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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
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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.
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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.
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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).
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