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cme sports nutrition for young athletes cme educational objectives strength speed and stamina as well as 1 identify an effective means to decreased focus increased fatigue and assess the nutritional ...

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                                                                                                      CME
                                  Sports Nutrition for Young Athletes
                                                                                    CME EDUCATIONAL OBJECTIVES                         strength, speed, and stamina, as well as 
                                                                                      1.   Identify an effective means to              decreased focus, increased fatigue, and 
                                                                                         assess the nutritional status of a            increased risk of injury.
                                                                                         young athlete during the offi ce visit.            However, the message about eating 
                                                                                      2.   Review the most common per-                 needs to be pertinent to young athletes; 
                                                                                         formance detractors associated                otherwise, it goes unheeded. A focus 
                                                                                         with nutritional inadequacies in              on nutrition is not as accepted as an 
                                                                                         children and adolescents.                     emphasis on performance.
                                                                                      3.   Discuss specifi c nutritional guide-             The goal of sports nutrition is to 
                                                                                         lines for the young athlete and               help keep athletes playing their sport. 
                                                                                         how best to motivate the affected 
                                                                                         child to improve their overall nutri-         To do this, young athletes need to learn 
                                                                                         tional health.                                not only what to eat and drink, but why, 
                                                                                                                                       when, and how much they should con-
                                                                                        Leslie Bonci, MPH,RD,CSSD,LDN, is              sume. In addition, it is in the athlete’s 
                                                                                      Director of Sports Nutrition, University         best interest to educate the family (par-
                                                                                      of Pittsburgh Medical Center and au-             ents, grandparents, guardians) about 
                                                                                      thor of Sport Nutrition for Coaches              fuel for sport.
                                                                                      (HumanKinetics, 2009).                               Team physicians should schedule 
                                                                                        Dr. Bonci has disclosed no relevant fi -        a time to talk with their teams in ad-
                                                                                      nancial relationships.                           vance, during, and after the regular 
                                                                                        doi: 10.3928/00904481-20100422-11              season about the importance of proper 
                                                                                                                                       hydration and fueling, or better yet, en-
                                                                                               ptimal nutrition is a critical          list the expertise of a sports dietitian.
                                                                                               component of growth and de-                 As part of a comprehensive sports 
                                                                                   Ovelopment but also plays an  exam, it is important to ask questions of 
                                                                                   integral role in sports performance. The            the athlete and/or caregiver. You can have 
                                                                                   young athlete who is not well-fueled                the athlete or his/her parent/caregiver to 
                                                                                   or hydrated may experience defi cits in              fi ll out a nutrition assessment form in ad-
                                                                                                           Leslie Bonci, MPH, RD, CSSD, LDN
                               300  |  www.PediatricSuperSite.com                                                                                 PEDIATRIC ANNALS 39:5  |  MAY 2010
                       33905Bonci.indd   300905Bonci.indd   300                                                                                                                55/3/2010   5:30:30 PM/3/2010   5:30:30 PM
                                                                                       CME
                                                                                                                    baseline requirements.1 Sweat losses 
                                                                                                                    are higher compared with non-athletes, 
                                                                                                                    and younger athletes generate more 
                                                                                                                    heat. As little as a 1% decrease in body 
                                                                                                                    fl uid can result in a decrease in endur-
                                                                                                                    ance.2 Although optimal hydration is 
                                                                                                                    essential for performance and injury 
                                                                                                                    prevention, many young athletes do not 
                                                                                                                    get what they need. Fluid may not be 
                                                                                                                    available, accessible, or permitted (ie, 
                                                                                                                    teachers who do not allow beverages in 
                                                                                                                    class). Coaches may not schedule fl uid 
                                                                                                                    breaks for their athletes. Some athletes 
                                                                                                                    may load up on carbonated beverages, 
                                                                                                                    sweetened teas, or fruit drinks, which 
                                                                                                                    may provide calories in excess of need. 
                                                                                                                       In addition, some of your athletes 
                                                                                                                    may opt to abstain from consuming fl u-
                                                                                                                    ids during the day because of fear about 
                                                                                                                    needing to use school restrooms, which 
                                                                                                                    they may deem unsafe.
                                                                                                                       Fluid guidelines are listed below, as 
                                                                                                                                                      3
                                                                                                                    well as in Table 2 (see page 302).
                                                                                                                    FLUID GUIDELINES FOR ATHLETES
                                                                                                                    Weigh in and out
                                                                                                                       Encourage athletes to weigh in be-
                                                                                                                    fore and after practice to gauge sweat 
                                                                                                                    loss and replace fluid appropriately. 
                                                                                                                 © iStockphoto.comBe an advocate for your young ath-
                                                                                                                    letes and ask that schools purchase 
                           vance. A nutrition assessment form can      he is too nervous to eat before games.       scales, or recommend that parents do-
                           help identify potential areas of concern,      This type of “show and tell” can be       nate old scales to teams.
                           which can be addressed during the exam.     very useful for your patients, helping          For exercise of less than 60 minutes’ 
                           A sample form can be found online at        them to see what may be performance-         duration, water is fi ne. For activities 
                           http://www.teamunify.com/vatst/__doc_       impairing behaviors and, subsequently,       lasting more than 1 hour, recommend 
                           _/Nutrition%20Screening%20Form.pdf          making recommendations for improve-          a sports drink. Morning void should 
                           (accessed April 21, 2010).                  ment based on timing, quantity, or  be light in color and copious. Athletes 
                              Preface the “eating” discussion  choices of foods/fl uids.                             should drink on a schedule: fl uid upon 
                           with your athlete by asking him/her            Many athletes’ “complaints” may  waking, with every meal, and before, 
                           to tell you how he/she feels when do-       have a nutrition-related cause and solu-     during, and after practices/compe-
                           ing sports (ie, energy levels, strength,    tion. Table 1 (see page 302) lists some      tition. They should consume fl uids 
                           speed, recovery).                           common performance detractors, pos-          throughout the day, which may require 
                              You can use the questionnaire to pro-    sible nutrition causes, and solutions.       a hydration prescription from a physi-
                           vide objective data for your patient. For                                                cian for teachers who do not permit 
                           example, the basketball player who tires    SPECIFIC GUIDELINES                          beverages in the classroom. Consume 
                           early in the game may tell you that he         Many young athletes are inadequate-       liquid foods, such as applesauce, soup, 
                           doesn’t eat breakfast, may not drink be-    ly hydrated. Fluid needs for young  chili, yogurt, milk, or smoothies, and 
                           fore or during practices. He reveals that   athletes are 0.5 to 1 L/day above the        bring a water/sports bottle to practice.
                           PEDIATRIC ANNALS 39:5  |  MAY 2010                                                                 www.PediatricSuperSite.com  |  301 
                    33905Bonci.indd   301905Bonci.indd   301                                                                                          55/3/2010   5:30:31 PM/3/2010   5:30:31 PM
                                                                                                      CME
                                                                                                       TABLE 1.
                                                           Performance Detractors and Suggested Nutritional Solutions
                                     Performance Detractors                   Possible Nutrition Causes                                Suggested Nutrition Solutions
                                                                        No fuel/fl uid before or during activity
                                                                                                                         Food/fl uid 30-60 minutes prior and regularly during sport
                                             Fatigue                                  Low iron
                                                                                                                                 Appropriate calories for growth and sport
                                                                                 Insuffi cient calories
                                         Muscle cramps          Inadequate or excess fl uid; inadequate sodium intake     Adequate fl uid and sodium for salty sweaters (those who 
                                                                                                                                show signs of salt loss, including cake sweat)
                                                                                 Inadequate calories                       Eating bigger portions and more often during the day
                                      Inability to gain mass
                                                                          No protein before lifting, only after                     Protein and carbs pre- and post-lifts
                                                                                                                                         Eating at regular intervals
                                                                                   Skipping meals                               Focus on fat-free foods; include fat, protein,
                                       Inability to lose fat              Too many calorie from beverages                                 and carbs at every meal 
                                                                       Eating more than needed post-exercise                         Limiting calories from beverages
                                                                                                                            Post-exercise fuel needs are more a snack than meal
                                                                             TABLE 2.                                                  Sodium 
                                                          Fluid Guidelines for Children3                                                   Although some young athletes may 
                                                                                                                                       consume sodium in excess of need, 
                                                   Age/sex                                    Daily Fluid Needs                        others may not ingest what they re-
                                                                                                                                       quire. The dietary reference intakes 
                                             4 to 8, boys and girls                             5 cups (1.2 L)                         (DRIs) for sodium are listed in Table 3 
                                                 9 to 13, boys                                  8 cups (1.8 L)                         (see page 303).
                                                                                                                                           Salty sweaters may require more so-
                                                 9 to 13, girls                                 7 cups (1.6 L)                         dium than recommended, especially if 
                                                  14-18, boys                                  11 cups (2.6 L)                         they exhibit signs of salt loss, includ-
                                                                                                                                       ing cake sweat (salt on skin, clothes, 
                                                  14-18, girls                                  8 cups (1.8 L)                         inner rim of caps); sweat that stings 
                                                                                          4                                            the eyes; and sweat that tastes salty. 
                                                                        Gauging Hydration                                                  This may be a problem in young 
                                                            Educate your athletes on the WUT principle:                                athletes whose parents are on sodium-
                                                                Weight ( loss of >1% after exercise)                                   restricted diets. Foods may be prepared 
                                                                                                                                       without salt, and low-sodium products 
                                                               Urine (dark colored and low volume)                                     may be purchased. You can advise your 
                                                                      Thirst (increased thirst)                                        salty sweaters to do the following:
                                                                                                                                             •    Add 1/4 of salt to 20 oz of 
                                                                                           5                                                      sports drink;
                                                                      Hydration for Exercise
                                                                                                                                             •    Eat pickles, crackers, pretzels, 
                                                                 2 hours before exercise: 18-24 oz.                                               or Chex Mix;
                                                                   30 minutes before: 12-16 oz.                                              •    Have rice or pasta cooked in 
                                                                                                                                                  bouillon;
                                                                  Every 20 minutes during: 5-9 oz.                                           •    Add salt to foods; or
                                                        After activity:16-24 oz. of fl uid for every pound lost                               •    Drink vegetable juice or to-
                                                                                                                                                  mato juice.
                               302  |  www.PediatricSuperSite.com                                                                                 PEDIATRIC ANNALS 39:5  |  MAY 2010
                       33905Bonci.indd   302905Bonci.indd   302                                                                                                                55/3/2010   5:30:32 PM/3/2010   5:30:32 PM
                                                                                                                      CME
                                    CALORIES                                                        Some of your patients may have                                                 TABLE 3. 
                                        You may have patients who con-                          parents who are on carbohydrate-re-                                      DRIs for Sodium
                                    sume calories in excess of need; how-                       stricted diets. It would not be out of 
                                    ever, young athletes may not consume                        the question for a young soccer play-                                   Age/sex            Sodium (mg)/day
                                    enough calories. In addition, the con-                      er, who has had school and club team 
                                    cern about one’s appearance in certain                      practice, to come home to a meal of                                4-8, boys and girls        1,200-1,900
                                                                      6
                                    sports may drive intake.  The DRIs for                      chicken and vegetables, which would                               9-13, boys and girls        1,500-2,200
                                    calories based on age are listed in Ta-                     be suboptimal. You may need to be the 
                                    ble 4. These are general guidelines and                     one to stress to parents the importance                          14-18, boys and girls        1,500-2,300
                                    must be tailored to the energy demands                      of providing a quality carbohydrate 
                                    of the sport, growth, and metabolism.                       source at all meals, especially at dinner 
                                    There are several online tools for ath-                     because activity is usually after school                                           TABLE 4.
                                    letes to use to gauge calorie intake,                       or in the evening hours. Listed below                                    DRIs for Calories 
                                    including www.mypyramid.gov and  are the carbohydrate requirements for                                                                  Based on Age
                                    www.calorieking.com.                                        various athletic situations.
                                        Another option is an online tool that                         •     1.5-2.5 g/lb body weight for light                         Age/sex              Daily Calories
                                    focuses on nutrient density by having                                   training (2 to 3 times per week);                     4-8, boys and girls        1,400-1600
                                    individuals keep track of foods con-                              •     2.5-4 g/lb for moderate train-                            9-13, boys             1,800-2,200
                                    sumed by food group (www.nutrien-                                       ing (3 to 5 times per week);
                                    trichfoods.org is a great resource). In                           •     4-4.5 g/lb for pre-event load-                            9-13, girls            1,600-2,200
                                    addition, it is important to remember                                   ing; and                                                 14-18, boys             2,200-2,600
                                                                                                                                                     8
                                    that calorie adequacy is not only a                               •     0.8 gm/lb for post-event fueling                         14-18, girls               2,000
                                    function of the number of calories con-
                                    sumed but also how those calories are                       PROTEIN
                                    ingested throughout the day.                                    Although protein is not the primary                                            TABLE 5.
                                        Encourage your patients to eat  fuel substrate for sport, it is important 
                                    throughout the day, instead of upload-                      for muscle and bone health and should                                   Dietary Reference 
                                    ing calories.                                               comprise at least 12% to 15% of the                                    Intakes for Protein
                                                                                                                            1
                                                                                                daily caloric intake.  The DRIs for pro-                                                     Daily Protein 
                                    CARBOHYDRATE                                                tein are listed in Table 5.                                            Age/sex              Requirements
                                        Carbohydrate is the primary fuel                            These are the recommendations to                              4-8, boys and girls            19 g
                                    substrate for sport. However, not all                       prevent a defi ciency but they may not 
                                                                                                                                          9                           9-13, boys                 34 g
                                    young athletes meet their daily carbo-                      be adequate for all athletes.  For in-
                                    hydrate requirements. The minimum  stance, an athlete who is trying to in-                                                        9-13, girls                34 g
                                    needs are 180 g/day for basic body                          crease mass or is trying to lose weight                              14-18, boys                 52 g
                                    functions, plus additional carbohydrate                     may need more protein per day. The 
                                    for the energy expenditure associated                       recommended amounts of protein for                                   14-18, girls                46 g
                                    with exercise.                                              specifi c sport situations are:
                                        Gluconeogenesis from non-carbohy-                             •     Training: 0.5 to 0.7 g/lb;
                                    drate sources provides 130 g of carbo-                            •     Endurance athlete: 0.5 to 0.8                   with appropriate and adequate plant-
                                    hydrate/day with the remainder coming                                   g/lb;                                           based protein sources. Also, recommend 
                                                                           7
                                    from ingested carbohydrates.  The carbo-                          •     Strength trained athletes:  0.5                 food fi rst, rather than protein powders. If 
                                    hydrate requirements for young athletes                                 to  0.8 g/lb;                                   you have athletes who ask about protein, 
                                                                                1
                                    may range from 200-500 g/day.  Young                              •     Athletes who are restricting  a protein isolates, such as whey protein, 
                                    athletes can benefi t from some guidance                                 calories: 0.8 to 0.9 g/lb; and                  are a better choice than a protein pow-
                                    regarding the more nutrient-rich sources                          •     Maximum usable protein: 0.9                     der. Protein isolates provide only pro-
                                    of carbohydrate, including fruits, vegeta-                              to 1.0 g/lb (body weight).                      tein, not mega doses of micronutrients. 
                                    bles, grains such as cereals, bread, rice,                      For athletes who are vegetarian, ask                    Provide guidance about the use of these 
                                    pasta, and, of course, potatoes, corn, and                  about overall food intake, stressing the                    products  (ie, not as a meal replacement 
                                    corn products, such as grits and tortillas.                 importance of replacing animal protein                      but as a supplement to food).
                                    PEDIATRIC ANNALS 39:5  |  MAY 2010                                                                                                    www.PediatricSuperSite.com  |  303 
                           33905Bonci.indd   303905Bonci.indd   303                                                                                                                                       55/3/2010   5:30:32 PM/3/2010   5:30:32 PM
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...Cme sports nutrition for young athletes educational objectives strength speed and stamina as well identify an effective means to decreased focus increased fatigue assess the nutritional status of a risk injury athlete during ce visit however message about eating review most common per needs be pertinent formance detractors associated otherwise it goes unheeded with inadequacies in on is not accepted children adolescents emphasis performance discuss speci c guide goal lines help keep playing their sport how best motivate affected child improve overall nutri do this need learn tional health only what eat drink but why when much they should con leslie bonci mph rd cssd ldn sume addition s director university interest educate family par pittsburgh medical center au ents grandparents guardians thor coaches fuel humankinetics team physicians schedule dr has disclosed no relevant time talk teams ad nancial relationships vance after regular doi season importance proper hydration fueling or bet...

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