Energy substrate utilization during prolonged exercise with and without carbohydrate intake in preadolescent and adolescent girls

Sleep, Nutrition, and Injury Risk in Adolescent Athletes: A Narrative Review

This narrative review explores the impact of sleep and nutrition on injury risk in adolescent athletes. Sleep is viewed as essential to the recuperation process and is distinguished as an active participant in recovery through its involvement in growth, repair, regeneration, and immunity. Furthermore, the literature has shown that the sleep of athletes impacts elements of athletic performance including both physical and cognitive performance, recovery, injury risk, and mental well-being. For sleep to have a restorative effect on the body, it must meet an individual's sleep needs whilst also lasting for an adequate duration and being of adequate quality, which is age-dependent. The literature has suggested that athletes have increased sleep needs compared to those of the general population and thus the standard recommendations may not be sufficient for athletic populations. Therefore, a more individualised approach accounting for overall sleep health may be more appropriate for addressing sleep needs in individuals including athletes. The literature has demonstrated that adolescent athletes achieve, on average, ~6.3 h of sleep, demonstrating a discrepancy between sleep recommendations (8-10 h) and actual sleep achieved. Sleep-wake cycles undergo development during adolescence whereby adaptation occurs in sleep regulation during this phase. These adaptations increase sleep pressure tolerance and are driven by the maturation of physiological, psychological, and cognitive functioning along with delays in circadian rhythmicity, thus creating an environment for inadequate sleep during adolescence. As such, the adolescent period is a phase of rapid growth and maturation that presents multiple challenges to both sleep and nutrition; consequently, this places a significant burden on an adolescent athletes' ability to recover, thus increasing the likelihood of injury. Therefore, this article aims to provide a comprehensive review of the available literature on the importance of sleep and nutrition interactions in injury risk in adolescent athletes. Furthermore, it provides foundations for informing further investigations exploring the relation of sleep and nutrition interactions to recovery during adolescence.

Acute Cardiometabolic and Exercise Responses to Breakfast Omission Versus Breakfast Consumption in Adolescent Girls: A Randomised Crossover Trial

Girls often begin to skip breakfast during adolescence. This study compared the acute effect of breakfast omission versus consumption on cardiometabolic risk markers and perceived appetite and mood during rest and/or exercise in adolescent girls classified as habitual breakfast consumers. Girls (aged 13.2 ± 0.7 years) completed two 5.5 h conditions in a randomised crossover design: breakfast omission (BO) and standardised breakfast consumption (BC). A standardised lunch was provided at 3 h. Incremental cycling exercise was performed at 5 h. Blood and expired gas samples were taken at regular intervals. Whilst pre-lunch plasma glucose, insulin, and Metabolic Load Index incremental area under the curve (IAUC) were significantly lower in BO versus BC, post-lunch differences were reversed and larger in magnitude. Peak plasma glucose and insulin were significantly higher in BO versus BC. Pre-lunch perceived fullness and hunger were significantly lower and higher, respectively, in BO versus BC. Perceived energy and concentration were lower, and tiredness was higher, in BO versus BC. Exercise peak fat oxidation and Fatmax were unaffected. The lower physical activity enjoyment in BO versus BC approached significance. To conclude, acutely omitting breakfast adversely affects cardiometabolic risk markers and exercise enjoyment among adolescent girls who habitually consume breakfast.

Sex-specific maturation of muscle metabolites carnosine, creatine, and carnitine over puberty: a longitudinal follow-up study

Due to the invasiveness of a muscle biopsy, there is fragmentary information on the existence and possible origin of a sexual dimorphism in the skeletal muscle concentrations of the energy delivery-related metabolites carnosine, creatine, and carnitine. As these metabolites can be noninvasively monitored by proton magnetic resonance spectroscopy, this technique offers the possibility to investigate if sexual dimorphisms are present in an adult reference population and if these dimorphisms originated during puberty using a longitudinal design. Concentrations of carnosine, creatine, and carnitine were examined using proton magnetic resonance spectroscopy in the soleus and gastrocnemius muscles of an adult reference population of female (n = 50) and male adults (n = 50). For the longitudinal follow-up over puberty, 29 boys and 28 girls were scanned prepuberty. Six years later, 24 boys and 24 girls were rescanned postpuberty. A sexual dimorphism was present in carnosine and creatine, but not carnitine, in the adult reference population. Carnosine was 28.5% higher in the gastrocnemius (P < 0.001) and carnosine and creatine were respectively 19.9% (P < 0.001) and 18.2% (P < 0.001) higher in the soleus of male when compared with female adults. Through puberty, carnosine increased more in male subjects compared with female subjects, both in the gastrocnemius (+10.43% and -10.83%, respectively; interaction effect: P = 0.002) and in the soleus (+24.30% and +5.49%, respectively; interaction effect: P = 0.012). No significant effect of puberty was found in either creatine (interaction effect: P = 0.307) or carnitine (interaction effect: P = 0.066). A sexual dimorphism in the adult human muscle is present in carnosine and creatine, but not in carnitine.NEW & NOTEWORTHY This is the first study to investigate sexual dimorphisms in skeletal muscle carnosine, creatine, and carnitine concentrations in a substantial adult reference population (n = 100). A sexual dimorphism is present in both carnosine and creatine at adult age. The origin of the sexual dimorphisms is investigated using a longitudinal design over puberty in 24 males and 24 females. The sexual dimorphism in carnosine originated partly during puberty for carnosine, but not for creatine.

The effect of the menstrual cycle and hyperglycaemia on hormonal and metabolic responses during exercise

Purpose

Variations in substrate metabolism have been identified in women during continuous steady-state aerobic exercise performed at the same relative intensity throughout discrete phases of the menstrual cycle, although some evidence exists that this is abolished when carbohydrate is ingested. This investigation examined the effects of a supraphysiologic exogenous glucose infusion protocol, administered during two phases of the menstrual cycle (follicular and luteal) in eumenorrheic women to identify differences between metabolic, hormonal and substrate oxidative responses.

Methods

During the experimental conditions, blood glucose was infused intravenously at rates to “clamp” blood glucose at 10 mM in seven healthy females (age 20 ± 1 y, mass 55.0 ± 4.1 kg, \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\dot V{O_{2peak}}$$\end{document}V˙O2peak 40.0 ± 1.8 ml/kg/min). Following 30 min of seated rest, participants exercised on a cycle ergometer for 90 min at 60% \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\dot V{O_{2peak}}$$\end{document}V˙O2peak. During the rest period and throughout exercise, blood metabolites and hormones were collected at regular intervals, in addition to expired air for the measurement of substrate oxidation.

Results

Significant differences between ovarian hormones and menstrual phase were identified, with estrogen significantly higher during the luteal phase compared to the follicular phase (213.28 ± 30.70 pmol/l vs 103.86 ± 13.85 pmol/l; p = 0.016), and for progesterone (14.23 ± 4.88 vs 2.11 ± 0.36 nmol/l; p = 0.042). However, no further significance was identified in any of the hormonal, metabolite or substrate utilisation patterns between phases.

Conclusion

These data demonstrate that the infusion of a supraphysiological glucose dose curtails any likely metabolic influence employed by the fluctuation of ovarian hormones in eumenorrheic women during moderate exercise.

Carbohydrate Drink Use During 30 Minutes of Variable-Intensity Exercise Has No Effect on Exercise Performance in Premenarchal Girls

PURPOSE

This study examined the physiological, perceptual, and performance effects of a 6% carbohydrate (CHO) drink during variable-intensity exercise (VIE) and a postexercise test in premenarchal girls.

METHODS

A total of 10 girls (10.4 [0.7] y) participated in the study. VO2peak was assessed, and the girls were familiarized with VIE and performance during the first visit. The trial order (CHO and placebo) was randomly assigned for subsequent visits. The drinks were given before VIE bouts and 1-minute performance (9 mL/kg total). Two 15-minute bouts of VIE were completed (10 repeated sequences of 20%, 55%, and 95% power at VO2peak and maximal sprints) before a 1-minute performance sprint.

RESULTS

The mean power, peak power, heart rate (HR), %HRpeak, and rating of perceived exertion during VIE did not differ between trials. However, the peak power decreased, and the rating of perceived exertion increased from the first to the second bout. During the 1-minute performance, there were no differences between the trial (CHO vs placebo) for HR (190 [9] vs 189 [9] bpm), %HRpeak (97.0% [3.2%] vs 96.6% [3.0%]), rating of perceived exertion (7.8 [2.3] vs 8.1 [1.9]), peak power (238 [70] vs 235 [60] W), fatigue index (54.7% [10.0%] vs 55.9% [12.8%]), or total work (9.4 [2.6] vs 9.4 [2.1] kJ).

CONCLUSION

CHO supplementation did not alter physiological, perceptual, or performance responses during 30 minutes of VIE or postexercise sprint performance in premenarchal girls.

Metabolic Flexibility during Exercise in Children with Obesity and Matched Controls

BACKGROUND

Impaired metabolic flexibility (MetFlex) could contribute to ectopic fat accumulation and pathological conditions, such as type 2 diabetes. MetFlex refers to the ability to adapt substrate oxidation to availability. To the best of our knowledge, no studies have examined MetFlex under exercise conditions in children with obesity (OB) compared with a control group (CON) without obesity. Therefore, the primary objective was to compare MetFlex during exercise in children with OB compared with CON matched for chronological age, sex, and biological maturation. A better understanding of MetFlex could help elucidate its role in the pathogenesis of childhood obesity and insulin resistance.

METHODS

Children with obesity and without obesity age 8 to 17 yr attended two visits, which included anthropometric measurements, blood work (OB group only), a maximal aerobic fitness (V˙O2max) test, and MetFlex test with a C-enriched carbohydrate (1.75 g per kg of body mass, up to 75 g) ingested before 60 min of exercise at 45% V˙O2max. Breath measurements were collected to calculate exogenous CHO (CHOexo) oxidative efficiency as a measure of MetFlex.

RESULTS

CHOexo oxidative efficiency (CHOexo oxidized/CHO ingested × 100) during exercise was significantly lower in OB (17.3% ± 4.0%) compared with CON (22.6% ± 4.7%, P < 0.001). CHOexo contributed less to total energy expenditure during exercise in OB compared with CON (P < 0.001), whereas the contribution of endogenous CHO (P = 0.19) and total fat was not significantly different (P = 0.91).

CONCLUSIONS

The ability to oxidize oral CHO, an indicator of MetFlex, was 23.5% lower in children with obesity compared with controls, independent of age, sex, and pubertal effects. Thus, obesity at a young age could be associated with reduced MetFlex and future comorbidities.

Endogenous versus exogenous carbohydrate oxidation measured by stable isotopes in pre-pubescent children plus 13C abundances in foods consumed three days prior

PURPOSE

The purposes of the present study were to (a) examine resting metabolism, substrate utilization, and endogenous versus exogenous carbohydrate (CHO) oxidation before and after 30-g rapidly-digesting carbohydrate (RDC) ingestion using indirect calorimetry and breath test analysis of stable isotope concentrations in pre-pubescent children and (b) report the 13C abundances in foods consumed for three days prior.

METHODS

Nineteen children (n = 10 boys, n = 9 girls) at Tanner stage I or II participated (mean age ± 95% CI = 9.84 ± 0.77 y) in this study. Food was administered to the children for three days preceding their scheduled breath tests. Breath tests and indirect calorimetry were performed after an 8-h fast before and 60 min following consumption of a 30-g simple RDC drink consisting of maltodextrin and sucrose. Open circuit spirometry and indirect calorimetry monitored resting metabolism and CHO oxidation. Separate breath samples were taken every 15 min. Samples of all foods and breath samples were analyzed for 13C and 12C abundances with a stable-isotope mass spectrometer.

RESULTS

13C in expired breath samples were -23.81 ± 1.64‰ at baseline and increased every 15 min after consumption of the CHO drink (p < 0.001-0.009). Cumulative total, endogenous, and exogenous CHO utilization increased during the post-prandial period (p < 0.001). Endogenous CHO oxidation was consistently greater than exogenous CHO oxidation (p < 0.001-0.002).Blood glucose was elevated from baseline at 30- and 60-min post-prandial (p < 0.001). Insulin did not change over time (p = 0.184).

CONCLUSIONS

The foods provided during the 3-day controlled diet effectively minimized 13C variation prior to metabolic testing. The 13C abundances of foods reported herein should serve as practical recommendations to reduce 13C intake before breath tests. While endogenous CHO oxidation remained greater in proportion to exogenous CHO oxidation, these findings suggest that even a relatively small amount of RDC can increase exogenous CHO oxidation and blood glucose in normal-weight children. To further examine shifts in endogenous versus exogenous CHO utilization, we recommend that future studies take steps to minimize 13C variation before breath tests and examine changes in substrate metabolism at rest and during exercise in normal weight and overweight pre-pubescent children.

CLINICAL TRIAL REGISTRATION NUMBER

NCT03185884.

Contributions of Fat and Carbohydrate Metabolism to Glucose Homeostasis in Childhood Change With Age and Puberty: A 12-Years Cohort Study (EARLYBIRD 77)

Puberty-a period when susceptibility to the onset of Type 2 diabetes (T2D) increases-is marked with profound physiological and metabolic changes. In the EarlyBird cohort, children who developed impaired fasting glycemia in adolescence already exhibited higher fasting blood glucose at 5 years of age, independent of their body mass index (BMI), suggesting that pubertal factors may modify existing predisposition. Understanding how the physiological changes during childhood influence glucose homeostasis and how the central energy metabolism may help deciphering the mechanisms that underlie the risk of developing T2D in children and adults. We investigated these associations by analyzing glycemic variations with molecular markers of central energy metabolism, substrate oxidation status and pubertal stages in the EarlyBird cohort. The EarlyBird study is a non-interventional, prospective cohort study, that recruited 307 healthy UK children at age 5, and followed them annually throughout childhood for 12 years. Longitudinal data on blood biochemistry, respiratory exchange ratio, and anthropometry, available from 150 children were integrated with fasting glycemia. The gradual rise in blood glucose during childhood associates with age-dependent changes in molecular processes and substrate oxidation status, namely (i) greater pre-pubertal fat utilization, ketogenesis, and fatty acid oxidation, and (ii) greater pubertal carbohydrate oxidation and glycolytic metabolism (Cori and Cahill Cycles) associated with different amino acid exchanges between muscle and other tissues (proline, glutamine, alanine). Since children's metabolic and nutritional requirements evolve during childhood, this study has potential clinical implications for the development of nutritional strategies for disease prevention in children.

Carbohydrate consumption and variable-intensity exercise responses in boys and men

PURPOSE

The effect of carbohydrate (CHO) supplementation on physiological and perceptual responses to steady-state exercise has been studied in children. However, little is known about these responses to variable-intensity exercise (VIE) and how these responses might differ from adults. This study examined the physiological and perceptual effects of CHO on VIE in boys and men.

METHODS

Eight boys (11.1 ± 0.9 years) and 11 men (23.8 ± 2.1 years) consumed CHO or a placebo (PL) beverage before and throughout VIE (three 12-min cycling bouts with intensity varying every 20-30 s between 25, 50, 75, and 125% peak work rate). Pulmonary gas exchange was assessed during the second 12-min bout. RPE was assessed twice per bout.

RESULTS

In CHO, blood glucose increased and then decreased more from pre-exercise to 12 min and was higher in this trial at the end of exercise in men versus boys. In boys, blood glucose in CHO was higher at 24 and 36 min of exercise than in PL. RER during the CHO trial was higher in both groups; the other physiological responses were unaffected by CHO. All RPE measures (whole body, legs and chest) increased over time, but were not different between groups or trials.

CONCLUSION

Blood glucose patterns during VIE were differentially affected by CHO in boys and men, but most physiological and perceptual responses to VIE were unaffected by CHO in either group. Knowledge of the underlying mechanisms of glucose regulation and effects on physical performance during this type of exercise in children is warranted.

Validity and reliability of a novel metabolic flexibility test in children with obesity

Existing methods for diagnosing diabetes and for identifying risk of diabetes development are completed under resting conditions and based on adult data. Studying additional methods to identify metabolic risk in children is warranted. Our objective was to examine the validity and reliability of a metabolic flexibility (MetFlex) test for screening glycemia and insulin resistance (IR) in children. We hypothesized higher MetFlex during exercise would be correlated with lower fasting glucose and homeostasis model assessment of insulin resistance (HOMA-IR) and higher whole body insulin sensitivity index (WBISI) and insulin secretion-sensitivity index-2 (ISSI-2). Thirty-four children with obesity (14 boys, 20 girls) attended two visits. At visit 1, an oral glucose tolerance test (OGTT) was followed by anthropometric and aerobic fitness (V̇o_2max) assessments. Insulin and glucose during the OGTT were used to calculate HOMA-IR, WBISI, and ISSI-2. At visit 2, a ¹³C-enriched carbohydrate drink was ingested before 60 min of exercise at 45% V̇o_2max. Breath measurements were collected to calculate area under the curve exogenous carbohydrate to measure MetFlex. Pearson's r correlation showed no significant association between MetFlex during exercise with fasting glucose ( r = -0.288, P = 0.110). MetFlex was associated with log-HOMA-IR ( r = -0.597, P = 0.024), log-WBISI ( r = 0.575, P = 0.051), and log-ISSI-2 ( r = 0.605, P = 0.037) in boys but not girls. When repeated ( n = 18), MetFlex was deemed a reliable test (intraclass correlation coefficient = 0.692). MetFlex during exercise was negatively associated with IR and β-cell function in boys. Further research is required to explore clinical utility of the MetFlex test and explain the lack of association in girls. NEW & NOTEWORTHY This study is the first to investigate the validity and reliability of a novel noninvasive metabolic flexibility (MetFlex) test for identifying insulin resistance in children with obesity. MetFlex was measured during exercise using [¹³C]glucose stable isotope methodology. Findings showed that MetFlex was negatively associated with insulin resistance in boys but not in girls with obesity. Future work is required to investigate these sex differences. MetFlex test results were deemed reliable when repeated on a separate day.

Effect of 7 days of exercise on exogenous carbohydrate oxidation and insulin resistance in children with obesity

The capacity to match carbohydrate (CHO) oxidation with CHO availability (deemed metabolic flexibility (MetFlex)) may be important for type 2 diabetes prevention. In adults, impaired MetFlex is associated with insulin resistance (IR), which can be improved with as little as 7 days of exercise. Whether this occurs similarly in children is unknown. We hypothesized that 7 consecutive days of exercise would improve MetFlex and IR in children with obesity. Twelve children (8 boys, 4 girls) completed 2 study visits before (PRE) and 2 study visits after (POST) exercise training. At visit 1, fasting blood was collected, and anthropometry and maximal oxygen uptake were assessed. At visit 2, a ¹³C-enriched CHO drink was ingested before exercise (3 × 20 min) at ∼59% maximal oxygen uptake. Exogenous CHO oxidative efficiency, used as a surrogate measurement of MetFlex, was calculated from breath samples. During training, participants alternated between continuous and high-intensity interval cycling sessions at home under supervision. In spite of good training adherence, there was no improvement in MetFlex (PRE: 20.7% ± 1.8%, POST: 18.9% ± 4.9%, p = 0.22) or homeostasis model assessment of insulin resistance (PRE: 8.7 ± 4.6, POST: 8.1 ± 6.0, p = 0.51). Future research should investigate exercise volume, sex, and pubertal effects on the early responsiveness of MetFlex to exercise therapy.

Physical Activity Duration but Not Energy Expenditure Differs between Daily and Intermittent Breakfast Consumption in Adolescent Girls: A Randomized Crossover Trial

Background

It is not known whether breakfast frequency affects physical activity (PA) in children or adolescents.

Objective

This study examined the effect of daily compared with intermittent breakfast consumption on estimated PA energy expenditure (PAEE) in adolescent girls.

Methods

Under a randomized crossover design, 27 girls [mean ± SD age: 12.4 ± 0.5 y, body mass index (in kg/m2): 19.3 ± 3.0] completed two 7-d conditions. A standardized breakfast (∼1674 kJ) was consumed every day before 0900 in the daily breakfast consumption (DBC) condition. The standardized breakfast was consumed on only 3 d before 0900 in the intermittent breakfast consumption (IBC) condition, alternating with breakfast omission on the remaining 4 d (i.e., only water consumed before 1030). Combined heart rate accelerometry was used to estimate PAEE throughout each condition. Statistical analyses were completed by using condition × time of day repeated-measures ANOVA. The primary outcome was PAEE and the secondary outcome was time spent in PA.

Results

Daily estimated PAEE from sedentary or light-, moderate-, or vigorous-intensity PA and total PAEE were not significantly different between the conditions. The condition × time of day interaction for sedentary time (P = 0.05) indicated that the girls spent an additional 11.5 min/d being sedentary in the IBC condition compared with the DBC condition from 1530 to bedtime (P = 0.04). Light PA was 19.8 min/d longer in the DBC condition than in the IBC condition (P = 0.05), which was accumulated from waking to 1030 (P = 0.04) and from 1530 to bedtime (P = 0.03). There were no significant differences in time spent in moderate PA or vigorous PA between the conditions.

Conclusions

Adolescent girls spent more time in light PA before 1030 and after school and spent less time sedentary after school when a standardized breakfast was consumed daily than when consumed intermittently across 7 d. However, breakfast manipulation did not affect estimated daily PAEE. This trial was registered at www.isrctn.com as ISRCTN74579070.

Energy substrate utilization with and without exogenous carbohydrate intake in boys and men exercising in the heat

Little is known about energy yield during exercise in the heat in boys compared with men. To investigate substrate utilization with and without exogenous carbohydrate (CHOexo) intake, seven boys [11.2 ± 0.2 (SE) yr] and nine men (24.0 ± 1.1 yr) cycled (4 × 20-min bouts) at a fixed metabolic heat production ( Ḣ p) per unit body mass (6 W/kg) in a climate chamber (38°C and 50% relative humidity), on two occasions. Participants consumed a 13C-enriched 8% CHO beverage (CARB) or placebo beverage (CONT) in a double-blinded, counterbalanced manner. Substrate utilization was calculated for the last 60 min of exercise. CHOexo oxidation rate (2.0 ± 0.3 vs. 2.5 ± 0.2 mg·kg fat-free mass−1·min−1, P = 0.02) and CHOexo oxidation efficiency (12.8 ± 0.6 vs. 16.0 ± 0.9%, P = 0.01) were lower in boys compared with men exercising in the heat. Total carbohydrate (CHOtotal), endogenous CHO (CHOendo), and total fat (Fattotal) remained stable in boys and men ( P > 0.05) during CARB, whereas CHOtotal oxidation rate decreased ( P < 0.001) and Fattotal oxidation rate increased over time similarly in boys and men during CONT ( P < 0.001). The relative contribution of CHOexo to total energy yield increased over time in both groups ( P < 0.001). In conclusion, endogenous substrate metabolism and the relative contribution of fuels to total energy yield were not different between groups. The ingestion of a CHO beverage during exercise in the heat may be as beneficial for boys as men to spare endogenous substrate.

No difference in exogenous carbohydrate oxidation during exercise in children with and without impaired glucose tolerance

The capacity to match carbohydrate (CHO) utilization with availability is impaired in insulin-resistant, obese adults at rest. Understanding exogenous carbohydrate (CHOexo) oxidation during exercise and its association to insulin resistance (IR) is important, especially in children at risk for type 2 diabetes. Our objective was to examine the oxidative efficiency of CHOexo during exercise in obese children with normal glucose tolerance (NGT) or impaired glucose tolerance (IGT). Children attended two visits and were identified as NGT (n = 22) or IGT (n = 12) based on 2-h oral glucose tolerance test (OGTT) glucose levels of <7.8 mmol/l or ≥7.8 mmol/l, respectively. Anthropometry, body composition, and aerobic fitness (V̇o2max) were assessed. Insulin and glucose at baseline, 30, 60, 90, and 120 min during the OGTT were used to calculate measures of insulin sensitivity. On a separate day, a (13)C-enriched CHO drink was ingested before exercise (3 × 20 min bouts) at 45% V̇o2max Breath measurements were collected to calculate CHOexo oxidative efficiency. CHOexo oxidative efficiency during exercise was similar in IGT (17.0 ± 3.6%) compared with NGT (17.1 ± 4.4%) (P = 0.90) despite lower whole body insulin sensitivity in IGT at rest (P = 0.02). Area under the curve for insulin (AUCins) measured at rest during the OGTT was greater in IGT compared with NGT (P = 0.04). The ability of skeletal muscle to utilize CHOexo was not impaired during exercise in children with IGT.

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.

Muscle metabolism changes with age and maturation: How do they relate to youth sport performance?

AIM

To provide an evidence-based review of muscle metabolism changes with sex-, age- and maturation with reference to the development of youth sport performance.

METHODS

A narrative review of data from both invasive and non-invasive studies, from 1970 to 2015, founded on personal databases supported with computer searches of PubMed and Google Scholar.

RESULTS

Youth sport performance is underpinned by sex-, age- and maturation-related changes in muscle metabolism. Investigations of muscle size, structure and metabolism; substrate utilisation; pulmonary oxygen uptake kinetics; muscle phosphocreatine kinetics; peak anaerobic and aerobic performance; and fatigue resistance; determined using a range of conventional and emerging techniques present a consistent picture. Age-related changes have been consistently documented but specific and independent maturation-related effects on muscle metabolism during exercise have proved elusive to establish. Children are better equipped for exercise supported primarily by oxidative metabolism than by anaerobic metabolism. Sexual dimorphism is apparent in several physiological variables underpinning youth sport performance. As young people mature there is a progressive but asynchronous transition into an adult metabolic profile.

CONCLUSIONS

The application of recent developments in technology to the laboratory study of the exercising child and adolescent has both supplemented existing knowledge and provided novel insights into developmental exercise physiology. A sound foundation of laboratory-based knowledge has been established but the lack of rigorously designed child-specific and sport-specific testing environments has clouded the interpretation of the data in real life situations. The primary challenge remains the translation of laboratory research into the optimisation of youth sports participation and performance.

High cycling cadence reduces carbohydrate oxidation at given low intensity metabolic rate

Cycling cadence (RPM)-related differences in blood lactate concentration (BLC) increase with increasing exercise intensity, whilst corresponding divergences in oxygen uptake (V.O₂) and carbon dioxide production (V.CO₂) decrease. Aim of the present study was to test whether a higher RPM reduces the fraction (%) of the V.O₂ used for carbohydrate oxidation (relCHO) at a given BLC. Eight males (23.9 ± 1.6 yrs; 177 ± 3 cm; 70.3 ± 3.4 kg) performed incremental load tests at 50 and 100 RPM. BLC, V.O₂ and V.CO₂ were measured. At respiratory exchange ratios (RER) < 1, relCHO were calculated and the constant determining 50 % relCHO (k_CHO) was approximated as a function of the BLC. At submaximal workload V.O₂, V.CO₂, and relCHO were lower (all p < 0.002; η² > 0.209) at 50 than at 100 RPM. No differences were observed in V.O₂peak (3.96 ± 0.22 vs. 4.00 ± 0.25 l · min⁻¹) and RER_peak (1.18 ± 0.02 vs. 1.15 ± 0.02). BLC was lower (p < 0.001; η² = 0.680) at 50 than at 100 RPM irrespective of cycling intensity. At 50 RPM, kCHO (4.2 ± 1.4 (mmol · l⁻¹)³) was lower (p = 0.043; η² = 0.466) than at 100 RPM (5.9 ± 1.9 (mmol · l⁻¹)³). This difference in k_CHO reflects a reduced CHO oxidation at a given BLC at 100 than at 50 RPM. At a low exercise intensity, a higher cycling cadence can substantially reduce the reliance on CHO at a given metabolic rate and/or BLC.

Acute changes in substrate oxidation do not affect short-term food intake in healthy boys and men

The acute relationship between substrate oxidation as measured by respiratory exchange ratio (RER) and food intake (FI) has not been defined. The purpose of the study was to determine acute relationships between RER, modified by exercise and a glucose load, and FI and net energy balance (NEB) in physically active normal-weight boys and men. In a crossover design, 15 boys (aged 9-12 years) and 15 men (aged 20-30 years) were randomly assigned to 4 conditions: (i) water and rest, (ii) glucose-drink and rest, (iii) water and exercise, and (iv) glucose-drink and exercise. Indirect calorimetry was used to determine RER, energy expenditure, and carbohydrate and fat oxidation. Subjective appetite and blood glucose were also measured. RER was higher after glucose (0.91 ± 0.01) compared with water (0.87 ± 0.01) (p < 0.0001), and after exercise (0.91 ± 0.01) compared with rest (0.88 ± 0.01) (p = 0.0043) in men (0.91 ± 0.01) compared with boys (0.88 ± 0.01) (p = 0.0002). FI (kcal·m(-2)) did not differ between boys and men. Glucose (582 ± 24 kcal·m(-2)) reduced FI compared with water (689 ± 25 kcal·m(-2)) (p < 0.0001), and further decreased FI when combined with exercise (554 ± 34 kcal·m(-2)) (p = 0.0303). NEB was reduced with exercise (573 ± 25 kcal·m(-2)) compared with the sedentary condition (686 ± 24 kcal·m(-2)) (p < 0.0001), but was higher after the glucose drink (654 ± 27 kcal·m(-2)) compared with water (605 ± 25 kcal·m(-2)) (p = 0.0267). No correlations were found between RER and FI or NEB in boys and men, except in the control condition of resting with water. In conclusion, the short-term modification of substrate oxidation by glucose and/or exercise in normal weight and active boys and men did not affect FI and NEB.

Increased lipid oxidation during exercise in obese pubertal girls: a QUALITY study

OBJECTIVE

This study explores differences in LO rates between pre-pubertal and pubertal girls of three body weight status groups.

METHODS

The sample included 39 pre-pubertal girls [12 normal-weight (NW), 12 overweight (OW), and 15 obese (OB)] and 37 pubertal girls [16 NW, 10 OW, and 11 OB]. Following a rest period, the girls performed a graded maximal cycling test. The %LO contribution was computed at each stage.

RESULTS

The %LO contribution did not differ between NW, OW, or OB pre-pubertal girls at each exercise stage. In contrast, pubertal OB girls showed a statistically significantly higher %LO contribution at 25, 50, and 75 W stages compared with OW and NW as well as with OB pre-pubertal girls.

CONCLUSIONS

Our results demonstrate that entering puberty is a period associated with differentiation in substrate selection in obese girls. A higher %LO contribution may help girls to solicit more fat while performing submaximal exercise.

The effect of puberty on fat oxidation rates during exercise in overweight and normal-weight girls

Excess weight is often associated with insulin resistance (IR) and may disrupt fat oxidation during exercise. This effect is further modified by puberty. While studies have shown that maximal fat oxidation rates (FOR) during exercise decrease with puberty in normal-weight (NW) and overweight (OW) boys, the effect of puberty in NW and OW girls is unclear. Thirty-three NW and OW girls ages 8–18 yr old completed a peak aerobic capacity test on a cycle ergometer. FOR were calculated during progressive submaximal exercise. Body composition and Tanner stage were determined. For each participant, a best-fit polynomial curve was constructed using fat oxidation vs. exercise intensity to estimate max FOR. In a subset of the girls, IR derived from an oral glucose tolerance test ( n = 20), and leptin and adiponectin levels ( n = 11) were assessed in relation to FOR. NW pre-early pubertal girls had higher max FOR [6.9 ± 1.4 mg·kg fat free mass (FFM)−1·min−1] than NW mid-late pubertal girls (2.2 ± 0.9 mg·kg FFM−1·min−1) ( P = 0.002), OW pre-early pubertal girls (3.8 ± 2.1 mg·kg FFM−1·min−1), and OW mid-late pubertal girls (3.3 ± 0.9 mg·kg FFM−1·min−1) ( P < 0.05). Bivariable analyses showed positive associations between FOR with homeostatic model assessment of IR ( P = 0.001), leptin ( P < 0.001), and leptin-to-adiponectin ratio ( P = 0.001), independent of percent body fat. Max FOR decreased in NW girls during mid-late puberty; however, this decrease associated with puberty was blunted in OW girls due to lower FOR in pre-early puberty. The presence of IR due to obesity potentially masks the effect of puberty on FOR during exercise in girls.

Carbohydrate supplementation and prolonged intermittent high-intensity exercise in adolescents: research findings, ethical issues and suggestions for the future

In the last decade, research has begun to investigate the efficacy of carbohydrate supplementation for improving aspects of physical capacity and skill performance during sport-specific exercise in adolescent team games players. This research remains in its infancy, and further study would be beneficial considering the large youth population actively involved in team games. Literature on the influence of carbohydrate supplementation on skill performance is scarce, limited to shooting accuracy in adolescent basketball players and conflicting in its findings. Between-study differences in the exercise protocol, volume of fluid and carbohydrate consumed, use of prior fatiguing exercise and timing of skill tests may contribute to the different findings. Conversely, initial data supports carbohydrate supplementation in solution and gel form for improving intermittent endurance running capacity following soccer-specific shuttle running. These studies produced reliable data, but were subject to limitations including lack of quantification of the metabolic response of participants, limited generalization of data due to narrow participant age and maturation ranges, use of males and females within the same sample and non-standardized pre-exercise nutritional status between participants. There is a lack of consensus regarding the influence of frequently consuming carbohydrate-containing products on tooth enamel erosion and the development of obesity or being overweight in adolescent athletes and non-athletes. These discrepancies mean that the initiation or exacerbation of health issues due to frequent consumption of carbohydrate-containing products by adolescents cannot be conclusively refuted. Coupled with the knowledge that consuming a natural, high-carbohydrate diet -3-8 hours before exercise can significantly alter substrate use and improve exercise performance in adults, a moral and ethical concern is raised regarding the direction of future research in order to further knowledge while safeguarding the health and well-being of young participants. It could be deemed unethical to continue study into carbohydrate supplementation while ignoring the potential health concerns and the possibility of generating similar performance enhancements using natural dietary interventions. Therefore, future work should investigate the influence of pre-exercise dietary intake on the prolonged intermittent, high-intensity exercise performance of adolescents. This would enable quantification of whether pre-exercise nutrition can modulate exercise performance and, if so, the optimum dietary composition to achieve this. Research could then combine this knowledge with ingestion of carbohydrate-containing products during exercise to facilitate ethical and healthy nutritional guidelines for enhancing the exercise performance of adolescents. This article addresses the available evidence regarding carbohydrate supplementation and prolonged intermittent, high-intensity exercise in adolescent team games players. It discusses the potential health concerns associated with the frequent use of carbohydrate-containing products by adolescents and how this affects the research ethics of the field, and considers directions for future work.

Influence of hormonal status on substrate utilization at rest and during exercise in the female population

During exercise, substrate utilization plays a major role in performance and disease prevention. The contribution of fat and carbohydrates to energy expenditure during exercise is modulated by several factors, including intensity and duration of exercise, age, training and diet, but also gender. Because sex hormone levels change throughout a woman's lifetime (in connection with puberty, the menstrual cycle, use of oral contraceptives and menopause), the female population has to be considered specifically in terms of substrate utilization, and metabolic and hormonal responses to exercise. Before puberty, there is no difference between males and females when it comes to substrate oxidation during exercise. This is not the case during adulthood, since women are known to rely more on fat than men for the same relative intensity of exercise. Among adult women, the menstrual cycle and use of oral contraceptives may influence substrate oxidation. While some authors have noted that the luteal phase of the menstrual cycle is connected with greater lipid oxidation, compared with the follicular stage, other authors have found no difference. Among oral contraceptive users, fat oxidation is sometimes increased during prolonged exercise with a concomitant rise in lipolytic hormones, as well as growth hormone. If this result is not always observed, the type of oral contraceptive (monophasic vs triphasic) and hormone doses may be implicated. Menopause represents a hormonal transition in a woman's life, leading to a decline in ovarian hormone production. A decrease in fat oxidation is consequently observed, and some studies have demonstrated a similar respiratory exchange ratio during prolonged exercise in postmenopausal women and in men. As is the case during puberty, no sex difference should thus appear after menopause in the absence of hormonal replacement therapy (HRT). Results concerning women who take HRT remain conflicting. HRT may act on fat loss by increasing lipid metabolism, but this depends on how the treatment is administered (orally vs transdermally). To better understand the role of ovarian hormones in substrate oxidation, studies have made use of animal protocols to investigate cellular mechanisms. Estradiol and progesterone seem to have opposite effects, with greater lipid oxidation when estradiol is used alone. However, the concentrations used (physiological levels or pharmacological doses) may considerably modify fuel selection. In cases where conflicting data are observed in studies of substrate utilization and prolonged exercise in women, methodological reasons must be called into question. Too many parameters, which oftentimes are not specified, may modulate substrate utilization and metabolic and hormonal responses to prolonged exercise. Although information is generally provided about the type of exercise, its duration and the subjects' training level, detailed information is not always given about the subjects' nutritional state and, more specifically, the hormonal status of female subjects. The primary purpose of this review was to identify the impact of hormonal status on substrate oxidation among female subjects at rest and during exercise. A second aim was to describe gender differences in substrate utilization during exercise.

Fluid Balance and Dehydration in the Young Athlete

Many young athletes train and compete under conditions that put their body fluid balance at risk, and hypohydration is usually the major concern. Another less frequent condition is hyperhydration that—if accompanied by other risk factors—may cause hyponatremia. Water and electrolyte losses during physical activities occur primarily from sweat. Such losses have been identified mostly in active (but nonathletic) young populations under laboratory settings. Studies have been trying to estimate fluid losses in the athletic population under field conditions, taking into account the sport modality and environmental conditions. Besides these external conditions, young athletes adopt different drinking attitudes, which may depend on knowledge, education, and the opportunities to drink during the break periods as well as fluid availability. Focusing on the young athlete, this review will discuss water and sodium losses from sweat, the effects of hypohydration on performance, and fluid intake attitudes within and during practices and competitions. Some considerations related to the methods of identifying hydration status and guidelines are also given, with the understanding that they should be individually adapted for the athlete and activity. The young athlete, parents, coaches, and athletic/health professionals should be aware of such information to prevent fluid imbalances and the consequent hazardous effects on performance and health.

Carbohydrate intake reduces fat oxidation during exercise in obese boys

The recent surge in childhood obesity has renewed interest in studying exercise as a therapeutic means of metabolizing fat. However, carbohydrate (CHO) intake attenuates whole body fat oxidation during exercise in healthy children and may suppress fat metabolism in obese youth. To determine the impact of CHO intake on substrate utilization during submaximal exercise in obese boys, seven obese boys (mean age: 11.4 ± 1.0 year; % body fat: 35.8 ± 3.9%) performed 60 min of exercise at an intensity that approximated maximal fat oxidation. A CHO drink (CARB) or a placebo drink (CONT) was consumed in a double-blinded, counterbalanced manner. Rates of total fat, total CHO, and exogenous CHO (CHO(exo)) oxidation were calculated for the last 20 min of exercise. During CONT, fat oxidation rate was 3.9 ± 2.4 mg × kg fat-free mass (FFM)(-1 )× min(-1), representing 43.1 ± 22.9% of total energy expenditure (EE). During CARB, fat oxidation was lowered (p = 0.02) to 1.7 ± 0.6 mg × kg FFM(-1 )× min(-1), contributing to 19.8 ± 4.9% EE. Total CHO oxidation rate was 17.2 ± 3.1 mg × kg FFM(-1 )× min(-1) and 13.2 ± 6.1 mg × kg FFM(-1) × min(-1) during CARB and CONT, respectively (p = 0.06). In CARB, CHO(exo) oxidation contributed to 23.3 ± 4.2% of total EE. CHO intake markedly suppresses fat oxidation during exercise in obese boys.

Fat oxidation rate and the exercise intensity that elicits maximal fat oxidation decreases with pubertal status in young male subjects

The range of exercise intensities that elicit high fat oxidation rates (FOR) in youth and the influence of pubertal status on peak FOR are unknown. In a longitudinal design, we compared FOR over a range of exercise intensities in a small cohort of developing prepubertal male subjects. Five boys all at Tanner stage 1 (ages 11-12 yr) and nine men (ages 20-26 yr) underwent an incremental cycle ergometry test to volitional exhaustion. FOR curves were determined from indirect calorimetry during the final 30 s of each increment. The same protocol was duplicated annually in the boys as they progressed through puberty. The peak FOR was considerably higher (P<0.05) in boys at Tanner 1 (8.6+/-1.5 mg.kg lean body mass(-1).min(-1)) (mean+/-SD) compared with men (4.2+/-1.1 mg.kg lean body mass(-1).min(-1)). FOR dropped as boys developed through puberty (Tanner 2/3 peak rate=7.6+/-0.6 mg.kg lean body mass(-1).min(-1); Tanner 4 peak rate=5.4+/-1.8 mg.kg lean body mass(-1).min(-1), main effect of Tanner stage; P<0.05) to the levels found in men (not significant). The exercise intensity that elicited peak FOR was higher in the boys at Tanner 1 [56+/-6% peak aerobic power (VO2 peak)] than in men (31+/-4% VO2 peak) (P<0.001). This value tended to decrease by Tanner stage 4 (45+/-10% VO2 peak, main effect of Tanner stage; P=0.06). We conclude that, compared with men, prepubertal boys have higher relative FOR throughout a wide range of exercise intensities and that FOR drops as boys develop through puberty.

The endocrine response and substrate utilization during exercise in children and adolescents

Adolescence is a time of rapid growth caused by significant changes in hormone levels. For many, it is also a time of increased physical activity and sport that places a large demand on energy reserves. Exercise is known to cause perturbations in endocrine and metabolic systems in children and adolescents, yet careful characterization of these responses is only now being conducted. It does not appear that prepubertal youth have a different muscle composition than adults. However, these youth do have a lower anaerobic capacity and a greater reliance on aerobic metabolism during activity. Prepubertal adolescents may have an immature glucose regulatory system that influences glycemic regulation at the onset of moderate exercise. During heavy exercise, muscle and blood lactate levels are lower in children than in adults and there is a greater reliance on fat as fuel. The exercise intensity that causes maximal fat oxidation rate and the relative rate of fat oxidation decreases as adolescents develop through puberty. The mechanism for the attenuated lipid utilization with the advancement of puberty, and the impact that this may have on body composition, are unknown. Surprisingly, prepubertal adolescents have relatively high rates of exogenous glucose oxidation, perhaps because of their smaller endogenous carbohydrate reserves. Further study is needed to determine the optimal exogenous carbohydrate feeding regimen for peak performance in adolescence. Studies are also needed to determine whether physical activity, at an intensity targeted to maximize fat oxidation, help to lower body adiposity in overweight youth.