WEATŁI REARTIC

Sports Nutrition for Young Athletes

Nancy Cotugna, RD, DrPH; Connie E. Vickery, RD, PhD; and
Sheldon McBee, MS, NSCA-CPT

ABSTRACT: Nutritional needs for peak athletic performance include sufficient calorie intake,
adequate hydration, and attention to timing of meals. Student aJletes and their advisors often
are misinformed or have misconceptions about sports nutrition. This paper identifies nutritional
needs of young athletes, reviews common misconceptions, and examines the nutrition knowledge
of alletes and their sources of nutrition information. Topics covered include energy, carbohy-
diate, protein, fat anfi micronutrient needs, hydration requirements, ñming of meals, and issues
related to age, gender, and specific sports. Other issues addressed include “making weight” and
ergogenic aids. Proper nutrition for young athletes is critical not only to their athletic success, but
more importantly to their growth, development, and overaL health. Nutritional recommendations
should be based on the most current scientific data; we provide information about appropriate
resources for the school nurse when advising student athletes and their coaches and parents.
ELY WORDS: nunition, spoits, student athletes

INTRODUCTION
and sports, and to provide information on appropriate
Nutrition is important to athletic performance re resources for the school nurse when advising not only
gardless of the • 6 e of the athlete. Appropriate infor- athletes, but also their parents and coaches.
mation regarding diet should be provided to athletes
so they can make healthy food cbOlces. Athletes have NUTRITIONAL NEEDS OF THE ATHLETE
unique needs that include sufficient caloric intake for
sport, adequate hydration, and timing of meals for peak Adequate nutrition to cover the biological needs for
performance; however, they often are misin- formed or growth and development of all young people can be
have misconceptions aßout these topics. Those who met by following the Dietary Guidelines (or
interact with athletes and may be in a po- sition to Americans (U.S. Department of Health and Human
inßuence nutritional intake, such as coaches, parents, Services fi
and school nurses, also may need current in- formation U.S. Department of Agriculture, 2005). The latest edi-
about nutritional needs ob the atmete. lt is irnportant tion of these guidelines was released in early 2005 and
that those who provide nutritional guid- ance to is available online (www.healthierus.gov/dietarygui-
athletes have the appropriate knowledge base and delines). However, in addition to normal nutritional
dispense accurate information. The purpose of this needs, there are other nutritlonal concerns for young
paper is to ideritify the nutritional needs of young atnletes that require consideration, including addi-
athletes, to review misconceptions about nutrition tional calo0c needs, timing of Food intake, aöequate
hydration, and use or misuse of dietary supplements.
Nanny Conigna, RD, DrEH, is a professor irr the Department of
Health, Nutriñon, and Exercise Sciences at the University of Dela- Energy Needs
ware, Newark, DE.
Connie £. Vickery, RD, Pt, is a professor m the Department or 1- The energy-providing nutrients include carbohy-
t'•alth, Nutriñon, and Exercise Sciences at the University of Dela- ware, drate, protein, and fat. The largest percentage of an
Newark, DE. atMete’s caloric intake, at least 50%, should come
Sheldon VcBee, MS, NACE-CPT, is a personal trainer at be Uni- from carbohydrates (Litt, 2004). lt is im ortant for
versal .mletic Club, Lancaster, PA.
alletes to consume enough carbohydrate order to
meet High-intensity energy neeös, to maintain blood

Vom me 22, N u m ber 6 Dezember 2005 The Journal of School N atsin9 323
 glucose, and to restore muscle glycogen stotes (Lem-
hydrate and protein meal should follow a workout,
on, 1998).
with balanced meals following every 2M hours.
Protein intake is also important for athletes. Protein
is required for hormone and enzyme production, nu-
trient transfer in the blood, connective tissue support, Water Needs
and repair of tissue in response to periods of exercise. Hydration is a very important aspect of spoits nu-
Protein needs for athletes are slightly higher than tation that must be monitored closely. Disturbancet
those for be general population. A typical intake of in ßuid and electrolyte balance include ö eliydration
protein fO£ most athletes Should be 1.2—2. 0 g/kg of and 1ow sodium concentration (Barr, 1999). During
body weight per day 3enkin5 fi Reaburn, 2000). There exercise, athletes sweat in order to help control rises
is a limit or protein synthesis that can occur; there- in core boö y ternpeiature that cause ßuid Moss and
fore, protein intWe beyond these amounts is not nec- may cause a loss ob sodium, iron, and calcium through
essary (American Dietetic Association, Dietitians of sweat (AD.YDC/ACSM, 2000; Maugham, 2002)
Canada, and American College of Sports Medicine An athlete who loses too much water due to
{ADA/DC/ACSMj, 2000). Protein needs can be dehydration may respond with decreased performance
satisfied by diet alone and should not iequñ e and may in- crease the risk of heat stroke (Coyle,
supplementation (ADA/DC/ACFM; Vaughan, 2002). If 2004). Fluids are necessary for hydrafion and
protein intake is too high, it can produce extra urea, maintenance of electro- lyte balance (Vaughan, 2002).
can increase risk of dehydration, and can cause Ten to 12 cups (80—96 oz) of water a day should be
calcium loss (Millward, 2003). AthleteS should consumed to maintain adequate hydration. An intake
consume 10—15% of total cal- ories from protein of about 12-20 oz of duid 2—3 hours before exercise is
(ADA/DC/ACSM; Lemon, 199 8). beneficial (Casa, 2000). During exercise, 6—12 oz of
Fat intake is important for producing energy, pro- fluids should be consumed every 15-20 minutes.
tecting organs, providing insulation to the body, and Carbohydrate and electrolyte drinks, also referred to
facilitating fat-soluble vitamin uptake and essential as sports drinks, of about 4-8% carbohydrate are
fatty acid intake. Fat intake should be 20—25% of useful for endurance athletes to consume during
total calorie intake. There is no benefit to athletes for a competition for mainte- nance of blood sugar and
fat intake that is less than 15% or greater than 30% of hydration, although plain water is also appropriate
total calories (ADA/DC/ACSM, 2000). (Convertino et al., 1996). During recovery, an intake of
The micronutrients—vitamins and minerals—also about 16—24 oz of fluid per pound lost is sufficient
have an important role in the health Of dthletes. They (ADA/DC/ACSM). To en sure proper hydration, it is
are essential players in energy production, liemoglo- important for athletes to consume enough fluids
bin synthesis, bone health, immune function, and an- throughout the day, during exercise, and during
tioxidant activity (ADA/DC/ACSM, 2000). Micronum- recovery from periods of exer- cise.
ent needs typically can be met by athletes consuming
a high energy intake and a balanced diet. Therefore, SPECIFIC NUTRtTION NEEDS
supplementation with vitamins and minerals is usu-
ally unnecessary (Vaughan, King, fi Lea, 2004). Athletes have unique nutritional needs based on
age, gender, level of athletics, sport, and weight. It is
Eating Before, During, and After a Sports Event lmportant to understand the characteristics of ath-
letes, because this affects energy, macronutrient, mi
Timing of food consumption based on the time of cronutrient, and fluid needs.
a competition or exercise event is important. The abil-
ity to perform and to recover Tom exercise can be pos-
itively or negatively affected by dietary intake before,
during, and after the event. The pre-event meal should
be low in fat, fiber, and caffeine; moderate in protein;
and high in complex carbohydrates and fluid. Meals
are best consumed at least 3-4 hours before competi-
tion to minimize gastric distress, nausea, vomiting,
cramps, and sloggishness (Clark, 2003). During exer-
ci5e, especially long endurance events, it is beneficial
to maintain blood sugar by consuming about 30—60 Age
g/hr of carbohydrate via sports drinks (ADA/DC/
The dietcy needs of child athletes younger than i 1
ACSM, 2000).
years of age are different than those of older athletes
After je event, adä quate energy in the form of car-
(Steen, 1996). For the child aJlete, energy intake
bohydrate mtist be consumed to replenish glycogen
should be high enough to support growth and matu-
stores. Protein alsO 5hOilld be consumed in moderate
ration while providing enough energy and duids for
amounts too muscle repair. Therefore a mined carbo-

324 the Journal of Schoo! Nursing Dezember 2005 Volume 21, Number 6
 the additional phySiCal activity. Percentage body fat require high elements of strength, power, or speed. An
and weight should r.ot be used a5 Criteria for spOrtS emphasis on a structured body weight or low body
participation. CNldren do not tolerate temperature weight usually is not observed in these sports. .3s a
exoerrle5 as well as older Athletes. Their Ugher result, athletes in these sports report eating disorders
relative body surface area causes them to acclimate to less frequency than do those in sports that emphasize
heat more slowly. They also sweat less, produce more leanness (Parks ñ Read, i99 7; Jundgot-Borgen, 1999).
heat, anñ are less able to transfer heat from muscle to Over the past 3 decades, be height, weight, and body
skin— all increasing the risk of dehydration. Special mass index of elite high SChOO1 football linemen has
empha- sis should be placed on ensuring adequate increased. Tbs has been attributed to better nutrition
fluid intake in Old athletes before, during, and after and training (Wang, Perko, Downey, fi Yesalis, 1993).
activity.
For the adolescent athlete, increasing independence e w ht th e at
and peer pressure that can induence food selections eves
may lead to sufiopñ mal dietary intake Cth potential ee and ciat d wit
nutrient deficiencies (5teen, 2000). Adolescent ath-
decrea ed ea ed
letes have an increased risk Of iron deficiency. Calcium ce
intake by adolescents is also well below recommended ed
amounts. It is important to monitor the height, at
weight, and body mass index of children as they enter
puberty to ensure that the additional nutrients and
energy needed to fuel growth spurts that occur at this
time are provided. However, it should be kept in mind Girls’ participation in sports has risen dramañcally
that athletes may weigh more than chart recommen- (Van de Loo fi Johnson, 1995). Female athletes may
dations because they are more muscular. When nutri- have problems with menstruation, stature, and inad-
ent intake becomes suboptimal, the adolescent athlete equate nutrition when workouts become too intense
may be at considerable risk for negative health cont and energy intake is too restricted at a young age
sequences, such as an increase in fractures and ane- (Beals, 2004). The athlete who must remain lean or
mia, as well as a lack of stamina to perform in athletic must have an aesthetically appealing appearance to
events (Litt, 2004). Food restriction among adolescent compete and to perform with power is of considerable
athletes has been associated with stunted growth, loss concern to health professionals. Athletes participating
of lean body mass, and altered metabolism (Beals, in figure skating, diving, synchronized swimming,
2004).
running, rh ]qmic dance, gymnastics, cheerleading,
long-distance sports, bodybuildlng, and weight-class
Gender sports are more inclined to eating disorders due to
pressure to be thin (Van de Loo fi Johnson; Ziegler,
Athletes may choose to participate in sports that Sharp, Hughes, Evans, fi Khoo, 2002). Key nutrients
require them to be in classes of weight or where
such as iron and calcium often are missing from be
weight is stressed as a priority for peak performance.
diets of female athletes who restrict calories (Ziegler,
Sports of this type include gymnastics, running, figure
Hensley, Roepke, Whitaker, Craig, fi Drewnowski,
skating, wrestling, and boxing.
1998). Severe food restriction due to distorted views
A sport that has received considerable attention
of Meanness may compromise both health and perfor-
among boys is nestling. A common myth in nes-
tling is that the athlete can have an advantage if he mance.
competes at a lower weight class; this often leads to Disordered eating, defined as any of several psycho-
the practice of ”cutting weight” for a competitive logical disorders (such as anorexia nervosa or bulimia)
edge (Perriello, Almquist, Conkwright, Cutter, characterized by serious disturbances of eating behav-
Gregory, fi Pitrezzi, 1995). Athletes in weight ClaSS ior, may cause impaired performance, inneased risk of
sports have been observed to have a higher risk of injury, depression, duid and electrolyte imbalance,
developing eat- ing disorders when ñequently and theimor egulatory changes (Sunhgot-B orgen,
measured for weight (Rockwell, Nickols- 1999). Restricted eating has been identified as a mech-
Richardson, ñ Thye, 2001). Rapid weight loss, as anism for avoiding overdevelopment and appearing
corrimonly observed among mestlers, is a major prepubertal among young girls participating in aes-
concern among school nurses and other health thetic sports. Weight loss techniques such as starva-
professionals. Aggressive weight loss in these tion have become a mechanism for avoiding overde-
athletes has been associated with decreased strength velopment and appearing prepubertal in an attempt
and power, decreased endurance and performance, to maintain a compeñtive figure. Arrival of menarche is
growth retardation, eating disorders, increased health often associated with increases in weight, arid this can
risks, and other negative effects (Perriello et al.). be seen as a problem in the eyes of the aestheñc female
The sports of football, weight events, track and atMete. The combination of disordered eating,
field, power lifting, bodybuilding, and basketball can

Volume 21, Number 6 December 2005

amenorrhea, and osteoporosis i5 known as be female coaches and trainers (Habasñ , 2000). Other i es°<rces
athlete triad (Sherñman Thompson, 2004). include physicians, nutritionists, teammates, friend
Tvpically, girls parñ cipating in sports such as bas and crash-diet books Miller, 2002; Rock.
(Conhgeni
Netball, softball, volleyball, and soccer report fewer in- well, Lickols-Richardson, fi Thye, 2001). Certain
cidences of eating disorders than do Nose involved in sports have athletes who ma) rely on coaches most
sports such as dance, running, gymnaStiCs, and figure often for munition guidance. When coache5 are cis-
skating iManoie, 2002) . Despite thls, femñ e athletes informed about nutrition, this becomes a potential
tend to have a greater concern about weight than problem ioi the athlete.
male athletes have (Parks Mr Read, 1997). This puts
them at increased risk for developing eating disorders. Inappropriate Nutrition Recommendations by
Coaches
NUTRITION ISSUES OF CONCERN
Coaches often play a role in influencing the dietary
Nutrition Knowledge of Athletes habits of atMete5, especially in sports such as nestling
Athletes do not demonstrate a sufficient knowledge and gymnastics. Gymnasts and wrestlers have been
of nutrltiOn for their performance needs despite a re- observed to rely less on parents and health
ported high interest in nutrition. Lack of nutrition profession- als and more on coaches for nutrition
knowledge has been observed at the high school level guidance (Sundgot-Borgen, 1996). A study of high
and may be attributed to the sources to which athletes school wres- tling coaches showed that nearly hail
look for nutrition guidance. Knowledge of protein rated themselves as knowledgeable about nutrition,
needs, vitamin and mineral needs, and fluid needs has yet the majority ei- der agreed with or were undecided
been shown to be lacking among athletes (Shifflett, about the state- ment that “weight loss gives a
Timh m, Kahanov, 2002). Nutrition competitive edge” (Sos- sin, 1997). Coaches have been
misconceptions also were observed among athletes reported to recommend inappropriate macronutrient
regarding duids and hydration, precompetition meals, intake, fluid restriction, and weight gain for athletes
arid protein needs. ExampleS include the following. (Shifflett et aI., 2002). Many suggest multivitamin and
never eat after S p.m.; 800 kcal/day is adequate energy protein supplement use despite lack of documented
intake; eat only when the food is cold; no eating of scientific evidence supporting these practices
meat, bread, or potatoes, no drlnking of fluids during (Rockwell ct at., 2001). Most coaches have limited
training (Sundgot-Borgen, 1996). Those with knowledge and training in nutrition, yet often pTovide
misinformation may make wrong food choices that nutritional advice.
may affect their performance (Rosenbloom,
Jonnalagadda, fi Skinner, 2002). Athletes’ knowledge Weight Control
and use of ergogenic aids are of particular importance.
Many athletes use sup- plements and ergogenic aids In order to maximize or maintain sports perfor-
witnout knowledge of their efficacy (Bums, Schiller, mance, some athletes may be seeking either to gain
Merrick, fi Wolf, 2004). High school athletes witn weight (such as for football) or to lose weight (such as
aspirations of playing col- legiate sports have reported for gymnastics, skating, wrestling). ln either case, the
being more likely to use supplements to improve weight change should be achieved gradually and
athletic performance (Sobal fi Marquart, 1994). should be initiated early—well before the start of the
Despite little knowledge of the use of ergogenic aids, competitive season or event (ADA/DC/ACSM, 2000;
athletes may spend a lot of money on these products. McArdle, 1999). Weight gain can be accomplished
through additional calorie intake and strength train-
Sources of Nutrition Information
ing, whereas weight loss can be accomplished with a
reduced calorie intake and/or increased calorie
AtMetes tend to get nutrition information from expen- diture (ADA/DC/ACSM; Manore, 1999;
magazines, health food store personnel, coaches, Thompson fi Manore, 2000; Ziegler, Nelson, Barratt-
gym overs, and other athletes (ADA/DC/ACSM, Foinell, Fi- veash, fi Drewnowski, 2001). However,
2000). Due to the fact that athletes know that they calorie restric- tion should never jeopardize normal
have unique nutritional needs, they often seek growth. The ap- propriateness of weight restriction for
guidance or accept prescribed diets. One study certain sports such as wrestling, skañ ng, and
reported that 10% of athletes had been on an gymnastics has been an area of great concern.
“individualized” training diet prescrlbed for them by Wrestling guidelines about safe practices for making
an unreliable source (Schmalz, 1993). They tend to weight are available from most state high school
turn to resources other than health professionals, athletic associations (Denehy, 2002). Some are
which may lead to conñ n- ued lack of good nutrition available on the Internet (for exam- ple,
education (Habash, 2000). Most athletes are likely www.iaü saa.org) and are reliable resources for the
to look to tieé patents for nutrition information and school nurse. Guidelines for figure skaters and gym-
guidance, but Neo rely on nasts also have been published (LaPiana tr Bramble,
2000; Ziegler fi Jonnalagadda, 2000).

The Journal of School Nursing Decem ber 2005 Volu me 24 , Number 6

 Ergogenic Aids
(www1.£iCaa. 0rg). Information on this site man be
Athletes are in a very competitive environment. In use-
ful for high schOOl athletes and coaches, as •elL The
a world where success is so important, it is easy to student athlete link has a SQCtion on nutrition, per-
understand why athletes turn to meJods such as us- ing formance, and a checklist Cth guidelines on healthy
ergogenic supplements to give them an edge. Ei- eating. Other resources for ni›niiiOn guidelines in-
goger.ie aids are any substance or procedure that may clude the American Heart Association, textbOOks, jour-
aid physical work or athletic performance. There are nals, regist ered dietitians (RDs), and eduration
5everal ct goge nic aids that claim to enhance athletic through classes and workshops. School nurses can net-
performance or to improve exercise capacity. Athletes work with local RDs WhO have Sports nutrition exper-
may waste a lot of money on supplements that do not use. They can find these individuals by accessing the
work as claimed or, more importantly, that jeopardize Website of the American Dietetic Ass o ciation
them health. (www.eatrigLt.org), linking to “Find a Nutrition Pro-
A recent study has shown that 88% of college ath- fessional” and entering the local ZIP code.
letes used one or more nutritional supplements (Burns
et a1., 2004). Although supplement use has not been CONCLUSION
studied thoroughly in younger athletes, it is not out- Proper nuoition for young athletes is critical not
side the realm of possibilities that many of them are only to their athletic success, but, more importantly,
using suppiement5 as well. Students should be ques- to their growth, development, and overall health. In
tioned about be types of supplements they use and what general, neither athletes nor coaches have sufficient
they think the effects are. A common miscon- ception knowledge in nutrition to create an environment that
among young aWetes is that vitamins pro- vide energy can result successfully in enhanced performance and
or increa5e muscle strength, yet there is no evidence to optimal health.
support this.
The National Collegiate Athletic Association
(NCAA) does not ban dietary supplements because
they are not considered drugs; however, the NCAA
does indicate that the use of supplements is at the stu-
dent athlete’s own risk (NCAA, 2005). Counseling of
athletes about ergogenic aids should be done after
careful evaluation of the safety and efficacy of the sup-
plement (ADA/DC/ACSM, 2000). A separate article in The school nurse sfiould be an important resource
this issue is devoted to the topic of ergogenic aids. ioi young athletes. The 2005 Dieta Guidelines [or
Amencans can serve as the foundation for baseline nu-
IMPLICATIONS FOR SCHOOL NURSING PRACTICE tritional recommendations for good health. If nurses
are knowledgeable about sports nutrition and have a
Sports nutriñon guidance for athletes can take support network for nuoition information, they can
many forms. Nurses might provide individual coun- help young athletes understand their sports nutrition
seling, distribute handouts or booklets, present or needs.
make arrangements for seminars to be presented to
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328 The journal of School Nursing December 2005 Volume 21, Number 6