Nutrition for the young athlete

Flavia Meyer1, Helen O`Connor2, Susan M Shirreffs3

1
Department of Physical Education, ESEF –UFRGS, Porto Alegre, Brazil
2
Exercise and Sport Science, University of Sydney, Sydney, Australia
3
School of Sport and Exercise Sciences, Loughborough University, UK

Corresponding author:
Flavia Meyer
Department of Physical Education
ESEF-UFRGS
Porto Alegre, Brazil

Phone (55) 51 308-5861

E-mail: [email protected]

Running title: nutrition in young athletes

ABSTRACT

Athletics is a popular sport among young people. To maintain health and

optimise growth and athletic performance, young athletes need to consume
an appropriate diet. Unfortunately, the dietary intake of many young athletes
follows population trends rather than public health or sports nutrition
recommendations. To optimise performance in some disciplines, young
athletes may strive to achieve a lower body weight or body fat content and
this may increase their risk for delayed growth and maturation, amenorrhea,
reduced bone density and eating disorders. Although many of the sports
nutrition principles identified for adults are similar for young athletes, there
are some important differences. These include a higher metabolic cost of
locomotion and preferential fat oxidation in young athletes during exercise.
Young athletes, particularity children, are at a thermoregulatory disadvantage
due to a higher surface area to weight ratio, a slower acclimatisation and
lower sweating rate. An appropriate dietary intake rather than use of
supplements (except when clinically indicated) is recommended to ensure
young athletes participate fully and safely in athletics.

Key words: energy, carbohydrate, fat, protein, calcium, iron, hydration

1
INTRODUCTION
Adequate dietary intake is important to maintain health, growth and
maturation as well as to minimise injury and optimise sports performance. An
appropriate diet will help to develop sound dietary habits which follow though
to adulthood and, together with physical activity, reduce the risk for many
lifestyle diseases (Bass and Inge 2006). Optimum diet and exercise in
childhood and adolescence will promote an enjoyable, health promoting and
rewarding experience with athletic participation throughout life. However,
when young athletes are exposed to diet or training regimens that are too
rigorous for their age, level of maturation or individual limits, the benefits of
sports participation may be eliminated or even deleterious (American
Academy of Pediatrics 2001a).

Young athletes differ from adults and their non-athletic peers in important
physiological, metabolic and biomechanical aspects (Bar-Or, 2001). These
differences have implications for their nutritional needs (Table 1). Due to
ethical considerations involving invasive or potentially harmful experimental
research methods, limited information is available on the physiological and
nutritional requirements of young athletes with even less available on each of
the specific disciplines of athletics. This paper will therefore focus on the
most important and unique features of young athletes in general and where
possible use information from athletics disciplines.

Table 1. Nutritional Considerations of Young Athletes

1. Greater protein needs per kilogram body weight to satisfy their
growth requirements
2. Greater calcium needs to support bone accretion
3. Higher metabolic cost of movement per body mass
4. Relatively more fat use during exercise
5. Sweat electrolyte losses differ between children, adolescents, and
adults.
6. Dehydration is more detrimental to children than to adults
Adapted from Bar-Or, 2001

NUTRITION NEEDS FOR THE YOUNG ATHLETE

Energy Requirements, Growth and Maturation
Adequate energy is required to meet the needs for growth, health, body
mass maintenance, daily physical activity and training. Chronic inadequate
energy intake may result in short stature, delayed puberty, menstrual
irregularities, poor bone health and increased risk of injuries (Bass and Inge,
2006). Female adolescents in particular who participate in distance running,
walking and jumping events may be at an increased risk of inadequate
energy intake and disordered eating as a result of their pursuit of a lighter
and leaner physique (Manore, Kam and Loucks, 2007).

Some estimates for energy expenditure in young athletes have been derived
from adult data; however, this approach is flawed as children are less
metabolically efficient (Bar-Or, 2001). Children’s energy requirements per kg
of body mass during walking and running can be as much as 30% higher
than in adults (MacDougall et al., 1983; Krahenbuhl and Williams, 1992).
This may be due to a higher resting energy expenditure (Rowland, 2004),
greater stride frequency (Unnithan and Eston, 1990), differences in kinematic
variables due to knee joint range of motion, variation in total body mechanical
work and power (Unnithan et al., 1999) and more co-contraction of
antagonist leg muscles (Frost et al., 2002). These above mentioned studies
were performed in non-athletic children and it is likely that the energy cost of
locomotion decreases in trained child and adolescent athletes. Regular
training may also increase energy expenditure by mechanisms other than

2
increased training demands. In a study of obese boys, daily energy
expenditure increased by 12% more than estimated from training alone
(Blaak et al., 1992). This has not been systematically studied in young non-
obese athletes but there is some evidence that energy expenditure may be
more than expected (Bolster et al., 2001). When undergoing heavy training, it
is likely that young athletes adapt by conserving energy through increasing
sedentary behaviours during the day (Petrie et al., 2004).

Given these considerations it is difficult to establish a dietary reference intake

(DRI) for energy in young athletes. Most countries provide guidance to
accommodate sedentary through to very active or heavy activity for age and
gender categories but these activity categories are vague and do not
consider the mismatch often observed between chronological age and
maturational development. These reference values can be considered to be
no more than a guide. Monitoring growth, body mass and other
anthropometric variables can help health professionals to assess if energy
intake is adequate for a given young athlete to maintain growth, health and
performance.

Because children are beginning to train and compete at earlier ages, there is
an increasing concern as to whether the energetic demand of athletic training
can have negative effects on growth and maturation. Theintz et al., (1993)
suggested that linear growth in young female gymnasts might be delayed by
the intense training. They followed a cohort of adolescent gymnasts (~22
h/week of training) and swimmers (~8 h/week of training) over 2-3 years. The
gymnasts had a lower growth rate (~5.5 cm/yr) than swimmers (~8.0 cm/yr).
A subsequent study (Theintz, 1994) reported a catch-up growth in the
gymnasts when their training was temporarily decreased or stopped. Such
delayed growth, however, seems more likely to result from inadequate
nutritional practices than from excessive training as increased physical
activity and musculoskeletal stress are, in fact, necessary for optimal growth
(Borer, 1995). Prospective studies of children and adolescents involved in
recreational exercise lasting more than 15 h per week (Bonen, 1992),
strength training twice a week with light to moderate loads (Sandres et al.,
2001), or club-level sports (Fogelholm et al., 2000) show no growth or
maturation impairment. Even competitive sports did not impair pre-pubertal
growth, but individual genetic responses may be important (Damsgaard et
al., 2000). Indeed, an important variable to consider is selection bias. Certain
sports show advantages for the early maturing individuals, especially for
males, and other sports, especially gymnastics and dance, favour the late-
developing female. Gymnasts are shorter, lighter, and have lower percentage
of body fat than their peers from a very young age (Malina, 1994a).

On average, boys who participate in sports have normal growth rates and
maturation (Malina, 1994a). Some are even advanced in maturation since
their increased muscle mass favours power and performance (Malina et al.,
2000). Malina (1994b) reviewed the growth and maturation of young athletes
in various modalities, including track and field. Male distance runners (10-18
years) have heights about the 50th percentile but body mass below.
Sprinters tend to be at or above the 50th percentile, while throwers are
substantially taller and heavier (both around 90th percentile) than all the
others including jumpers (around 50th percentile). Track athletes did not differ
in skeletal maturity from their non-athletic peers. Statures of distance runners
and female sprinters tend to be above the 50th percentile while the mass of
female distance runners is below.

Possibly one of the greatest threats to energy intake is the practice of weight
control in young athletes. If a reduction in body mass is required, it should be
gradual and not more than 1.5% of body mass each week (American
Academy of Paediatrics, 2005). Mass loss to achieve a light and lean

3
physique may be the goal of some athletes, particularly female distance
runners as this is clearly a benefit to performance (O’Connor, Olds, and
Maughan, 2007). However, this also increases the risk for energy deficiency,
menstrual irregularity, bone health and eating disorders. These issues have
been reviewed elsewhere (Manore, Kam and Loucks et al., 2007).

Macronutrient intake
Carbohydrate (CHO)
Glycogen stores are lower in children than in adults (Boisseau and
Delamarche, 2000), and enzymes involved in glycolytic capacity may not be
fully developed. A lower lactate dehydrogenase activity has been observed in
children and may explain their decreased anaerobic capacity and lactate
production (Berg et al., 1986; Kaczor et al., 2005). Glycolytic enzyme deficits
may disappear during adolescence as little to no difference has been
observed in muscle glycolytic enzymes in adolescent age groups
(Haralambie, 1982). Due to lack of research, it is unclear whether young
athletes need CHO intakes (per kg body mass per day) comparable to those
of adults (Burke, Millet and Tarnopolsky, 2007). One study using magnetic
resonance spectroscopy on adolescent athletes to assess muscle glycogen
utilisation reported a depletion of 35% in glycogen stores after a simulated
soccer match (~42 min). An association between glycogen used and time to
exhaustion was also observed (Rico-Sanz et al., 1999). In a subsequent
study (Zehnder et al., 2001), the researchers found a CHO intake of 4.8 g
kg/d almost restored glycogen levels to pre-simulation levels. These studies
suggest that carbohydrate remains an important fuel to optimise athletic
performance and recovery in young athletes. However, examples from other
sports are required to develop specific guidelines on CHO consumption.

There are no studies of glycogen or CHO loading in children or adolescents.

Due to the risk of fatigue, irritability and inadequate nutrient intake in addition
to no greater performance benefit when compared to the modified version
(Burke, Millet and Tarnopolsky. 2007) the classical method of glycogen
loading would not be recommended to young athletes. In any case, the only
events requiring this preparation would be the walk and the marathon and
these are not usual competition events for athletes under the age of 18
years.

Carbohydrate-containing foods are generally important in the diet of young

athletes to maintain health. Wholegrains, fruits, vegetables and milk/yoghurt
are nutritious sources of carbohydrate and other key nutrients including,
vitamins, minerals and dietary fibre. An adequate intake of these foods is
recommended by public health agencies worldwide due to their association
with a reduced risk of disease. Use of refined carbohydrates (e.g. sports
drinks, gels and bars) to support energy intake during training and
competition can be useful for young athletes as for adults (Burke, Millet and
Tarnopolsky 2007); however, there is a concern that their overuse may
increase the risk for childhood obesity and dental caries/erosion. Active
children or adolescents using sports drinks or foods appropriately to manage
energy needs in conjunction with training/competition are at low risk for
unwanted fat accumulation or obesity (Mundt et al., 2006). Little research is
available on dental health, but preventative advice to young athletes is
prudent. The potential cariogenicity of fermentable CHO-containing foods
and drinks is reduced by water rinsing, eating casein-containing foods or
using chewing gum (preferably sugar-free) immediately after CHO
consumption (Sank, 1999). Dental erosion can also be minimized by
reducing contact time with the teeth by consuming fluids through a straw or a
squeeze bottle (Murray and Drummond, 1996; Milesovic 1997).Good dental
hygiene (brushing and flossing) and regular dental check-ups are also
recommended

4
The effect of CHO drinks consumed during exercise is not as well studied in
children as in adults. During heavy exercise, total CHO utilization in
adolescents may be as great as 1.0-1.5 g/kg/h (Riddell et al., 2000). Only
when duration of exercise increases, is there a greater reliance on blood
glucose, which can lead to a gradual decrease in glycaemia. (Riddell and
Iscoe, 2006). Using a 13C isotopic label, Riddell et al., (2000) found that the
addition of glucose induced a sparing of endogenous glucose utilization in
boys (from 68% to 59% of total energy utilisation). Ingestion of a glucose
solution equal to the amount of carbohydrate that the boys were expending
during 60 min cycling at 60% VO2max decreased fat utilisation from 32% to
18% of total energy expended. During one-hour cycling at ~70% VO2peak,
ingestion of a 6% CHO-electrolyte solution had no effect on rating of
perceived exertion in boys (Timmons and Bar-Or, 2003). Ingestion of CHO
during exercise improved the performance time by 40% when boys (10-14
years) cycled at 90% of their VO2max (Riddell et al., 2001). In these studies,
however, subjects were not athletes.

For adults, the recommended CHO concentration for a drink to be ingested

during exercise is about 6% (American College of Sports Medicine, 2007).
An increased CHO, energy content and osmolality may decrease the gastric
emptying rate (Murray et al., 1999) and cause gastrointestinal discomfort.
When 18 adolescents performed intermittent high intensity exercise for 48
min (treadmill sprinting, lateral hops and shuttle run), ingestion of an 8%
CHO drink caused a higher rating of gastrointestinal discomfort (stomach
upset and side ache) than ingestion of a 6% drink (Shi et al., 2004).
Therefore, the 6% CHO content of drink may be better tolerated by young
athletes during exercise but more studies are required.

Fat
Children seem to oxidise relatively more fat than CHO when compared to
adults during exercise at a given relative intensity (Duncan and Howley,
1999). This is based on studies using respiratory exchange ratio (RER)
during (Martinez and Haymes, 1992, Riddel et al., 2001, Timmons, Bar-Or
and Riddell, 2003) and after exercise (Hebestreit, Mimura, and Bar-Or,
1993). Preferential fat oxidation is also indicated by a greater increase in
plasma free glycerol (Macek and Vavra, 1981) and free-fatty acid
(Delamarche et al., 1992) concentrations during prolonged exercise. Lactate,
the by product of CHO metabolism and an inhibitor of fatty acid mobilization
and uptake (Brooks and Mercier, 1994), has been consistently found to be
lower in children than in adults after sub-maximal, maximal or supra-maximal
exercise (Martinez and Haymes, 1992; Mahon et al., 1997; Hebestreit et al.,
1996). Compared to late-pubertal and young adults, early-pubertal and mid-
pubertal males had lower RER and lactate values at most sub-maximal
exercise intensities (Stephens, Cole and Mahon, 2006). Therefore, the
development of an adult-like metabolic pattern seems to occur between mid-
to late-puberty and it is completed by the end of puberty.

Hormonal responses to exercise could contribute to maturity-related

differences in fuel metabolism (Boisseau and Delamarche, 2000). Younger
children show lower sympathetic activity during prolonged exercise
(Delamarche et al., 1992), which may also explain lower glycolytic
metabolism, but is inconsistent with higher rates of lipolysis and fat oxidation.
A transient decrease in insulin sensitivity and a compensatory increase in
insulin concentration may also alter fuel use (Moran et al., 1999). Despite the
indication that children rely more on fat as an energy source during exercise,
there is no evidence that young athletes involved in endurance activities will
benefit from a higher fat content in their diet (Burke, Millet and Tarnopolsky ,
2007). On the contrary, high-fat food ingestion before exercise may reduce
(by 40%) the magnitude of growth hormone secretion during exercise. This
was observed when children ingested a lipid rich shake (0.8 g of fat per kg of

5
body mass) 45 min prior to cycling intermittently for 30 min (Galassetti et al.,
2006). If this growth hormone increase during exercise is important to muscle
adaptation and growth, this response to high fat ingestion may have a
negative effect.

Consumption of fat should be in accordance with public health guidelines

(American Heart Association, 2005). Of the 25-35% of daily energy from fat,
saturated fats should provide no more than 10% Dietary guidelines also
emphasise low intake of trans fat and cholesterol (<300 mg). Young athletes
aiming to reduce body mass or fat may overly restrict dietary fat intake. Aside
from the concern regarding inadequate energy intake, and impaired growth
and development, dietary fat restriction may result in an insufficient intake of
essential fatty acids and fat soluble vitamins. Strict elimination may also
result in inadequate intake of protein-rich foods including lean meats and
dairy foods and associated nutrients including iron, zinc and calcium (Petrie
et al., 2004).

Protein
Children and adolescents have higher protein needs than adults to support
growth. In fact, adequate intakes of both energy and protein are essential to
maintain a positive nitrogen balance (Tipton, Jeukendrup and Hespel, 2007).
Limited data are available on the protein requirements of young athletes. In
one of the few available studies, untrained children walked for 45-60 min per
day (3.2-6.4 km/d) for 6 weeks. Whole body protein oxidation increased but
protein synthesis and breakdown decreased, presumably to conserve
protein and prevent negative nitrogen balance. This may also have been
influenced by the children not adequately increasing energy intake to match
requirement (Bolster et al., 2001). In a study (Pikosky et al., 2001) employing
resistance training (twice a week for 6 weeks), a down-regulation of protein
metabolism in the children was also observed.

In most western countries, protein intakes typically exceed requirements so it

is likely most young track and field athletes consume adequate amounts. In
most situations, protein intake will be adequate if energy intake meets
requirements, and even in studies of young athletes who typically restrict
energy intake, protein intakes have usually been observed to be adequate
(Bass and Inge 2006). In adults, the upper level of protein requirement for
athletics training is recommended to be 1.7 g/kg/d (Tipton, Jeukendrup and
Hespel, 2007) and it is expected that this is also adequate for children and
adolescents. Nevertheless, it is reasonable to conclude that athletes on more
rigid energy restriction or ‘bulky’ higher fibre vegan vegetarian diets (due to
difficultly consuming adequate energy rather than sufficient protein) may be
more at risk of failing to achieve adequate protein intakes.

Micronutrient intake
Iron
Inadequate iron intake and iron deficiency are commonly reported in athletes
(Deakin, 2006). Adolescent female athletes in particular are at higher risk
due to their menstrual losses. This group is also more likely to consume
inadequate iron. Some studies report that up to 40-50% of female athletes
have low ferritin stores (Rowland, Stagg and Kelleher, 1991). Low iron intake
may not necessarily result in anaemia but chronically low intake may impair
muscle metabolism (Beard, 2001) and cognitive function (Grantham-
McGregor and Ani 2001). Diagnosis of iron deficiency based on serum ferritin
alone is problematic as increases in plasma volume associated with the
growth spurt and possibly as an acute response to training can present as a
false positive. Approaches to detection and clinical management have been
reviewed elsewhere (Deakin, 2006). Low intakes can be ameliorated by
providing young athletes with strategies for increasing dietary iron and

6
optimising conditions and forms of iron that are readily absorbable. Medically
supervised supplementation may sometimes be required.

Calcium
Dietary calcium recommendations are based on the amount required to
maintain calcium balance and promote optimum bone accretion rates.
Calcium balance studies suggest there is a threshold for calcium intake
beyond which any additional calcium does not result in further retention
(reviewed Kerr, Khan and Bennell 2006). When calcium intake is low during
childhood and adolescence, higher calcium retention efficiencies (as high as
50%) partially compensate for the deficit (Abrams et al., 1997). This is
different from adults with skeletal deficiency, where retention rates of only 4-
8% are observed (Kerr, Khan and Bennell et al., 2006). However, a very low
calcium intake (<400 mg/day) is deleterious for bone development and health
(Lanou, Berkow, and Barnard, 2005).

Around 26% of bone mineral is accrued during puberty (Bailey et al., 1999).
Many exercise interventions have demonstrated a positive influence of
activity, particularly high impact activities such as jumping, on bone accrual.
Evidence also suggests that there is greater benefit if this is commenced
prior to puberty (MacKelvie, Kahn and McKay 2002). In contrast,
amenorrhoea in female athletes has a detrimental effect on bone mineral
content (Manore et al., 2007). Bone mass in amenorrhoeic athletes is below
age-matched controls at weight bearing sites (Drinkwater, Nilson and
Chestnut, 1984). Poor bone quality predisposes to bone fractures, and a
lower bone mineral density is associated with an increased rate of bone
fracture in girls (Goulding et al., 1998) and boys (Goulding et al., 2001, Pires
et al, 2005). Occurrence of fractures was associated with low levels of
calcium intake (Goulding et al, 2000, Pires et al.,2005 ) and a lower activity
level (Pires et al., 2005). Despite the difficulty in determining the incidence of
stress fractures in track and field athletes, prospective studies have found a
range of 11% to 21% (stress fractures per 100 athletes) (Nattiv, 2000).

Dietary supplements
Many young athletes are drawn towards dietary supplements and their
promise of improved performance. In a survey among 32 UK junior track and
field athletes (~18 years), 62% were using supplements, mainly multivitamins
and minerals, with the expectation that they improve health, immune function
and performance (Nieper, 2005). In a study by O’Dea (2003) of Australian
adolescents in the general community, supplements were used for perceived
short-term health benefits, prevention of illness, improved immunity, to boost
energy or sports performance and correct poor dietary intake. Although
vitamin and mineral supplementation may improve the nutritional status of
youngsters consuming marginal amounts of these nutrients from food, no
scientific evidence supports the general use of supplements to improve
performance. Young athletes following reduced energy or vegetarian diets,
who are amenorrheic or who are diagnosed with iron depletion may benefit
from supplementation under medical or dietetic supervision.

A popular supplement with young athletes is creatine monohydrate. A survey

in 1103 young athletes 5.6% reported using creatine (Metzl et al., 2001). Its
use was more common among boys (8.8%) than girls (1.8%) and strength-
dependent athletes (football players, wrestlers, gymnastics and hockey
players), but it was reported among athletes involved in every sport, including
track and field (1.4%). Due to a lack of evidence for long term safety, use of
creatine is not recommended for children under 18 years of age (American
College of Sports Medicine, 2000). Although some case reports indicate
adverse effects, most of these are anecdotal or applicable to individuals with
underlying disease (Patel, Torres and Greydanus, 2005).

7
Hydration and thermoregulation
Young athletes who perform prolonged or intense, intermittent exercise can
present with dehydration (greater sweat loss than fluid intake), which may
affect performance and health (Falk, 1998; Sawka, 1992). Despite the lower
sweat rate of children compared to adults, laboratory studies with controlled
exercise and environmental conditions show that children can potentially
dehydrate as much as adults if no fluid is ingested (Meyer and Bar-Or, 1994).
The age of the athletes also influences sweat loss. In a simulated duathlon
race, older boys (> 15 years) had a higher sweat rate (~ 1.3 L/h) than
younger boys (~ 0.64 L/h) and both groups became dehydrated despite free
access to water (Iuliano et al., 1998). Fluid intake was higher during cycling
and at rest than during the run, indicating that exercise mode and recovery
periods affect voluntary fluid intake in adolescents (Iuliano et al., 1998).
During a triathlon race, about 50% of boys and girls dehydrated by 2-3%.
One in three boys (8-13 yrs) dehydrated 2%, and 7% exceeded 3%
dehydration (Wilk, Aragon-Vargas and Bar-Or, 2001).

The influence of hydration status on exercise performance is most clearly

understood for adults undertaking endurance exercise (Shirreffs et al. 2007).
There is no published literature on the influence of hydration status on
performance in athletic events in young athletes but dehydration, by 2% of
body mass, impaired basketball skills in 12 to 15 yr-old boys (Dougherty et
al. 2006).

Children, compared to adults, have a greater increase in core temperature as

they become dehydrated (Bar-Or et al., 1980). In addition to their lower
sweating rate and higher metabolic cost of locomotion, other factors can
make thermoregulation harder in children (Falk, 1998). Their higher surface
area to body mass ratio causes a greater heat gain when air temperature is
above skin temperature (Bar-Or, 1989). The heat acclimatization process
may be delayed as compared to adults (Inbar et al., 1981) so when summer
starts, young athletes may be more vulnerable to heat-related problems
(Bergeron, McKeag and Casa, 2005; Godek, Godek, and Bartolozzi, , 2005)

Children may not fully hydrate when they have water to drink ad libitum
during exercise (Bar-Or et al., 1980; Bar-Or et al., 1992). Wilk and Bar-Or
(1996) studied unacclimatised boys who cycled intermittently in the heat
(35oC, 43% RH) for three hours. In separate sessions they could drink plain
water, flavoured water or the same flavoured solution with CHO-NaCl.
Compared to plain water, voluntary ingestion was 45% greater with flavoured
water; but addition of CHO (6%) and NaCl (18 mmol/l) induced a further
increase in voluntary drinking sufficient to prevent dehydration. Subsequent
studies have confirmed these findings (Wilk et al., 1998; Rivera-Brown et al.,
1999; Rodriguez et al., 1995; Horswill et al., 2005).

Although sweat sodium losses are generally lower in children than in adults
(Meyer et al, 1992), maintaining hydration in children with sports drinks
containing about 20-25 mEq/L of sodium does not result in sodium overload
and indeed a slight negative sodium balance may occur due to the sweat and
urinary losses (Meyer et al., 1995). In adults, hyponatraemia (blood Na+
concentration < 130 mEq/l) is mainly reported in long events (>4-6 h) when
low sodium drinks are ingested to excess. Young athletes may also be at risk
of hyponatraemia during exercise (Patel et al., 2005), but this has not been
surveyed.

In order to start training or competition euhydrated, young athletes may be

advised to follow recommendations similar to those given to adult athletes
(Shirreffs et al, 2007). During exercise, if necessary, they should drink
periodically with volumes depending on their sweat rates. If the activity is
prolonged (>1 h) or intense and intermittent, sodium and CHO should

8
perhaps be added to a flavoured liquid. After exercise, water and sodium
should be actively replaced if significant losses have occurred (Shirreffs,
2001). Young athletes seem to know about these general recommendations
but do not follow them or are not aware of specific amounts of fluids to be
consumed (Nichols et al., 2005).

Recommendations can be adapted to conditions that make young athletes

vulnerable to water-electrolyte or metabolic disturbances. Many common
paediatric diseases including asthma (Nystad, 1997) and Type 1 diabetes
(Riddell and Iscoe, 2006) place no restriction on exercise (American
Academy of Pediatrics, 2001b) or participation in competitive sports.
Dehydration in asthmatics may accentuate bronchoconstriction (Kalhoff,
2003). Other less common conditions are of interest because of very high
sweat NaCl losses, such as in cystic fibrosis (Bar-Or et al., 1992, Kriemler et
al., 1999) or increased risk of hyponatraemia, such as in renal diseases
(Patel et al., 2005).

Ingestion of fluids and maintenance of euhydration does not necessarily

prevent heat problems caused by the environmental stress. The American
Academy of Pediatrics (2000) made recommendations according to the
environmental heat stress expressed by the Wet Bulb Globe Temperature
(WBGT) (Table 2).

Table 2. Restraints on activities at different levels of heat stress.

WBGT (°C) Restraints on Activities

All activities allowed, but be

< 24 alert for prodromes of heat-
related illness in prolonged
events
Longer rest periods in the
24.0 – 25.9 shade; enforce drinking
every 15 minutes

Stop activity of
26 – 29 unacclimatised persons and
other persons with high risk;
limit activities of all others
(disallow long-distance
races, cut down further
duration of other activities

> 29 Cancel all athletic activities

From American Academy of Pediatrics 2000, Committee on Sports Medicine

and Fitness.

SUMMARY AND GUIDELINES

Children and adolescents have specific nutritional needs, and although the
principles of sports nutrition are similar to adults, there are some important
differences, particularly with respect to energy expenditure, fuel utilisation
and thermoregulation during exercise. During this life stage, particularly in
girls, there is an increased risk for inadequate dietary intake secondary to
dieting to optimise physique. This increases the risk for energy deficiency,
disordered eating, menstrual irregularity and reduced bone density.
Appropriate nutrition is critical during these growing years to maintain health,
growth and the development of athletic potential. The guidelines below
provide recommendations to optimise and support participation of children
and adolescents in the various disciplines of athletics

9
Summary of recommendations for young track and field athletes
Clear consensus for • There is limited research on the nutrition
requirements of young athletes and a need
for further study.
• Compared to adults, studies in children and
adolescents consistently suggest they have
a higher cost of locomotion, a greater fat
oxidation and less efficient
thermoregulation.
• Young athletes, parents and coaches would
benefit from education on the importance of
nutrition for optimising growth, health and
athletic performance.
• Major differences in the dietary
requirements of young athletes include an
increased requirement for energy, protein
and probably carbohydrate compared to
non-athletic peers. Intakes of micronutrients
may also be elevated, particularly iron, but
more research is required. Iron is the most
commonly reported nutritional deficiency.
• Bone accrual during childhood and
adolescence is critical to optimise peak
bone mass. Adequate energy and dietary
intake, particularly calcium is important as is
regular weight bearing physical activity,
particularly if commenced prior to and
maintained thought puberty. Reduced bone
mass increases fracture risk for athletes.
• Athletes aiming to reduce body mass or fat
content are at a greater risk of consuming
inadequate energy intake which may result
in delayed growth and maturation and, in
female adolescents, amenorrhoea and
reduced bone density.
• In following sports nutrition guidelines,
young athletes should be well within the
recommendations made by public health
agencies. This ensures athletic participation
from a young age has a positive influence
on dietary intake and future health.
• Young athletes should monitor their fluid
intake and be educated in specific
recommendations of hydration.
• When appropriate, young athletes should
begin exercise euhydrated and maintain
hydration status close to euhydration during
training or competition by drinking if
necessary.
• After exercise that results in a significant
sweat loss, water and electrolytes should be
replaced.
• Drinks should be easily available in bottles
that facilitate ingestion and according to
individual preference.
Clear Consensus against • The classical method of glycogen loading is
not recommended for young athletes and the
modified version is only required for
marathons or race walks which are usually

10
 not undertaken in track and field events until
athletes are at least 18 years.
• Supplements, unless clinically indicated, are
not recommended.
• Young athletes should not ingest excessive
volumes of drinks during exercise. They
should be advised to monitor body mass
before and after the exercise.
Issues that are equivocal • The effect of CHO intake and increased
glycogen stores on performance and other
physiologic and metabolic responses in
young athletes is unknown.

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