Dietary Intake, Body Composition and Iron Status in Experienced and Elite Climbers

A literature review of biomarkers used for diagnosis of relative energy deficiency in sport

Introduction

The review aims to summarize the markers used in diagnosing relative energy deficiency in sport (REDs) and compare them with the REDs CAT2 score.

Methods

A systematic search was performed in the PubMed, Web of Science, and SPORTDiscus databases during April 2023. The descriptors used were "athlete" AND "REDs," along with respective entry terms. The selection process followed the PRISMA 2020 recommendations, identifying 593 records, from which 13 studies were ultimately selected. Seventy-nine markers were identified and categorized into six groups: bone mineral density (BMD), metabolic resting rate, blood biomarkers, anthropometrics, nutritional intake, and performance parameters. The most frequently utilized biomarkers included BMD, anthropometric parameters (e.g., body mass index, body mass, and fat mass), and the triiodothyronine (T3) concentration.

Results

According to the REDs CAT2 pointed indicators, the biomarkers varied among the studies, while 7 out of the 13 included studies achieved a ≥60% agreement rate with this tool. The prevalence of low energy availability, an etiological factor in the development of REDs, was detected in 4 out of 13 studies, with an average of 39.5%.

Conclusion

In conclusion, this review highlights the most commonly used markers in diagnosing REDs, such as BMD, anthropometric parameters, and T3 hormone concentration. Due to the current inconsistencies, standardizing diagnostic methodologies is crucial for future research. By focusing on widely used markers, this review aids future research planning and result interpretation and points out the ongoing need for methodological consistency in evolving diagnostic tools.

Systematic Review Registration

https://www.crd.york.ac.uk/, PROSPERO (CRD42022320007).

Social media behaviors and body type ideals predict weight loss and food tracking behaviors among recreational climbers

Introduction

Elite and recreational climbers may be at risk for disordered eating, low energy availability (LEA), and increased injury as a result. Social media use among athlete and non-athletes can lead to body image disturbances resulting in unhealthy weight loss practices exacerbating LEA and injury risk. Therefore, the objective of this study was to examine relationships between social comparative behaviors on social media, body type ideals and outcomes, and health behaviors among adult recreational climbers.

Methods

Participants (n = 324) were adult recreational climbers from the U.S. (29.30 ± 9.99 years old and 50% female). Participants answered a 66-item questionnaire comprised of demographics, climbing characteristics, social media behaviors, body type ideals, training and nutrition-seeking behaviors, and weight and food tracking behaviors.

Results

Most participants (78.7%) indicated strength-to-weight ratio was important for climbing performance. Many participants perceived they could perform better at rock climbing if their body proportions were different (59.3%). These body type ideals were found to be significant predictors of performing weight loss and food-tracking behaviors (all p < 0.001). Higher amounts of social comparative behaviors on social media and social physique anxiety independently and significantly predicted attempting weight loss to improve climbing ability (p < 0.001 and p = 0.001 respectively). Those who followed climbing influencers, used Instagram frequently for training and nutrition information, perceived they could perform better at rock climbing if their body proportions were different, or were female and college-aged had significantly higher mean social comparative behavior scores (all p < 0.01).

Discussion

This study expands on prior work with elite climbers by providing a possible explanation for how climbing-related body type ideals and certain social media behaviors can perpetuate negative body image and compensatory behaviors among a general climbing population. Because unhealthy weight management behaviors can lead to injury and health disturbances, broad education programming and social media campaigns should be developed to shift body ideals and nutrition behaviors among recreational climbers.

Nutrition knowledge, weight loss practices, and supplement use in senior competition climbers

Introduction

Sport climbing has gained increased scientific attention, including studies investigating the dietary habits and nutritional requirements of climbers; however, significant gaps in the literature remain. An assessment of nutritional knowledge, weight loss for competition, and supplement use has not been previously reported in senior competition climbing athletes.

Methods

Fifty climbers (26 male, 24 female; BMI 21.6 ± 1.9; 23.7 ± 5.2 years) participated in the study. Participants answered a 72-item questionnaire, comprised of demographic data and three main sections to assess general and sports nutrition knowledge, weight loss strategies, and supplement use.

Results

The mean nutrition knowledge score was 'average', with considerable individual variation (53.5 ± 11.1 %). There were no significant sex differences in the general (GNK) or sport (SNK) nutrition knowledge scores, or effect of age. Significantly higher knowledge was demonstrated by national vs. international athletes for the GNK scores (11.09 ± 1.58 vs. 9.58 ± 1.75; p = 0.028). Participants scored well in questions concerning protein, carbohydrates, alcohol, and supplements, and conversely, performed poorly in hydration and micronutrient related questions. Less than one-fifth of respondents had access to a dietitian. Forty-six percent of males and 38% of female climbers reported intentional weight loss for competition on at least one occasion. Of those, ~76% reported utilizing concerning practices, including methods that conform with disordered eating and/or eating disorders, dehydration, vomiting, and misuse of laxatives. Approximately 65% of athletes reported using at least one nutritional supplement in the previous 6 months, with 44% reporting multiple supplement use. There was no significant difference in supplement use between sexes or competition level.

Discussion

Due to the established importance of nutritional intake on athlete health and performance, educational support should be employed to improve knowledge in climbers and address shortcomings. Moreover, intentional weight loss for climbing competition is common, with most athletes achieving ~3-8% body weight loss over ≥2 weeks. It is crucial that professionals working with competitive climbers are vigilant in identifying athletes at risk of concerning weight management and establish referral pathways to the appropriate specialist services. High quality intervention trials to assess the efficacy of ergogenic aids in climbing remains inadequate.

Physiological Characteristics, Dietary Intake, and Supplement Use in Sport Climbing

PURPOSE OF REVIEW

As sport climbing has become an Olympic sport and keeps gaining in popularity, there is growing interest in the role of diet and the effect of dietary supplements on climbing performance. The aim of this review is to provide an insight into the dietary intake of climbers and discuss ergogenic aids that could improve their performance.

RECENT FINDINGS

Limited information is available regarding the dietary intake and eating habits of climbers, and the studies conducted are few and far between. The diet of climbers is apparently suboptimal, with inadequate energy intakes often owning to insufficient carbohydrate consumption. Likewise, supplement use and ergogenic aids for climbing performance are largely unexplored. Several ergogenic aids have been suggested to improve climbing performance; however, only two have been examined directly on climbing-specific outcomes. The dietary intake, eating behaviors, and supplement use in sport climbers are not well studied, and available information is most likely outdated. Considerably, more work is needed to determine which ergogenic aids can be beneficial for climbing performance.

Comparisons and associations among anthropometric indices of first and second division and assistant soccer referees

Introduction

Body composition is an important predictor of performance and a key component of health and physical fitness. Therefore, the purposes of this study were to compare soccer referees of the first and second divisions and field assistant referees from Iran and to analyze associations of a body shape index (ABSI), body adiposity index (BAI), abdominal volume index (AVI), body roundness index (BRI), conicity index (ConI), and body mass index (BMI) with body fat percentage (%BF).

Methods

A total of 270 male soccer referees from the first (n = 124) and second (n = 72) divisions and assistant referees (n = 74) participated in this study. Skinfold thickness (measured at the chest, biceps, triceps, subscapular, abdominal, iliac crest, and front thigh), height, weight, hip circumference, and waist circumference were assessed to evaluate waist-to-height ratio (WHtR), %BF, and also ABSI, BRI, BAI, ConI, and AVI according to the ISAK protocol.

Results

The main results indicated differences in WHR, WHtR, ABSI, BRI, AVI, ConI, and BF% with the assistant referees presenting higher values (p < 0.05). When considering the backward selection model, there were some associations with %BF in each group, specifically BMI, BAI, and ABSI in the first division; BMI, WHR, and ABSI in the second division; and BMI in the assistant referee group (all p < 0.05).

Discussion

The present study did not confirm the hypothesis that the first-division referees presented better body composition-related variables than the second division or assistant referees. Instead, it showed that the assistant referees that participated in both divisions showed a tendency to higher values which suggests that the level of division is not a major factor when analyzing body composition.

Dietary Intake of Protein and Essential Amino Acids for Sustainable Muscle Development in Elite Male Athletes

Athletes need to develop a relatively high muscle mass and low body adipose tissue for the sake of better athletic performance. A full range of nine essential amino acids and eleven non-essential amino acids have to attend in appropriate amounts for protein biosynthesis. The aim of the observational comparative cross-sectional study was to assess the association between the diet quality profile and training-induced muscle mass estimated by bioelectrical impedance among elite male athletes. The research sample comprised 18.1 ± 3.1 year-old Lithuanian professional male athletes (n = 234). The study participants were enrolled to complete 24-h dietary recalls of three non-consecutive days. The body composition was assessed using the bioelectrical impedance analysis (BIA) method. The present study showed a significant insufficiency of the mean carbohydrate intake of 5.7 g/kg/day in a group of aerobic male athletes. The lower muscle mass of aerobic male athletes was related to the lower-carbohydrate diet (adjusted odd ratio (ORadj) 0.3; 95% confidence interval (CI): 0.1-0.7). The mean protein intake of 1.8 g/kg/day was optimal for anabolism in the samples of both anaerobic and aerobic male athletes. The protein intake in appropriate doses was potentially associated with an increase in muscle mass only in anaerobic male athletes (ORadj 2.2; 95% CI: 1.3-3.7). The positive relationship was revealed between the possible muscle mass gain and the increased intakes of amino acids such as isoleucine and histidine among anaerobic athletes (ORadj 2.9; 95% CI: 1.1-4.7 and ORadj 2.9; 95% CI: 1.0-4.3, respectively). An inverse feasible association was indicated between a higher intake of valine and lower muscle mass quantities among anaerobic male athletes (ORadj 0.1; 95% CI: 0.1-0.5). The recommendations for sports nutritionists should emphasize the necessity of advising professional athletes on dietary strategies on how to manipulate dietary amino acid composition with respect to achieving long-term body composition goals.

Mapping the complexities of Relative Energy Deficiency in Sport (REDs): development of a physiological model by a subgroup of the International Olympic Committee (IOC) Consensus on REDs

The 2023 International Olympic Committee (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs) notes that exposure to low energy availability (LEA) exists on a continuum between adaptable and problematic LEA, with a range of potential effects on both health and performance. However, there is variability in the outcomes of LEA exposure between and among individuals as well as the specific manifestations of REDs. We outline a framework for a 'systems biology' examination of the effect of LEA on individual body systems, with the eventual goal of creating an integrated map of body system interactions. We provide a template that systematically identifies characteristics of LEA exposure (eg, magnitude, duration, origin) and a variety of moderating factors (eg, medical history, diet and training characteristics) that could exacerbate or attenuate the type and severity of impairments to health and performance faced by an individual athlete. The REDs Physiological Model may assist the diagnosis of underlying causes of problems associated with LEA, with a personalised and nuanced treatment plan promoting compliance and treatment efficacy. It could also be used in the strategic prevention of REDs by drawing attention to scenarios of LEA in which impairments of health and performance are most likely, based on knowledge of the characteristics of the LEA exposure or moderating factors that may increase the risk of harmful outcomes. We challenge researchers and practitioners to create a unifying and dynamic physiological model for each body system that can be continuously updated and mapped as knowledge is gained.

Associations of micronutrients exposure with cadmium body burden among population: A systematic review

BACKGROUND

The absorption and accumulation of cadmium (Cd) within the human body can be influenced by the status of certain micronutrients, while available evidence for the association between micronutrient exposure and Cd body burden remains fragmented and inconsistent. To address this issue, this article reviews and synthesizes epidemiological studies that examine the association between micronutrient exposure and Cd burden in humans, to elucidate the potential association between micronutrient exposure and Cd body burden.

METHODS

We conducted a systematic review of epidemiologic studies reporting the association between micronutrient status and Cd body burden among the population. Relevant articles were selected based on predetermined criteria from PubMed, Web of Science, and Scopus databases published from 2000 to 2021. The exposures that were evaluated included micronutrients (zinc, selenium, iron, calcium, and vitamins) status or intakes of them. The outcome of interest was the Cd body burden as indicated by blood Cd or urinary Cd levels. The quality of included studies was assessed using The Joanna Briggs Institute critical appraisal tool. We extracted data from each article, including study design, study site, study population, micronutrient status, Cd body burden, and the correlations between micronutrient status and Cd body burden.

RESULTS

Our systematic search yielded 1660 articles. Of these, forty-four were selected for inclusion based on prespecified criteria. These selected articles evaluated the relationship between Cd body burden and seven different micronutrients, namely, selenium (Se), zinc (Zn), calcium (Ca), iron (Fe), vitamin A, vitamin B12, and vitamin D. The majority of studies (n = 41) were observational, while only three were randomized controlled trials. Among the seventeen studies assessing Zn status, ten reported a negative association between serum Zn levels or intake and urinary and blood Cd levels. Results were inconsistent among the ten studies examining the association between Se levels and Cd body burden. Six studies showed that Cd in blood and urine was negatively correlated with serum ferritin (SF), a biomarker of body Fe status. Two studies reported a negative correlation between Ca and blood Cd.

CONCLUSIONS

This synthesis of available evidence suggests that certain micronutrients, especially Zn and Fe, may play a role in reducing the Cd body burden among populations. The evidence strongly supports a negative association between Zn, Fe, and Cd body burden, whereas evidence for Se, Ca and vitamins is insufficient to draw definitive conclusions regarding their relationship with Cd body burden. In addition, observational studies limit the ability to infer a causal relationship between micronutrients and Cd body burden, highlighting the need for additional intervention studies. Our review may inform nutrient supplementation guidance, control of Cd body burden, and future research to mitigate the adverse health effects of Cd in the context of global Cd pollution.

The Evaluation of Energy Availability and Dietary Nutrient Intake of Sport Climbers at Different Climbing Levels

Proper nutrition is the basis for athletes' performances when competing or training. The increasing training volume accompanying the increase in advancement should go hand in hand with the appropriate supply of energy as well as macro and micronutrients. The diet of climbing representatives due to the desire to achieve a low body weight may be deficient in energy and micronutrients. Our study aimed to evaluate the differences in energy availability and nutrient intake of female and male sport climbers at different climbing levels. Anthropometric parameters and the resting metabolic rate were measured, the questionnaire about climbing grade and training hours was filled, and a 3-day food diary was fulfilled by 106 sport climbers. Based on the collected data, the energy availability as well as the macro- and micronutrient intake was calculated. Low energy availability (EA) was observed among both genders of sport climbing representatives. A significant difference between EA in various levels of advancement was found in the male group (p < 0.001). Differences in carbohydrate intake (g/kg/BW) between sexes were observed (p = 0.01). Differences in nutrients intake between climbing grade were found in both the female and male groups. In the group of female elite athletes, the adequate supply of most of the micronutrients can imply a high-quality diet despite the low calorie content. It is necessary to educate sport climbing representatives about the importance of proper nutrition as well as the consequences of insufficient energy intake.

Dietary Intakes and the Risk of Low Energy Availability in Male and Female Advanced and Elite Rock Climbers

ABSTRACT

Monedero, J, Duff, C, and Egan, B. Dietary intakes and the risk of low energy availability in male and female advanced and elite rock climbers. J Strength Cond Res 37(3): e8-e15, 2023-There is a culture among rock climbers of striving to maintain low body mass and percentage body fat to enhance performance. Diet practices based on this belief might lead to increased risk of low energy availability (LEA) or eating disorders (EDs). Twenty-five advanced or elite rock climbers (male, n = 14; female, n = 11) had body composition measured, completed 4-day food intake and physical activity diaries while wearing an accelerometer and heart rate monitor, and completed the Eating Attitudes Test (EAT)-26 and the Low Energy Availability in Females Questionnaire (LEAF-Q; n = 11 female subjects only). EAT-26 scores of 3.5 (1.8, 7.0) [median (IQR)] and 9.3 ± 6.4 (mean ± SD ) for male and female subjects, respectively, indicated low risk of ED in this cohort, but 4 female subjects were at high risk of LEA according to LEAF-Q scores. Suboptimal (<45 kcal·kg·FFM -1 ·d -1 ) and LEA (<30 kcal·kg·FFM -1 ·d -1 ) were evident in 88 and 28%, respectively, of climbers. However, only the female climbers had energy intakes (1775 ± 351 kcal·d -1 ) significantly lower than their calculated energy requirements (2056 ± 254 kcal·d -1 ; p = 0.006). In all subjects, carbohydrate intakes were lower (male subjects: 3.8 ± 1.2 g·kg -1 ·d -1 , p = 0.002; female subjects: 3.4 ± 0.7 g·kg -1 ·d -1 , p < 0.001), and fat intakes were higher (male subjects: 1.6 ± 0.5 g·kg -1 ·d -1 , p < 0.001; female subjects: 1.4 ± 0.4 g·kg -1 ·day -1 , p < 0.001) than current sports nutrition recommendations, and inadequate intakes of calcium, magnesium, and vitamin D were observed. Female subjects specifically had lower than recommended intakes of protein and iron. These results show that advanced and elite rock climbers have a high prevalence of LEA and have a risk of having nutritional deficiencies as result of their diet.

Accuracy of Resting Metabolic Rate Prediction Equations in Sport Climbers

Resting metabolic rate (RMR) represents the energy required to maintain vital body functions. In dietary practice, RMR is determined by predictive equations on the basis of using body weight or fat-free mass. Our study aimed to assess whether predictive equations used to estimate RMR are reliable tools for estimating the energy requirements of sport climbers. The study included 114 sport climbers whose RMR was measured with a Fitmate WM. Anthropometric measurements were performed with X-CONTACT 356. The resting metabolic rate was measured by indirect calorimetry and was compared with the RMR estimated by 14 predictive equations on the basis of using body weight/fat-free mass. All equations underestimated RMR in male and female climbers, except for De Lorenzo's equation in the group of women. The De Lorenzo equation demonstrated the highest correlation with RMR in both groups. The results of the Bland-Altman tests revealed an increasing measurement error with increasing metabolism for most of the predictive equations in male and female climbers. All equations had low measurement reliability according to the intraclass correlation coefficient. Compared with the indirect calorimetry measurement results, none of the studied predictive equations demonstrated high reliability. There is a need to develop a highly reliable predictive equation to estimate RMR in sport climbers.

Evaluation of Supplement Use in Sport Climbers at Different Climbing Levels

The lack of specific recommendations on the use of supplements for sport climbers may be the reason for their misuse by athletes of this discipline. This study aimed to evaluate choices of dietary supplementation, the reasons for taking them, and the source of information on supplementation among sport climbers at different levels. In addition, how climbers subjectively evaluated the impact of their diets in supporting selected aspects of climbing training was evaluated. We enrolled 110 regular sport climbers (40 women and 70 men) from Wroclaw, Poland, who completed a validated questionnaire, assessing their use of dietary supplements, attitudes towards the influence of diet on sports performance, and climbing level. Their anthropometric measurements were also collected. Participants regarded diet as an important element of sports performance. Sport climbers indicated the Internet to be the main source of information on supplements. Health maintenance and improvement of recovery were the most frequently chosen reasons for taking dietary supplements. The most common supplements were isolated protein, vitamin C, vitamin D, magnesium, and amino acid blends. However, participants rarely used supplements suggested as beneficial for sport climbing performance. Therefore, developing recommendations for supplementation in sport climbing and promoting this should be an elementary part of the preparation for climbing training.

Vegan nutrition: a preliminary guide for health professionals

Since the beginning of the 21st century, interest in vegan diets has been rapidly increasing in most countries. Misconceptions about vegan diets are widespread among the general population and health professionals. Vegan diets can be health-promoting and may offer certain important advantages compared to typical Western (and other mainstream) eating patterns. However, adequate dietary sources/supplements of nutrients of focus specific to vegan diets should be identified and communicated. Without supplements/fortified foods, severe vitamin B12 deficiency may occur. Other potential nutrients of focus are calcium, vitamin D, iodine, omega-3 fatty acids, iron, zinc, selenium, vitamin A, and protein. Ensuring adequate nutrient status is particularly important during pregnancy, lactation, infancy, and childhood. Health professionals are often expected to be able to provide advice on the topic of vegan nutrition, but a precise and practical vegan nutrition guide for health professionals is lacking. Consequently, it is important and urgent to provide such a set of dietary recommendations. It is the aim of this article to provide vegan nutrition guidelines, based on current evidence, which can easily be communicated to vegan patients/clients, with the goal of ensuring adequate nutrient status in vegans.

Prevalence of amenorrhea in elite female competitive climbers

Elite competitive sport climbers exhibit a high strength-to-weight ratio and are reported in the literature to be lighter and leaner than their athletic counterparts. Current research regarding nutrition among climbers is sparse but suggests that they may be at high risk for low energy availability and Relative Energy Deficiency in Sport (RED-S). The prevalence of amenorrhea, one of the primary indicators of RED-S, is unknown in this athletic population. The purpose of this study was to determine the prevalence of current (previous 12 months) amenorrhea among elite level competitive sport climbers.

Methods

An anonymous online survey was distributed via email to 1,500 female climbers registered as competitors within the International Federation of Sport Climbing to assess the prevalence of amenorrhea over the past 12 months.

Results

A total of 114 female sport climbers answered all survey questions regarding menstrual function and 18 athletes (15.8%) presented with current amenorrhea. The majority of the athletes (72%; n = 82) were categorized with eumenorrhea. An additional 14 athletes (12.3%) provided information that indicated irregular cycles, but answers to all menstrual cycle questions were not congruent to elicit a classification of amenorrhea and these athletes were categorized with a menstrual status of unsure. The average BMI for climbers with eumenorrhea was 20.8 ± 1.8 kg/m2 and 19.9 ± 2.4 kg/m2 for those with amenorrhea. A higher percentage of climbers with amenorrhea revealed they currently struggle with an eating disorder compared to those without amenorrhea (13.5 vs. 22.2%, respectively).

Conclusion

This study indicates that some female climbers competing at the World Cup level do have menstrual disturbances with relatively normal BMIs and some currently struggle with one or more eating disorders. Even though World Cup competitions use BMI critical margins to screen competitors, this research highlights the need for more medical supervision of competitive elite female sport climbers in order to protect their overall health, including menstrual function. Further research is required to clarify how many climbers suffer from endocrine abnormalities related to RED-S. With more scientific evidence in this area practitioners will be better equipped to educate the athlete and coach with evidence-based nutrition recommendations.