legitimise the information. Frequently multiple dietary components were advocated within one article e.g. fat, omega-3 fatty acids, thiamine, zinc and high-glycaemic index foods. Furthermore advice would cover numerous nutritional effects, e.g. strengthening bones, reducing stress and boosting testosterone, with little contextualisation. The emphasis on attainment of a mesomorphic body image permitted promotion of slimming diets.Advice to increase calorie and protein intake to augment muscle mass was frequent (183 and 262 references, respectively). Such an anabolic diet was advised in various ways, including consumption of traditional protein foods (217 references) and sports foods (107 references), thereby replicating muscle magazines' support for nutritional supplements. Although advice to increase consumption of red meat was common (52 references), fish and non-flesh sources of protein (eggs, nuts & pulses, and soy products) together exceeded red meat in number of recommendations (206 references). Advice widely asserted micronutrients and phytochemicals from plant food (161 references) as being important in muscle building. This emphasis diverges from stereotypical gender-based food consumption patterns.Dietary advice for control of body weight largely replicated that of muscularity, with strong endorsement to consume fruits and vegetables (59 references), diets rich in nuts and pulses and fish (66 references), as well as specific micronutrients and phytochemicals (62 references). Notably there was emphasis on fat-burning, good fats and consumption of single foods, with relatively little mention of dietary restriction.

CONCLUSIONS

Despite the widespread use of scientific information to endorse dietary advice, the content, format and scientific basis of dietary content of MH leaves much to be desired. The dietary advice as provided may not be conducive to public health.

The effect of protein timing on muscle strength and hypertrophy: a meta-analysis

Protein timing is a popular dietary strategy designed to optimize the adaptive response to exercise. The strategy involves consuming protein in and around a training session in an effort to facilitate muscular repair and remodeling, and thereby enhance post-exercise strength- and hypertrophy-related adaptations. Despite the apparent biological plausibility of the strategy, however, the effectiveness of protein timing in chronic training studies has been decidedly mixed. The purpose of this paper therefore was to conduct a multi-level meta-regression of randomized controlled trials to determine whether protein timing is a viable strategy for enhancing post-exercise muscular adaptations. The strength analysis comprised 478 subjects and 96 ESs, nested within 41 treatment or control groups and 20 studies. The hypertrophy analysis comprised 525 subjects and 132 ESs, nested with 47 treatment or control groups and 23 studies. A simple pooled analysis of protein timing without controlling for covariates showed a small to moderate effect on muscle hypertrophy with no significant effect found on muscle strength. In the full meta-regression model controlling for all covariates, however, no significant differences were found between treatment and control for strength or hypertrophy. The reduced model was not significantly different from the full model for either strength or hypertrophy. With respect to hypertrophy, total protein intake was the strongest predictor of ES magnitude. These results refute the commonly held belief that the timing of protein intake in and around a training session is critical to muscular adaptations and indicate that consuming adequate protein in combination with resistance exercise is the key factor for maximizing muscle protein accretion.

Preventing dance injuries: current perspectives

Dancers are clearly athletes in the degree to which sophisticated physical capacities are required to perform at a high level. The standard complement of athletic attributes - muscular strength and endurance, anaerobic and aerobic energy utilization, speed, agility, coordination, motor control, and psychological readiness - all are essential to dance performance. In dance, as in any athletic activity, injuries are prevalent. This paper presents the research background of dance injuries, characteristics that distinguish dance and dancers from traditional sports and athletes, and research-based perspectives into how dance injuries can be reduced or prevented, including the factors of physical training, nutrition and rest, flooring, dancing en pointe, and specialized health care access for dancers. The review concludes by offering five essential components for those involved with caring for dancers that, when properly applied, will assist them in decreasing the likelihood of dance-related injury and ensuring that dancers receive optimum attention from the health care profession: (1) screening; (2) physical training; (3) nutrition and rest; (4) specialized dance health care; and (5) becoming acquainted with the nature of dance and dancers.

Nutritional practices of athletes in oman: a descriptive study

OBJECTIVE

Adequate dietary intake is crucial for optimum training and performance of athletes. There is almost no available information related to dietary practices among Omani athletes, especially during the competition. This study aimed to assess the nutritional practices (nutritional knowledge, eating habits and daily nutrients intake) among Omani male handball athletes in Muscat city, Oman.

METHODS

This is a cross sectional study including 35 male handball athletes involved in serious training for no less than three years. Data collection was done through personal interviews using a study questionnaire which enlisted questions relating to socio-demographic information, anthropometric measurements and nutritional practices. All the study participants declared no intake of anabolic steroids.

RESULTS

The mean age of the study participants was 27 ± 3 years. Their anthropometric assessment revealed that their mean height was 166 ± 12 cm, mean weight was 75 ± 10 kg, and body mass index was 27 ± 3. Nutritional knowledge analysis revealed that 80% had no nutritional supervision by a nutritionist/dietitian. Their knowledge of nutritional requirements was only 23% correct for total energy intake, 63% for protein intake, 46% for carbohydrate intake, 11% for fat intake and 83% for water intake. Eating habits indicated that 55% had <3 meals/day, 51% had lunch as the principal meal, 51% always added extra salt to their food, 28% took protein supplements on a daily basis, and 51% used pre-competition glycogen load diet. However, none consumed vitamins or mineral supplements. The mean daily caloric intake was 3674 ± 265 kcal/day, which was roughly comprised of 596 ± 66 g carbohydrates, 147 ± 28 g of protein and 78 ± 20 g of total fat.

CONCLUSION

Professional nutritional supervision is needed in order to improve the nutritional knowledge and eating habits of Omani athletes, and therefore improve their athletic performance.

Use of Dietary Supplements among Professional Athletes in Saudi Arabia

The objective of this study was to understand the usage patterns of dietary supplements among professional athletes in Saudi Arabia. The survey consisted of sixteen questions divided into four categories: use of supplements, reason for consumption of supplements, personal beliefs about supplements, and behavior. The questionnaires were given to the three teams residing in Riyadh: Al Hilal, Al Nasr, and Al-Shabab. Out of the 105 athletes surveyed, we found that only 98 are currently taking dietary supplements and the mean age and standard deviation were 25.74 ± 2.90. The survey results showed a high percentage of athletes (93.3%; n = 98) using different dietary supplements throughout the season, 43.8% (n = 43) reported using supplements for performance, and 32.6% (n = 32) believed in health benefits as a reason for using dietary supplements. Our results showed that a total of 87 (88.7%), 81 (82.6%), and 51 (52.0%) athletes are consuming sports drinks, vitamin C, and multivitamins, respectively. Meanwhile, those supplements ranking among the least used included omega 6 (18.6%), creatine (16.3%), and Ginkgo biloba (10.2%). A majority of athletes indicated that their use of supplements was for the purpose of improving their health and performance.

Nutrient intake, serum lipids and iron status of colligiate rugby players

Background

There are two main playing positions in rugby (backs and forwards), which demonstrate different exercise patterns, roles, and physical characteristics. The purpose of this study was: 1) to collect baseline data on nutrient intake in order to advise the athletes about nutrition practices that might enhance performance, and 2) to compare serum lipids, lipoproteins, apolipoproteins (apo), lecithin:cholesterol acyltransferase (LCAT) activity, and iron status of forwards and backs.

Methods

The sporting group was divided into 18 forwards and 16 backs and were compared with 26 sedentary controls. Dietary information was obtained with a food frequency questionnaire.

Results

There were significant differences among the three groups. The forwards had the highest body weight, body mass index, percentage of body fat (calculated by sum of four skinfold thicknesses), as well as the highest lean body mass, followed by the backs and the control group. The mean carbohydrate intake was marginal and protein intake was lower than the respective recommended targets in all three groups. The mean intakes of calcium, magnesium, and vitamins A, B₁, B₂, and C were lower than the respective Japanese recommended dietary allowances or adequate dietary intakes for the rugby players. The forwards had significantly lower high-density lipoprotein cholesterol (HDL-C) and HDL₂-C than the backs and had significantly higher apo B and LCAT activity than the controls. The backs showed significantly higher HDL-C, HDL₃-C, low-density lipoprotein cholesterol, and apo A-I, and LCAT activity than the controls. Four forwards (22%), five backs (31%), and three controls (12%) had hemolysis. None of the rugby players had anemia or iron depletion.

Conclusion

The findings of our study indicate that as the athletes increased their carbohydrate and protein intake, their performance and lean body mass increased. Further, to increase mineral and vitamin intakes, we recommended athletes increase their consumption of green and other vegetables, milk and dairy products, and fruits. The forwards showed more atherogenic lipid profiles than the backs, whereas the backs showed not only anti-atherogenic lipid profile, but also showed more atherogenic lipid profile relative to the control group. Additionally, our study showed none of the rugby players experienced anemia and/or iron depletion.

Creatine metabolism and safety profiles after six-week oral guanidinoacetic acid administration in healthy humans

OBJECTIVES

Guanidinoacetic acid (GAA) is a natural precursor of creatine, yet the potential use of GAA as a nutritional additive for restoring creatine availability in humans has been limited by unclear efficacy and safety after exogenous GAA administration. The present study evaluated the effects of orally administered GAA on serum and urinary GAA, creatine and creatinine concentration, and on the occurrence of adverse events in healthy humans.

METHODS AND RESULTS

Twenty-four healthy volunteers were randomized in a double-blind design to receive either GAA (2.4 grams daily) or placebo (PLA) by oral administration for 6 weeks.

CLINICAL TRIAL REGISTRATION

www.clinicaltrials.gov, identification number NCT01133899. Serum creatine and creatinine increased significantly from before to after administration in GAA-supplemented participants (P < 0.05). The proportion of participants who reported minor side effects was 58.3% in the GAA group and 45.5% in the placebo group (P = 0.68). A few participants experienced serum creatine levels above 70 µmol/L.

CONCLUSION

Exogenous GAA is metabolized to creatine, resulting in a significant increase of fasting serum creatine after intervention. GAA had an acceptable side-effects profile with a low incidence of biochemical abnormalities.

Protein timing and its effects on muscular hypertrophy and strength in individuals engaged in weight-training

The purpose of this review was to determine whether past research provides conclusive evidence about the effects of type and timing of ingestion of specific sources of protein by those engaged in resistance weight training. Two essential, nutrition-related, tenets need to be followed by weightlifters to maximize muscle hypertrophy: the consumption of 1.2-2.0 g protein.kg -1 of body weight, and ≥44-50 kcal.kg-1 of body weight. Researchers have tested the effects of timing of protein supplement ingestion on various physical changes in weightlifters. In general, protein supplementation pre- and post-workout increases physical performance, training session recovery, lean body mass, muscle hypertrophy, and strength. Specific gains, differ however based on protein type and amounts. Studies on timing of consumption of milk have indicated that fat-free milk post-workout was effective in promoting increases in lean body mass, strength, muscle hypertrophy and decreases in body fat. The leucine content of a protein source has an impact on protein synthesis, and affects muscle hypertrophy. Consumption of 3-4 g of leucine is needed to promote maximum protein synthesis. An ideal supplement following resistance exercise should contain whey protein that provides at least 3 g of leucine per serving. A combination of a fast-acting carbohydrate source such as maltodextrin or glucose should be consumed with the protein source, as leucine cannot modulate protein synthesis as effectively without the presence of insulin. Such a supplement post-workout would be most effective in increasing muscle protein synthesis, resulting in greater muscle hypertrophy and strength. In contrast, the consumption of essential amino acids and dextrose appears to be most effective at evoking protein synthesis prior to rather than following resistance exercise. To further enhance muscle hypertrophy and strength, a resistance weight- training program of at least 10-12 weeks with compound movements for both upper and lower body exercises should be followed.

Treatment of metabolic syndrome by combination of physical activity and diet needs an optimal protein intake: a randomized controlled trial

BACKGROUND

The recommended dietary allowance (RDA) for protein intake has been set at 1.0-1.3 g/kg/day for senior. To date, no consensus exists on the lower threshold intake (LTI = RDA/1.3) for the protein intake (PI) needed in senior patients ongoing both combined caloric restriction and physical activity treatment for metabolic syndrome. Considering that age, caloric restriction and exercise are three increasing factors of protein need, this study was dedicated to determine the minimal PI in this situation, through the determination of albuminemia that is the blood marker of protein homeostasis.

METHODS

Twenty eight subjects (19 M, 9 F, 61.8 ± 6.5 years, BMI 33.4 ± 4.1 kg/m²) with metabolic syndrome completed a three-week residential programme (Day 0 to Day 21) controlled for nutrition (energy balance of -500 kcal/day) and physical activity (3.5 hours/day). Patients were randomly assigned in two groups: Normal-PI (NPI: 1.0 g/kg/day) and High-PI (HPI: 1.2 g/kg/day). Then, patients returned home and were followed for six months. Albuminemia was measured at D0, D21, D90 and D180.

RESULTS

At baseline, PI was spontaneously 1.0 g/kg/day for both groups. Albuminemia was 40.6 g/l for NPI and 40.8 g/l for HPI. A marginal protein under-nutrition appeared in NPI with a decreased albuminemia at D90 below 35 g/l (34.3 versus 41.5 g/l for HPI, p < 0.05), whereas albuminemia remained stable in HPI.

CONCLUSION

During the treatment based on restricted diet and exercise in senior people with metabolic syndrome, the lower threshold intake for protein must be set at 1.2 g/kg/day to maintain blood protein homeostasis.

Prevention of elbow injuries in youth baseball pitchers

CONTEXT

Although baseball is a relatively safe sport, numerous reports suggest a rapid rise in elbow injury rate among youth baseball pitchers.

EVIDENCE ACQUISITION

PUBMED WAS SEARCHED FOR EPIDEMIOLOGIC, BIOMECHANICAL, AND CLINICAL STUDIES OF ELBOW INJURIES IN BASEBALL (KEYWORDS: "youth OR adolescent" AND baseball AND pitching AND "ulnar collateral ligament OR elbow"; published January 2000 - April 2012). Studies with relevance to youth baseball pitchers were reviewed. Relevant references from these articles were also retrieved and reviewed. Original data, insight, and recommendations were added.

RESULTS

The majority of baseball elbow injuries are noncontact injuries to the dominant arm resulting from repetitive pitching. Five percent of youth pitchers suffer a serious elbow or shoulder injury (requiring surgery or retirement from baseball) within 10 years. The risk factor with the strongest correlation to injury is amount of pitching. Specifically, increased pitches per game, innings pitched per season, and months pitched per year are all associated with increased risk of elbow injury. Pitching while fatigued and pitching for concurrent teams are also associated with increased risk. Pitchers who also play catcher have an increased injury risk, perhaps due to the quantity of throws playing catcher adds to the athlete's arm. Another risk factor is poor pitching biomechanics. Improper biomechanics may increase the torque and force produced about the elbow during each pitch. Although throwing breaking pitches at a young age has been suggested as a risk factor, existing clinical, epidemiologic, and biomechanical data do not support this claim.

CONCLUSIONS

Some elbow injuries to youth baseball pitchers can be prevented with safety rules, recommendations, education, and common sense. Scientific and medical organizations have published safety rules and recommendations, with emphasis on prevention of overuse and pitching while fatigued. STRENGTH-OF-RECOMMENDATION TAXONOMY (SORT): A.

Significant effect of a pre-exercise high-fat meal after a 3-day high-carbohydrate diet on endurance performance

We investigated the effect of macronutrient composition of pre-exercise meals on endurance performance. Subjects consumed a high-carbohydrate diet at each meal for 3 days, followed by a high-fat meal (HFM; 1007 ± 21 kcal, 30% CHO, 55% F and 15% P) or high-carbohydrate meal (HCM; 1007 ± 21 kcal, 71% CHO, 20% F and 9% P) 4 h before exercise. Furthermore, just prior to the test, subjects in the HFM group ingested either maltodextrin jelly (M) or a placebo jelly (P), while subjects in the HCM ingested a placebo jelly. Endurance performance was measured as running time until exhaustion at a speed between lactate threshold and the onset of blood lactate accumulation. All subjects participated in each trial, randomly assigned at weekly intervals. We observed that the time until exhaustion was significantly longer in the HFM + M (p < 0.05) than in HFM + P and HCM + P conditions. Furthermore, the total amount of fat oxidation during exercise was significantly higher in HFM + M and HFM + P than in HCM + P (p < 0.05). These results suggest that ingestion of a HFM prior to exercise is more favorable for endurance performance than HCM. In addition, HFM and maltodextrin ingestion following 3 days of carbohydrate loading enhances endurance running performance.

Nutrition education by a registered dietitian improves dietary intake and nutrition knowledge of a NCAA female volleyball team

Eleven female participants from a NCAA Division I volleyball team were evaluated for adequate energy and macronutrient intake during two off-seasons. Total energy and macronutrient intake were assessed by food records and results were compared against estimated needs using the Nelson equation. Dietary intervention was employed regarding the individual dietary needs of each athlete as well as a pre- and post-sports nutrition knowledge survey. Post dietary intervention, total energy, and macronutrient intake improved, as well as a significant improvement in sports nutrition knowledge (p < 0.001). Nutrition education is useful in improving dietary intake and nutrition knowledge of female athletes.

The ingestion of combined carbohydrates does not alter metabolic responses or performance capacity during soccer-specific exercise in the heat compared to ingestion of a single carbohydrate

This study was designed to investigate the effect of ingesting a glucose plus fructose solution on the metabolic responses to soccer-specific exercise in the heat and the impact on subsequent exercise capacity. Eleven male soccer players performed a 90 min soccer-specific protocol on three occasions. Either 3 ml · kg(-1) body mass of a solution containing glucose (1 g · min(-1) glucose) (GLU), or glucose (0.66 g · min(-1)) plus fructose (0.33 g · min(-1)) (MIX) or placebo (PLA) was consumed every 15 minutes. Respiratory measures were undertaken at 15-min intervals, blood samples were drawn at rest, half-time and on completion of the protocol, and muscle glycogen concentration was assessed pre- and post-exercise. Following the soccer-specific protocol the Cunningham and Faulkner test was performed. No significant differences in post-exercise muscle glycogen concentration (PLA, 62.99 ± 8.39 mmol · kg wet weight(-1); GLU 68.62 ± 2.70; mmol · kg wet weight(-1) and MIX 76.63 ± 6.92 mmol · kg wet weight(-1)) or exercise capacity (PLA, 73.62 ± 8.61 s; GLU, 77.11 ± 7.17 s; MIX, 83.04 ± 9.65 s) were observed between treatments (P > 0.05). However, total carbohydrate oxidation was significantly increased during MIX compared with PLA (P < 0.05). These results suggest that when ingested in moderate amounts, the type of carbohydrate does not influence metabolism during soccer-specific intermittent exercise or affect performance capacity after exercise in the heat.

A critical review of recommendations to increase dietary protein requirements in the habitually active

Some scientists and professional organisations have called for an increase in dietary protein for those who reach a threshold level of exercise, i.e. endurance athletes. But there are individual scientists who question this recommendation. Limitations in the procedures used to justify changing the recommended daily allowance (RDA) are at issue. N balance has been used to justify this increase; but it is limiting even when measured in a well-controlled clinical research centre. Experimental shortcomings are only exacerbated when performed in a sports or exercise field setting. Another laboratory method used to justify this increase, the isotope infusion procedure, has methodological problems as well. Stable isotope infusion data collected during and after exercise cannot account for fed-state gains that counterbalance those exercise losses over a 24 h dietary period. The present review concludes that an adaptive metabolic demand model may be needed to accurately study the protein health of the active individual.

Intake of Nutritional Supplements among People Exercising in Gyms in Beirut City

The use of nutritional supplements among exercisers in gyms has been never investigated in the Middle East. The aim of the current study was to assess the prevalence intake of nutritional supplements and the potential influencing factors among people exercising in gyms in Beirut city. In this cross-sectional study, 512 exercisers, aged between 20 and 50 years, were randomly selected from gyms. The intake of nutritional supplements was reported among 36.3% (95% confidence interval 32.2–40.5) of participants, with a weak presence of medical supervision. Patterns of supplement use differed by gender and age. Men and younger exercisers were found to focus on supplements associated with performance enhancement and muscle building, while women and older exercisers were more concerned with health-promoting products such as vitamins, minerals, and herbal supplements. An appropriate dissemination of accurate and scientifically sound information regarding the benefits and side effects of nutritional supplements is highly recommended in the sports environment in Beirut city.

National Athletic Trainers' Association position statement: safe weight loss and maintenance practices in sport and exercise

OBJECTIVE

To present athletic trainers with recommendations for safe weight loss and weight maintenance practices for athletes and active clients and to provide athletes, clients, coaches, and parents with safe guidelines that will allow athletes and clients to achieve and maintain weight and body composition goals.

BACKGROUND

Unsafe weight management practices can compromise athletic performance and negatively affect health. Athletes and clients often attempt to lose weight by not eating, limiting caloric or specific nutrients from the diet, engaging in pathogenic weight control behaviors, and restricting fluids. These people often respond to pressures of the sport or activity, coaches, peers, or parents by adopting negative body images and unsafe practices to maintain an ideal body composition for the activity. We provide athletic trainers with recommendations for safe weight loss and weight maintenance in sport and exercise. Although safe weight gain is also a concern for athletic trainers and their athletes and clients, that topic is outside the scope of this position statement.

RECOMMENDATIONS

Athletic trainers are often the source of nutrition information for athletes and clients; therefore, they must have knowledge of proper nutrition, weight management practices, and methods to change body composition. Body composition assessments should be done in the most scientifically appropriate manner possible. Reasonable and individualized weight and body composition goals should be identified by appropriately trained health care personnel (eg, athletic trainers, registered dietitians, physicians). In keeping with the American Dietetics Association (ADA) preferred nomenclature, this document uses the terms registered dietitian or dietician when referring to a food and nutrition expert who has met the academic and professional requirements specified by the ADA's Commission on Accreditation for Dietetics Education. In some cases, a registered nutritionist may have equivalent credentials and be the commonly used term. All weight management and exercise protocols used to achieve these goals should be safe and based on the most current evidence. Athletes, clients, parents, and coaches should be educated on how to determine safe weight and body composition so that athletes and clients more safely achieve competitive weights that will meet sport and activity requirements while also allowing them to meet their energy and nutritional needs for optimal health and performance.

Nutrient intake and adherence to dietary recommendations among US workers

OBJECTIVE

To assess nutrient intake according to dietary guidelines among US worker groups.

METHODS

Participants of 1999 to 2004 National Health and Nutrition Examination Survey completed two 24-hour recall dietary interviews to assess daily intake of protein, carbohydrate, fat, cholesterol, calcium, sodium, and fiber. Employed participants (n = 8987) were classified as (1) white collar, (2) service worker, (3) farmer, and (4) blue collar.

RESULTS

Nutrient intake varied by occupational group, particularly for fiber, sodium, calories, and percentage of calories from protein, saturated fat, and carbohydrate. Adherence to recommendations was noted for saturated fat and cholesterol, but workers were poorly adherent to recommendations for all other nutrients, particularly fiber.

CONCLUSIONS

Workers display differences in nutrient intake across occupational groups with poor eating behaviors evident across all groups. Fiber is particularly poorly consumed, with less than 5% of all US workers meeting the recommendations.