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UEFA expert group statement on nutrition in elite football. Current evidence

to inform practical recommendations and guide future research Consensus
statement
Article in British Journal of Sports Medicine · October 2020

DOI: 10.1136/bjsports-2019-101961
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Consensus statement
UEFA expert group statement on nutrition in elite

football. Current evidence to inform practical
recommendations and guide future research
James Collins,1,2 Ronald John Maughan,3 Michael Gleeson,4 Johann Bilsborough,5,6
Asker Jeukendrup,4,7 James P Morton,8 S M Phillips ‍ ‍,9 Lawrence Armstrong,10
Louise M Burke ‍ ‍,11 Graeme L Close ‍ ‍,8 Rob Duffield ‍ ‍,5,12
Enette Larson-Meyer,13 Julien Louis ‍ ‍,8 Daniel Medina,14 Flavia Meyer ‍ ‍,15
Ian Rollo,4,16 Jorunn Sundgot-Borgen ‍ ‍,17 Benjamin T Wall,18 Beatriz Boullosa,19
Gregory Dupont ‍ ‍,8 Antonia Lizarraga,20 Peter Res,21 Mario Bizzini,22
Carlo Castagna ‍ ‍,23,24,25 Charlotte M Cowie,26,27 Michel D’Hooghe,27,28
Hans Geyer,29 Tim Meyer ‍ ‍,27,30 Niki Papadimitriou,31 Marc Vouillamoz,31
Alan McCall ‍ ‍2,12,32
For numbered affiliations see ABSTRACT an attempt to prepare players to cope with these
end of article. Football is a global game which is constantly evolving, evolutions and to address individual player needs.
showing substantial increases in physical and technical Nutrition can play a valuable role in optimising the
Correspondence to
demands. Nutrition plays a valuable integrated role in physical and mental performance of elite players
Dr Alan McCall, Arsenal
Performance and Research optimising performance of elite players during training during training and match-play, and in maintaining
team, Arsenal Football Club, and match-play, and maintaining their overall health their overall health throughout a long season.
London, UK; throughout the season. An evidence-based approach Good nutrition choices can support the health and
Protected by copyright.
amccall@arsenal.c o.uk to nutrition emphasising, a ’food first’ philosophy (ie, performance of footballers: the type, quantity and
Accepted 18 June 2020 food over supplements), is fundamental to ensure timing of food, fluids and supplements consumed
effective player support. This requires relevant scientific can influence players’ performance and recovery
evidence to be applied according to the constraints of during and between matches.1 2 However, the rapid
what is practical and feasible in the football setting. The evolution of the game itself, in addition to changes
science underpinning sports nutrition is evolving fast, in our understanding of sports nutrition, has created
and practitioners must be alert to new developments. In uncertainty as to the appropriate nutritional deci-
response to these developments, the Union of European sions to make at specific moments in time and in
Football Associations (UEFA) has gathered experts in specific contexts. In 2017, the steering committee
applied sports nutrition research as well as practitioners of the current UEFA nutrition expert statement
working with elite football clubs and national (JC, RM, JB, AMcC) committed3 to undertake an
associations/federations to issue an expert statement expert-led statement to update the knowledge and
on a range of topics relevant to elite football nutrition: research about nutrition in elite football. We high-
(1) match day nutrition, (2) training day nutrition, (3) lighted that the last expert-led statement on elite
body composition, (4) stressful environments and travel, football nutrition had been written 11 years earlier.
(5) cultural diversity and dietary considerations, (6) While sports nutrition research since the last
dietary supplements, (7) rehabilitation, (8) referees and expert statement1 has in some instances helped to
(9) junior high-level players. The expert group provide a advance our knowledge and shape our practical
narrative synthesis of the scientific background relating strategies with elite footballers, the influx of new
to these topics based on their knowledge and experience research brings with it confusion as to the relevance
of the scientific research literature, as well as practical and veracity of current advice. It is often difficult for
experience of applying knowledge within an elite sports practitioners to interpret the available evidence and
setting. Our intention is to provide readers with content
make sense of the controversies that may exist, in
to help drive their own practical recommendations. In
particular with the influx of different and opposing
addition, to provide guidance to applied researchers
© Author(s) (or their messages, especially from social media channels.4
where to focus future efforts.
employer(s)) 2020. No In these instances, expert-led statements can be a
commercial re-use. See rights powerful tool to aid practitioners with clarity on
and permissions. Published
current research evidence.
by BMJ.
UEFA EXPERT GROUP STATEMENT ON This executive summary of the full scientific
To cite: Collins J, NUTRITION IN ELITE FOOTBALL: EXECUTIVE article—the ‘UEFA expert group statement’—
Maughan RJ, provides a series of infographics illustrating
Gleeson M, et al.
SUMMARY
Br J Sports Med Epub ahead Football (soccer) is a global game which is constantly important practical applications and insights that
of print: [please include Day evolving with substantially increasing physical and are intended to help practitioners take away some
Month Year]. doi:10.1136/ technical demands of match play. Training regi- key points from the full article. We strongly advise
bjsports-2019-101961 mens have become more demanding physically, in practitioners to read and digest the full article and
Collins J, et al. Br J Sports Med 2020;0:1–27. doi:10.1136/bjsports-2019-101961 1

Consensus statement
not only the practical infographic summary. This will ensure a The physical and technical demands of elite football have
more in-depth appreciation of the scientific evidence and the increased in recent years,5 6 as have the financial implications
critical appraisals from the many experts involved which accom- of winning or losing. Training regimens have been adapted
pany the recommendations, in addition to understanding the accordingly; they are more demanding and more sophisticated
fuller context and how to apply in their own practice. as they prepare players to cope with the evolution in match
In this expert group statement, nine specific topics have demands. Congested match schedules have been suggested to
been identified: (1) match day (MD) nutrition, (2) training day increase the risk of injury to players.7 8 Kick-off times have
nutrition, (3) body composition, (4) stressful environments become more variable, with teams required to play early or late
and travel, (5) cultural diversity and dietary considerations, (6) to accommodate television schedules. The travel required to
dietary supplements, (7) rehabilitation, (8) referees and (9) junior compete in multiple domestic and international tournaments
high-level players. Our narrative synthesis and critical appraisal adds to the demands on players, with different logistical chal-
takes into account the diversity of the footballing community, lenges depending on the geographical location. The reality
including both male and female players, outfield players and being that the best players play the most often. Moreover,
goalkeepers and match officials. football truly is a global game9: frequent intracontinental and
As part of this process, UEFA has consulted with many special- intercontinental matches and the migration of foreign players
ists from the game to provide insights on the current role and both result in greater cultural diversity and associated nutri-
future direction of nutrition in football. We often hear from the tional considerations.
scientific community of the importance of sports science within The exponential rise in sports nutrition research in recent
football, but too often the voices of coaches are not heard in best years has advanced our knowledge and expertise, but brings
practice guidelines, when they could offer valuable insight. Part with it confusion as to what is actually sound advice. Those
of this executive summary includes an editorial by one of the providing sports science support at elite level should follow an
world’s most iconic coaches, Arsène Wenger, who discusses the evidence-based approach,10 but it is often difficult for practi-
coach’s perspective on nutrition within the current footballing tioners to interpret the available evidence and make sense of the
landscape and looks to the future of nutrition for players and controversies that may exist in particular with the influx of noise
teams around the world. We also have a brief ‘warm up’ to this (ie, flawed messages) from social media channels.4 This, in part,
UEFA expert statement from Marc Vouillamoz, UEFA Head of reflects the limitations of our current knowledge: we know, for
example, that the recommended dietary allowance (RDA) is the
Medical and Antidoping and an editorial from Dr Tim Meyer,
average daily dietary intake that suffices to meet the nutrient
Chairman of the UEFA Medical Committee: these provide
requirements of nearly all (98%) healthy people, but it is unclear
important antidoping and medical perspectives on the impor-
how these values should be applied in the assessment of dietary
tance of nutrition in football.
intakes of footballers and other athletic populations. We should
As you will read in the full article and is evident throughout
also recognise that much of the available data on dietary intakes
the series of infographics, the UEFA expert statement advocates
is flawed, and probably does not reflect the true nutrient and
an evidence-based approach to nutrition, and emphasises a ‘food
energy intake of the populations that have been studied.11
first’ philosophy (ie, prioritising food over supplements to meet
Expert-led statements can be a powerful tool to aid practitioners
nutrient requirements) as being fundamental to ensure effective
in these instances, but although there are recent examples in
player support. It is crucial that clubs and national associations,
different sporting situations,2 12 the most recent example of this
where possible, use the services of qualified professionals with
in football-specific nutrition was a consensus published over a
nutrition-related undergraduate degrees, postgraduate qualifica- decade ago.1
tions in sport and exercise nutrition and professional registration The aim of this paper is to provide a narrative synthesis of the
(depending on the country). current evidence relating to various topics in elite football nutri-
The expert statement process was created by a steering tion and in doing so, this manuscript is targeted at researchers,
committee (JC, RJM, JB, AMcC) who identified the topics scientists and practitioners with scientific knowledge and
to be included and compiled a list of research and field-based understanding.
experts. Expert group members (n=31 in total) included basic This UEFA expert group statement endorses and supports
and applied researchers (n=6) and field- based practitioners a ‘food first’ philosophy. This aims to establish best practice
(n=5); the majority (n=14) had a background of both research recommendations and represents an important next step in
and field-based practice and six were UEFA Medical Committee supporting the growth of nutrition within football. It is crucial
members. It is intended that this narrative synthesis will provide that clubs and national associations, where possible, use the
readers with the scientific underpinning to inform their practical services of qualified professionals with nutrition-related under-
recommendations and strategies. In addition, we aim to guide graduate degrees, postgraduate qualifications in sport and exer-
applied researchers to focus their future efforts in regards to elite cise nutrition and professional registration (depending on the
football nutrition research. country); for simplicity, we use the term ‘sports nutritionist’
throughout.
We note several limitations to the evidence base from which
INTRODUCTION recommendations of best practice can be reached:
Good nutrition choices can support the health and performance 1. There is little research specific to football, and the laboratory
of footballers: the type, quantity and timing of food, fluids and models that have been developed to simulate the game gen-
supplements consumed can influence players’ performance and erally fail to replicate the demands of match play. As such,
recovery during and between matches.1 2 However, the rapid results need to be extrapolated from different sports and sim-
evolution of the game itself, in addition to changes in our under- pler exercise protocols.
standing of sports nutrition, creates uncertainty as to the appro- 2. Those studies that have used football as a model have been
priate nutritional decisions to make at specific moments in time done with players engaged at recreational level. There is very
and in specific contexts. little information derived from studies of elite players.
2 Collins J, et al. Br J Sports Med 2020;0:1–27. doi:10.1136/bjsports-2019-101961

Consensus statement
3. Many of the methods that have been used to assess the di- (~45–60 min) pre-match warm-ups and, while they cover less
etary habits of players and their nutritional status are fun- total distance and perform fewer high-intensity activities, they are
damentally flawed and do not provide reliable information. rarely substituted and need to be prepared for a full 90–120 min
4. As with all studies, publication bias can increase the risk of match.17 The physical and technical demands of match play for
a skewed picture of the efficacy of nutrition interventions, elite outfield male footballers have increased substantially in
especially those involving the use of supplements. Studies recent years,5 6 likely as a result of tactical modifications.6 While
that do not produce a positive outcome are less likely to be the total distance covered decreased by a trivial magnitude of
published than those that produce positive results. 2% (10679±956 vs 10881±885 m) between 2006 and 2013,
We also recognise that, despite the great popularity of women’s high-intensity and sprint running have increased substantially,
football, there are few relevant studies. Nutritional needs and with high-intensity running distance and high-intensity actions
practices likely vary more within one sex than between sexes: up by ~30% (890±299 vs 1151±337 m) and ~50% (118±36
the sex of the player is therefore another factor to be taken into vs 176±46), respectively.5 Over that same period of time, sprint
account when considering the needs of an individual player. distance and number of sprints rose by ~35% (232±114 vs
350±139 m) and ~85% (31±14 vs 57±20), respectively. This
trend is seen in all outfield positions (central defenders, full-
EXPERT GROUP STATEMENT PROCESS
backs, central midfielders, wide midfielders and attackers).5
A steering committee (JC, RJM, JB, AMcC) identified the topics
Evolutions in technology have revealed that players make more
to be included and compiled a list of research and field-based
passes (35±17 vs 25±13), and that these are more successful
experts. Expert group members (n=31 in total) including basic
(83%±10% vs 76±13%).5 These increased physical and poten-
and applied researchers (n=6) and field- based practitioners
tially technically demanding (eg, cognitive) tasks make effective
(n=5); the majority (n=14) had a background of both research
nutritional strategies even more important.
and field-based practice and six were UEFA Medical Committee
Research on elite female players is sparse. The available
members. An outline of the expert group statement was agreed
evidence highlights that elite female players (international level)
by all members: the authors were asked to focus on what is
cover approximately the same average total distance as their male
currently known from scientific research combined with their
counterparts, but they run less at high speeds.18 An important
practical knowledge and expertise. First drafts of each section
point to note is that no study has compared the high-speed or
were collated by the steering committee to form the basis of the
sprinting demands of male and female players relative to indi-
first full draft. This was circulated to all expert group members:
vidual maximum speed. The use of absolute speed thresholds
the applied researchers focused on the narrative synthesis of the
does not reflect differences in the maximum speed of individual
scientific research literature and the practitioners on the ecolog-
players19 or gender differences.
ical validity in the football setting. Comments were collated and
changes made before further review by the expert group. This
process continued until agreement was reached on the specific
Preparation for match play (carbohydrates and fluids)
sections and recommendations included (the whole process
CHO is the primary fuel for muscle during high-intensity activ-
lasted from December 2017 to December 2019). A meeting
ities; it is therefore a key macronutrient when preparing players
between the steering committee and UEFA Medical Committee
for match play. On the day prior to a match (MD-1), training is
members (June 2019) was held to discuss and agree on any final
usually light and CHO intake should be at least 6–8 g/kg body
amendments or additions that needed to be made and these were
mass (BM) to elevate muscle and liver glycogen stores.20 While
then circulated to the expert group for their review. This resulted
the glycogen cost of elite match play in either male or female
in one further draft version before finalisation (December 2019).
players is not yet known,21 data from a friendly match involving
The key recommendations are aimed at both male and female
lower division Danish male players demonstrate that approxi-
professional players, the majority of whom will be training and
mately 50% of muscle fibres are classified as empty or partially
playing full time. Distinctions between male and female players
empty after match play.22 Players who begin a game with low
are clearly made where appropriate; unless otherwise stated, the
muscle glycogen stores will cover less distance and much less at
key recommendations apply to both sexes. Additional sections
high speed, particularly in the second half, than those who have
focus on elite referees and elite junior players (ie, players aged
ensured adequate glycogen stores.23 Where the match schedule
under 18 years and belonging to a professional football academy
consists of congested fixtures (eg, domestic fixtures, European
and training full-time).
competition, international games), CHO intake should be main-
tained within this range (6–8 g/kg BM/day) for the 48–72 hours
EXPERT GROUP TOPIC 1: MATCH DAY NUTRITION between games to promote adequate glycogen storage. The
Match play demands reality is that players often consume less than this and daily
During a football match, players engage in a variety of activi- intake may be closer to about 4 g/kg BM.16 A conscious focus on
ties from walking to sprinting, changing direction, jumping and the intake of CHO-rich foods is needed, with increased CHO
striking the ball, in addition to contact with opposition players. intake at the cost of fat intake (and possibly protein intake) to
In outfield players, heart rate is maintained at an average of ensure adequate glycogen restoration.
85% of maximum and the average relative exercise intensity at Maintaining an appropriate hydration status will support
70% of maximal oxygen uptake (VO2max) over the duration players’ health and performance.24 Sweating is the primary mech-
of the match,13 equating to an energy expenditure of ~1300– anism to dissipate the metabolic heat generated during football
1600 kcal,14 15 whereby carbohydrates (CHO) contribute training and match play in both cool and hot environments.25 26
about 60%–70% of the total energy supply.15 The total MD Players should aim to start the match fully hydrated: daily BM
energy expenditure has been estimated at ~3500 kcal.16 To measurements,27 degree of thirst,28 urine colour,29 osmolality
date, no studies have been performed to assess the physiolog- and urine-specific gravity can be useful indicators of hydration
ical demands or fatigue responses of goalkeepers specifically.17 status.30 A urine osmolality of <700 mOsmol/kg or a specific
Limited research suggests that goalkeepers perform extended gravity of <1.020 suggests euhydration and >900 mOsmol/

Consensus statement
kg, hypohydration, although individual variability is present.31 which limit intake to warm-up and half-time (see below) and to
For games with an early kick-off, the day prior to the match the fear or actual experience of gastrointestinal problems during
represents a key opportunity to optimise the players’ hydration matches. This is a situation where sports foods (eg, CHO drinks,
status for the match the following day. gels) can provide a preferred delivery option, to minimise these
It has become popular in recent years to suggest that the only gastrointestinal issues. Stoppages during the match may also
advice relating to hydration that is either necessary or appro- provide a valuable opportunity for players with increased CHO
priate for those involved in sport is to drink according to the and/or fluid needs or for the whole team in hot conditions (see
dictates of thirst.32 This may not be appropriate in many team the section ‘Expert group topic 4’ on stressful environments).
sport contexts, including football training and match play.33 The Receptors in the oral cavity detect CHO consumed during
availability of fluids and the sensation of thirst may not coin- exercise and exert central effects that may reduce the percep-
cide, and some forward planning (eg, understanding individual tion of effort.49 CHO mouth rinsing has been shown to increase
sweat losses, developing individualised hydration plans, along- self-selected jogging speed with likely benefits in sprint perfor-
side player education) can ensure that each player’s hydration mance during intermittent exercise.50 The implications for foot-
needs are met. ball are still unclear,51 but the use of CHO mouth rinsing during
breaks in match play (eg, half-time, extra-time, injury stoppages,
medical breaks) could potentially enhance performance in situ-
Pre-match (CHO and fluids)
ations where CHO consumption is limited by gastrointestinal
On MD itself, CHO intake is again one of the most important
concerns. On the other hand, it has been noted in recent tour-
considerations. Within an overall guideline of 6–8 g/kg BM
naments that some players appear to misunderstand the mouth
CHO per day, it is recommended that players consume a CHO-
rinsing strategy and spit out the CHO- containing fluid even
rich meal (1–3 g/kg BM) 3–4 hours before kick- off to ensure
when there are no gastrointestinal problems. This may be partly
that they begin the match with adequate glycogen stores. The
due to the design of a scientific investigation in which there is an
pre-match meal is of particular importance for the promotion
interest in distinguishing between the central nervous system and
of liver glycogen stores, given that such stores can be reduced
muscle fuel effects of CHO intake during exercise. Indeed, swal-
by about 50% after an overnight fast.34 This may be particu-
lowing the drink following a ~5 s exposure in the mouth allows
larly important for matches with a lunchtime kick-off, and it
both effects to occur simultaneously; this will be important in
highlights the importance of optimising nutritional preparation
scenarios in which a player’s workload is high and CHO supplies
during the day prior to the match. The pre-match meal should be
may become limiting. It should be remembered that matches can
easily digestible to reduce the risk of gastrointestinal problems
extend to extra time and penalty shoot-outs where both the
(eg, reflux, discomfort). The pre-match meal should also make
brain and muscle may benefit from additional fuel support and
players ‘feel better’35 so comfort should be considered, rather
activation.
than rigid strategies focused solely on meeting CHO intake
Sweat rates vary greatly between players and are primarily
guidelines. Player ‘rituals’ can be strongly held and education
influenced by the intensity of exercise, environmental conditions
combined with practising pre-match fuelling in training or lower
and acclimation status.52 During training and matches sweat
priority matches, can be an important tool to optimise glycogen
rates in male players have been reported to range from 0.5 to
stores and player readiness for match play.
2.5 L/hour26 53 54: lower values are generally reported in female
Data from many studies suggest that high CHO intakes before
players because of lower BM and lower absolute work rates.55–57
and during a match can delay fatigue36 and enhance the capacity
Sweat also contains electrolytes, primarily sodium, concentra-
for intermittent high- intensity exercise.37 38 Benefits of pre-
tions of which vary substantially between players.54 Mechanisms
match meals may extend to players’ technical performance. For
by which sweating-induced hypohydration might impair foot-
example, increased dribbling speed was observed when profes-
ball performance are not completely elucidated, but may include
sional youth footballers consumed a larger breakfast (500 vs 250
increased cardiovascular strain,58 impaired cognitive function,59
kcal, with 60% CHO) 135 min before a match.39
increased perception of effort,60 reduced physical function60
Finally, players should aim to start the match euhydrated
and reduced technical skills.61 It is likely that individual players
by ingesting 5–7 mL/kg BM of fluid in the 2–4 hours prior to
may be more or less sensitive to hypohydration during exercise.
kick-off.40 This allows time for excess fluid to be voided prior to
Therefore as a guide, players should aim to drink sufficient fluids
exercise, targeting a urine that is pale yellow in colour.29
to prevent a deficit of >2%–3% of pre-exercise BM during exer-
cise,39 62 while avoiding gains in BM (hyperhydration) and also
During match play (CHO and fluids) ensuring their fuel needs are met.38
Sufficient CHO and fluid intake are the two main nutritional Both hydration and CHO intake may require special attention
considerations during match play. Research evidence typi- in matches where extra time (2×15 min) is played. All match
cally shows performance benefits in protocols simulating foot- nutrition strategies, including the use of supplements (eg, sports
ball matches when CHO is consumed during exercise at rates foods), should be practised in training and minor matches to
of ~30–60 g/hour,41–44 or when 60 g is consumed before each allow individualised protocols to be developed and to identify
half.45 It is therefore recommended that ~30–60 g CHO is adverse effects in players, as well as allowing them the opportu-
consumed after warm-up and again at half-time to meet these nity to become accustomed to any potential adverse effects, with
guidelines. CHO ingestion during intermittent exercise also minimal impact on important match performance.
seems to improve shooting performance,38 46 dribbling speed,47
and passing,46 48 although the effects on sprinting, jumping,
change of direction speed and cognition are less consistent.37 41 Recovery from match play (CHO, fluids, protein)
The current practices of elite players appear to be at the lower A primary objective following a competitive match is to reduce
end of the ~30–60 g/hour scale; players in the English Premier the time needed to fully recover.63 One essential goal is to rapidly
League reported mean CHO intakes of 32 g/hour just before and replenish CHO stores. Postmatch meals and snacks should target
during a match.16 This may be attributed to the match rules, a CHO intake of ~1 g/kg BM/hour for 4 hours.64 This is usually

Consensus statement
facilitated by the consumption of drinks and snacks in the demands of match play,6 85 86 detailed analysis of the customary
changing rooms followed by post-match meals at the stadium, training loads of elite footballers is comparatively recent and
during travel and at home. Sports foods may provide a preferred remains limited.20 87–89 These data demonstrate that training
option to supply macronutrients, especially to achieve CHO loads are lower than those experienced in match play, including
guidelines when appetite may be reduced or when sourcing food total distance (<7 vs ~10–13 km),20 high-speed running distance
away from the home environment. Players should also aim to (<300 vs >900 m),90 sprint distance (<150 vs >200 m)91 and
reduce any fluid and electrolyte deficit soon after the match65; average speed (<80 vs ~100–120 m/min).20 Absolute daily
however, in most situations there is sufficient opportunity and training loads depend on many factors including phase of the
time to restore euhydration and electrolyte balance with normal season,89 player position,89 coaching philosophy,88 89 frequency
eating/drinking practices, while also meeting other recovery of games,92 player starting status88 and player-specific training
objectives.63 65 goals such as manipulation of body composition93 or rehabilita-
Elite football players may not achieve CHO targets in tion from injury.94
recovery from evening games,66 suggesting suboptimal glycogen In the traditional in-season scenario of one match per week,
resynthesis patterns, the result of which is likely problematic for players may complete four to five ‘on-field’ training sessions
recovery and preparation during congested fixture schedules. where the absolute training load is likely to be periodised across
As discussed above, daily CHO intake in the range of 6–8 g/kg the weekly microcycle according to the proximity and impor-
BM in the 24 hours following a game (MD +1) will continue to tance of the game itself.20 Players may also undertake additional
replenish glycogen stores and this intake should be maintained ‘off-field’ sessions, such as strength training. The aim is to stimu-
for up to 48–72 hours after the match during congested fixture late both aerobic and strength adaptations while simultaneously
schedules. Higher intakes and additional nutritional strategies rehearsing technical skills and tactics. It is noteworthy, however,
may be required when players report symptoms of muscle sore- that gym and field-based training sessions may not always be
ness and damage, as glycogen synthesis is impaired in the pres- delivered in a systematic and structured sequence.95 The order
ence of muscle damage.67–69 To optimise protein synthesis for of these can influence players’ habitual macronutrient intake and
repair and adaptation, meals and snacks should be scheduled to the magnitude of the strength adaptations induced.96 Both abso-
achieve intakes of 20–25 g of (high-quality) protein at 3–4 hour lute daily intake and distribution of macronutrient intake have
intervals.70–72 Furthermore, there is emerging evidence that the capacity to affect training performance and recovery and to
consuming 30–60 g of casein protein prior to sleep can enhance modulate training adaptations.
overnight protein synthesis.73
Although postexercise protein intake undoubtedly increases
protein synthetic rates and net protein accretion, this is a slow Carbohydrate requirements for training
process and there is little evidence of acute improvements in Given the role of muscle and liver glycogen in supporting energy
muscle function.74 Some studies have reported reductions in production during match play,22 it is important to consider
muscle soreness with postexercise intake of protein or branched their contribution to training goals. Unfortunately, the lack of
chain amino acids,75 but the overall effects are small. Consuming specific data on muscle glycogen utilisation during typical field-
polyphenol-rich tart cherry juice has become a popular interven- based football training sessions makes it difficult to develop
tion to accelerate muscle recovery in different sports,76 77 but clear guidelines on the CHO requirements for training97 other
recent investigation in football did not show improved recovery than to suggest that they differ from the requirements for match
markers of function or subjective soreness.78 Therefore, the play. Some information can be gleaned from the investigation
available evidence does not support its specific use in football. of energy expenditure in English Premier League players during
Reducing exercise-induced muscle inflammation and free radical a 7-day in-season microcycle consisting of two games and five
production, particularly with large doses of individual antioxi- training days.16 The mean daily expenditure of outfield players
dant vitamins C and E, may interfere with adaptive processes in was assessed at ~3500 kcal/day,16 with goalkeepers’ energy
muscle and is therefore discouraged.79 expenditure being ~600 kcal/day less.98 In these studies, the
mean daily energy intake reported by players was comparable to
energy expenditure, and BM did not change during the assess-
Alcohol
ment period. Players reported an adjustment of daily CHO
Some players may drink alcohol in social settings with team-
intake according to the perceived load, whereby ~4 and 6 g/kg
mates, friends and family, or as a means to relieve stress, anxiety
BM were consumed on training and MDs, respectively. None-
or depression; this is particularly likely to occur after a match.63
theless, given the importance of muscle glycogen for preparation
Occasional intake of small amounts (no more than 2 units/day)
and recovery from match play, it is suggested that players should
of alcohol is not harmful, but alcohol use can interfere with
increase CHO intake on MD-1, MD and MD +1 to between 6
recovery by impairing liver and glycogen resynthesis,80 muscle
and 8 g/kg BM. However, even at ~8 g/kg BM, muscle glycogen
myofibrillar protein synthesis81 and rehydration.82 Drinking
content in type II fibres may not be completely restored 48 hours
large doses of alcohol can also impair next-day countermove-
after a match.99
ment jump performance83 and also directly suppress a wide
Alternatively, given the lower absolute daily loads on typical
range of immune responses84 and players should therefore mini-
training days (ie, one session per day in a one game per week
mise or avoid intake during key periods of training and match
microcycle) coupled with the fact that players typically do not
play when recovery is a priority.
perform any additional structured training outside of the club,
daily intakes ranging from 3 to 6 g/kg BM may be sufficient to
EXPERT GROUP TOPIC 2: TRAINING DAY NUTRITION promote fuelling and recovery. In accordance with these lower
Overview of training calendar, objectives and training load absolute loads, it is unlikely that most players require CHO
The football season is typically categorised into three distinct intake during training.16 However, this may depend on the dura-
phases: preseason, in-season and off-season (see table 1). Despite tion and intensity of the training session, the timing of training
more than four decades of research examining the physical in relation to the last meal and the potential benefits of practising

Consensus statement
Table 1 The training carbohydrate intake continuum

Typical daily external training
load parameters
(as quantified during pitch-
Desired training based training according to Suggested daily
Training scenario Training objectives adaptations GPS; HSR ≥19.8 km/hour) CHO range Comments
Preseason training ►► To improve players’ physical/ ►► Increase aerobic Duration: 60–180 min 4–8 g/kg BM Suggested range accommodates likely
mental/tactical qualities and anaerobic Total distance: 3–12 km variations in loads (eg, potential twice
►► To prepare players for a full fitnessIncrease lean HSR: >400 m per day sessions, recovery days) as
playing season mass/reduce fat well as individual training goals (eg,
►► To avoid injury and illness mass manipulation of body composition to
►► Increase/maximise accommodate weight loss and fat loss
strength, speed, or weight gain and lean mass gain).
power for For example, twice per day training
performance and structures would likely require higher
injury prevention CHO intakes (eg, 6–8 g/kg BM/day),
whereas lower absolute intakes may be
required where players are aiming for
body fat loss or training intensity and
duration is reduced (eg, 4–6 g/kg BM/
day).
In-season training ►► To maintain physical ►► Maintain aerobic Duration: 45–90 min 3–8 g/kg BM Suggested range accommodates likely
(one game per qualities (and improve and anaerobic Total distance: 2–7 km variations in loads across the microcycle
week) where possible/appropriate) fitness HSR: 0–400 m (eg, low load days and MD-1 CHO
►► To keep players injury and ►► At least maintain loading protocols) as well as individual
illness free strength, power, training goals (eg, manipulation of
►► To practise MD nutrition speed body composition). For example, MD-1
strategies ►► Maintain lean BM and MD +1 would require higher CHO
►► Train the gut to intakes (eg, 6–8 g/kg BM/day), whereas
tolerate CHO during lower absolute intakes may be required
football-specific on other days of the week (eg, 3–6 g/kg
training (occasional BM/day) depending on training intensity,
use) duration and player-specific goals.
In-season training ►► To avoid injury and illness ►► Restore muscle Duration: <60 min 6–8 g/kg BM Suggested range accommodates
(congested fixture ►► To accelerate recovery function as quickly Total distance: <3 km the requirement to replenish muscle
periods) as possible HSR: <50 m glycogen stores in the 48–72 hours
►► Promote glycogen period between games. During this time,
resynthesis it is suggested that players consistently
►► Fluid replacement: consume CHO within this range so as to
rehydration promote glycogen availability.
►► Alleviate mental
fatigue
Off-season training ►► To avoid detraining ►► Minimise the loss N/A <4 g/kg BM Suggested intake accommodates the
►► To ensure players come back of aerobic and cessation of normal training loads,
ready for the demands of the anaerobic capacity to avoid gains in fat mass. Note, for
preseason ►► Minimise decrements players who may be undergoing higher
in strength, power, training loads (eg, off-season training
speed programmes) CHO intake should be
►► Minimise decreases increased accordingly.
in lean mass and
increases in fat mass
BM, body mass; CHO, carbohydrate; HSR, high speed running; MD, match day; N/A, not available.
CHO consumption during exercise to ‘train the gut’ to better training adaptation.101 Such levels of protein intake can easily
absorb and tolerate intake during matches. Daily CHO require- be achieved from a mixed diet provided the energy intake is
ments for training should operate on a sliding scale of 3–8 g/ sufficient to meet the demands of training.102 Recent dietary
kg BM/day depending on the specific training scenario, fixture surveys suggest that most professional players report meeting or
schedule and player-specific training goals (further context is exceeding the 1.6–2.2 g/kg BM/day protein intake recommended
provided in table 1). for football. In professional players from the English Premier
League, reported daily intakes of protein averaged 2–2.5 g/kg
Protein recommendations for training BM/day and were consistent across a 7-day in-season training
Daily football training places stress on the musculoskeletal and period.16 This intake (approximately 200 g/day) was greater than
tendinous tissues, and there is a need to remodel and repair these that previously reported (<150 g/day) by adult players from the
protein-containing structures to maintain and improve their Scottish103 and Dutch104 leagues and is around twice the RDA in
integrity and function. Players may benefit from the provision of Europe, as previously highlighted. With judicious dietary plan-
higher quantities of protein than are needed by the general popu- ning, protein supplements are probably not needed for most
lation. The RDA for protein is 0.8 g/kg BM/day in Europe,100 players, although they provide a convenient and easily digest-
but higher intakes up to 1.6–2.2 g/kg BM/day appear to enhance ible alternative to foods, especially in the post-training period.

Consensus statement
Where protein supplements are consumed at a dose of 0.3–0.4 g/ <15%–20% of energy often requires an unnecessary avoidance
kg BM/meal, whey protein is considered a prudent choice owing of a range of foods with valuable nutrient profiles. At the other
to its higher leucine content and digestibility.105 end of the spectrum, there is renewed interest in chronic adapta-
Ideally, three to four discrete protein-containing meals should tion to a ketogenic low-CHO, high-fat (LCHF) diet to enhance
be consumed each day, with at least ~0.4 g/kg BM/meal, which the capacity for fat utilisation during exercise.112 Although there
at four meals would provide ~1.6 g protein/kg BM/day.101 This are anecdotal reports that some professional football players or
strategy requires a plan to include protein-rich foods at each teams follow such a diet (or a low-CHO (LC) diet), no observa-
eating occasion to provide a sufficient dose to stimulate protein tional or intervention studies involving team sports and LCHF
remodelling. Protein quality may be important for players diets are available. Furthermore, it has been shown that although
as the amino acid leucine, is an important trigger for muscle trained muscle can use large amounts of fat at relatively high
protein remodelling and ~2.5 g of leucine per meal would be exercise intensities (eg, up to 75% VO2max) when CHO avail-
optimal.105 Leucine content is highest in dairy-based proteins ability is limited, this is associated with an increased oxygen cost/
(2.5 g leucine/25 g serve of whey protein), high in meat (2.5 g reduced exercise economy which may at least partially explain
leucine/140 g of lean beef or boneless chicken breast), eggs the impairment of performance at higher exercise intensities.113
(2.5 g leucine/5 standard eggs) and plant-protein isolates like Due to the lack of evidence, an LCHF diet is not recommended
soya (2.5 g leucine/30 g serve of isolated soya protein).105 Plant- for footballers.
based proteins can also be used, but a higher protein intake is
required for the same effect on muscle protein synthesis.105
As in the general population, football players often exhibit a Essential micronutrients for training
skewed pattern of daily protein intake (the hierarchical order For elite footballers, the demands of both training and match
in which protein is consumed being dinner>lunch>break- play may also increase the requirements for some micronutrients
fast>snacks), which while potentially meeting their daily protein to support metabolic processes within the body. There are many
intake (~1.6 g protein/kg BM/day) does not optimally stimulate different classifications of micronutrients, including vitamins,
protein synthesis on each meal occasion, although footballers are minerals and trace elements essential for growth and develop-
reported to consume ~0.3–0.4 g/kg BM at main meals,66 in line ment of the body. The most frequent cases of suboptimal status
with current recommendations. and key recommendations are outlined below.
Emerging research on presleep protein consumption suggests
that this is an important consideration for football players. Over-
night is a natural regenerative phase and yet is also a time when Vitamin D
nutrient intake is usually low or absent. Preliminary evidence Vitamin D is a controversial topic in sports nutrition. Inad-
supports presleep protein ingestion106 107 at a dose of ~0.4 g/ equate serum vitamin D concentrations have been reported
kg BM within 3 hours of bed in a full meal or perhaps 0.5 g/kg to impair muscle function and recovery114 and to compro-
BM if consumed as supplemental protein 1–2 hours before bed mise immune health,115 so it is essential that football players
to improve training adaptation during periods of high training who are deficient are identified and treated accordingly. It is
volume.66 Professional players have typically reported an intake a unique vitamin in that it can be synthesised in the skin via
of only 0.1 g/kg BM at this time-point, highlighting an oppor- sunlight exposure, with <20% of daily needs typically coming
tunity for improved nutritional choices that would potentially from the diet.116 The average daily intake across the world is
improve training adaptation.66 approximately 100–250 IU (1 ug = 40 IU), which is less than
During energy restriction, protein requirements are likely the current RDA of 400 IU (UK) and 600 IU (North America).
increased due to the catabolic milieu created by an energy The ability to synthesise vitamin D from sunlight is dependent
deficit.108 109 Nonetheless, it is possible, even during a severe on geography and meteorology, with UVB radiation being insuf-
energy deficit, at least for athletes with high body fat, to lose fat ficient to convert 7-dehydrocholesterol in the skin to vitamin
and gain muscle simultaneously.108 For this reason, it is prudent D at high latitudes, especially in the winter months. Paradox-
to recommend a higher protein intake (perhaps 2.0–2.4 g/kg ically, studies demonstrate that, compared with Caucasians,
BM/day) that is dependent on training load and other metabolic black and Hispanic people are at elevated risk of vitamin D
stresses, such as weight loss or rehabilitation from injury (see the deficiency (with darker skin colour reducing synthesis) but at
section ‘Expert group statement topic 7’ on nutrition for injury lower risk of osteoporosis, rapid bone loss and associated frac-
rehabilitation).94 110 tures.116 Given that many footballers reside in countries far from
the equator, and that many of them use sunscreen during the
summer months, it is not surprising that footballers117 occasion-
Fat requirements for training ally present with vitamin D deficiencies. English Premier League
Dietary fat is an important part of a player’s training nutrition as football players showed a seasonal pattern in vitamin D status,
an energy source, a vehicle for the intake and absorption of fat- with 65% of players presenting with inadequate serum concen-
soluble vitamins and a source of essential fatty acids. Adequate trations of 25(OH)D (25-hydroxy vitamin D, the best marker
intakes of linoleic acid (an omega-6 fatty acid) and α-linolenic of vitamin D status) in the winter months.118 Low intakes have
acid (an omega-3 fatty acid) typically provide ~10% of the also been recorded in female players.119 120 The current target
overall dietary energy intake of sedentary people.111 Athletes serum 25(OH)D concentration defined by the US Institute of
are often advised to adjust fat intake to allow protein and CHO Medicine and European Food Standards Agency is 50 nmol/L,
requirements to be met within total energy targets and to follow although this may be conservative121 and it would be reasonable
community guidelines regarding the minimal intake of trans fatty for athletes to aim for serum 25(OH)D concentrations of at least
acids and caution with the intake of saturated fats. This typically 75 nmol/L. There is emerging evidence that athletes can have
leads to a fat intake of 20%–35% of total dietary energy. While too much supplemental vitamin D122; therefore, if a deficiency is
some players may restrict fat intake to reduce total energy intake observed, 2000 IU/day of vitamin D3 is suggested with retesting
or because they think it is ‘healthy’, overrestricting fat intake to to confirm postsupplementation levels.

Consensus statement
Iron
Table 2 .Food sources of calcium
Iron is the functional component of haemoglobin and myoglobin
as well as being an essential constituent of non-haem sulphur Food and serving size Calcium content (mg)*
enzymes and haem-containing cytochromes involved in oxida- Whole or skimmed cows’ milk (200 mL) 240
tive ATP production. Therefore, iron deficiency, even without Calcium-enriched soy milk (200 mL) 240
anaemia, can have negative implications for aerobic perfor- Hard cheese, for example, cheddar (30 g) 220
mance.123–125 Due to regular blood loss during menstrual bleeding Yoghurt (120 g) 200
(and possibly due to a diet less rich in meat), postpubertal female Sardines, with bones (½ tin) 258
players are at the highest risk of iron deficiency.126 127 While iron Broccoli (2 spears) 34
deficiency in athletes is common, with a prevalence of about Kale (67 g) 100
15%–35% in female athletes and 5%–11% in male athletes,128 Orange (1 medium size) 75
data on professional football players at various stages of the Typical multivitamin/mineral supplement 200
season are limited. Iron deficiencies may present as lethargy *Note that the RDA is 700–1000 mg/day.
and reduced performance and can be identified through blood RDA, recommended dietary allowance.
screening. A reasonable time frame for assessment of iron status
is once per year in male players and twice per year in female
players (more frequently when iron deficiency has been detected and black stools. The tolerable upper intake level (UL) is 45 mg/
in recent monitoring). day; high-dose iron supplements of >45 mg/day elemental iron
Anaemia is considered present when blood haemoglobin levels should not be taken unless iron deficiency is present, as there is
are <115 g/L (females) or <125 g/L (males), although some labo- a real danger of harmful iron toxicity. For further information
ratories may use slightly different cut-off values. Iron deficiency on iron considerations, readers are directed to a review by Sim
is defined as low serum ferritin (<35 µg/L) and normal (ie, not et al.128
yet affected) blood haemoglobin values. In young athletes, iron
deficiency represents the most frequent cause for anaemia; it
is typically tested for by determining serum ferritin, the most Calcium
established marker for the amount of stored iron.129 130 Anaemia Calcium is important for the maintenance of bone tissues,
in the presence of low serum ferritin indicates that the anaemia is skeletal muscle and cardiac contraction and nerve conduction.
due to iron deficiency. For anaemia with regular ferritin values, it
Serum calcium concentration is tightly regulated by calcitonin
is necessary to consider other possible causes. In the cases of iron and parathyroid hormone regardless of acute calcium intake.
deficiency anaemia, there is a need for iron substitution. When The largest store of calcium in the body is in the skeleton and
only ferritin is lower than normal, a diet rich in iron, particularly this store is mobilised when dietary intake is inadequate, leading
red meat, is recommended to avoid the development of overt to demineralisation of bone tissue through the action of para-
anaemia and make sure that other haem-containing proteins/ thyroid hormone. Dairy products are the main dietary sources
enzymes can be maintained at a sufficient level. Additionally, of calcium, but it is also found in green leafy vegetables, nuts
a period of iron supplementation may be considered at levels and soya beans (table 2) The RDA for calcium is 1000 mg/day
above the RDA after consultation with qualified medical and (North America) or 700 mg/day (UK) for adults and 1300 mg/
dietetic practitioners. Parenteral (ie, intravenous) supplemen- day (North America) or 1000 mg/day (UK) for adolescents.
tation is usually not indicated. Only in cases of pathologically An athlete’s diet should include a higher intake of 1500 mg/
impaired iron digestion from the gut (such as in coeliac disease) day through dietary sources or supplementation if required to
is an intravenous administration justified, also with further optimise bone health in cases of relative energy deficiency in
consideration of maximum infusion volumes outlined by the sport (RED-S).133 Calcium may be lost through sweat, although
most recent antidoping regulations. Determination of transferrin modestly; this can hypothetically reduce serum ionised calcium
saturation can be an alternative means of assessing iron status concentration, resulting in an increase in parathyroid hormone
when ferritin is not available.130 This sometimes occurs when production, thus stimulating bone resorption.134 Significant
an infection or inflammation is present at the same time because dermal calcium losses have been reported following prolonged
ferritin is an acute-phase protein and typically increases slightly exercise alongside an increase in parathyroid hormone.135 In
during such episodes. support of this hypothesis, ingestion of 1350 mg of calcium
Low iron status may result from red cell haemolysis, gastro- 90 min prior to exercise has been shown to attenuate deleterious
intestinal bleeding, sweating, inflammation, menstruation in changes in biomarkers of bone resorption.136 This suggests that
female players and inadequate dietary intake.131 132 The bioavail- dermal sweat losses, as well as urinary losses,137 although small,
ability of dietary iron is substantially lower in vegetarian diets may be an important consideration. Particular attention should
than meat-based diets, so the growing interest in veganism is a therefore be given to football players training or competing in
concern with regard to dietary iron content. The current RDA hot environments, especially if they have low dietary calcium
for iron is 18 mg (in North America) or 14.8 mg (in the UK) for intakes. If supplements are to be used, calcium carbonate and
females, and 8 mg (North America) or 8.7 mg (UK) for males. calcium citrate are well absorbed. Finally, recent research has
Where possible, iron should be consumed from highly bioavail- highlighted that magnesium is an emerging consideration with
able sources (haem iron), including meat and seafood. Vitamin its role in energy production, muscle function, bone heath,
C should be co-ingested with non-haem iron sources to enhance immune function and pain modulation. A recent 8-year study
absorption, and foods or fluids that impair iron absorption, in Olympic athletes highlighted 22% of athletes were deficient
such as tea and coffee, should be avoided around meal times. (estimated from erythrocyte magnesium concentration) at one
Numerous oral iron preparations are available, and most are time-point. Furthermore, athletes with a history of Achilles or
equally effective if appropriately taken. Gastrointestinal side patella tendon pain had significantly lower magnesium levels
effects of supplementation can include constipation, nausea than average.138

Consensus statement
Staying healthy throughout the season therefore footballers should follow the standard recommenda-
The high physical and psychological demands of participation tion of at least five portions of fruit and vegetables per day on
in elite football may weaken immunity and increase the risk of at least 5 days per week. Several studies in athletes indicate that
illness.139 140 The most common illnesses in elite footballers are daily consumption of polyphenol supplements151 152 or bever-
those affecting the respiratory tract (58%) and gastrointestinal ages (eg, non-alcoholic beer, green tea)152 153 is also associated
tract (38%), with an incidence of 1.5 illness episodes per 1000 with reduced respiratory infection risk in athletes. Footballers
player-days.141 Several factors are associated with increased risk should limit alcohol intake to no more than 2 units per day and
of illness, including preseason training (higher training load and avoid binge drinking, which is known to negatively impact the
low energy intake to implement weight loss strategies for some functioning of immune cells.84
players), winter months, fixture congestion,92 psychological Some well- controlled studies in athletes have indicated
stress and depression.139 142 143 Poor oral health has also been that daily probiotic ingestion results in fewer days of respira-
reported in elite players,144 with pain, psychosocial impacts and tory illness and lower severity of illness symptoms,145 154 with
effects on eating and sleeping affecting their ability to train, their general support for a reduced incidence of respiratory illness
MD performance and their recovery. Players should take respon- being provided by a recent meta-analysis of data from 12 studies
sibility for their oral health aided by their existing medical team involving both athletic and non-athletic populations.155 These
and a dentist. benefits have been limited to protocols involving Lactobacillus
and Bifidobacterium species, with daily doses of ~1010 live
bacteria. A smaller number of studies indicate that probiotics
Preventing illness in players
may also reduce the severity and/or duration of gastrointestinal
Preventing or at least minimising the risk of illness is a key
illness in athletes.154 Currently, there is insufficient evidence to
component in player health management. Illness prevention
justify the use of any other supplements to boost immunity and/
strategies are important to achieve uninterrupted training and
or reduce infection incidence.
to reduce the risk of illness that can prevent participation or
Finally, serious gastrointestinal illness caused by bacterial
contribute to underperformance in both training and matches.
contamination may occur in relation to the storage and prepara-
Several nutritional strategies may be effective in helping immu-
tion of food consumed in training ground restaurants or venues
nity,145 146 although other considerations are just as important
used for postmatch buffets (eg, the changing room or team bus).
in reducing infection risk, including good personal, home and
Minimising the risk of such problems requires attention to food
training venue hygiene, managing the training and competition
hygiene, with a focus on cross-contamination, cleaning, chilling
load, ensuring adequate recovery and sleep, psychological stress
and cooking. Resources that address these ‘4 Cs’, including
management and monitoring players to detect early signs and
hygiene training documents and videos, can be found on the
symptoms of illness, overreaching and overtraining.139
UK Food Standards Agency website (www.food.gov.uk/business-
industry/food-hygiene).
Nutritional strategies to limit illness risk
Performance teams can consider adopting nutritional measures
EXPERT GROUP TOPIC 3: BODY COMPOSITION
to maintain robust immunity in players.145 146 For most players,
Nutrient intakes can have a profound impact of a player’s body
and particularly for those who are illness-prone, these should
composition which in turn may impact their performance.
be implemented throughout the season or at least during the
There are different time points throughout the season where
autumn and winter months and during periods of fixture conges-
players may need to manipulate their intake to illicit changes in
tion, when infection risk is highest. Adequate levels of essential
fat mass (FM) or skeletal muscle mass (fat free soft tissue mass
nutrients are important to support immune health. Inadequate
(FFSTM)).156 This may occur during preseason or during injury
protein-energy intake or deficiencies in certain micronutri-
where nutrient intake may need to be altered to the needs of
ents (eg, iron, zinc, magnesium, manganese, selenium, copper,
physical output.157 This relationship is very important to the
vitamins A, C, D, E, B6, B12 and folic acid) decrease immune
athlete’s health and performance as it is often not reflected in
defences against invading pathogens and make the individual
BM measurement alone.
more susceptible to infection.145 146 Low energy availability
The sports nutritionist and performance team are required
(EA) is associated with increased risk of illness, and restricting
to work closely to plan out how the interaction between diet
CHO (eg, ‘training low’) may increase immunosuppressive stress
and training will change body composition. These interventions
hormone responses.140 Protein intakes of at least 1.2 g/kg BM/
should be justified, well planned out and executed.158 Increased
day are required for optimal immune function147 and there is
FFSTM may be a desired training adaptation with benefits of
some evidence, in cases of overreaching, that even higher intakes
enhanced strength and power. Moreover, the preservation of
(up to 3 g/kg BM/day) can reduce the incidence of respiratory
FFSTM during injury and immobilisation is crucial.93 159 In
infection.148 In general, a broad- range multivitamin/mineral
contrast, excess body fat will negatively affect a player’s power-
supplement is the best choice to support food intake in situations
to-weight ratio, acceleration capacity and overall energy expen-
where food choices and quality may be limited. Several studies
diture.160 However, players may also choose to manipulate
in athletes and the general population have provided evidence of
body composition (FFSTM or FM levels) to achieve a desired
the importance of vitamin D status in optimising immune defence
appearance, and the desire for a lean or muscular physique may
against the common cold.115 116 Hence, players who are deficient
conflict with the player’s performance goals. Each player’s body
or insufficient in vitamin D are likely to benefit from vitamin D3
composition goals should be agreed between the player and the
supplementation (2000 IU/day to correct a deficiency or to avoid
performance team.
the possibility of a deficiency during the winter months). Taking
75 mg/day of zinc supplements (lozenges) when symptoms of a
cold begin is reported to reduce the duration of symptoms.140 149 Assessing body composition
High intakes of fresh fruit and vegetables are associated with Methods of assessing body composition in football must be valid,
reduced infection risk in highly physically active people,145 150 reliable and practically feasible to monitor meaningful change,

Consensus statement
with four or five compartment (4C or 5C) methods remaining on elite female players are scarce, but mean FM levels of approx-
the criterion method of assessment, known as gold standard. imately 16% have been observed in US collegiate division 1
Adherence to standardisation in any assessment protocol will players. Most elite clubs regularly monitor players, and this area
assist minimising technical and biological error and allow recog- of research will continue to evolve in terms of position-specific
nition of the smallest meaningful changes and therefore improve and seasonal trends. To date, it appears that seasonal changes
longitudinal tracking of body composition.161 162 Field methods typically include lower FM and greater FFSTM mid-season and
such as anthropometry (skinfolds), bioelectrical impedance anal- at the end of the season.176
ysis and ultrasound are all commonly used with degrees of accu- Notwithstanding these observations, both male and female
racy and precision in athletic populations.163–167 Many of the players may perform well with FM levels outside the normally
current laboratory methods including underwater weighing, air accepted range: it is not known if a change in physique would
displacement plethysmography, isotope dilution methods, MRI, result in better performance. Performance metrics, such as
three-dimensional photonic scanning and dual X-ray absorpti- training or match data (eg, GPS) or functional tests (eg, coun-
ometry (DXA) have precision errors between 1% and 4.5%,164 termovement jumps), alongside body composition may help to
but are not often easily accessible, expensive and may require provide objective feedback as to what is appropriate for each
high levels of expertise to process and interpret results. player.
With advancements in technology and reductions in costs,
there is a recent shift toward the use of DXA scanning to
assess body composition including bone mineral density in Relative energy deficiency in sport
elite athletes. Indeed, there have been many studies that have In an attempt to conform to various self-imposed expectations
described the body composition of a wide array of different or demands from others, many female athletes restrict energy
athletes in numerous sports that have used the field method of intake and develop the clinical syndrome originally known as the
DXA. There have now been several validation studies, mostly female athlete triad178 and later introduced as RED-S179 appli-
in healthy humans, showing that DXA has greater levels of cable in both male and female athletes with or without disor-
accuracy than alternate methods such as skinfold-derived body dered eating (DE) or eating disorders (ED). Although football
fat or bioelectrical impedance analysis measures.168 169 In fact, is not considered one of the high-risk sports for RED-S179 or
several validation studies with various manufacturers of DXA DE,180 it should be noted that only a few studies have evaluated
have shown a similar level of accuracy as the 4C model.170 171 markers of low EA181 and conditions associated with RED-S and/
Indeed, recent research has demonstrated that the DXA-derived or DE in football players.132
FM percentage was strongly associated with a gold stan-
Reed et al181 assessed EA based on the match between reported
dard 5C model (24.4%±12.0% vs 24.9%±11.1%, r=0.983,
energy intakes and training expenditure in the NCAA women’s
p<0.001).172 Due to several manufacturers and software, many
division I; they found that 26%, 33% and 12% of players met
different DXA units, while not interchangeable, showed excep-
the criteria for low EA preseason, mid-season and postseason,
tionally good precision and accuracy for FFSTM, bone mineral
respectively. It is known, however, that such assessments are
content and FM and may be more appropriate when assessing
fraught with errors of reliability and validity.182 Meanwhile,
change in leaner athletic populations in comparison to other
Prather et al183 investigated 220 female football players repre-
practical methods, namely anthropometry and bioelectrical
senting a youth club, an NCAA division I university team, and a
impedance analysis.173
women’s professional team to identify components and outputs
Ensuring standardisation in positioning, food and hydration
of low EA; they found that 8% were at risk for ED, while 19%
status will reduce errors associated with the use of DXA.161 162 174
had menstrual dysfunction and 9% reported stress fractures. In
Practitioners must recognise that radiation exposure, although
generally small, will limit the frequency of measurements, so the a study of 17 female Norwegian junior and senior national team
timing of assessments should be carefully planned. Anthropom- football players, 24% had DE, 9% had menstrual dysfunction
etry provides an acceptable, cost-effective, practical, assessment and 13% reported a history of stress fractures.132 The contribu-
of body composition, when conducted by someone with appro- tion of low EA to bone health and injury rates is one of the key
priate kinathropometric training (eg, International Society for reasons for concern about energy mismatches, and it has been
the Advancement of Kinanthropometry). The use of absolute identified as a problem in males as well as females.181 Indeed, a
skinfold measurements is recommended to assess changes in recent study of male and female endurance runners by Heikura
body composition rather than calculating percentage body fat et al184 found a 4.5-fold increase in bone injury rates with low
using equations.175 EA in 37% of females (with amenorrhoea) and 40% of males
(with low serum testosterone). Factors which may contribute to
low EA include changes in BM and composition, and changes
What is the optimum body composition for an elite football to training volume/intensity without associated changes to
player? fuelling.179
The optimum physique, in terms of FFSTM and FM levels, The management of body composition in football requires
varies according to an individual player’s physiology, and their knowledge and skills in how to approach an athlete with unre-
field position and playing style. Indeed, there is no single value alistic expectations, methods or goals regarding lower FM, how
for either BM or FM content against which targets or judge- to present/discuss the results of body composition assessments
ments should be made. Mean FM levels in elite male players and when to raise the alarm and engage other support staff, to
measured by DXA typically range from ~8% to 13%,93 176 prevent severe energy restriction or EDs.175 180 It is also recom-
although lower158 and higher177 values have also been recorded. mended that team protocols are standardised to ensure that
Goalkeepers are typically taller and heavier with greater FM monitoring is undertaken precisely, accurately and longitudi-
than outfield players.158 Elite senior male players have, on nally, that body composition data are integrated with other test
average, higher FFSTM than players in under (U)21 and U18 parameters, and that team support staff are aware of the health
teams, although differences in FM may not be significant.93 Data risks associated with RED-S and DE.

Consensus statement
EXPERT GROUP TOPIC 4: STRESSFUL ENVIRONMENTS AND concentrated solutions, which can slow the delivery of fluid
TRAVEL to the body.195 It is also recommended that CHO intake after
When matches are played in stressful environments, the cardio- the warm-up and at half-time is reduced to ~20–50 g, when
vascular, thermoregulatory, metabolic and perceptual strain is fluid intake is prioritised over substrate delivery. Further-
exacerbated.185 186 Heat exposure is a widely recognised risk, more, providing chilled beverages will promote voluntary fluid
with increased sweat loss and dehydration presenting a threat intake196 and can limit the rise in core temperature that would
to performance and health.187 Conversely, exposure to cold and otherwise occur.197 In particular, CHO-infused ice-slushies offer
high-altitude environments stimulates diuresis, increases respi- an appealing strategy for cooling, rehydrating and nutritional
ratory water loss and reduces thirst, again predisposing athletes replenishment.
to dehydration.185 Furthermore, international fixtures, major The few players who have both a high sweat rate and a high
tournaments and preseason training camps can require extensive sweat sodium concentration (which can be determined using
long-distance air travel, with exposure to dry cabin air and altered validated sweat composition testing) should receive individual-
access to fluid and nutritional intakes potentially resulting in ised guidance and monitoring of salt and fluid intake. However,
mild-to-moderate dehydration.188 Congested competitive sched- the whole-body balances of water, sodium and potassium are
ules seldom permit prior exposure to these environments, and complex and determining the dietary intake required to replace
although exposure to heat, altitude or travel may be brief, rarely sweat and urine losses requires considerable technical exper-
is physiological or perceptual acclimatisation available to atten- tise and laboratory instruments.198 The ideal solution involves
uate the strain. A range of thermoregulatory, sleep and travel accurate diet records, urinalysis and whole- body sweat anal-
interventions exist to assist in these environments; however, yses.182 Other methods (eg, estimation, normal clinical values,
with the exception of heat, there is limited evidence for recom- extrapolation of local sweat collections) fail to characterise an
mended nutritional strategies to further support players exposed athlete’s fluid-electrolyte turnover accurately. When the support
to match demands in stressful environments. In this section, we of a sports nutritionist, exercise physiologist or sports medi-
focus on playing in hot environments and make some reference cine physician is not possible, we recommend two actions: first,
to the limited information pertaining to nutritional interventions consume ample fluids and foods with high sodium, potassium
in other stressful environments, in the hope of stimulating future and water contents.199 Second, self-assess hydration status each
research in these areas. morning by recording body weight, assessing thirst and observing
urine colour.200
Hot environments
Important matches are often played in hot conditions, such as
High altitudes and cold environments
the UEFA Champions League final (played in May each year) and
Matches played at altitude are the least common of the
the UEFA European Football Championship or FIFA World Cup
stressful environments for practitioners to plan for. The most
finals (played in June and July every 4 years). Football matches
notable include matches in La Paz, Bolivia (~3600 m). Altitude
in the heat result in decreased total and high-intensity distance
(>1500 m) results in decreased running performance for unaccli-
covered, partly compensated for by altered technical engage-
matised players.185 201 At elevations >1500 m, appetite decreases
ment, for example, increased successful passes and crosses.186
and food preferences change,202 so that both the absolute and
Furthermore, increased deep organ and muscle temperatures,
voluntary consumption of CHO increases at the expense of fat
alongside similar cardiovascular responses for reduced match
and protein. Also, endurance exercise performance is adversely
work rates, highlight the increased thermal strain of playing in
affected if diet is manipulated to decrease CHO intake. Easily
the heat.186
In hot environments, dehydration potentiates hyperthermia, consumed liquid or solid CHO foods can help to maintain
increases cardiovascular strain and elevates perceived exertion. performance and macronutrient balance. When residing at
Specifically, a body weight loss of 3%–4% induced by dehydra- altitude for more than a few days, for example, during alti-
tion may decrease muscular strength by 2%, power by 3% and tude training camps, maintenance of body weight (ie, ensuring
high-intensity exercise endurance by 10%.189 Field measurements adequate daily energy and water intake) is a priority.203 Above an
of sweat losses during football training show increasing sweat altitude of 3000 m, the increased production of red blood cells
rates as ambient temperature increases.54 Laboratory studies may require an adequate dietary iron intake (100–300 mg of
indicate that ambient temperature,190 humidity191 wind speed192 elemental iron per day),204 but this should be guided by the team
and solar load192 193 all influence endurance performance. While doctor based on an individual player’s iron status; particularly
UEFA competitions implement designated 3 min cooling breaks for extended camps if predeparture iron is low.205 Given the lack
during each half when temperatures are >32°C dry bulb and of evidence on nutrition-based interventions for competition at
>27°C wet bulb globe temperature, further interventions such altitude, further research is required.
as precooling may assist player performance and health. The risk While some matches may be played in extreme heat, others
of players experiencing significant hypohydration is exacerbated may be played in cold conditions, including some UEFA Cham-
when training or playing matches in the heat. Accordingly, the pions League matches or other leagues around the world.
primary nutritional needs of players in a hot environment are Players can cope with cold environments by wearing appropriate
to replace fluid and sodium losses. It is not necessary to drink clothing. Provided the weather is not extreme and the work rate
to fully compensate sweat losses but, as a guide, BM loss should is maintained at a high level, cold should not be a problem if
be restricted to less than about 2%–3% of the starting mass.194 appropriate clothing is worn. UEFA regulations on playing in
Important additions to rehydration beverages therefore include the cold specify that when the temperature is −15°C or colder,
CHO and electrolytes (particularly sodium) to optimise football the match is postponed unless both teams agree to play. CHO
performance.45 46 178 requirements are increased in cold environments, while the
When rehydration is the priority, ingesting a 2%–6% CHO effects of dehydration may be less detrimental to performance.2
beverage may be of greater benefit to the player than more However, further research is needed to determine the effects of

Consensus statement
playing in the cold and how nutritional strategies might be able can maintain most parameters of physical performance over
to help. Ramadan, although sleep and nutrition should be optimised to
reduce the likelihood of any cumulative fatigue.214 For a compre-
Flying across time zones hensive overview on Ramadan in football, readers are directed
The speed and power of professional footballers are reduced in to Maughan et al215 for further information.
the aftermath of long-haul travel (>15 hours) across multiple Where possible, training should be scheduled to allow for the
time zones (>4–5), although it is reportedly possible to maintain most appropriate nutrition support: when training is scheduled
prolonged intermittent-sprint performance.206 It is likely that after sunset, players can benefit from food and fluid consump-
reduced performance exists with travel distances of >10 hours tion before, during and after training.216 Players should make
and 2–3 time zones. The disrupted sleep patterns resulting the most of the important meals: Suhour (the predawn meal)
from desynchronisation of endogenous circadian rhythms and should be eaten as close as possible to sunrise and should be high
external day-night cues (ie, jet lag), concurrent with reduced in CHO, as well being used to contribute to daily protein and
mood and motivation (ie, travel fatigue), are the likely causes of fluid targets; Iftar (the first meal after sunset) is important to
reduced player performance for up to 72 hours following travel. support recovery and may be adapted to meet the overall nutri-
The severity of this disorder is proportional to the number of tional needs for the day.216 Players should still fuel according
time zones crossed and the cumulative sleep loss, thus primary to the demands of the training or MD (maintaining the overall
interventions that target improved sleeping behaviour, limit intakes outlined in the sections ‘Expert group topics 1 and 2’
perceived fatigue and improve motivation are important.207 on match and training day nutrition, respectively). Making use
Light is the most powerful external regulator of circadian of fluids and sports foods may reduce gastrointestinal discom-
rhythms. Dietary manipulations such as moderating food fort. Sufficient fluid and electrolyte intake should be achieved in
amount, type and intake patterns have been proposed,188 but small amounts spread over the waking hours after sunset, to fully
the evidence does not support any method unequivocally.208 replace sweat losses.216
Oral melatonin,209 slow- release caffeine210 or a combination Players should be individually monitored with training loads
of the two may reduce the negative consequences of jet lag.210 prescribed accordingly, to reduce the risk of illness and injury,
There are important considerations around the sourcing and and limit unnecessary dehydration.216 Adherents to other faiths
side effects of melatonin and readers are directed to a recent and their practices should also be considered, for example, Tisha
review211 for further considerations for travel. All pharmacolog- B’Av, the annual Jewish day of fasting, which coincided with the
ical sleep interventions should be overseen by a medical doctor, London 2012 Olympic Games.216
although sleep hygiene (as part of wider travel hygiene) should
always be considered first. Food allergies and intolerances
A food allergy is defined as an adverse immune- mediated
EXPERT GROUP TOPIC 5: GLOBALISATION—CULTURAL response, which occurs reproducibly on exposure to a given
DIVERSITY AND DIETARY CONSIDERATIONS food and is absent when the food is avoided.217 Reactions can
The elite football community has become much more mobile range in severity from minor abdominal discomfort through to
in recent years. This progression has been particularly evident anaphylaxis, with reactions generally developing within minutes
in Europe since the 1995 Bosman ruling, with player migra- of exposure. The most common food allergies include fish, shell-
tion within the five major European leagues (England, France, fish, peanuts and tree nuts, with some geographical variance.218
Germany, Italy and Spain) increasing from 19% in 1995/96 to Food allergy is determined by means of a thorough medical and
47% in 2015/16. Differences in migration are seen across conti- nutrition history to guide validated diagnostic methods, such as
nents: North American Major League Soccer (49%) and Europe a skin prick measurement of food-specific IgE levels or double-
(48%) have the highest proportion of foreign players (the English blind, placebo-controlled food challenges.218 219
Premier League having the highest at 66%), with lower propor- Food intolerances are reactions which are not immune-
tions in Asia (18%) and Latin America (14%).212 In addition to mediated (eg, lactose or gluten intolerance). The symptoms are
the evolving diversity of elite teams, there are multiple interna- less clear, with frequently unspecific symptoms occurring hours
tional club and national team competitions, preseason camps, to days after exposure, possibly including abdominal bloating or
friendly games and commercial obligations that mean travel to pain, loose stools, fatigue or headache.219 At this time, aside from
foreign countries is now a common occurrence for elite teams lactose intolerance, there are no validated diagnostic methods
and their players. As a consequence of this increasing globali- for establishing food intolerance.218 Coeliac disease is another
sation, various related challenges are more apparent for perfor- common condition (autoimmune disease) for which validated
mance and nutritional team staff. medical testing exists. It is important that validated diagnostic
testing is conducted, under the guidance of a medical doctor,
before undertaking an exclusion diet in response to allergy or
Religious beliefs and implications for dietary practices
intolerance-related symptoms.
Practitioners should be aware of the cultural considerations for
all players. Collaboration with the club chefs is important to
ensure all foods provided on training and MDs are culturally Special diets
acceptable. With approximately 23% of the world’s population There is increasing interest in a more diverse range of diets for
being Muslim and >50 countries considered Muslim majority football players (and athletes in general) with some consuming
nations,213 Ramadan is an important consideration for players and even advocating specific diets such as gluten-free, vegetarian
and a particular challenge for many elite football teams. During and vegan for performance reasons. The reality is that, despite
the holy month of Ramadan, Muslims fast from sunrise until an increase in the number of players adopting these emerging
sunset. Many Muslim players will continue to train and compete diets, there has been no scientific research into their effect on
during Ramadan, although each must decide how they approach football performance. However, it is important to discuss the
the situation. The available evidence indicates that elite players issue and provide our expert opinion at this time.

Consensus statement
Gluten- free diets (GFDs) have gained popularity among D status), it is crucial that this is overseen by the medical and
athletes, with 41% of athletes without coeliac disease reported performance support team with input from the sports nutri-
to consume a GFD at least half of the time.220 Following a GFD tionist where appropriate. In the face of increasing unvalidated
is essential when managing clinical conditions such as coeliac technology available to players and staff, any testing must be
disease (a serious autoimmune disease of the small intestine both valid and reliable, and used to answer a specific question
triggered by gluten that affects about 1% of adults) or wheat about an individual player. There is currently a lack of evidence
allergy; many others may follow GFDs due to perceived health for genetic testing and nutrition prescription.
or performance benefits, although no differences in gastroin-
testinal symptoms, systemic inflammation or exercise perfor- Food contamination
mance in athletes without coeliac disease have been shown when The findings of food contamination with the prohibited anabolic
following a GFD.221 Rather than avoiding gluten itself, a low agent clenbuterol both in China228 and in Mexico, where at
fermentable oligosaccharides, disaccharides, monosaccharides the FIFA U-17 World Cup in 2011, a total of 109 out of 208
and polyols (short-chain CHOs) diet has been associated with urine samples yielded clenbuterol findings, although at very low
improvements in gastrointestinal symptoms for individuals with levels,229 are a cause for concern. Player vacations and travel
non-coeliac gluten sensitivity.218 222 for competitions may lead to exposure. Teams should consult
There are many different types of vegetarian diet. Vegetarian their national association or WADA for the latest advice. Player
diets exclude meat, fish and poultry, whereas stricter vegan diets education is crucial, and sports nutritionists may devise meat-
exclude all animal products including dairy, eggs and honey. free menus or advise eating at recommended outlets to mini-
Other varieties include lacto-vegetarian (permits dairy but not mise risk. Such precautionary measures can reduce, but not
eggs), ovo-vegetarian (permits eggs but not dairy) and flexitarian eliminate, the risk of inadvertent exposure to clenbuterol in
(includes meat, poultry, fish, eggs or dairy but only occasionally at-risk countries, for example, Mexico, China and Guatemala,230
or in small quantities). The recent popularity of vegetarian diets so it is important to inform the relevant antidoping organisa-
appears to reflect current public trends, although considerable tions (WADA, National Anti-Doping Organizations, antidoping
variability exists in different countries.223 Approximately 22% of commissions of national associations) about the whereabouts of
the world’s population is thought to be vegetarian,224 although individuals and teams.
the only study in elite athletes found the prevalence to be 8%.225
Although a vegetarian diet has been associated with a reduced
risk of chronic diseases in non-athletic populations,226 its effect EXPERT GROUP TOPIC 6: DIETARY SUPPLEMENTS
on athletic performance has not been established.218 227 A well- Definition and categorisation of supplements
balanced vegetarian diet can provide a full range of macronutri- Dietary supplements come in many shapes and forms, and any
ents and micronutrients but, depending on the type of vegetarian definition or classification system must recognise this diver-
diet, may result in lower calcium, iodine, iron, zinc, vitamin B12, sity.231 There is no single definition of a ‘supplement’ that is
omega-3 fatty acid and creatine intakes, although protein needs completely satisfactory and independent of context. In a recent
are commonly met in athletes meeting overall energy require- IOC consensus statement,232 the following definition of ‘dietary
ments and eating a variety of protein-rich foods.226 supplement’ was proposed:
Evidence suggests there are health benefits associated with A food, food component, nutrient, or non-food compound that is
vegetarian diets, but at present there is little evidence that vege- purposefully ingested in addition to the habitually-consumed diet
tarian diets are superior to omnivorous diets for improving with the aim of achieving a specific health and/or performance
athletic performance. Finally, and as previously detailed in the benefit.
section ‘Expert group topic 2’ on training day nutrition, there
is little evidence to support a ketogenic, LCHF diet for player Athletes/players give many reasons for using supplements, and
performance. these are often shaped by the promotional materials targeted
Further work is required to understand the interplay between at them by manufacturers. Claims such as ‘build muscle’, ‘burn
sports nutrition and sustainability and how principles can be fat’, ‘increase energy’ and ‘stay healthy’ are emotive and highly
incorporated within best practice nutrition recommendations. valued by athletes. It is important to remember, however, that
Now more than ever, players may also modify dietary habits for the supplements industry is driven by financial motives and
their own perceived health, performance or ethical reasons. The responds to consumer demand and acceptance. The evidence to
literature about this is scarce within athletic populations; readers support these claims is often lacking and may also be at risk of
are directed to a review by Lis et al218 for further information. both natural and industry-driven publication bias. In general, the
scientific literature favours studies reporting positive findings as
they are considered more ‘newsworthy’, but some of the authors
Personalised nutrition of this statement have also found that studies showing ‘positive’
A player’s nutrition should be periodised and personalised to effects are promoted while those finding no (or negative) effects
meet their training and match demands and individual objectives may be blocked by sponsors of the research.
(eg, reduced body fat or increased muscle mass) but, as high-
lighted in this section, cultural, religious, ethical, medical and Prevalence of supplement use within elite football
even just individual food preferences will affect a player’s food Supplement use is widespread in sport and there is some
choices. evidence that its prevalence varies according to the sport, as well
Due to the risks to health and/or performance associated with as the training and performance level, age, sex and culture of
many forms of dietary restriction, any major dietary change the individuals concerned.231 In elite football, only two studies
should be evaluated and monitored under the guidance of the have provided data on the prevalence of supplement use.233 234
team’s sports nutritionist and medical doctor. Aljaloud and Ibrahim233 reported that 93% of 108 players from
Where biomarker testing (ie, blood, urine, saliva) is required three different Saudi professional teams regularly used supple-
to inform any intervention (eg, a blood test for iron or vitamin ments. The most-used supplements were sports foods (87% of

Consensus statement
players consumed sports drinks) and vitamins (81% consumed alternative to meet nutrient targets. Table 3 lists sports foods
vitamin C). Studies conducted on national team players during with supporting scientific evidence that may be considered in the
the 2002 and 2006 FIFA World Cups also indicated widespread circumstances where ‘food-first’ is not feasible.
use of supplements.234 Each team physician was asked to docu-
ment nutritional supplements taken in the 72 hours prior to each
Performance
match during both tournaments, making the objective validity
Although some dietary supplements may be effective in
of these data questionable. Approximately 43% of players in the
improving performance in some specific exercise models or
2002 and 2006 tournaments were reported to have used supple-
sports, very few have undergone football-specific tests and some
ments. Sports foods and drinks were not considered supplements
studies of match play simulations have involved participants with
in this study, resulting in a lower prevalence than in other studies.
only recreational level experience or an absence of any football
experience. The evidence that professional footballers would
Supplements that may be useful benefit from these supplements is very limited. Furthermore,
The football player’s nutritional programme should be centred based on general methodological considerations it is likely that
around a ‘food first’ approach, with supplements used only to there are fewer benefits than in other sporting contexts. Since
meet specific health and/or performance objectives. The dose many commonly used supplements will display a large interin-
and duration of supplementation should be recorded, and dividual variability in terms of response, they should be trialled
responses, including both positive and adverse effects, should be and monitored in training before being used in competition.
monitored by the team’s sports nutritionist in collaboration with The evidence for some performance supplements (eg, caffeine,
other key stakeholders, including the team’s medical doctor. creatine) is stronger than for others (β-alanine, nitrate). Sodium
Regular review is essential. bicarbonate was removed from this category by the expert group
Recognising that any system of supplement classification must due to its lack of use within elite football. Negative effects must
take into account the needs of many diverse groups, including also be considered, as highlighted in the ‘concerns and use’
consumers, manufacturers and legislators, categorisation by column in table 3. Performance supplements not listed here can
target function or action is recommended. While accepting be considered to have insufficient evidence to support use.
that there is no sound evidence of efficacy in many cases, the
classes of supplements listed in table 3 might nevertheless be
recognised. Products with very different characteristics might be Supplements and adverse analytical findings
found within the same category, and some supplements might be The risk of a positive doping test resulting from the use of dietary
found in more than one category. The recommendations here supplements has been recognised for two decades. Both indepen-
are closely aligned with those of the IOC consensus.232 dent analyses carried out by various laboratories and analytical
checks carried out by the US Food and Drug Administration have
identified contamination of supplements with pharmaceutical
Micronutrients agents that are not listed on the label. Geyer et al237 analysed
Where a player is identified as suffering from a specific micronu- 634 nutritional supplements from 215 different suppliers in 13
trient deficiency, a dietary solution should be sought, although countries with ~15% containing prohormones not declared on
a prompt and effective solution may not always be possible. the label. In 2007, it was reported that ~25% of 58 supplements
Micronutrients often requiring supplementation in athletes purchased through US- based outlets were contaminated with
include vitamin D, iron and calcium.232 Supplements used for steroids.238 In a more recent survey, Matthews239 concluded that
this purpose should be sourced from a reputable supplier and ‘poor manufacturing processes and intentional contamination
used only at the therapeutic dose and for the shortest possible with many banned substances continue to occur in dietary supple-
time required to restore adequate nutrient status. Players with ments’. Historically, anabolic steroids have been the pharmaceu-
restricted eating patterns, whether for religious, cultural or ticals most commonly found in muscle building supplements,
ethical reasons, or due to restricted energy intake during periods while stimulants and anorectic agents are more commonly found
of weight reduction, may benefit from the use of a broad spec- in tonics and weight loss supplements, respectively. However,
trum, low-dose multivitamin and mineral preparation, but again new supplements have appeared on the sport supplements
this should be assessed on an individual basis. These supplements market in recent years, containing a larger variety of different
present no major risk for health, except with chronic supplemen- prohibited doping substances.240–243 Banned stimulants have
tation and/or high doses. Routine iron supplementation can do been found in so-called training or pre-workout boosters, while
more harm than good, and the risk of iron toxicity is very real.235 muscle building products have been shown to contain prohib-
It should also be recognised that athletes who self- prescribe ited selective androgen receptor modulators, aromatase inhib-
supplements to provide essential nutrients are often those least itors, β2-agonists, new anabolic steroids and growth hormone
likely to require them.236 Players are therefore advised not to releasing peptides. Products containing prohibited diuretics,
purchase their own supplements but to use only those provided/ stimulants and β2-agonists are frequently advertised as weight
recommended by the sports nutritionist, or at least agreed on by loss or fat burner supplements. Also, erythropoiesis-stimulating
the team doctor. agents, that is, endurance performance enhancers, were found
to contain prohibited inorganic cobalt and nickel.240–243 This
Sports foods may be interpreted as supporting the idea that contamination
Footballers should have clear nutritional guidelines to follow is not accidental, but rather the result of deliberate adulteration
on training and MDs. Due to the usual organisation of training of otherwise ineffective products. Inadvertent doping with stim-
sessions in a day (concurrent ‘on pitch’ sessions followed by ulants and anabolic steroids may also result from the consump-
resistance work) with limited breaks in training and match play, tion of traditional Asian medicines.241 244 The principle of strict
it is not always possible for players to consume foods in the form liability means that ignorance of the presence of a prohibited
of meals. In this situation, sports foods (eg, CHO-electrolyte substance in a product is not an acceptable excuse and sanctions
drinks, gels and recovery shakes) can provide a convenient will still be applied.230

Consensus statement
Table 3 Dietary supplements, sports foods and beverages that are potentially useful for footballers (adapted from Maughan et al232)
Type of supplement and examples Use Concerns Main mechanisms Protocol
Micronutrients
Vitamin D Prevent or treat deficiency Inappropriate use or when See section on micronutrients. According to Doctor’s
Iron to help maintain health and taken with lack of monitoring prescription.
Calcium performance. or supervision can lead to
health problems.
Sports foods
Carbohydrate (CHO)-electrolyte drinks Supply convenient Greater cost than whole foods. Macronutrient and/or fluid supply. See sections on match day (topic
CHO gels macronutrients to support Inappropriate use or amounts 1) and training (topic 2).
Sports bars and confectionery energy or recovery needs for when taken with lack of
Recovery shakes training and match play. monitoring or supervision.
Protein drinks
Protein-enhanced food
Liquid meal supplements
Performance
Caffeine Reduces perception of fatigue, Highly individual response Central nervous stimulant. 3–6 mg/kg BM, in the form
enhances endurance, repeated (both positive and negative). Adenosine receptor antagonist. of anhydrous caffeine (ie, pill
sprint performance,301 302 skill Side effects with high doses or powder form), consumed
and fine motor control303 304 and include anxiety, nausea, ~60 min prior to exercise or
improves cognitive function.304 insomnia, tremors and reduced lower caffeine doses (<3 mg/
sleep quality. More serious side kg BM, ~200 mg), provided
effects include tachycardia and both before and at half-time
arrhythmias. consumed with a CHO source.
Sports foods (or coffee) provide
multiple options for delivery.
Dose of caffeine should first be
evaluated using lower caffeine
doses to assess response,
especially if used regularly in
training and match play.
Note: caffeine is currently on
WADA’s monitoring programme,
so the WADA list should be
checked prior to use in case of a
change in status.
Creatine Improves high-intensity Potential for 1–2 kg BM Increases muscle creatine stores, Loading phase: ~20 g/day
repeated sprint performance.305 increase after creatine increasing the resynthesis of (divided into four equal daily
Enhances training capacity and loading. No negative health phosphocreatine.311 doses), for 5–7 days.
chronic training adaptations effects following appropriate Maintenance phase: 3–5 g/day
(muscle strength and power306 protocols.310 (single dose) for the duration of
and lean BM).307 308 May also Falsely increased creatinine the supplementation period.
support brain function.309 levels. Lower dose approaches (2–5 g/
day) for 28 days may avoid the
associated increase in BM307;
~4–6 weeks are required
following chronic creatine
supplementation for levels to
return to baseline.
20 g of creatine (5 g dose on
four occasions beginning on the
same day of fatiguing exercise)
may promote muscle glycogen
resynthesis in the first 24 hours
postexercise.312
Note: concurrent consumption
with a mixed protein/CHO source
(~50 g of protein and CHO) may
enhance muscle creatine uptake
via insulin stimulation.
Continued

Consensus statement
Table 3 Continued
Type of supplement and examples Use Concerns Main mechanisms Protocol
β-alanine Evidence is contradictory: Possible skin rashes and/or Increases muscle carnosine, an Daily consumption of ~65 mg/
may improve high-intensity transient paraesthesia (skin important intracellular buffer.314 kg BM, ingested via a split-
exercise and repeated sprint tingling). dose regimen (ie, 0.8–1.6 g
performance.259 A positive correlation every 3–4 hours) to give up to
May enhance training between the magnitude of 6.4 g/day over an extended
capacity.305 muscle carnosine change and supplement time frame of
performance benefit remains to 4–12 weeks. Protocol requires
be established. planning alongside training
Sprint training may be more and match loads. Further
effective to increase the investigation required into
buffering capacity of the long-term supplementation (ie,
muscle.313 >12 weeks).
Nitrate Limited football-specific Individual response to Increases tissue nitrite and nitric Protocol: acute performance
evidence. Improves economy supplementation. oxide, which reduces the oxygen benefits are most likely seen
and endurance exercise Possibility of minor cost of exercise via enhanced within 2–3 hours following
performance,305 and football- gastrointestinal upset. function of type II muscle fibres a nitrate bolus of 5–9 mmol
specific intermittent exercise Beetroot juice may discolour and reduces the ATP cost of force (310–560 mg).
performance in amateur urine. production. Prolonged periods of nitrate
players.315 Performance gains harder intake (>3 days) may also be
to obtain in highly trained beneficial to performance. High
athletes with well-developed nitrate-containing foods include
aerobic capacity.316 leafy green and root vegetables,
including spinach, rocket salad,
celery and beetroot, which may
provide a food first solution for
chronic use.
In a team sport such as football, where it may be decided by tree to guide athletes, and those who advise them, through deci-
the sports nutritionist or doctor that supplements should be sions on supplement use.245
given to a whole team (either the same mix or a different combi-
nation per player), extreme caution must be taken by everyone
EXPERT GROUP TOPIC 7: NUTRITION FOR INJURY
involved. WADA rules state that if three or more players from
the same team commit an anti-doping rule violation in the same REHABILITATION
competition period, the entire team may be disqualified from Nutritional considerations of the injured (elite) athlete have
competition.230 historically been neglected within research related to sports
nutrition, which has primarily focused on performance and
recovery/adaptation. Nevertheless, while there is much to learn
How to minimise risk
in this space, a collection of laboratory-based studies and elite
The difficulty in quality assurance for dietary supplements is not
athlete case studies can be drawn on to devise some nutritional
so much a question of regulation but rather one of enforcing the
strategies that may be appropriate for the injured footballer.
regulations that are already in place. In almost every country,
The high physical demands of the elite game combined with
consumer protection legislation exists to ensure that products on
increasingly dynamic movements mean that the risk of injury is
sale are fit for purpose. In the case of supplements, these regula-
also high. When an injury occurs, teams are faced with a unique
tions relate primarily to safety rather than to efficacy. Third-party
challenge: to bring a player back as quickly but also as safely
testing programmes are now in place that allow athletes who use
as possible. Nutrition may aid in optimising the rehabilitation
supplements to make choices that will reduce the risk of a posi-
process and facilitating the desired return.
tive doping outcome as a result of using contaminated supple-
ments. Examples include: ‘Kölner Liste’ for Germany, ‘Informed
Sport’ for the UK, ‘AFNOR NF V 94–001’ for France and Injury healing process
‘HASTA’ for Australia. These programmes cannot eliminate the Most injuries rapidly trigger inflammatory processes that initiate
risk entirely, but the sensible player will limit the use of supple- wound healing and soft tissue and/or bone repair. Care should
ments and will choose supplements that have been screened for be taken to ensure sufficient energy and protein intake and avoid
the presence of doping agents by a reputable and independent deficiencies in calcium, vitamins D and C, zinc, copper and manga-
company. None of the current athlete-centred quality assurance nese, all of which may impair the initial healing process.246 247
programmes for dietary supplements tests for the presence of the Injuries sustained in football typically occur when performing
active ingredients. They are focused entirely on the presence of intense muscular contractions; this is likely to exacerbate the
WADA-prohibited substances. Athletes should be aware of this level of systemic and local inflammation after injury (a physio-
and should not see these schemes as a guarantee that a product logical response assumed to contribute to the subsequent decon-
is safe and effective to use. Rather, they should be part of a risk ditioning of the muscle and/or tendon).248 Although a range of
reduction strategy.245 ‘nutraceuticals’ (including phenolic compounds, curcuminoids
Where so much is at stake, often for little tangible return, the and n-3 polyunsaturated fatty acids) have been proposed as
risks associated with supplements should be considered carefully potential strategies to combat the acute inflammatory process,249
before use. An expert panel assembled by the Medical and Scien- direct evidence of their anti-inflammatory effects in humans is
tific Commission of the IOC has recently published a decision lacking. Furthermore, inhibition of postinjury inflammation has

Consensus statement
not been shown to attenuate tissue deconditioning, and could avoiding drastic reductions in energy intake, is perhaps the most
be counterproductive to the healing process.250 251 Thus, while crucial nutritional aspect during rehabilitation. Bearing in mind
several important questions remain, the available evidence does that the majority of absences from training or competition due
not support any nutritional strategies that might limit injury- to injuries will be ≤4 weeks,267 it is prudent to follow the above
induced inflammation. guidelines while the player is away from normal training, and
move back towards nutritional recommendations to support
optimal training performance and adaptations (detailed in the
Minimising effects of deconditioning section ‘Expert group topic 2’) as the player moves along the
After the initial wound healing response comes rehabilitation, spectrum of return to play.
which is possibly of most nutritional relevance to the injured
footballer by virtue of the time spent in this phase. Rehabilitation
requires a period (anywhere from days to months) of whole body EXPERT GROUP TOPIC 8: REFEREES
(eg, hospitalisation/bed-rest) or local (eg, limb immobilisation) Refereeing is an intermittent high- intensity activity, and elite
disuse and/or reduced activity (eg, reduced/absent training load). football referees are reported to maintain about 80%–90% of
During this time, rapid soft tissue and bone deconditioning can their maximum heart rate and 70%–80% of their maximum
be expected as a result of mechanical unloading. Skeletal muscle oxygen uptake during competitive matches,268 while expending
appears to be the tissue most susceptible to disuse, with atrophy up to 1200 kcal.269 270 Blood lactate concentration may be
and deconditioning (eg, reduced force-generating and oxidative elevated at crucial moments of the game when repeated sprinting
capacities) evident after only a few days.252 Bone deminerali- with incomplete recovery occurs.268 271 Unlike players, referees
sation has been reported as early as 1 week into disuse,253 and are not involved in body contact, but they must keep up with the
although tendon tissue seems more resistant to disuse atrophy, game whatever the imposed tempo, limiting their possibility to
by ~2 weeks tendon metabolic and functional properties begin compensate for demanding phases of the match.271 The amount
to decline.254 255 of high-intensity activity is similar to that reported in midfielders,
Alterations in energy requirements during rehabilitation but referees accumulate a lower overall sprint distance, although
should be monitored, since shifting to a positive or negative with longer bouts during the match.268 271 272 The physical and
energy balance will modulate aspects of deconditioning.256 257 physiological demands can impact cognitive performance in
Moreover, a decline in dietary protein intake will accelerate decision making.271
muscle loss irrespective of energy balance.258 The rapid devel- There is limited literature on the nutritional considerations
opment of muscle ‘anabolic resistance’ to protein intake239 259 of match officials. Historically, nutritional recommendations for
requires defined dietary protein recommendations during disuse. elite referees were mainly adapted from those of professional
Current recommendations for attenuating muscle loss (and football players, without considering the different characteristics
regaining muscle) during rehabilitation include: distributing240 241 (ie, age and body composition) or the particular match/training
adequate amounts (20–30 g)242 243 of leucine-rich (≥2.5 g per demands of the two populations.273 A new publication on the
meal)259 protein throughout the day, including pre-sleep.239 The most recent male and female FIFA referee selections (for both
efficacy of such an approach is supported by (limited) labora- the 2014 FIFA men’s and 2015 women’s World Cups) offers
tory data245 and applied case studies,90 with the resultant recom- more specific knowledge in this area.274 Elite football referees
mended daily protein intake being ≥1.6 g/kg BM.106 Emerging have lower energy needs relative to top- class footballers on
data indicate potential roles for specific nutritional compounds MD. During training, total energy and CHO intakes should be
in retaining/restoring muscle tissue during rehabilitation (eg, adapted according to the individual training load and increased
omega-3 fatty acids,260 β-hydroxy-β-methylbutyrate,261 ursolic only around MDs and during periods of intense training or when
acid262), although these require corroboration in relevant human engaged in occupations with a high- energy demand. Specific
studies110 and therefore cannot be recommended at this time. nutrient recommendations are generally similar to those for
The bone collagen protein synthesis rate also increases in players.
response to protein provision,263 with an overall positive effect
on bone turnover.264 Although collagen present in tendon and
muscle appears resistant to the anabolic effects of protein,263 data EXPERT GROUP TOPIC 9: JUNIOR PLAYERS
indicate that protein supplementation augments tendon hyper- It is important to highlight some specific considerations and key
trophy during training.265 Furthermore, recent work has identi- recommendations for junior elite football players (ie, profes-
fied vitamin C enriched dietary gelatin (which can be included sional, under 18 years). Nutritional support is key to ensuring
as part of daily protein provision) as a novel strategy to support that junior players can cope with the demands of training and
tendon repair.266 Collectively, therefore, available data suggest match play. An additional goal is to ensure life-long buy-in to
that nutritional considerations for the rehabilitation of bone and good nutritional choices as this will help to optimise growth,
tendon are similar to those for muscle after injury (with respect health, performance, recovery, training adaptations and body
to energy balance and macronutrient intake). composition. The nutritional approach to junior players has
It must also be recognised that the different phases of injury the particular challenge of dealing with young people whose
provide a continuum of altered nutritional needs depending on bodies are changing as they mature biologically, a process which
stage and duration of injury. To date, establishing nutritional does not necessarily correlate with chronological age. Young
guidelines along this continuum, especially with such diverse players may have different nutritional needs from those of adults
injuries (in terms of duration, severity and type), are not available. because they are in a phase of growth, and they are more reliant
A recent case study measured energy expenditure of ~3100 kcal/ on fat oxidation during exercise.275 The RDAs of some essential
day during the first 6 weeks of ACL rehabilitation in an elite micronutrients (eg, calcium and phosphorus for both males and
Premier League player,159 close to that of outfield players in full females, and iron for males) are higher for junior players than
training. Given the metabolic demand of tissue/wound recovery adults, although it should be recognised that good young players
processes, staying as close to energy balance as possible and thus are often physically, if not always emotionally, mature. As with

Consensus statement
adult players, emphasising a ‘food first’ philosophy is essential to the exogenous intake in both temperate289 and hot (38°C)290
when educating junior players. conditions. Sparing endogenous CHO reserves could help delay
fatigue and improve performance.
Protein needs increase during adolescence and with inten-
Energy demands
sive football training, so a daily intake of up to 1.6 g/kg BM
Football does not overemphasise leanness, but some studies
for junior players would be appropriate. 285 Such extra protein
using self-reporting techniques have reported that male276–279
intake is easily achievable from dietary sources, without the
and female120 181 280 281 junior football players may not meet their
need for supplements. One study has recently shown that
extra dietary energy needs. A severe chronic energy deficit will
junior male footballers met or exceeded the dietary protein
impair growth and general health, as well as being detrimental
recommendations, although their distribution of protein
to participation in football training. Conversely, participation in
intake over the day was not optimal.288 The relative distri-
youth sports seems to promote the optimum physical activity
bution of protein ingestion was, as in adults, skewed from
level to stimulate growth and bone health when nutritional
dinner (highest) to lunch to breakfast (lowest). Recommen-
needs are achieved.282 The magnitude energy availability of elite
dations should emphasise balanced distribution of protein in
adolescent football players varies and energy deficit appears to
meals to optimise muscle development. Players, especially
be greater on MDs and heavy training days,276 which may affect
those undertaking restrictive or vegetarian diets, 285 should
their performance.
be individually evaluated to verify that they are achieving a
Recent research has quantified changes in body composition
sufficient protein intake.
and resting metabolic rate (RMR) in a cohort of male English
Daily energy intake from fat should be 25%–35% of total
Premier League academy soccer players from U12 to U23 age
energy intake and cholesterol intake should not exceed
groups. An increase in both fat free mass (FFM) and RMR of
300 mg. 291 A higher absolute intake for junior players should
~400 kcal/day was recorded between ages 12 and 16, thus
only be as a result of increased energy demands, and there is
highlighting the requirement to adjust daily energy intake to
no evidence for a greater dietary need compared with their
support growth and maturation.283 In addition, a subsequent
non-a thletic peers. Due to concerns about becoming over-
study demonstrated that daily total energy expenditure (TEE)
weight, some junior players restrict dietary fats, which may
progressively increases as players transition through the academy
cause micronutrient deficiencies including iron, calcium and
pathway, likely a reflection of growth and maturation of key
vitamins A, D, E and K.111 Milk provides a good amount
physical parameters as well as increased physical loading: U18
of calcium (~300 mg/250 mL serving), which is critical for
players presented with a TEE (3586±487 kcal/day) that was
bone mineral growth and health. Adolescent athletes’ daily
approximately 600 and 700 kcal/day higher than both the U15
calcium intake should be 1200–1500 mg (compared with
(3029±262 kcal/day) and U12/13 players (2859±265 kcal/day),
700 mg RDA for adults). 285 A 7-y ear prospective study 292
respectively.284 Such differences in TEE is likely due to a combi-
showed that inadequate vitamin D intake increased the risk
nation of differences in anthropometric profile, RMR and phys-
of stress fractures among adolescent girls, especially those
ical loading between squads. An important finding is that TEE
involved in daily high-impact activities. Overall, recommen-
is comparable to or exceeds that previously reported in adult
dations for adolescents vary from 400 to 600 IU/day. Assess-
Premier League soccer players.
ment of bone health (densitometry) and vitamin D status
As already mentioned (in the section ‘Expert group topic 3’),
may be useful, particularly in those with previous injuries
energy deficiency in sport (RED-S)179 may affect female junior
or a slighter build, since collisions and intense efforts are
athletes, and the junior males, with deleterious effects on various
frequent in football.
nutrition-related functions, such as gastrointestinal, immunolog-
Iron requirements are also high during growth, especially
ical and hormonal functions, as well as on bone development
in girls following menarche, and iron deficiency may impair
and the risk of developing eating disorders. Players should be
high-intensity and endurance performance. To achieve the daily
evaluated on joining a football academy and monitored period-
recommendations according to age (8 mg from 9 to 13 years
ically thereafter using appropriate charts to examine changes
and 11–15 mg from 14 to 18 years, for boys and girls), players
in height-for-weight, weight-for-age, BMI-for-age and body
should ingest iron-containing foods with vitamin C and limit
composition.
their intake of absorption inhibitors (eg, tea and coffee). It is
important to examine the iron status of junior football players
Macronutrients, micronutrients and supplements regularly by measuring their serum ferritin and blood haemo-
For specific information on different macronutrients and micro- globin concentrations. Unless iron deficiency is confirmed, iron
nutrients, readers are directed to expert group topic 2 on training supplementation is not beneficial.
day nutrition for all ages. Mild (1%–2% BM loss) hypohydration has been shown
Daily CHO recommendations by body weight for junior foot- to impair high-intensity cycling 293 and basketball294 perfor-
ballers are similar to those of senior players,285 with CHO inges- mance in active and athletic boys. A concern when playing in
tion spread strategically over the day and in amounts relative the heat is further hypohydration, which exacerbates hyper-
to the intensity of training loads,286 varying from very low to thermia and the risk of exertional heat illness. 295 Challenges
moderate (~3–6 g/kg BM), and high to upper level (~6–8 g/kg to hydration status include tournament play-offs involving
BM).2 Elite junior football players have been reported to have successive games, with insufficient time for recovery. Junior
lower CHO intakes than currently recommended.287 288 players have been reported to arrive for training sessions and
Studies on CHO loading in young players are lacking, but competitions already hypohydrated, as indicated by urinary
intake should be sufficient to optimise glycogen stores and markers.296–298
deliver glucose as energy for repeated high- intensity sprints
and performance. During long training sessions and matches, Dietary supplements
some CHO intake may be favourable. Active boys consuming Due to a lack of benefit/safety evidence, general use of dietary
CHO (60 g/L) beverages shifted their relative energy reliance supplements should be restricted, and a sports nutritionist

Consensus statement
or team doctor should evaluate the specific needs299 of the 15
Federal University of Rio Grande do Sul, Porto Alegre, Brazil
16
individual players, the team and local policies. Many adoles- PepsiCo Life Sciences, Global R&D, Gatorade Sports Science Institute, Birmingham,
UK
cents consume supplements, often as a result of mass media 17
Department of Sports Medicine, The Norwegian School of Sport Sciences, Oslo,
and misinformation provided by suppliers. 299 Parents and Norway
coaches may also have erroneous beliefs and wrongly supply 18
Department of Sport and Health Sciences, College of Life and Environmental
their children and/or athletes with supplements. 300 Sciences, University of Exeter, Exeter, UK
19
In summary, well- planned nutritional strategies may help Mexican Football Federation, Mexico City, Mexico
20
FC Barcelona, Barcelona, Spain
junior football players to achieve a successful athletic perfor- 21
Dutch Olympic Team, Amsterdam, Netherlands
mance and to optimise their recovery, growth, maturation and 22
Research and Human Performance Lab, Schulthess Clinic, Zurich, Switzerland
23
body composition, avoid injuries and achieve a long athletic and University of Rome Tor Vergata, Rome, Italy
24
healthy lifestyle. Technical Department, Italian Football Federation (FIGC), Florence, Italy
25
Italian Football Referees Association, Bologna, Italy
26
Technical Directorate, Football Association, Burton upon Trent, UK
27
Medical Committee, UEFA, Nyon, Switzerland
CONCLUSION 28
Medical Centre of Excelence, Schulthess Clinic, Zurich, Switzerland
Over the past decade, the game of football has changed, both 29
Center for Preventive Doping Research, German Sport University Cologne, Cologne,
physically and technically. At the same time, football-specific Germany
30
research in sports nutrition has expanded greatly. To reflect Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken,
these changes, UEFA commissioned an expert group, including Germany
31
Medical & Anti-doping, UEFA, Nyon, Switzerland
applied researchers and field-based practitioners, to provide an 32
Sport, Exercise and Health Sciences, School of Applied Sciences, Edinburgh Napier
overview and narrative synthesis of the current evidence on a University, Edinburgh, UK
range of topics related to the optimisation of the health and
performance of elite players and officials in order to guide prac- Twitter James Collins @JamesCollinsPN, Michael Gleeson @profmikegleeson,
tical recommendations and guide future research. We share a Johann Bilsborough @jbils1972, Asker Jeukendrup @jeukendrup, S M Phillips
series of updates on scientific knowledge and where possible and @mackinprof, Julien Louis @Jlnlouis, Ian Rollo @Rollo_I, Jorunn Sundgot-Borgen
@Jorunn_SB, Charlotte M Cowie @drccowie and Alan McCall @Alan_McCall_
appropriate provided a critical narrative synthesis.
Specifically we have covered (1) MD nutrition, (2) training Contributors The main steering committee consisted of JC, RJM, MG, JB and
AMcC. All authors contributed to the full manuscript. The authors were assigned
day nutrition, (3) body composition, (4) stressful environments a specific topic to write fully and then all authors reviewed and provided input
and travel, (5) cultural diversity and dietary considerations, for final version. Specifically AJ—match-day nutrition, JPM and LB—training day
(6) dietary supplements, (7) rehabilitation, (8) referees and (9) nutrition, MG—staying healthy, GLC—micronutrients, JB—body composition, LA,
junior high-level players. RD—stressful environments, JC and TM—cultural and dietary differences, RJM and
JL—supplements, BW—rehabilitation nutrition, CC and MB—referees, FM—junior
Our narrative synthesis and critical appraisal takes into account
players, JS-B and EL-M—key differences between male and female players. Football
the diversity of the footballing community, including both male nutrition practitioners/heads of performance GD, DM, BB, PR and AL reviewed all
and female players, outfield players and goalkeepers and match stages of the planning and written manuscript to ensure ecological validity to the
officials. We have outlined how the type, quantity and timing practical setting. The UEFA Medical Committee members TM, MV, MD’H, HG, CC
of foods, fluids and supplements can influence the performance and NP were involved in planning stages as the governing body commissioning the
experts. They were additionally involved in all stages of the manuscript to review
and recovery of players during and between matches, while also and provide editing suggestions and comments. AMcC and JC were the main
recognising the cultural significance of food and nutrition as part coordinators during the process.
of this truly global sport. Funding The authors have not declared a specific grant for this research from any
With this expert statement, we hope that these scientific funding agency in the public, commercial or not-for-profit sectors.
underpinnings can inform practitioners to drive a set of clear Competing interests JC has received payment for sports nutrition consultancy
practical recommendations in their own setting. In addition, we work with Arsenal Football Club, England Football Association and France Football
will highlight the key areas for future research to be targeted in Federation. Through his consultancy he also receives payment for nutrition services
order to improve confidence in recommendations and shed light with individuals and corporate organisations. He is author of a book (The Energy
on emerging areas within football nutrition. The reader should Plan) for which he receives payment from Penguin Random House. He has written
articles for BBC Good Food for which he has received payment. He co-authored an
note that this expert group statement represents level 5 (expert article in 2014 and presented at European College of Sports Sciences in 2019 for The
opinion) evidence. Gatorade Sports Science Institute, for which he received honoraria. He has received
travel and accommodation expenses to speak at conferences over the past 5 years
Author affiliations including; UEFA Medical Symposium, Isokinetic Football Medicine Strategies, Swedish
1
Intra Performance Group, London, UK Sports Medicine Congress and International Sport & Exercise Nutrition Conference.
2 He is a council member and past president of The Royal Society of Medicine’s Food &
Performance and Research Team, Arsenal Football Club, London, UK
3 Health Forum. He received from UEFA the cost of flight and accommodation to
School of Medicine, St Andrews University, St Andrews, UK
4 attend an Expert Group Meeting with the UEFA Medical Committee in Brussels,
School of Sports Exercise and Health Sciences, Loughborough University,
Loughborough, UK Belgium, to discuss preparation of this manuscript.” He did not receive any other
5
Faculty of Health, University of Technology, Sydney, New South Wales, Australia form of financial support directly related to this manuscript. RM holds an honorary
6
New England Patriots, Foxboro, MA, USA (unpaid) professorship at the School of Medicine, St Andrews University, Scotland. He
7
MySport Science, Birmingham, UK holds visiting (unpaid) professorships at Stirling University and at the Chinese
8
Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, University of Hong Kong. He is co-author of two books published by Oxford
Liverpool, UK University Press (Biochemistry of Exercise and Training; The Biochemical Basis of
9
Kinesiology, McMaster University, Hamilton, Ontario, Canada Sports Performance) for which he receives royalties. He is Program Director on the
10
Human Performance Laboratory, University of Connecticut, Storrs, CT, USA IOC Diploma programs in Sports Medicine, Sports Nutrition and Sports Physical
11
Mary MacKillop Institute for Health Research, Australian Catholic University, Therapies, for which he receives honoraria and additionally contributes lectures to
Melbourne, VIC, Australia those programs, for which he has received honoraria. He was a member of the
12
Medical Department, Football Federation Australia, Sydney, New South Wales, Expert Scientific Committee of the IOC Medical and Scientific Commission. This
Australia position was unpaid, but travel to meetings and accommodation were provided. He
13
Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, contributed a scientific review to a meeting of the Gatorade Sports Science Institute
USA in Texas in March 2019: travel and accommodation were paid and an honorarium
14
Athlete Care and Performance, Monumental Sports & Entertainment, Washington, was received for participation in the meeting and for preparation of a summary
DC, USA paper for publication in the SSI Sports Science Exchange. He participated in an ACSM

Consensus statement
online podcast in 2019 for which an honorarium was received. He participated in a financial support for participating in this manuscript. LB is an author or editor of
sports medicine education meeting organised by the Medical Committee of the textbooks on sports nutrition for which she receives royalties. She is a Program
German Football Federation in Frankfurt in January 2020: travel expenses and an Director and contributor to the IOC Diploma programs in Sports Nutrition for which
honorarium were paid. He has participated in numerous other international sports she receives honoraria. Prior to June 2020 she was Head of Sports Nutrition and
nutrition symposia between 2015 and the present for which travel and Chief of Nutrition Strategy at the Australian Institute of Sport, where her
accommodation were provided. He received from UEFA the cost of flight and representation at numerous international sports nutrition symposia and workshops
accommodation to attend an Expert Group Meeting with the UEFA Medical was generally undertaken within her job description and any travel reimbursements
Committee in Brussels, Belgium, to discuss preparation of this manuscript.” He did and honoria were provided to the AIS. Presentations during the period of 2015-2020
not receive any other form of financial support directly related to this manuscript. in which the activity and its support were undertaken as private consultancy include:
MG is co-author of two books published by Oxford University Press (Biochemistry of 2015 Berlin Marathon powerbar conference; 2019 ACSM meeting and pre-
Exercise and Training; The Biochemical Basis of Sports Performance) for which he conference GSSI workshop (supported by the International Association of Athletics
receives royalties. He is also co-author of 3 other books; one published by Human Federation and Gatorade); 2019 Northern Ireland Workshop on Sports Nutrition
Kinetics (Sport Nutrition), one published by Routledge (Exercise Immunology) and (supported by Dairy Council Northern Ireland) and the 2016 SCAN conference and
the other by Meyer & Meyer Sport (Eat, Move, Sleep, Repeat; Beating Type 2 2019 FNCE conference (supported by the Academy of Nutrition and Dietetics). She
Diabetes) all of which he receives royalties for. He has contributed to several has received a research grant from the Alliance of Potato Research and Education.
recorded lectures for which he received honoraniums for; 2020 to the IOC Diploma She did not receive any form of financial support directly related to this manuscript.
program Sports Nutrition, 2020 to the Nutrition Society Training Academy, 2020 to GC has previously received payment for nutrition consultancy at Everton, Nottingham
the My Sport Science Academy. He was a member of the IOC Expert Scientific Group Forest and West Bromwich Albion and Aston Villa Football clubs, Munster Rugby,
on training load and illness/injury in 2015. This position was unpaid, but travel to a England Rugby The Lawn Tennis Association The Football Association, The English
meeting and accommodation were provided. Other international symposia were Institute of Sport and The Saudi Arabian Olympic Association and The European Tour
attended as speaker where honorarium was paid plus travel and accommodation; Golf. He currently advises HealthSpan Elite and NutritionX for which he receives an
Japan, 2016, London 2015, Barcelona 2015, Vienna, 2015. Mike also contributed a honorarium and in the past has advised GetBuzzing bars. GC has spoken on several
scientific review on nutrition, exercise and immune function for a sport nutrition occasions for GSSI and produced articles for their exchange series for which he
company, NutritionX, in 2020 for which an honorarium was received. He has received an honorarium. He has spoken at a number of other conferences, symposia
received complimentary tickets for Leicester City FC football matches for occasional and other events within the last five years: travel and accommodation were provided
nutrition consultancy advice but no honoraria were received. He has spoken at a for most of these, but no record has been kept. GC currently or has previous received
number of other conferences, symposia and other events within the last five years: research grants from the MRC, BSSRC, GSK, Sirtris, Research into Ageing, Aliment
travel and accommodation were provided for most of these, but no record has been Nutrition, Naturecan, HH Sheikh Mansour Bin Zayad Al Nahyan Global Arabian Horse
kept. He did not receive any form of financial support directly related to this Flat Racing Festival, The Racing Foundation, The British Horse Racing Association, The
manuscript. JB has presented at the Arsenal Sports & Exercise Medicine conference Rugby Football Union, The Lawn Tennis Association, Newport Gwent Dragons,
in London, UK, where travel and accommodation were paid by Arsenal FC. He has Gloucester Rugby, Everton FC, Aston Villa FC. GC has delivered guest lectures for the
co-authored two chapters in the book, ’The Science and Application of High-intensity IOC diploma in Sport Nutrition and The Football Science Institute for which he
interval training (HIIT) with no honorarium nor any royalties received. He did not received an honorarium. GC has previously performed consultancy work for Callaway
receive any form of financial support directly related to this manuscript. AJ holds a Golf and Quooker Taps. He did not receive any form of financial support directly
visiting professorship at the Loughborough University, UK and is director of related to this manuscript. RD receives is Joint Head of Research & Development at
mysportscience. He is also co-founder and CEO of CORE Nutrition planning. He is Football Federation Australia and is paid for this role. He has received travel and
author of a book sport nutrition by Human Kinetics for which he receives royalties. accommodation funding to speak / present at several international congress,
He is board member of the IOC Diploma programs in Sports Medicine. Asker worked including; the Football Science Institute, Football Federation Australia, Tennis
as a consultant for the Dutch Olympic Committee NOC*NSF, Red Bull Leipzig, FC Australia, Brazil National Football Federation, UFSC Brazil, Canadian Institute of
Barcelona, PSV Eindhoven, Athletic Club de Bilbao, US Soccer, Red Bull Athlete Sport, Bristol City FC and UdS Germany. He is not affiliated or received any travel,
Performance Center, Jumbo Visma Pro cycling, Universidad d’Europea de Madrid, accommodation, funding from any nutrition company in the last 10 years. He did not
University of Barcelona, CAR, VIC University, Hiddit, SinSeb, Enervit, Volanthen, receive any form of financial support directly related to this manuscript. EL-M is
Friesland Campina, Nutrition Society, Clif, Snelle Jelle, Jumbo Supermarkten, PepsiCo, author of a book published by Human Kinetics (Plant-Based Sports Nutrition: Expert
Unit Nutrition, BF Eventos, Mexican sports nutrition federation and the Turkish sports Fueling Strategies for Training, Recovery, and Performance) for which she receives
nutrition federation. Travel expenses and an honorarium were paid. He has royalties. She was a member of the Dietary Supplements and the High-Performance
participated in numerous other international sports nutrition symposia between Athlete Expert Scientific Committee of the IOC Medical and Scientific Commission in
2015 and the present for which travel and accommodation were provided. He did 2017; this committee assignment was unpaid, but travel to the group meeting and
not receive any form of financial support directly related to this manuscript. JM has accommodation were provided. She contributed scientific presentations to a meeting
received research grants from UEFA, Science in Sport, Lucozade Ribena Suntory, of the Gatorade Sports Science Institute in Florida in Oct 2017 and Gatorade at NFL
GlaxoSmithKline, Liverpool Football Club, Everton Football Club, British Horseracing Combine in Feb 2020: travel and accommodation were paid and an honorarium was
Authority, Racing Welfare Foundation, Port Adelaide FC, English Institute of Sport received for participations at both meetings and for preparation of a summary paper
and MuscleSound. He has received paid consultancy for Liverpool Football Club, for publication in the SSI Sports Science Exchange in 2018. She presented at a
Team Sky, Healthspan Elite, FA Premier League, Irish Football Association, The Danone Essential Dairy and Plant-Based Proteins Board Meeting in New York in July
Football Association, Rangers FC and Science in Sport. He is the current Director of in 2019 for which travel, accommodations and an honorarium were paid. She has
Performance Solutions for Science in Sport. He is the co-author of the textbook participated in numerous other national nutrition and medical conferences between
Biochemistry for Sport and Exercise Metabolism and receives annula royalties form 2015 and the present for which travel and accommodation and typically an
Wiley. He has received travel and accommodation costs to speak at over 50 honorarium were received. She did not receive any form of financial support directly
conferences in the last 5 years. He did not receive any form of financial support related to this manuscript. JL has received payment for sport nutrition consultancy
directly related to this manuscript. SP reports personal fees from Enhanced Recovery work with French Football Federation, Liverpool Football Club, Lille Football Club,
(donated to charity), equity from Exerkine (donated to charity), grants from Canadian Paris-Dakar association. He has received travel/accommodation funding and
Institutes of Health Research, grants from National Science and Engineering Council, honorariums to speak / present at several national/international conferences
personal fees (Travel and Honorarium, 2018) from US National Dairy Council, between 2015 to present) including: Research day of the Dairy Council UK; European
personal fees from US Dairy Export Council (Traval and Honorarium, 2019), personal College of Sport and Exercise Physicians, Paris, France; International conference of
fees from Leprino Foods (2017), personal fees from Agropur (2018), grants from Sports Physiotherapy, Kuala Lumpur, Malaysia; French Football Federation congress
Alliance for Potato Research and Education, grants from US National Dairy Council, for S&C coaches, Paris; congress of the Mexican Nutrition Society, Guadalajara; and
outside the submitted work; In addition, Dr. Phillips has a patent 3052324 congress of the Swiss Nutrition society, Nottwil. He has contributed to several
(Canadian) issued to Exerkine, a patent 16/182891 (US) pending to Exerkine, and a recorded lectures for which he received honorariums for the IOPN Diploma, London,
patent 2018157258 (Worldwide) pending to Exerkine. He did not receive any form UK. He co-supervised a PhD project funded by a nutrition company (Lactalis, Laval,
of financial support directly related to this manuscript. LA received honoraria as an France). He did not receive any form of financial support directly related to this
occasional consultant and reimbursement for travel expenses from the Drinking manuscript. DM has no conflicts to disclose. He did not receive any form of financial
Water Research Foundation, Alexandria, VA, USA and from Danone Nutricia support directly related to this manuscript. FM is the main editor of a book published
Research, France. He previously received research grant funding from both by CRC Press, Taylor & Francis Group (Fluid Balance, Hydration and Athletic
organizations. He formerly served as the elected President of the American College Performance) for which she receives royalties. She hold a visiting professor position
of Sports Medicine (unpaid), 2015-2016. He received honoraria and reimbursement at the Human Movement Graduate Program from 2018 to 2020 (unpaid) at the
of travel expenses from five universities and the Texas Regional Chapter of the Federal University of Rio Grande do Sul. She did not receive any form of financial
American College of Sports Medicine during a speaking tour in 2018. He presently support directly related to this manuscript. IR is an employee of the Gatorade Sports
serves as a member of the Medical & Science Advisory Board, Korey Stringer Science Institute (GSSI), a division of PepsiCo, Incorporated. The views expressed in
Institute, University of Connecticut, USA (unpaid). Professor Armstrong received no this article are those of the authors and do not necessarily reflect the position or

Consensus statement
policy of PepsiCo, Incorporated. Ian leads the FC Barcelona, innovation hub company in the last 5 years. She is employed by the Football Association and has a
certificate in sports nutrition, he is co-author on the FC Barcelona Sports Nutrition private medical practice. She is member of the UEFA medical committee and have
guide for Football and co-organises the FCB conference in Sports nutrition, all as paid expenses (travel & accommodation) for UEFA medical committee meetings. She
part of his role with GSSI. Ian co-authored a chapter on nutrition in the book “Elite received from UEFA the cost of flight and accommodation to attend an Expert Group
Soccer Players” with no honorarium nor any royalties received. He not receive any Meeting with the UEFA Medical Committee in Brussels, Belgium, to discuss
form of financial support directly related to this manuscript. JSB holds a preparation of this manuscript.” She did not receive any other form of financial
professorship at the Norwegian School of Sports Science in Oslo Norway. She support directly related to this manuscript. MD: The travel to attend an Expert Group
receives research grants from The Norwegian Woman’s Public Health Association, the Meeting with the UEFA Medical Committee in Brussels, Belgium, to discuss
Norwegian Extra Foundation for Health and Rehabilitation, The Norwegian preparation of this manuscript was paid by UEFA. No other conflicts to declare. He
Association of Youth Mental Health, and the Dam Foundation and TINE SA. She has did not receive any other form of financial support directly related to this manuscript.
contributed with lectures for the IOC Diploma programs in Sports Medicine and HG has received honorarium and reimbursement of travel and accommodation
Sports Nutrition and receives honoraria for about one lecture per year. She was a expenses for expert statements in doping cases in connection with nutritional
member of the Expert Scientific Committee of the IOC Medical and Scientific supplements for several federations and anti-doping organisations, including UEFA
Commission. She has also been a member in IOC working group (position papers). and FIFA and several National Anti-Doping Agencies. He has received daily fees and
These positions were unpaid, but travel to meetings and accommodation were reimbursement of travel and accommodation expenses for his participation in WADA
provided. She is also an International trustee (ACSM) and Vice president in Nordic expert groups for the athlete biological passport. He has received honorarium and
Eating Disorder Society. These positions are unpaid, but travel to meetings and reimbursement of travel and accommodation expenses for lectures about doping
accommodation are provided. BW Received honorarium for consultancy with risks of nutritional supplements in congresses of several medical societies. He has
Nutricia. BW is the editor of one book (carnitine metabolism and human nutrition) received reimbursement of travel and accommodation expenses for his participation
published by CRC press for which he receives royalties. He has made lecture at the IOC consensus conference about nutritional supplements. The travel to attend
contributions to the International Society for Sports and Exercise Conference (ISENC), an Expert Group Meeting with the UEFA Medical Committee in Brussels, Belgium, to
Nutrition Society, European Society for Parenteral and Enteral Nutrition (ESPEN) and discuss preparation of this manuscript was paid by UEFA. No other conflicts to
Physiological Society which were unpaid for which he received expenses. He has declare. He did not receive any other form of financial support directly related to this
received travel and expenses for an organised symposium (by Ketchum PR, US) at manuscript. TM has never received any royalties or fees from nutritional companies
American Society for Nutrition (ASN) and the Reducetarian Conference. He has or other relevant sources. For none of his publications has he ever received any
received payments from various UK universities for external examining with the last financial compensation except for one article about the management of infectious
5 years. He did not receive any form of financial support directly related to this diseases in the Aspetar Sports Medicine Journal. He received from UEFA the cost of
manuscript. BB is co-author of two books, one published by McGrawHill (Nutrición flight and accommodation to attend an Expert Group Meeting with the UEFA
Deportiva) for which she receives royalties and another one published by Medical Committee in Brussels, Belgium, to discuss preparation of this manuscript.”
Organización Panamericana de la Salud (La Receta de los Campeones) for which she He did not receive any other form of financial support directly related to this
received royalties in the past. She is Program Director on the FMND-Nutrinfo Curse manuscript. NP: The travel to attend an Expert Group Meeting with the UEFA
in Sports Nutrition, for which she receives honoraria and additionally contributes Medical Committee in Brussels, Belgium, to discuss preparation of this manuscript
with one lectures to these program, for which she has received honoraria. She has was paid by UEFA. No other conflicts to declare. She did not receive any other form
participated in numerous international sports nutrition symposia between 2011 and of financial support directly related to this manuscript. MV: The travel to attend an
the present for which travel and accommodation were paid by The Mexican Football Expert Group Meeting with the UEFA Medical Committee in Brussels, Belgium, to
Federation. She advises The Coca Cola Company for issues related to their Sport discuss preparation of this manuscript was paid by UEFA. No other conflicts to
Beverage Powerade since 2012 for which she receives honoraria. She did not receive declare. He did not receive any other form of financial support directly related to this
any form of financial support directly related to this manuscript. GD is head of manuscript. AM has received a grant from FIFA to investigate health and
performance for CF Real Madrid. He holds visiting (unpaid) professorships at performance of footballers during the transition from club to national teams. He has
Liverpool John Moores University He previously worked for the French Football received travel and accommodation funding to speak / present at several
Federation, Lille FC and the universities of Artois and Lille. He is co-author of a book international congress between 2015 to present), including; the Isokinetic Football
on training methodology and performance (2007, three chapters (monitoring fatigue Medicine Strategies Conference (London and Barcelona), KNVB national federation,
and recovery, Thieme eds, 2017; Targeted Systems of the Body for Training in Football Danish SportsKongress, Denmark, Sportsfisio congress, Switzerland, The Barça
Science, Human Kinetics, 2016; Boosting Aerobic Performance in High-Performance Innovation Hub, Barcelona, Spain. Oslo Sports Trauma Research Group, Oslo, Norway.
training for Sports, Human Kinetics, 2016), for which he received royalties. He has Mapei Research Centre, Bergamo, Italy. Brazil National Football Federation, Rio,
lectured for Aspetar twice (2013, 2016) recovery and nutrition courses for which he Brazil, French Football Federation, Paris, France. He is not affiliated or received any
has received travel expenses, accommodation and an honorarium. He has spoken at travel, accommodation, funding from any nutrition company. He also received
33 international conferences on sports science and football for which he has consultancy fee from the French Football Federation for injury prevention
received travel expenses and accommodation, no honorariums have been received. recommendations for the 2018 FIFA World Cup. He received from UEFA the cost of
He did not receive any form of financial support directly related to this manuscript. flight and accommodation to attend an Expert Group Meeting with the UEFA
MAL: Toña is Professor of the Human Nutrition and Dietetics degree at the University Medical Committee in Brussels, Belgium, to discuss preparation of this manuscript.”
of Barcelona and Nutritional Advisor of FCB. She is involved in clinical consultation He did not receive any other form of financial support directly related to this
and advice to competitive athletes and she did not receive any form of financial manuscript.
support directly related to this manuscript. PR is currently employed by the Dutch
Olympic Team. He was formerly employed by AFC Ajax Amsterdam. He is owner of Patient consent for publication Not required.
PR Sportvoedingsadvies. Through his consultancy he also receives payment for Provenance and peer review Not commissioned; externally peer reviewed.
nutrition services with individuals and corporate organisations. He co-authored an
Data availability statement There are no data in this work.
article for The Gatorade Sports Science Institute, for which he received honoraria. He
received honoraria as an invited speaker for the Barça Sport Nutrition Conference ORCID iDs
and FrieslandCampina Institute congress “sport en voeding”. He did not receive any S M Phillips http://orcid.org/0000-0002-1956-4098
form of financial support directly related to this manuscript. MB has received travel Louise M Burke http://orcid.org/0000-0001-8866-5637
and accommodation funding (from the organizers and/or the Schulthess Clinic) to Graeme L Close http://orcid.org/0000-0002-7210-9553
speak/present at several international congress between 2015 to present, including: Rob Duffield http://orcid.org/0000-0002-5641-1314
the Isokinetic Football Medicine Strategies Conferences (2015-2019, London & Julien Louis http://orcid.org/0000-0002-9109-0958
Barcelona), Team Concept Conference 2016 (Las Vegas), the IOC World Conference Flavia Meyer http://orcid.org/0000-0002-7290-4354
2017, the World Conference of Sports Physical Therapy (Belfast 2017, Vancouver Jorunn Sundgot-Borgen http://orcid.org/0000-0002-1149-0442
2019), the Salzburg Sports PT Congress 2019, the ACL Consensus Meeting Gregory Dupont http://orcid.org/0000-0001-8057-882X
(Pittsburgh 2019), the International Conference on Football Refereeing (Lisbon Carlo Castagna http://orcid.org/0000-0002-8320-6404
2019), the International Society of Hip Arthroscopy Physiotherapy Meeting (Madrid Tim Meyer http://orcid.org/0000-0003-3425-4546
2019). As a member of F-MARC (2002- 2016) he received compensation from FIFA Alan McCall http://orcid.org/0000-0003-3780-8153
for his work during this time, but no other compensations or grants have been
received. Between 2015 and 2019 he has authored/co-authored nine book chapters
(football medicine, sports medicine) with no honorarium nor any royalties received. REFERENCES
He did not receive any form of financial support directly related to this manuscript. 1 Nutrition for football: the FIFA/F-MARC consensus conference. J Sports Sci
CC: Since 2007 I have been invited in international conference/seminar by FIFA and 2006;24:663–4.
UEFA for lectures on refereeing receiving no honorary but having paid travels, 2 Thomas DT, Erdman KA, Burke LM. American College of sports medicine joint
accommodation and daily expenses. I did not receive any form of payment for the position statement. nutrition and athletic performance. Med Sci Sports Exerc
contribution to this manuscript. CC has not received any honorarium from any 2016;48:543–68.

Consensus statement
3 Collins J, McCall A, Bilsborough J, et al. Football nutrition: time for a new consensus? 37 Phillips SM, Sproule J, Turner AP. Carbohydrate ingestion during team games
Br J Sports Med 2017;51): :1577–8. exercise: current knowledge and areas for future investigation. Sports Med
4 Burke LM. Communicating sports science in the age of the Twittersphere. Int J Sport 2011;41:559–85.
Nutr Exerc Metab 2017;27:1–5. 38 Russell M, Benton D, Kingsley M. Influence of carbohydrate supplementation on skill
5 Barnes C, Archer DT, Hogg B, et al. The evolution of physical and technical performance during a soccer match simulation. J Sci Med Sport 2012;15:348–54.
performance parameters in the English premier League. Int J Sports Med 39 Briggs MA, Harper LD, McNamee G, et al. The effects of an increased calorie
2014;35:1095–100. breakfast consumed prior to simulated match-play in Academy soccer players. Eur J
6 Bush M, Barnes C, Archer DT, et al. Evolution of match performance parameters Sport Sci 2017;17:858–66.
for various playing positions in the English premier League. Hum Mov Sci 40 American College of Sports Medicine, Sawka MN, Burke LM, et al. American College
2015;39:1–11. of sports medicine position stand. exercise and fluid replacement. Med Sci Sports
7 Bengtsson H, Ekstrand J, Hägglund M. Muscle injury rates in professional football Exerc 2007;39:377–90.
increase with fixture congestion: an 11-year follow-up of the UEFA champions 41 Baker LB, Nuccio RP, Jeukendrup AE. Acute effects of dietary constituents on motor
League injury study. Br J Sports Med 2013;47:743–7. skill and cognitive performance in athletes. Nutr Rev 2014;72:790–802.
8 Dupont G, Nedelec M, McCall A, et al. Effect of 2 soccer matches in a week on 42 Baker LB, Rollo I, Stein KW, et al. Acute effects of carbohydrate supplementation on
physical performance and injury rate. Am J Sports Med 2010;38:1752–8. intermittent sports performance. Nutrients 2015;7:5733–63.
9 FIFA. Why is football the world game? 2008. Available: https://www.fifa.com/ 43 Nicholas CW, Williams C, Lakomy HK, et al. Influence of ingesting a carbohydrate-
live-scores/news/y=2008/m
=7/news=why-football-the-g lobal-game-830125.html electrolyte solution on endurance capacity during intermittent, high-intensity shuttle
[Accessed 12 Sep 2019]. running. J Sports Sci 1995;13:283–90.
10 Coutts AJ. Challenges in developing evidence-based practice in high-performance 44 Russell M, Kingsley M. The efficacy of acute nutritional interventions on soccer skill
sport. Int J Sports Physiol Perform 2017;12:717–8. performance. Sports Med 2014;44:957–70.
11 Archer E, Lavie CJ, Hill JO. The failure to measure dietary intake engendered a 45 Rodriguez-Giustiniani P, Rollo I, Witard OC, et al. Ingesting a 12% Carbohydrate-
Fictional discourse on Diet-Disease relations. Front Nutr 2018;5:105. Electrolyte Beverage Before Each Half of a Soccer Match Simulation Facilitates
12 Burke LM, Castell LM, Casa DJ, et al. International association of athletics Retention of Passing Performance and Improves High-Intensity Running Capacity in
Federations consensus statement 2019: nutrition for athletics. Int J Sport Nutr Exerc Academy Players. Int J Sport Nutr Exerc Metab 2019;29:1–9.
Metab 2019;29:73–84. 46 Currell K, Conway S, Jeukendrup AE. Carbohydrate ingestion improves performance
13 Bangsbo J, Mohr M, Krustrup P. Physical and metabolic demands of training and of a new reliable test of soccer performance. Int J Sport Nutr Exerc Metab
match-play in the elite football player. J Sports Sci 2006;24:665–74. 2009;19:34–46.
14 Bangsbo J, Nørregaard L, Thorsø F. Activity profile of competition soccer. Can J Sport 47 Harper LD, Stevenson EJ, Rollo I, et al. The influence of a 12% carbohydrate-
Sci 1991;16:110–6. electrolyte beverage on self-paced soccer-specific exercise performance. J Sci Med
15 Ferrauti A, HT G, Merheim G, et al. Indirekte Kalorimetrie Im Fußball Sport 2017;20:1123–9.
indirect calorimetry in a soccer game. Deutsche Zeitschrift für Sportmedizin 48 Ali A, Williams C. Carbohydrate ingestion and soccer skill performance during
2006;57:142–6. prolonged intermittent exercise. J Sports Sci 2009;27:1499–508.
16 Anderson L, Orme P, Naughton RJ, et al. Energy intake and expenditure of 49 Carter JM, Jeukendrup AE, Jones DA. The effect of carbohydrate mouth rinse on 1-H
professional soccer players of the English premier League: evidence of carbohydrate cycle time trial performance. Med Sci Sports Exerc 2004;36:2107–11.
Periodization. Int J Sport Nutr Exerc Metab 2017;27:228–38. 50 Rollo I, Homewood G, Williams C, et al. The influence of carbohydrate mouth rinse
17 White A, Hills SP, Cooke CB, et al. Match-Play and performance test responses of on self-selected intermittent running performance. Int J Sport Nutr Exerc Metab
soccer Goalkeepers: a review of current literature. Sports Med 2018;48:2497–516. 2015;25:550–8.
18 Datson N, Drust B, Weston M, et al. Match physical performance of elite 51 Dorling JL, Earnest CP. Effect of carbohydrate mouth rinsing on multiple sprint
female soccer players during international competition. J Strength Cond Res performance. J Int Soc Sports Nutr 2013;10:41.
2017;31:2379–87. 52 Duffield R, McCall A, Coutts AJ, et al. Hydration, sweat and thermoregulatory
19 Murray NB, Gabbett TJ, Townshend AD, et al. Individual and combined effects of responses to professional football training in the heat. J Sports Sci 2012;30:957–65.
acute and chronic running loads on injury risk in elite Australian footballers. Scand J 53 Baker LB, Barnes KA, Anderson ML, et al. Normative data for regional sweat
Med Sci Sports 2017;27:990–8. sodium concentration and whole-body sweating rate in athletes. J Sports Sci
20 Anderson L, Orme P, Di Michele R, et al. Quantification of training load during 2016;34:358–68.
one-, two- and three-game week schedules in professional soccer players from the 54 Maughan RJ, Shirreffs SM, Merson SJ, et al. Fluid and electrolyte balance in
English premier League: implications for carbohydrate periodisation. J Sports Sci elite male football (soccer) players training in a cool environment. J Sports Sci
2016;34:1250–9. 2005;23:73–9.
21 Leatt PB, Jacobs I. Effect of glucose polymer ingestion on glycogen depletion during 55 Da Silva RP, Mündel T, Natali AJ, et al. Pre-game hydration status, sweat loss, and
a soccer match. Can J Sport Sci 1989;14:112–6. fluid intake in elite Brazilian young male soccer players during competition. J Sports
22 Krustrup P, Mohr M, Steensberg A, et al. Muscle and blood metabolites during Sci 2012;30:37–42.
a soccer game: implications for sprint performance. Med Sci Sports Exerc 56 Horowitz M. Heat acclimation, epigenetics, and cytoprotection memory. Compr
2006;38:1165–74. Physiol 2014;4:199–230.
23 Saltin B. Metabolic fundamentals in exercise. Med Sci Sports 1973;5:137–46. 57 Kilding AE, Tunstall H, Wraith E, et al. Sweat rate and sweat electrolyte composition
24 Shirreffs SM, Sawka MN, Stone M. Water and electrolyte needs for football training in international female soccer players during game specific training. Int J Sports Med
and match-play. J Sports Sci 2006;24:699–707. 2009;30:443–7.
25 Ekblom B. Applied physiology of soccer. Sports Med 1986;3:50–60. 58 González-Alonso J, Mora-Rodríguez R, Below PR, et al. Dehydration reduces cardiac
26 Shirreffs SM, Aragon-Vargas LF, Chamorro M, et al. The sweating response of elite output and increases systemic and cutaneous vascular resistance during exercise. J
professional soccer players to training in the heat. Int J Sports Med 2005;26:90–5. Appl Physiol 1995;79:1487–96.
27 Cheuvront SN, Ely BR, Kenefick RW, et al. Biological variation and diagnostic 59 Ganio MS, Armstrong LE, Casa DJ, et al. Mild dehydration impairs cognitive
accuracy of dehydration assessment markers. Am J Clin Nutr 2010;92:565–73. performance and mood of men. Br J Nutr 2011;106:1535–43.
28 Armstrong LE, Ganio MS, Klau JF, et al. Novel hydration assessment techniques 60 Mohr M, Krustrup P. Heat stress impairs repeated jump ability after competitive elite
employing thirst and a water intake challenge in healthy men. Appl Physiol Nutr soccer games. J Strength Cond Res 2013;27:683–9.
Metab 2014;39:138–44. 61 McGregor SJ, Nicholas CW, Lakomy HK, et al. The influence of intermittent high-
29 Armstrong LE, Pumerantz AC, Fiala KA, et al. Human hydration indices: acute and intensity shuttle running and fluid ingestion on the performance of a soccer skill. J
longitudinal reference values. Int J Sport Nutr Exerc Metab 2010;20:145–53. Sports Sci 1999;17:895–903.
30 Armstrong LE, Soto JA, Hacker FT, et al. Urinary indices during dehydration, exercise, 62 McDermott BP, Anderson SA, Armstrong LE, et al. National athletic trainers’
and rehydration. Int J Sport Nutr 1998;8:345–55. association position statement: fluid replacement for the physically active. J Athl
31 Kenefick RW, Cheuvront SN. Hydration for recreational sport and physical activity. Train 2017;52:877–95.
Nutr Rev 2012;70 Suppl 2:S137–42. 63 Nédélec M, McCall A, Carling C, et al. Recovery in soccer : part ii-recovery strategies.
32 Noakes TD. Is drinking to thirst optimum? Ann Nutr Metab 2010;57: :9–17. Sports Med 2013;43:9–22.
33 Nuccio RP, Barnes KA, Carter JM, et al. Fluid balance in team sport athletes and the 64 Burke LM, van Loon LJC, Hawley JA. Postexercise muscle glycogen resynthesis in
effect of Hypohydration on cognitive, technical, and physical performance. Sports humans. J Appl Physiol 2017;122:1055–67.
Med 2017;47:1951–82. 65 Maughan RJ, Leiper JB, Shirreffs SM. Restoration of fluid balance after exercise-
34 Nilsson LH, Fürst P, Hultman E. Carbohydrate metabolism of the liver in normal man induced dehydration: effects of food and fluid intake. Eur J Appl Physiol Occup
under varying dietary conditions. Scand J Clin Lab Invest 1973;32:331–7. Physiol 1996;73:317–25.
35 Williams C, Serratosa L. Nutrition on match day. J Sports Sci 2006;24:687–97. 66 Anderson L, Naughton RJ, Close GL, et al. Daily distribution of macronutrient intakes
36 Holway FE, Spriet LL. Sport-specific nutrition: practical strategies for team sports. J of professional soccer players from the English premier League. Int J Sport Nutr Exerc
Sports Sci 2011;29 Suppl 1:S115–25. Metab 2017;27:491–8.

Consensus statement
67 Costill DL, Pascoe DD, Fink WJ, et al. Impaired muscle glycogen resynthesis after 98 Anderson L, Close GL, Morgans R, et al. Assessment of energy expenditure of a
eccentric exercise. J Appl Physiol 1990;69:46–50. professional Goalkeeper from the English premier League using the doubly labeled
68 Doyle JA, Sherman WM, Strauss RL. Effects of eccentric and concentric exercise on water method. Int J Sports Physiol Perform 2019;14:681–4.
muscle glycogen replenishment. J Appl Physiol 1993;74:1848–55. 99 Gunnarsson TP, Bendiksen M, Bischoff R, et al. Effect of whey protein- and
69 Widrick JJ, Costill DL, McConell GK, et al. Time course of glycogen accumulation carbohydrate-enriched diet on glycogen resynthesis during the first 48 H after a
after eccentric exercise. J Appl Physiol 1992;72:1999–2004. soccer game. Scand J Med Sci Sports 2013;23:508–15.
70 Koopman R, Saris WHM, Wagenmakers AJM, et al. Nutritional interventions to 100 Authority EFS. Scientific opinion on dietary reference values for protein. Available:
promote post-exercise muscle protein synthesis. Sports Med 2007;37:895–906. http://www.efsa.europa.e u/sites/default/files/c onsultation/110712%2C0.pdf
71 Morton RW, McGlory C, Phillips SM. Nutritional interventions to augment resistance [Accessed 24 Sep 2019].
training-induced skeletal muscle hypertrophy. Front Physiol 2015;6:245. 101 Morton RW, Murphy KT, McKellar SR, et al. A systematic review, meta-analysis and
72 van Loon LJC. Role of dietary protein in post-exercise muscle reconditioning. Nestle meta-regression of the effect of protein supplementation on resistance training-
Nutr Inst Workshop Ser 2013;75:73–83. induced gains in muscle mass and strength in healthy adults. Br J Sports Med
73 Trommelen J, van Loon LJC. Pre-Sleep protein ingestion to improve the skeletal 2018;52:376–84.
muscle adaptive response to exercise training. Nutrients 2016;8:763. 102 Phillips SM, Fulgoni VL, Heaney RP, et al. Commonly consumed protein foods
74 Pasiakos SM, Lieberman HR, McLellan TM. Effects of protein supplements on muscle contribute to nutrient intake, diet quality, and nutrient adequacy. Am J Clin Nutr
damage, soreness and recovery of muscle function and physical performance: a 2015;101:1346S–52.
systematic review. Sports Med 2014;44:655–70. 103 Maughan RJ. Energy and macronutrient intakes of professional football (soccer)
75 Jackman SR, Witard OC, Jeukendrup AE, et al. Branched-Chain amino acid players. Br J Sports Med 1997;31:45–7.
ingestion can ameliorate soreness from eccentric exercise. Med Sci Sports Exerc 104 Bettonviel A EO, Brinkmans N YJ, Russcher K, et al. Nutritional status and
2010;42:962–70. daytime pattern of protein intake on match, Post-Match, rest and training days
76 Bell PG, Walshe IH, Davison GW, et al. Montmorency cherries reduce the oxidative in senior professional and youth elite soccer players. Int J Sport Nutr Exerc Metab
stress and inflammatory responses to repeated days high-intensity stochastic cycling. 2016;26:285–93.
Nutrients 2014;6:829–43. 105 Phillips SM. The impact of protein quality on the promotion of resistance exercise-
77 Vitale KC, Hueglin S, Broad E. Tart cherry juice in athletes: a literature review and induced changes in muscle mass. Nutr Metab 2016;13:64.
commentary. Curr Sports Med Rep 2017;16:230–9. 106 Snijders T, Res PT, Smeets JSJ, et al. Protein ingestion before sleep increases muscle
78 Abbott W, Brashill C, Brett A, et al. Tart cherry juice: no effect on muscle function loss mass and strength gains during prolonged Resistance-Type exercise training in
or muscle soreness in professional soccer players after a match. Int J Sports Physiol healthy young men. J Nutr 2015;145:1178–84.
Perform 2019:1–21. 107 Trommelen J, Kouw IWK, Holwerda AM, et al. Presleep dietary protein-derived amino
79 Peternelj T-T, Coombes JS. Antioxidant supplementation during exercise training: acids are incorporated in myofibrillar protein during postexercise overnight recovery.
beneficial or detrimental? Sports Med 2011;41:1043–69. Am J Physiol Endocrinol Metab 2018;314:E457–67.
80 Barnes MJ. Alcohol: impact on sports performance and recovery in male athletes. 108 Longland TM, Oikawa SY, Mitchell CJ, et al. Higher compared with lower dietary
Sports Med 2014;44:909–19. protein during an energy deficit combined with intense exercise promotes
81 Parr EB, Camera DM, Areta JL, et al. Alcohol ingestion impairs maximal post-exercise greater lean mass gain and fat mass loss: a randomized trial. Am J Clin Nutr
rates of myofibrillar protein synthesis following a single bout of concurrent training. 2016;103:738–46.
PLoS One 2014;9:e88384. 109 Murphy CH, Hector AJ, Phillips SM. Considerations for protein intake in managing
82 Hobson RM, Maughan RJ. Hydration status and the diuretic action of a small dose of weight loss in athletes. Eur J Sport Sci 2015;15:21–8.
alcohol. Alcohol Alcohol 2010;45:366–73. 110 Wall BT, Morton JP, van Loon LJC. Strategies to maintain skeletal muscle mass in
83 Prentice C, Stannard SR, Barnes MJ. Effects of heavy episodic drinking on physical the injured athlete: nutritional considerations and exercise mimetics. Eur J Sport Sci
performance in club level rugby union players. J Sci Med Sport 2015;18:268–71. 2015;15:53–62.
84 Afshar M, Richards S, Mann D, et al. Acute immunomodulatory effects of binge 111 Micronutrients, I.o.M.U.P.o. Dietary reference intakes for vitamin A, vitamin K,
alcohol ingestion. Alcohol 2015;49:57–64. arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel,
85 Reilly TT. A motion analysis of work rate in different positional roles in professional silicon, vanadium, and zinc. Washington DC: National Academies Press (US), 2001.
football match play. Journal of Human Movement Studies 1976;2:87–97. 112 Volek JS, Noakes T, Phinney SD. Rethinking fat as a fuel for endurance exercise. Eur J
86 Russell M, Sparkes W, Northeast J, et al. Changes in acceleration and deceleration Sport Sci 2015;15:13–20.
capacity throughout professional soccer Match-Play. J Strength Cond Res 113 Burke LM, Ross ML, Garvican-Lewis LA, et al. Low carbohydrate, high fat diet impairs
2016;30:2839–44. exercise economy and negates the performance benefit from intensified training in
87 Akenhead R, Harley JA, Tweddle SP. Examining the external training load of an elite race walkers. J Physiol 2017;595:2785–807.
English premier League football team with special reference to acceleration. J 114 Owens DJ, Sharples AP, Polydorou I, et al. A systems-based investigation into vitamin
Strength Cond Res 2016;30:2424–32. D and skeletal muscle repair, regeneration, and hypertrophy. Am J Physiol Endocrinol
88 Anderson L, Orme P, Di Michele R, et al. Quantification of Seasonal-Long physical Metab 2015;309:E1019–31.
load in soccer players with different starting status from the English premier League: 115 He C-S, Handzlik M, Fraser WD, et al. Influence of vitamin D status on respiratory
implications for maintaining squad physical fitness. Int J Sports Physiol Perform infection incidence and immune function during 4 months of winter training in
2016;11:1038–46. endurance sport athletes. Exerc Immunol Rev 2013;19:86–101.
89 Malone JJ, Di Michele R, Morgans R, et al. Seasonal training-load quantification 116 Owens DJ, Allison R, Close GL. Vitamin D and the athlete: current perspectives and
in elite English premier League soccer players. Int J Sports Physiol Perform new challenges. Sports Med 2018;48:3–16.
2015;10:489–97. 117 Close GL, Russell J, Cobley JN, et al. Assessment of vitamin D concentration
90 Bradley PS, Sheldon W, Wooster B, et al. High-Intensity running in English FA premier in non-supplemented professional athletes and healthy adults during the
League soccer matches. J Sports Sci 2009;27:159–68. winter months in the UK: implications for skeletal muscle function. J Sports Sci
91 Di Salvo V, Baron R, González-Haro C, et al. Sprinting analysis of elite soccer 2013;31:344–53.
players during European champions League and UEFA cup matches. J Sports Sci 118 Morton JP, Iqbal Z, Drust B, et al. Seasonal variation in vitamin D status in
2010;28:1489–94. professional soccer players of the English premier League. Appl Physiol Nutr Metab
92 Morgans R, Orme P, Anderson L, et al. An intensive winter fixture schedule induces 2012;37:798–802.
a transient fall in salivary IgA in English premier League soccer players. Res Sports 119 Clark M, Reed DB, Crouse SF, et al. Pre- and post-season dietary intake, body
Med 2014;22:346–54. composition, and performance indices of NCAA division I female soccer players. Int J
93 Milsom J, Naughton R, O’Boyle A, et al. Body composition assessment of English Sport Nutr Exerc Metab 2003;13:303–19.
premier League soccer players: a comparative DXA analysis of first team, U21 and 120 Gibson JC, Stuart-Hill L, Martin S, et al. Nutrition status of junior elite Canadian
U18 squads. J Sports Sci 2015;33:1799–806. female soccer athletes. Int J Sport Nutr Exerc Metab 2011;21:507–14.
94 Milsom J, Barreira P, Burgess DJ, et al. Case study: Muscle atrophy and hypertrophy 121 Vieth R, Bischoff-Ferrari H, Boucher BJ, et al. The urgent need to recommend an
in a premier league soccer player during rehabilitation from ACL injury. Int J Sport intake of vitamin D that is effective. Am J Clin Nutr 2007;85:649–50.
Nutr Exerc Metab 2014;24): :543–52. 122 Owens DJ, Tang JCY, Bradley WJ, et al. Efficacy of high-dose vitamin D supplements
95 Enright K, Morton J, Iga J, et al. Implementing concurrent-training and nutritional for elite athletes. Med Sci Sports Exerc 2017;49:349–56.
strategies in professional football: a complex challenge for coaches and practitioners. 123 Beard J, Tobin B. Iron status and exercise. Am J Clin Nutr 2000;72:594S–7.
Science and Medicine in Football 2017;1:65–73. 124 McClung JP, Gaffney-Stomberg E, Lee JJ. Female athletes: a population at risk of
96 Enright K, Morton J, Iga J, et al. The effect of concurrent training organisation in vitamin and mineral deficiencies affecting health and performance. J Trace Elem Med
youth elite soccer players. Eur J Appl Physiol 2015;115:2367–81. Biol 2014;28:388–92.
97 Jeong T-S, Bartlett JD, Joo C-H, et al. Acute simulated soccer-specific training 125 Woodson RD, Wills RE, Lenfant C. Effect of acute and established anemia on O2
increases PGC-1α mRNA expression in human skeletal muscle. J Sports Sci transport at rest, submaximal and maximal work. J Appl Physiol Respir Environ Exerc
2015;33:1493–503. Physiol 1978;44:36–43.

Consensus statement
126 Bruinvels G, Burden R, Brown N, et al. The prevalence and impact of heavy 160 Carling C, Orhant E. Variation in body composition in professional soccer players:
menstrual bleeding (menorrhagia) in elite and Non-Elite athletes. PLoS One interseasonal and intraseasonal changes and the effects of exposure time and player
2016;11:e0149881. position. J Strength Cond Res 2010;24:1332–9.
127 Pedlar CR, Brugnara C, Bruinvels G, et al. Iron balance and iron supplementation for 161 Hind K, Slater G, Oldroyd B, et al. Interpretation of dual-energy X-ray
the female athlete: a practical approach. Eur J Sport Sci 2018;18:295–305. Absorptiometry-Derived body composition change in athletes: a review and
128 Sim M, Garvican-Lewis LA, Cox GR, et al. Iron considerations for the athlete: a recommendations for best practice. J Clin Densitom 2018;21:429–43.
narrative review. Eur J Appl Physiol 2019;119:1463–78. 162 Thurlow S, Oldroyd B, Hind K. Effect of hand positioning on DXA total and regional
129 Clement DB, Sawchuk LL. Iron status and sports performance. Sports Medicine bone and body composition parameters, precision error, and least significant change.
1984;1:65–74. J Clin Densitom 2018;21:375–82.
130 Knovich MA, Storey JA, Coffman LG, et al. Ferritin for the clinician. Blood Rev 163 Mendes AP CP, Teixeira VHvan Dijk CN NP, Cohen M, DELLA Villa S, et al, eds.
2009;23:95–104. Nutritional guidelines for football players, in injuries and health problems
131 Shaskey DJ, Green GA. Sports haematology. Sports Med 2000;29:27–38. in football: what everyone should know. Springer Berlin Heidelberg,
132 Sundgot-Borgen J, Torstveit MK. The female football player, disordered eating, 2017: 595–606.
menstrual function and bone health. Br J Sports Med 2007;41 Suppl 1:i68–72. 164 Sutton L, Stewart A. Body composition in sport, exercise and health. Abingdon:
133 Kitchin B. Nutrition counseling for patients with osteoporosis: a personal approach. J Routledge, 2012.
Clin Densitom 2013;16:426–31. 165 Bilsborough JC, Greenway K, Opar D, et al. The accuracy and precision of DXA for
134 Barry DW, Hansen KC, van Pelt RE, et al. Acute calcium ingestion attenuates assessing body composition in team sport athletes. J Sports Sci 2014;32:1821–8.
exercise-induced disruption of calcium homeostasis. Med Sci Sports Exerc 166 Nuñez FJ, Munguia-Izquierdo D, Petri C, et al. Field methods to estimate fat-free
2011;43:617–23. mass in international soccer players. Int J Sports Med 2019;40:619–24.
135 Barry DW, Kohrt WM. Acute effects of 2 hours of moderate-intensity cycling on 167 Núñez FJ, Munguía-Izquierdo D, Suárez-Arrones L. Validity of field methods to
serum parathyroid hormone and calcium. Calcif Tissue Int 2007;80:359–65. estimate fat-free mass changes throughout the season in elite youth soccer players.
136 Haakonssen EC, Ross ML, Knight EJ, et al. The effects of a calcium-rich pre-exercise Front Physiol 2020;11:16.
meal on biomarkers of calcium homeostasis in competitive female cyclists: a 168 Avlonitou E, Georgiou E, Douskas G, et al. Estimation of body composition in
randomised crossover trial. PLoS One 2015;10:e0123302. competitive swimmers by means of three different techniques. Int J Sports Med
137 Foley KF, Boccuzzi L. Urine calcium: laboratory measurement and clinical utility. Lab 1997;18:363–8.
Med 2010;41:683–6. 169 Esco MR, Olson MS, Williford HN, et al. The accuracy of hand-to-hand bioelectrical
138 Pollock N, Chakraverty R, Taylor I, et al. An 8-year Analysis of Magnesium Status in impedance analysis in predicting body composition in college-age female athletes. J
Elite International Track & Field Athletes. J Am Coll Nutr 2020;39:443–9. Strength Cond Res 2011;25:1040–5.
139 Schwellnus M, Soligard T, Alonso J-M, et al. How much is too much? (Part 2) 170 Stewart AD, Hannan WJ. Prediction of fat and fat-free mass in male athletes using
International Olympic Committee consensus statement on load in sport and risk of dual X-ray absorptiometry as the reference method. J Sports Sci 2000;18:263–74.
illness. Br J Sports Med 2016;50:1043–52. 171 Clark RR, Sullivan JC, Bartok CJ, et al. DXA provides a valid minimum weight in
140 Walsh NP. Recommendations to maintain immune health in athletes. Eur J Sport Sci wrestlers. Med Sci Sports Exerc 2007;39:2069–75.
2018;18:820–31. 172 Wang Z, Heymsfield SB, Chen Z, et al. Estimation of percentage body fat by dual-
141 Bjørneboe J, Kristenson K, Waldén M, et al. Role of illness in male professional energy x-ray absorptiometry: evaluation by in vivo human elemental composition.
football: not a major contributor to time loss. Br J Sports Med 2016;50:699–702. Phys Med Biol 2010;55:2619–35.
142 Drew MK, Vlahovich N, Hughes D, et al. A multifactorial evaluation of illness risk 173 Leão C, Simões M, Silva B, et al. Body composition evaluation issue among young
factors in athletes preparing for the summer Olympic Games. J Sci Med Sport elite football players: DXA assessment. Sports 2017;5:17.
2017;20:745–50. 174 Tinsley GM, Morales E, Forsse JS, et al. Impact of acute dietary manipulations on
143 Gabbett TJ, Whyte DG, Hartwig TB, et al. The relationship between workloads, DXA and BIA body composition estimates. Med Sci Sports Exerc 2017;49:823–32.
physical performance, injury and illness in adolescent male football players. Sports 175 Ackland TR, Lohman TG, Sundgot-Borgen J, et al. Current status of body
Med 2014;44:989–1003. composition assessment in sport: review and position statement on behalf
144 Needleman I, Ashley P, Meehan L, et al. Poor oral health including active caries in of the AD hoc research Working group on body composition health and
187 UK professional male football players: clinical dental examination performed by performance, under the auspices of the I.O.C. Medical Commission. Sports Med
dentists. Br J Sports Med 2016;50:41–4. 2012;42:227–49.
145 Bermon S, Castell LM, Calder PC, et al. Consensus statement immunonutrition and 176 Milanese C, Cavedon V, Corradini G, et al. Seasonal DXA-measured body
exercise. Exerc Immunol Rev 2017;23:8–50. composition changes in professional male soccer players. J Sports Sci
146 Gleeson M. Immunological aspects of sport nutrition. Immunol Cell Biol 2015;33:1219–28.
2016;94:117–23. 177 Devlin BL, Kingsley M, Leveritt MD, et al. Seasonal changes in soccer players’ body
147 Wu G. Dietary protein intake and human health. Food Funct 2016;7:1251–65. composition and dietary intake practices. J Strength Cond Res 2017;31:3319–26.
148 Witard OC, Turner JE, Jackman SR, et al. High dietary protein restores overreaching 178 Nattiv A, Loucks AB, Manore MM, et al. American College of sports medicine
induced impairments in leukocyte trafficking and reduces the incidence of upper position stand. the female athlete triad. Med Sci Sports Exerc 2007;39:1867–82.
respiratory tract infection in elite cyclists. Brain Behav Immun 2014;39:211–9. 179 Mountjoy M, Sundgot-Borgen J, Burke L, et al. International Olympic Committee
149 Singh M, Das RR. Zinc for the common cold. Cochrane Database Syst Rev (IOC) consensus statement on relative energy deficiency in sport (RED-S): 2018
2013;6:CD001364. update. Int J Sport Nutr Exerc Metab 2018;28:316–31.
150 Nieman DC, Henson DA, Austin MD, et al. Upper respiratory tract infection is reduced 180 Sundgot-Borgen J, Meyer NL, Lohman TG, et al. How to minimise the health risks
in physically fit and active adults. Br J Sports Med 2011;45:987–92. to athletes who compete in weight-sensitive sports review and position statement
151 Nieman DC, Henson DA, Gross SJ, et al. Quercetin reduces illness but not immune on behalf of the AD hoc research Working group on body composition, health and
perturbations after intensive exercise. Med Sci Sports Exerc 2007;39:1561–9. performance, under the auspices of the IOC medical Commission. Br J Sports Med
152 Somerville VS, Braakhuis AJ, Hopkins WG. Effect of flavonoids on upper respiratory 2013;47:1012–22.
tract infections and immune function: a systematic review and meta-analysis. Adv 181 Reed JL, De Souza MJ, Kindler JM, et al. Nutritional practices associated
Nutr 2016;7:488–97. with low energy availability in division I female soccer players. J Sports Sci
153 Scherr J, Nieman DC, Schuster T, et al. Nonalcoholic beer reduces inflammation and 2014;32:1499–509.
incidence of respiratory tract illness. Med Sci Sports Exerc 2012;44:18–26. 182 Burke LM, Lundy B, Fahrenholtz IL, et al. Pitfalls of conducting and interpreting
154 Pyne DB, West NP, Cox AJ, et al. Probiotics supplementation for athletes - clinical and estimates of energy availability in free-living athletes. Int J Sport Nutr Exerc Metab
physiological effects. Eur J Sport Sci 2015;15:63–72. 2018;28:350–63.
155 Hao Q, Dong BR, Wu T. Probiotics for preventing acute upper respiratory tract 183 Prather H, Hunt D, McKeon K, et al. Are elite female soccer athletes at risk for
infections. Cochrane Database Syst Rev 2015;2:CD006895. disordered eating attitudes, menstrual dysfunction, and stress fractures? PM&R
156 Suarez-Arrones L, Lara-Lopez P, Maldonado R, et al. The effects of detraining and 2016;8:208–13.
retraining periods on fat-mass and fat-free mass in elite male soccer players. PeerJ 184 Heikura IA, Uusitalo ALT, Stellingwerff T, et al. Low energy availability is difficult
2019;7:e7466. to assess but outcomes have large impact on bone injury rates in elite distance
157 Silva JR, Brito J, Akenhead R, et al. The transition period in soccer: a window of athletes. Int J Sport Nutr Exerc Metab 2018;28:403–11.
opportunity. Sports Med 2016;46:305–13. 185 Garvican LA, Hammond K, Varley MC, et al. Lower running performance and
158 Sutton L WJ, Scott M, Reilly T. Body composition of international-and club level exacerbated fatigue in soccer played at 1600 M. Int J Sports Physiol Perform
professional soccer players measured by dual-energy x-ray absorptiometry (DXA).. In: 2014;9:397–404.
Reilly, G TA, ed. Contemporary Sport, Leisure and Ergonomics. Routledge, 2008. 186 Mohr M, Nybo L, Grantham J, et al. Physiological responses and physical
159 Anderson L, Close GL, Konopinski M, et al. Case study: muscle atrophy, hypertrophy, performance during football in the heat. PLoS One 2012;7:e39202.
and energy expenditure of a premier League soccer player during rehabilitation from 187 Armstrong LE. Nutritional strategies for football: counteracting heat, cold, high
anterior cruciate ligament injury. Int J Sport Nutr Exerc Metab 2019;29:559–66. altitude, and jet lag. J Sports Sci 2006;24:723–40.

Consensus statement
188 Waterhouse J, Kao S, Edwards B, et al. Transient changes in the pattern of food 220 Lis DM, Stellingwerff T, Shing CM, et al. Exploring the popularity, experiences, and
intake following a simulated time-zone transition to the East across eight time beliefs surrounding gluten-free diets in nonceliac athletes. Int J Sport Nutr Exerc
zones. Chronobiol Int 2005;22:299–319. Metab 2015;25:37–45.
189 Judelson DA, Maresh CM, Anderson JM, et al. Hydration and muscular performance: 221 Lis D, Stellingwerff T, Kitic CM, et al. No effects of a short-term gluten-free diet on
does fluid balance affect strength, power and high-intensity endurance? Sports Med performance in Nonceliac athletes. Med Sci Sports Exerc 2015;47:2563–70.
2007;37:907–21. 222 Biesiekierski JR, Iven J. Non-coeliac gluten sensitivity: piecing the puzzle together.
190 Galloway SD, Maughan RJ. Effects of ambient temperature on the capacity to United European Gastroenterol J 2015;3:160–5.
perform prolonged cycle exercise in man. Med Sci Sports Exerc 1997;29:1240–9. 223 Meyer N, Reguant-Closa A. “Eat as If You Could Save the Planet and Win!”
191 Maughan RJ, Otani H, Watson P. Influence of relative humidity on prolonged exercise Sustainability Integration into Nutrition for Exercise and Sport. Nutrients
capacity in a warm environment. Eur J Appl Physiol 2012;112:2313–21. 2017;9:412.
192 Otani H, Kaya M, Tamaki A, et al. Air velocity influences thermoregulation and 224 Leahy EL, Tol, SJ S. An estimate of the number of vegetarians in the world. The
endurance exercise capacity in the heat. Appl Physiol Nutr Metab 2018;43:131–8. Economic and Social Research Institute 2010;340.
193 Otani H, Kaya M, Tamaki A, et al. Effects of solar radiation on endurance exercise 225 Pelly FE, Burkhart SJ. Dietary regimens of athletes competing at the Delhi 2010
capacity in a hot environment. Eur J Appl Physiol 2016;116:769–79. Commonwealth games. Int J Sport Nutr Exerc Metab 2014;24:28–36.
194 Racinais S, Alonso JM, Coutts AJ, et al. Consensus recommendations on training and 226 Melina V, Craig W, Levin S. Position of the Academy of nutrition and dietetics:
competing in the heat. Br J Sports Med 2015;49:1164–73. vegetarian diets. J Acad Nutr Diet 2016;116:1970–80.
195 Shirreffs SM, Sawka MN. Fluid and electrolyte needs for training, competition, and 227 Craddock JC, Probst YC, Peoples GE. Vegetarian and omnivorous Nutrition—
recovery. J Sports Sci 2011;29 Suppl 1:S39–46. Comparing physical performance. Int J Sport Nutr Exerc Metab 2016;26:212–20.
196 Burdon CA, Johnson NA, Chapman PG, et al. Influence of beverage temperature on 228 Guddat S, Fußhöller G, Geyer H, et al. Clenbuterol - regional food contamination a
Palatability and fluid ingestion during endurance exercise: a systematic review. Int J possible source for inadvertent doping in sports. Drug Test Anal 2012;4:534–8.
Sport Nutr Exerc Metab 2012. 229 Thevis M, Schänzer W, Geyer H, et al. Traditional Chinese medicine and
197 Lee JKW, Shirreffs SM, Maughan RJ. Cold drink ingestion improves exercise sports drug testing: identification of natural steroid administration in doping
endurance capacity in the heat. Med Sci Sports Exerc 2008;40:1637–44. control urine samples resulting from MuSK (pod) extracts. Br J Sports Med
198 Armstrong LE, Case DJ. Methods to evaluate electrolyte and water turnover of 2013;47:109–14.
athletes. Athletic Training & Sport Health Care 2009;4:169–79. 230 WADA. The World Anti-Doping Code 2015 with 2019 amendments, 2019. Available:
199 Gebhardt SEaT. Nutritive value of foods, 2002. Available: https://naldc.nal.usda.gov/ https://www.wada-ama.org/en/what-we-d o/the-code [Accessed 1 Aug 2019].
download/C AT11131126/PDF 231 Garthe I, Maughan RJ. Athletes and supplements: prevalence and perspectives. Int J
200 Ganio MS, Armstrong LE, Kavouras SA. Hydration. In: Casa D, Stearns RL, eds. Sport Nutr Exerc Metab 2018;28:126–38.
Hydration, in sport and physical activity in the heat: maximizing performance and 232 Maughan RJ, Burke LM, Dvorak J, et al. IOC consensus statement: dietary
safety. New York, NY: Springer Nature, 2018: 83–100. supplements and the high-performance athlete. Int J Sport Nutr Exerc Metab
201 Aughey RJ, Hammond K, Varley MC, et al. Soccer activity profile of altitude versus 2018;28:104–25.
sea-level natives during acclimatisation to 3600 M (ISA3600). Br J Sports Med 233 Aljaloud SO, Ibrahim SA. Use of dietary supplements among professional athletes in
2013;47 Suppl 1:i107–13. Saudi Arabia. J Nutr Metab 2013;2013:1–7.
202 Roberts AC, Butterfield GE, Cymerman A, et al. Acclimatization to 4,300-m altitude 234 Tscholl P, Junge A, Dvorak J. The use of medication and nutritional supplements
decreases reliance on fat as a substrate. J Appl Physiol 1996;81:1762–71. during FIFA world CUPS 2002 and 2006. Br J Sports Med 2008;42:725–30.
203 Koehle MS, Cheng I, Sporer B. Canadian Academy of sport and exercise medicine 235 Mettler S, Zimmermann MB. Iron excess in recreational marathon runners. Eur J Clin
position statement: athletes at high altitude. Clin J Sport Med 2014;24:120–7. Nutr 2010;64:490–4.
204 Gore CJ, Rodríguez FA, Truijens MJ, et al. Increased serum erythropoietin but not red 236 Sousa M, Fernandes MJ, Carvalho P, et al. Nutritional supplements use in high-
cell production after 4 wk of intermittent hypobaric hypoxia (4,000-5,500 M). J Appl performance athletes is related with lower nutritional inadequacy from food. J Sport
Physiol 2006;101:1386–93. Health Sci 2016;5:368–74.
205 Gore CJ, McSharry PE, Hewitt AJ, et al. Preparation for football competition at 237 Geyer H, Parr MK, Mareck U, et al. Analysis of non-hormonal nutritional supplements
moderate to high altitude. Scand J Med Sci Sports 2008;18 Suppl 1:85–95. for anabolic-androgenic steroids - results of an international study. Int J Sports Med
206 Fowler PM, Knez W, Crowcroft S, et al. Greater effect of East versus West travel on 2004;25:124–9.
jet lag, sleep, and team sport performance. Med Sci Sports Exerc 2017;49:2548–61. 238 HFL. Supplements and banned substance contamination: Offering and informed
207 Fowler P, Duffield R, Howle K, et al. Effects of northbound long-haul international air choice, 2007. Available: https://www.informed-sport.com/ [Accessed 16 Apr 2018].
travel on sleep quantity and subjective jet lag and wellness in professional Australian 239 Mathews NM. Prohibited contaminants in dietary supplements. Sports Health
soccer players. Int J Sports Physiol Perform 2015;10:648–54. 2018;10:19–30.
208 Medical guidelines for air travel. aerospace Medical association, air transport 240 Cohen PA, Travis JC, Keizers PHJ, et al. Four experimental stimulants found in
medicine Committee, Alexandria, Va. Aviat Space Environ Med 1996;67:1–6. sports and weight loss supplements: 2-amino-6-methylheptane (octodrine),
209 Cardinali DP, Bortman GP, Liotta G, et al. A multifactorial approach employing 1,4-dimethylamylamine (1,4-DMAA), 1,3-dimethylamylamine (1,3-D MAA) and
melatonin to accelerate resynchronization of sleep-wake cycle after a 12 time-zone 1,3-dimethylbutylamine (1,3-D MBA). Clin Toxicol 2018;56:421–6.
westerly transmeridian flight in elite soccer athletes. J Pineal Res 2002;32:41–6. 241 Geyer H, Braun H, Burke LM, et al. A-Z of nutritional supplements: dietary
210 Piérard C, Beaumont M, Enslen M, et al. Resynchronization of hormonal rhythms supplements, sports nutrition foods and ergogenic aids for health and performance--
after an eastbound flight in humans: effects of slow-release caffeine and melatonin. Part 22. Br J Sports Med 2011;45:752–4.
Eur J Appl Physiol 2001;85:144–50. 242 Geyer H. Adulterated nutritional supplements and unapproved pharmaceuticals as
211 Halson SL, Burke LM, Pearce J. Nutrition for travel: from jet lag to catering. Int J Sport new sources of doping substances for fitness and recreational sports. In: Ahmadi N
Nutr Exerc Metab 2019;29:228–35. LA, Göran S, eds. Doping and public health. London, UK: Routledge, 2016: 64–70.
212 Poli LRaRB. Foreign players in football teams, 2016. Available: http://www.football- 243 Thevis M, Krug O, Piper T, et al. Solutions Advertised as erythropoiesis-stimulating
observatory.c om/IMG/pdf/mr12_eng.pdf [Accessed 12 Sep 2019]. products were found to contain undeclared cobalt and nickel species. Int J Sports
213 Miller T. Mapping the global Muslim population: A report on the size and distribution Med 2016;37:82–4.
of the world’s Muslim population, 2009. Available: http://www.pewforum.o rg/ 244 Thevis M, Geyer L, Geyer H, et al. Adverse analytical findings with clenbuterol
newassets/images/reports/Muslimpopulation/Muslimpopulation.pdf [Accessed 12 among U-17 soccer players attributed to food contamination issues. Drug Test Anal
Aug 2017]. 2013;5:372–6.
214 Abaïdia A-E, Daab W, Bouzid MA. Effects of Ramadan fasting on physical 245 Maughan RJ, Shirreffs SM, Vernec A. Making decisions about supplement use. Int J
performance: a systematic review with meta-analysis. Sports Med Sport Nutr Exerc Metab 2018;28:212–9.
2020;50:1009–26. 246 Curtis L. Nutritional research may be useful in treating tendon injuries. Nutrition
215 Maughan RJ, Zerguini Y, Chalabi H, et al. Ramadan and football. J Sports Sci 2012;30 2016;32:617–9.
Suppl 1. 247 Demling RH. Nutrition, anabolism, and the wound healing process: an overview.
216 Maughan RJ, Zerguini Y, Chalabi H, et al. Achieving optimum sports performance Eplasty 2009;9:e9.
during Ramadan: some practical recommendations. J Sports Sci 2012;30 Suppl 248 Pasini E, Aquilani R, Dioguardi FS, et al. Hypercatabolic syndrome: molecular
1:S109–17. basis and effects of nutritional supplements with amino acids. Am J Cardiol
217 Schäfer T, Böhler E, Ruhdorfer S, et al. Epidemiology of food allergy/food intolerance 2008;101:S11–15.
in adults: associations with other manifestations of atopy. Allergy 2001;56:1172–9. 249 Bell PG, McHugh MP, Stevenson E, et al. The role of cherries in exercise and health.
218 Lis DM, Kings D, Larson-Meyer DE. Dietary practices adopted by Track-and-Field Scand J Med Sci Sports 2014;24:477–90.
athletes: gluten-free, low FODMAP, vegetarian, and fasting. Int J Sport Nutr Exerc 250 Lin E, Kotani JG, Lowry SF. Nutritional modulation of immunity and the inflammatory
Metab 2019;29:236–45. response. Nutrition 1998;14:545–50.
219 Turnbull JL, Adams HN, Gorard DA. Review article: the diagnosis and management of 251 Tipton KD. Nutritional support for exercise-induced injuries. Sports Med 2015;45
food allergy and food intolerances. Aliment Pharmacol Ther 2015;41:3–25. Suppl 1:93–104.

Consensus statement
252 Wall BT, Snijders T, Senden JMG, et al. Disuse impairs the muscle protein 283 Hannon MP, Carney DJ, Floyd S, et al. Cross-Sectional comparison of body
synthetic response to protein ingestion in healthy men. J Clin Endocrinol Metab composition and resting metabolic rate in premier League Academy soccer players:
2013;98:4872–81. implications for growth and maturation. J Sports Sci 2020;38:1326–34.
253 Rittweger J, Winwood K, Seynnes O, et al. Bone loss from the human distal 284 Hannon MP, Parker LJF, Carney DJ, et al. Energy requirements of male academy
tibia epiphysis during 24 days of unilateral lower limb suspension. J Physiol soccer players from the English Premier League. Medicine and Science in Sports and
2006;577:331–7. Exercise 2020;Online ahead of print.
254 de Boer MD, Maganaris CN, Seynnes OR, et al. Time course of muscular, neural and 285 Desbrow B, McCormack J, Burke LM, et al. Sports dietitians Australia position
tendinous adaptations to 23 day unilateral lower-limb suspension in young men. J statement: sports nutrition for the adolescent athlete. Int J Sport Nutr Exerc Metab
Physiol 2007;583:1079–91. 2014;24:570–84.
255 Dideriksen K, Boesen AP, Reitelseder S, et al. Tendon collagen synthesis declines with 286 Henderson B, Cook J, Kidgell DJ, et al. Game and training load differences in elite
immobilization in elderly humans: no effect of anti-inflammatory medication. J Appl junior Australian football. J Sports Sci Med 2015;14:494–500.
Physiol 2017;122:273–82. 287 Devlin BL, Leveritt MD, Kingsley M, et al. Dietary intake, body composition,
256 Biolo G, Agostini F, Simunic B, et al. Positive energy balance is associated with and nutrition knowledge of Australian football and soccer players: implications
accelerated muscle atrophy and increased erythrocyte glutathione turnover during 5 for sports nutrition professionals in practice. Int J Sport Nutr Exerc Metab
wk of bed rest. Am J Clin Nutr 2008;88:950–8. 2017;27:130–8.
257 Paddon-Jones D, Sheffield-Moore M, Urban RJ, et al. Essential amino acid and 288 Naughton RJ, Drust B, O’Boyle A, et al. Daily distribution of carbohydrate, protein
carbohydrate supplementation ameliorates muscle protein loss in humans during 28 and fat intake in elite youth Academy soccer players over a 7-day training period. Int
days bedrest. J Clin Endocrinol Metab 2004;89:4351–8. J Sport Nutr Exerc Metab 2016;26:473–80.
258 Stuart CA, Shangraw RE, Peters EJ, et al. Effect of dietary protein on bed-rest-related 289 Timmons BW, Bar-Or O, Riddell MC. Influence of age and pubertal status on
changes in whole-body-protein synthesis. Am J Clin Nutr 1990;52:509–14. substrate utilization during exercise with and without carbohydrate intake in healthy
259 Rodríguez Rodríguez F, Delgado Ormeño A, Rivera Lobos P, et al. [Effects of ß-alanine boys. Appl Physiol Nutr Metab 2007;32:416–25.
supplementation on wingate tests in university female footballers]. Nutr Hosp 290 Leites GT, Cunha GS, Chu L, et al. Energy substrate utilization with and without
2014;31:430–5. exogenous carbohydrate intake in boys and men exercising in the heat. J Appl
260 Smith GI, Atherton P, Reeds DN, et al. Dietary omega-3 fatty acid supplementation Physiol 2016;121:1127–34.
increases the rate of muscle protein synthesis in older adults: a randomized 291 Gidding SS, Dennison BA, Birch LL, et al. Dietary recommendations for children and
controlled trial. Am J Clin Nutr 2011;93:402–12. adolescents: a guide for practitioners: consensus statement from the American heart
261 Deutz NEP, Pereira SL, Hays NP, et al. Effect of β-hydroxy-β-methylbutyrate association. Circulation 2005;112:2061–75.
(HMB) on lean body mass during 10 days of bed rest in older adults. Clin Nutr 292 Sonneville KR, Gordon CM, Kocher MS, et al. Vitamin D, calcium, and dairy
2013;32:704–12. intakes and stress fractures among female adolescents. Arch Pediatr Adolesc Med
262 Adams CM, Ebert SM, Dyle MC. Use of mRNA expression signatures to discover 2012;166:595–600.
small molecule inhibitors of skeletal muscle atrophy. Curr Opin Clin Nutr Metab Care 293 Wilk B, Meyer F, Bar-Or O, et al. Mild to moderate hypohydration reduces boys’ high-
2015;18:263–8. intensity cycling performance in the heat. Eur J Appl Physiol 2014;114:707–13.
263 Babraj JA, Smith K, Cuthbertson DJR, et al. Human bone collagen synthesis is a 294 Dougherty KA, Baker LB, Chow M, et al. Two percent dehydration impairs and six
rapid, nutritionally modulated process. J Bone Miner Res 2005;20:930–7.
percent carbohydrate drink improves boys basketball skills. Med Sci Sports Exerc
264 Townsend R, Elliott-Sale KJ, Currell K, et al. The effect of postexercise carbohydrate
2006;38:1650–8.
and protein ingestion on bone metabolism. Med Sci Sports Exerc 2017;49:1209–18.
295 Council on Sports Medicine and Fitness and Council on School Health, Bergeron MF,
265 Farup J, Rahbek SK, Vendelbo MH, et al. Whey protein hydrolysate augments tendon
Devore C, et al. Policy statement—Climatic heat stress and exercising children and
and muscle hypertrophy independent of resistance exercise contraction mode. Scand
adolescents. Pediatrics 2011;128:p. e741–7.
J Med Sci Sports 2014;24:788–98.
296 Decher NR, Casa DJ, Yeargin SW, et al. Hydration status, knowledge, and behavior in
266 Shaw G, Lee-Barthel A, Ross ML, et al. Vitamin C-enriched gelatin supplementation
youths at summer sports camps. Int J Sports Physiol Perform 2008;3:262–78.
before intermittent activity augments collagen synthesis. Am J Clin Nutr
297 Ersoy N, Ersoy G, Kutlu M. Assessment of hydration status of elite young male soccer
2017;105:136–43.
players with different methods and new approach method of substitute urine strip. J
267 Ekstrand J, Krutsch W, Spreco A, et al. Time before return to play for the most
Int Soc Sports Nutr 2016;13:34.
common injuries in professional football: a 16-year follow-up of the UEFA elite Club
298 Meyer F VK, Timmons BW, Wilk B. Fluid balance and dehydration in the young
injury study. Br J Sports Med 2020;54:421–6.
athlete: assessment considerations and effects on health and performance. American
268 Castagna C, Abt G, D’Ottavio S. Physiological aspects of soccer refereeing
Journal of Lifestyle Medicine 2012;6:489–501.
performance and training. Sports Med 2007;37:625–46.
269 D’Ottavio S CC. Physiological aspects of soccer refereeing. London, UK: Routledge, 2 99 Herriman M, Fletcher L, Tchaconas A, et al. Dietary supplements and
2002. young teens: misinformation and access provided by Retailers. Pediatrics
270 da Silva AI, Fernandes LC, Fernandez R. Energy expenditure and intensity of physical 2017;139:e20161257.
activity in soccer Referees during match-play. J Sports Sci Med 2008;7:327–34. 300 Manore MM, Patton-Lopez MM, Meng Y, et al. Sport nutrition knowledge, behaviors
271 Weston M, Castagna C, Impellizzeri FM, et al. Science and medicine applied to and beliefs of high school soccer players. Nutrients 2017;9:350.
soccer refereeing: an update. Sports Med 2012;42:615–31. 3 01 Gant N, Ali A, Foskett A. The influence of caffeine and carbohydrate
272 Stølen T, Chamari K, Castagna C, et al. Physiology of soccer: an update. Sports Med coingestion on simulated soccer performance. Int J Sport Nutr Exerc Metab
2005;35:501–36. 2010;20:191–7.
273 Reilly T, Gregson W. Special populations: the referee and assistant referee. J Sports 3 02 Kingsley M, Penas-R uiz C, Terry C, et al. Effects of carbohydrate-h ydration
Sci 2006;24:795–801. strategies on glucose metabolism, sprint performance and hydration
274 Schenk K, Bizzini M, Gatterer H. Exercise physiology and nutritional perspectives of during a soccer match simulation in recreational players. J Sci Med Sport
elite soccer refereeing. Scand J Med Sci Sports 2018;28:782–93. 2014;17:239–43.
275 Riddell MC. The endocrine response and substrate utilization during exercise in 303 Burke LM. Caffeine and sports performance. Appl Physiol Nutr Metab
children and adolescents. J Appl Physiol 2008;105:725–33. 2008;33:1319–34.
276 Briggs MA, Cockburn E, Rumbold PLS, et al. Assessment of energy intake and energy 304 Mielgo-Ayuso J, Calleja-Gonzalez J, Del Coso J, et al. Caffeine supplementation and
expenditure of male adolescent Academy-Level soccer players during a competitive physical performance, muscle damage and perception of fatigue in soccer players: a
week. Nutrients 2015;7:8392–401. systematic review. Nutrients 2019;11:440.
277 Briggs MA, Rumbold PLS, Cockburn E, et al. Agreement between two methods of 305 Peeling P, Binnie MJ, Goods PSR, et al. Evidence-Based supplements for
dietary data collection in male adolescent Academy-Level soccer players. Nutrients the enhancement of athletic performance. Int J Sport Nutr Exerc Metab
2015;7:5948–60. 2018;28:178–87.
278 Ruiz F, Irazusta A, Gil S, et al. Nutritional intake in soccer players of different ages. J 306 Maganaris CN, Maughan RJ. Creatine supplementation enhances maximum
Sports Sci 2005;23:235–42. voluntary isometric force and endurance capacity in resistance trained men. Acta
279 Russell M, Pennock A. Dietary analysis of young professional soccer players for 1 Physiol Scand 1998;163:279–87.
week during the competitive season. J Strength Cond Res 2011;25:1816–23. 307 Rawson ES, Stec MJ, Frederickson SJ, et al. Low-Dose creatine supplementation
280 Braun H, von Andrian-Werburg J, Schänzer W, et al. Nutrition status of young elite enhances fatigue resistance in the absence of weight gain. Nutrition
female German football players. Pediatr Exerc Sci 2018;30:157–67. 2011;27:451–5.
281 Martin L, Lambeth A, Scott D. Nutritional practices of national female soccer players: 308 Rawson ES PA. Mechanisms of muscular adaptations to creatine supplementation:
analysis and recommendations. J Sports Sci Med 2006;5:130–7. review article. International Journal of Sports Medicine 2007;8:43–53.
282 Varley I, Hughes DC, Greeves JP, et al. Increased training volume improves 309 Dolan E, Gualano B, Rawson ES. Beyond muscle: the effects of creatine
bone density and cortical area in adolescent football players. Int J Sports Med supplementation on brain creatine, cognitive processing, and traumatic brain injury.
2017;38:341–6. Eur J Sport Sci 2019;19:1–14.

Consensus statement
3 10 Cancela P, Ohanian C, Cuitiño E, et al. Creatine supplementation does 313 Kelly V. β-alanine: performance effects, usage and side effects. Br J Sports Med
not affect clinical health markers in football players. Br J Sports Med 2018;52:311–2.
2008;42:731–5. 314 Harris RC, Tallon MJ, Dunnett M, et al. The absorption of orally supplied beta-alanine
3 11 Harris RC, Söderlund K, Hultman E. Elevation of creatine in resting and and its effect on muscle carnosine synthesis in human vastus lateralis. Amino Acids
exercised muscle of normal subjects by creatine supplementation. Clin Sci 2006;30:279–89.
1992;83:367–74. 315 Nyakayiru J, Jonvik KL, Trommelen J, et al. Beetroot juice supplementation improves
3 12 Roberts PA, Fox J, Peirce N, et al. Creatine ingestion augments dietary high-intensity intermittent type exercise performance in trained soccer players.
carbohydrate mediated muscle glycogen supercompensation during the initial Nutrients 2017;9:314.
24 h of recovery following prolonged exhaustive exercise in humans. Amino 316 Jones AM. Dietary nitrate supplementation and exercise performance. Sports Med
Acids 2016;48:1831–42. 2014;44:35–45.
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UEFA expert group statement on nutrition in elite football. Current evidence

Article in British Journal of Sports Medicine · October 2020

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UEFA expert group statement on nutrition in elite

Collins J, et al. Br J Sports Med 2020;0:1–27. doi:10.1136/bjsports-2019-101961 1

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Table 1 The training carbohydrate intake continuum

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