∆ηµήτρης Παπανδρέου M.Sc. Κλινικός ∆ιαιτολόγος, Υποψήφιος ∆ιδάκτωρ

Ιατρικής Σχολής Θεσ/νικης

Dietary Intakes Status of elite athletes

D.Papandreou, M. Hassapidou, M. Hourdakis, K.Papakonstantinou, G.Tsitskaris and

A.Garefis.

Το άρθρο δηµοσιεύτηκε στο Aristotle University Medical Journal, Volume 33,(1)

2006:119-126

∆ιατροφική κατάσταση αθλητών υψηλού επιπέδου

ΠΕΡΙΛΗΨΗ

Σκοπός της παρούσας έρευνας ήταν να εξετάσει τα ανθρωποµετρικά χαρακτηριστικά και

να αξιολογήσει την διατροφική πρόσληψη και το ενεργειακό ισοδύναµο αθλητών υψηλού

επιπέδου, τεσσάρων διαφορετικών αθληµάτων στην Βόρεια Ελλάδα. Το δείγµα αποτελείτο από

10 αθλητές πετοσφαίρισης, 21 αθλητές καλαθοσφαίρισης, 20 αθλητές της άρσης βαρών και 31

αθλητές αποστάσεων. Οι δροµείς αποστάσεων είχαν το χαµηλότερο ποσοστό σωµατικού λίπους

ενώ οι αθλητές πετοσφαίρισης το υψηλότερο. Η πρόσληψη υδατανθράκων και λίπους ήταν

χαµηλότερη από την συνιστώµενη ενώ µόνο οι γυναίκες αθλήτριες τηρούσαν την προτεινόµενη

πρόσληψη πρωτεϊνών. Η πρόσληψη βιταµινών και ιχνοστοιχείων παρουσίασε µεγάλη

διακύµανση µεταξύ των αθλητών µε µερικούς από αυτούς να παρουσιάζουν χαµηλότερη

πρόσληψη από τις συνιστώµενες τιµές σε µερικές βιταµίνες. Η έρευνα έδειξε πιθανά διατροφικά

προβλήµατα που θα µπορούσαν να περιορίσουν την απόδοση των αθλητών και υποδεικνύει την

ανάγκη για τον διατροφικό έλεγχο και αξιολόγηση των αθλητών.

Introduction

Interest in sports in relation to nutrition has been increased greatly the last decades,

as healthy and suitable diet proved to play an important role in the athletic performance. A

number of studies (Beals ,2002; Leydon & Wall,2002; Paschoal ,2004) in the past have shown

that often athletes follow unbalanced diet. More specifically, they are in negative energy

balance (Leydon & Wall, 2002), have low carbohydrate intakes(Leydon & Wall, 2002;

Pashcoal, 2004) or low vitamin and mineral intakes(Clark et al., 2003). The low energy

intakes have been associated with marginal intakes of several important nutrients such as

calcium, iron, folate, vitamin E, copper, magnesium and others(Beals, 2002; Kim et al., 2002;

Leydon & Wall,2002; Clark et al., 2003; Dubnov & Constantini, 2004). Currently, there is

limited data regarding the dietary practices and nutritional status of Greek athletes

(Hassapidou, 2001;2002), and especially elite athletes(Hassapidou & Manstrantoni, 2001).

Hassapidou et al (2001) after examining the anthropometric characteristics and nutrient

intakes of adolescents’ swimmers in Greece found that the participating athletes had an

unbalanced diet and not an appropriate one that could maximize their athletic performance.

The purpose of the present study was to examine anthropometric characteristics and to assess

dietary intakes and energy balance of 82 male and female elite athletes, of four different

sports teams: volleyball players, basketball players, weightlifters and distance runners, in

Northern Greece.

METHODOLOGY

Subjects

All athletes were recruited, from four athletic teams in Thessaloniki. The final sample

consisted of 42 male and 40 female athletes (10 volleyball players, 21 basketball players, 20

weightlifters and 31 distance runners).The study protocol was approved by the University’s

Research Committee, and subjects provided written consent.

Anthropometric data

Data (Age, sex, height, weight, percentage of body fat) were collected to determine

the physical characteristics of athletes. Height was measured to the nearest centimeter

without shoes using a Seca stadiometer and weight was recorded to the nearest 0.1 kg with a

digital scale (Seca). Body mass index (BMI) was calculated for all athletes.

The same tester took all the body fat measurements. The bioelectrical impedance method

used and subjects wore minimal clothing during the measurements. Bioelectrical impedance

measures of body fat were taken using the Maltron instrument (Maltron, BF 906, Rayleigh,

Essex, UK) (Nationel Institutes of Health Technology Assessment Conference Statement,

1995). All subjects were instructed not to eat and exercised for 3 hours and not to drink for at

least 1 hour before the measurement. The subjects lay down and electrodes were placed on

the right hand and foot for the measurements.

Dietary intake

Dietary intake was estimated by 5-day recorded records (including both weekend days)

of food and drink consumed. Oral instructions were given to the athletes by a dietitian how to

record the food items. After the completion of all measurements the dietitian checked the

completed records. The average daily nutrient intake was calculated for each subject. Dietary

intakes were analyzed by a Nutritional Program, Diet 200A(Science technologies, 2001). In

the basic database were added Greek food recipes according to the Food Composition Tables

and Composition of Greek Cooked Food and Dishes (Trichopoulou, 1992).

Energy expenditure

RMR was estimated by using the equation [RMR (kcal/d)=-857 + 9.0 (Wt in kg) + 11.7

(Ht in cm)](De Lorenzo et al., 1999). Total daily energy expenditure (TEE) was calculated by

adding to RMR the energy cost for activity. The energy cost of activity has been calculated

based on the pal system. The pal system represents the values of the different activity levels

which reflect the energy expenditure as a multiple of BMR.

Analysis of data

The 2001 USA dietary reference intakes (Dietary reference intakes, 2001) were used

for assessing the adequacy of nutrient intake since no Greek standards were available. Since

dietary reference intakes do not refer specifically to athletes, the values used as standards for

comparisons of more carbohydrate and protein intakes were taken from scientific papers

(Burke et al., 2004; Tipton & Wolfe, 2004). All data were analyzed using the SPSS statistical

package (SPSS Inc, Chicago, SPSS for Windows, version 10.0, 1999). Data were expressed as

means [+ or -] standard deviation. Statistical differences between the samples were

determined by student’s t-test. ANOVA test was used to assess gender and sport differences

with nutrient intakes. The level of statistical significance for analysis was set at P<0.05.

Results

Table 1 shows the anthropometric characteristics of the male and female athletes. For

both men and women, distance runners had lower weights compared with athletes of the

other sports. The highest mean weight was found for male basketball players and female

weightlifters. When heights were compared it was found that male basketball players were

taller, followed by volleyball players. For women, volleyball players were found taller, followed

by distance runners. Male and female distance runners had lower percentages of body fat and

the highest mean percent body fat was unexpectedly found in male and female volleyball

players.

Table 1.Anthropometric characteristics of the athletes by sports (mean±SD)

Table 2 shows the results for TEE and energy intakes, reported by athletes. Energy intake

expressed as total caloric intake per day and as kcal per kg of body weight. The highest TEE,

for both male and female athletes, was found for weightlifters, followed by basketball players.

For men, the highest mean energy intake per day, as reported by the athletes, was found for

volleyball players, followed by weightlifters and the highest mean energy intake per kg body

weight was found for distance runners, followed by volleyball players. Basketball players had

the lowest mean energy intake per day and per kg body weight. For women, the highest mean

energy intake per day and per kg of body weight was found for distance runners, followed by

weightlifters. Volleyball players had the lowest mean daily energy intake and energy intake

per kg body weight.

Table 2. Energy expenditure and energy intakes of the athletes.

Macronutrient intakes as reported by the athletes are presented in Table 3. Male volleyball

players had the highest protein intakes (1,4 g/kg) compared with the other athletes who had

the same intakes (1g/kg). The percentage energy provided by proteins was the same for all

male sports (17 per cent). For women athletes, the percentage energy provided by proteins

ranged from 13 to 19 per cent.

Table 3. Macronutrient intakes of the athletes

For men, fat intakes ranged from 36 per cent of energy for distance runners and 38 per cent

for volleyball players to 39 per cent for basketball players and weightlifters. For women, fat

intakes ranged from 36 per cent of energy for basketball players to 42 per cent for

weightlifters.

Carbohydrate intake ranged from 45 to 48 per cent of total energy intake (2-4 g/kg body

weight) for men and from 38 to 47 per cent of total energy intake (2-4 g/kg body weight) for

women. The lowest carbohydrate intakes (45 and 38 per cent of energy) were found for male

and female weightlifters, respectively. The highest carbohydrate intakes (48 and 47 per cent

of energy) were found for male distance runners and female basketball players, respectively.

Table 4 shows the micronutrient intakes as reported by the athletes. Vitamin as well as

mineral intakes vary among athletic teams. Some mean values are below the RDA values for

both men and women athletes, showing an inadequate intake of vitamins and minerals by the

athletes.

Table 4. Micronutrient intakes of the athletes

DISCUSSION

In the present study the anthropometric characteristics and dietary intakes of male and

female elite athletes, of four different sports have been examined. Anthropometric

measurements were taken for all athletes. The results of this study indicated potential dietary

problems that could limit the performance of the athletes.

As expected, male and female distance runners had lower weights and percentage of body fat,

compared with the other athletes. In this sport low body weight and body fat are considered

necessary for optimal performance (Sykora et al., 1993). For both men and women, volleyball

players had higher mean percentages of body fat, although we would expect it for

weightlifters, as these athletes tend to have high percentages of body fat (Yoon, 2002).

For male basketball players and weightlifters, calculated energy expenditure was

higher from the reported energy intakes. The same reported for all female athletes.

Investigators in other countries (Mulligan & Butterfield, 1990; Myerson et al., 1991) have

reported this discrepancy between energy intake and expenditure in female athletes. In

studies on energy balance (Dueck et al., 1996; Kopp-Woodroffe et al., 1999), energy deficits

in amenorrheic athletes have ranged from 148 to 881 kcal/day. However, this discrepancy

may be due to the fact that subjects fail to record portions of food correctly, omit foods eaten

or restrict their food intake during the study period(Edwards et al., 1991). Furthermore, it

should be mentioned that energy expenditure has been calculated based on equations for RMR

and it has not been accurately measured (Frankefield et al., 2003). This is a limitation of the

method used and a factor that may have influenced the accuracy of the results found.

Clark et al (2003) found that the energy intakes of male athletes of different sports were

2.963-3.943 kcal per day. Another study (Hassapidou et al., 2002) defined the energy balance

of female athletes of different sports and found that they were in negative energy balance (-

482 kcal/ day to – 580 kcal/day). In our study, the mean reported energy intakes varied from

1901 ± 323 kcal per day for male basketball players to 2639 ± 293 kcal per day for male

volleyball players and from 1425 ± 684 kcal per day for female volleyball players to 1885 ±

203 kcal per day for female weightlifters. It has been reported by many investigators that

most male athletes meet their energy requirements and consume higher energy intakes

compared with female athletes (Clark, 1991; Hassapidou et al., 1999). These reports are in

accordance with our study.

Costill et al (1971) proved that athletes who have low carbohydrate intakes (40 per cent of

energy intake) show a constant decrease of the muscle glycogen during the competitive

season. In contrast, athletes who consume a diet rich in carbohydrates (70 per cent of energy

intake) retain their glycogen levels almost stable (Costil et al., 1071). It is generally

recommended that athletes should consume a diet rich in carbohydrates (70 per cent of

energy intake) and low in fat (30 per cent of energy intake). None of the male and female

athletes that participated in this study met these recommendations. In order to do so, they

should increase their carbohydrate intake and decrease their fat intake. Similar results have

been found in a study (Hassapidou et al., 2003) that assessed the dietary intakes of Greek

basketball players.

Tripton and Wolfe(Tipton & Wolfe, 2004) suggest a protein intake of 1.2 to 1.4 g/kg body

weight for endurance athletes and 1.2 to 1.7 g/kg for strength athletes. It is also

recommended that female athletes should consume 1.0 g protein per kg of body weigh

(Topton & Wolfe, 2004). In our study only female athletes met this recommendation. Male

athletes consumed lower grams of protein per kg than the recommended.

Vitamin and mineral intakes showed a wide variation among athletes and, although mean

intakes were above recommended values, some athletes had lower intakes than the dietary

reference intakes for certain vitamins and minerals. Both male and female athletic teams had

low consumption of zinc, vitamin B6, A, D and K. Female athletes had also low intake of iron

and calcium. Several recent studies (Weight et al., 1992; Dobnov & Constantini, 2004; Foo et

al., 2004) have found that the dietary iron intake of athletes, especially of female athletes, are

unsatisfactory and this appears to be a significant public health problem. According to studies

(Beals, 2002; Leydon & Wall, 2002; Clark et al., 2003), for most athletes, intakes of

micronutrients are marginal, which may compromise their sporting performance and both

their short- and long-term health. Whereas the adverse effects of restricted intakes of protein,

fat and carbohydrate on physical performance are well known, there is limited information

about the impact of low intakes of vitamins and minerals on the exercise capacity and

performance of humans (Lukaski, 2004 ). According to Lukaski et al, vitamin deficiencies do

not impair performance in contrast to mineral deficiencies. Iron deficiency, for example,

impairs muscle function and limits work capacity. Magnesium deprivation increases oxygen

requirements to complete submaximal exercise and reduces endurance performance (Lukaski,

2004). Attention must be given to those athletes in order to improve their nutritional status.

In conclusion, this study showed that the diet of participating athletes did not follow

the patterns recommended and was not appropriate for maximizing athletic performance. This

suggests that there is a need for providing nutritional information to the athletes in Greece, in

order to improve their diet and in this way their athletic performance.

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