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598530AJLXXX10.1177/1559827615598530American Journal of Lifestyle MedicineAmerican Journal of Lifestyle Medicine
research-articleXXXX
American Journal of Lifestyle Medicine Nov • Dec 2015
Mary Ellen Bingham, MS, RD, CSSD, Mimi E. Borkan,
and Paula A. Quatromoni, DSc, RD
Sports Nutrition Advice for
Adolescent Athletes: A Time to
Focus on Food
Abstract: Adolescents participating points that health professionals can use performance in sport. This advice is
1
in sport have high demands for in brief interactions with patients and built on the US Dietary Guidelines,
nutritional adequacy to meet their families are provided to endorse key which promote a nutritionally balanced
needs for growth, development, wellness behavioral strategies that young athletes eating pattern containing a daily variety
and athletics. Nutritional risk can can adopt to achieve peak athletic of nutrient-dense foods. Before bringing
be quite high in this population due performance and optimal nutritional sport-specific advice into the
to their unique needs, low access to status. conversation, the building blocks of
credible information and nutrition healthy eating and nutritional adequacy
professionals, and misinformation in Keywords: nutrition; adolescent; must be in place. Although athletes
the media and marketplace specifically sports; RED-S; disordered eating certainly have enhanced and often
targeting athletes. Physicians and other
health professionals have an opportunity Before bringing sport-specific advice
to communicate nutrition facts and
make evidence-based recommendations into the conversation, the building
about healthy eating in the setting
of their ongoing interactions with blocks of healthy eating and
adolescent athletes and their families.
The purpose of this review is to describe nutritional adequacy must be in
the nutritional needs of adolescents
participating in sport and highlight place.
the potential for nutritional risk.
Endorsed by professional organizations,
our recommendations emphasize a
balanced eating pattern that includes Sports Nutrition for unique nutritional needs that are
a wide variety of fresh, minimally Adolescents specific to their sport and their training
processed whole foods. Our approach regimens, proper nutrition to support
is to empower and teach adolescents Nutrition advice for adolescent athletes adolescent growth is necessary at the
to take responsibility for planning, has, at its foundation, the principles of core of any strategy to improve sports
preparing, and providing themselves sound nutrition focused on adequacy to performance. Because of their distinct
consistent access to foods and fluids support the adolescent’s needs for needs and transitional life stage,
that deliver nutrients needed for proper growth and development in addition to adolescent athletes are vulnerable to
fueling and recovery. Specific talking increased needs for training and nutritional risk, fad diets, disordered
DOI: 10.1177/1559827615598530. Manuscript received July 1, 2015; accepted July 6, 2015. From Miami Dolphins, Miami, Florida (MEB); University of New Hampshire,
Durham, New Hampshire (ME Borkan); and the Department of Health Sciences, Boston University, Boston, Massachusetts (PAQ). Address correspondence to: Paula A.
Quatromoni, DSc, RD, Department of Health Sciences, Boston University, 635 Commonwealth Ave, Boston, MA 02215; e-mail: paulaq@bu.edu.
For reprints and permissions queries, please visit SAGE’s Web site at http://www.sagepub.com/journalsPermissions.nav.
Copyright © 2015 The Author(s)
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vol. 9 • no. 6 American Journal of Lifestyle Medicine
19,20
eating, and marketing scams for disordered eating or clinical eating maturation of youths and adolescents
nutritional products that promise fast disorders, referral to an RD is and maintenance of a healthy body
10-12
results or improved performance despite recommended. In all cases, we weight. These nutritional goals can be
the lack of an evidence base behind specifically recommend a nondiet met by including a predominance of plant
14
most claims. approach to sports nutrition that is foods in the daily diet, specifically fruits,
For athletes, there are no shortcuts or weight neutral and centered on vegetables, whole grains, legumes, nuts,
substitutes for proper nutrition for respecting body shape and size seeds and unsaturated vegetable oils;
15
optimal performance in sport. diversity, promoting a holistic inclusion of lean animal proteins,
Supplements and functional foods will approach to achieve wellness and specifically low-fat dairy foods that
never overcome the deficits of poor athletic goals, and that is grounded in provide vitamin D and calcium, fish,
16
nutrition for an athlete. The needs of eating competence and intuitive, poultry, and iron-rich lean meats; and
17,18
adolescent athletes are different from the mindful eating. moderation of foods high in saturated or
needs of adults and professional athletes, trans fats, sodium, and added sugars. In
and the needs of competitive athletes are Healthy Eating Advice general, no vitamin and mineral
different from those of recreational for Adolescent Athletes supplements are required if an athlete is
athletes. Athletes in power sports have meeting energy needs by eating a
needs that are different from those in The nutritional well-being of athletes balanced diet containing a variety of
endurance sports and from those of depends on knowledgeable food whole foods and is maintaining body
9-13
sprinters. Even within a sport, field choices. In fact, because of their special weight.
players have different needs from needs for proper fueling and hydration, To meet such high nutritional needs,
goalies, and swimmers have different athletes are faced with several athletes need to fuel their bodies
2,3
needs from divers. Delving into these opportunities demanding well-informed frequently throughout the day. This
sport-specific nuances is beyond the food choices every day, at every meal. involves a daily commitment to 3 meals
scope of this review, but there are Yet many adolescent athletes pay little and frequent snacks strategically
several books written by registered attention to nutrition and largely placed before and after workouts,
dietitians (RDs) to guide athletes and underappreciate their protein and practice, and competition. This level of
4-8
practitioners more specifically. calorie needs, whereas others are commitment requires adolescent
Nonetheless, the common goal for every influenced by dieting advice, functional athletes to prioritize nutrition and
athlete is to achieve healthy eating foods/supplements marketed to athletes, feeding themselves, taking personal
behaviors centered on nutrient-dense and the desire to achieve either a responsibility for ensuring ready access
and varied food choices, adequate competitive edge or an idealized athletic to nutritious foods, snacks, and fluids.
hydration, dietary patterns that feature body type. With the help of a qualified Selection of foods that are nutrient
balanced meals and snacks to properly sports nutritionist, athletes can learn to dense, easily digested, and well
fuel training and competition and to meet their nutritional needs with a tolerated are equally high priorities.
enhance recovery, and intuitive eating flexible eating style that balances
behaviors that connect mind, body, and favorite foods with nutrient-rich foods to Nutritional Risk in
performance for the most successful satisfy hunger, fuel workouts, maximize Adolescent Athletes
outcomes. performance, and promote both
Whereas functional foods or physical health and emotional wellness. Athletes participating in different sports
nutritional supplements may be Athletes need a varied and balanced have unique nutritional needs because of
indicated for certain individuals under eating plan that is adequate in energy, differences in energy expenditure,
certain circumstances and under the macronutrients, essential fatty acids, fiber, hydration, and the demands of the sport.
supervision of a RD and/or physician, vitamins, and minerals. Although there are Challenges and obstacles to good
they do not form the basis of sports professional recommendations that guide nutrition are also distinct within
nutrition, and they are not generally the appropriate selection of foods and subgroups of athletes. Eating behavior is
9-13
recommended for adolescent athletes. fluids for athletes, the timing of nutrient highly personal, yet heavily influenced
A diet based on fresh and minimally and fluid intake relative to exercise and by environment and important others,
processed whole foods is what is competition, and supplement choices for including peers, teammates, professional
advocated by professional organizations, optimal health and sports athletes, coaches, celebrities, and the
10-12
including the Academy of Nutrition and performance, the underlying principles media. As such, unhealthy behaviors and
Dietetics and the American College of of sound nutrition for health promotion in nutrition misinformation can set an
10-12
Sports Medicine. For athletes whose the general adolescent population form athlete on a path that could undermine
goals include weight management or the foundation of dietary advice for those athletic performance, contribute to sports
altering body composition to either who participate in sports. The eating injuries, and have serious health
build muscle mass or lose body fat or pattern that is recommended is one that consequences. These circumstances
for athletes who have developed allows growth, development, and introduce vulnerability to nutritional risk
399
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American Journal of Lifestyle Medicine Nov • Dec 2015
that spans a spectrum and can include and activities of daily living, growth, successfully translate these guidelines
dieting, restrictive eating, disordered and supporting activities.23 The resulting from nutrients to foods, and from science
eating (anorexia nervosa, bulimia package of low energy availability, to practice.
nervosa, binge eating disorder, anorexia disordered eating behavior, and Recognizing nutritional risk and
athletica, and orthorexia nervosa), pathological weight control measures making referrals to RDs is essential for
misuse of nutritional supplements, that may include starvation, excessive those in need of nutrition assessment
“uninformed” vegetarianism, and a exercising, purging, or laxative abuse, and counseling. This task is a priority for
variety of unhealthy weight-cutting often driven by body image physicians and other health
practices that can sabotage athletic dysmorphia, results in hormonal and professionals who work with adolescent
performance. metabolic imbalances, serious medical athletes. In addition, having proactive
Adolescent athletes are quite vulnerable complications, sports injuries, and conversations with youths and families
to the ill effects of suboptimal nutrition. impaired athletic performance.24 to share evidence-based advice about
Not only is their performance in sport Adolescent athletes are vulnerable to healthy eating is a strategy that can
threatened, but their growth, the pressures of competitive sports and promote wellness, prevent injury, and
development, and maturation can be the demands of physical training on help athletes achieve their goals in sport.
impaired by poor nutrition. Among the their still-developing bodies as well as Appropriate messages that physicians
special issues that physicians caring for the influence of coaches, teammates, and other health professionals can
adolescent athletes are urged to address peers, parents, society, culture, and the convey in brief interactions to endorse
are nutritional needs and supplement media. There is tremendous pressure, healthy habits for adolescent athletes are
use. While focusing on achieving healthy for example, exerted by society and the summarized below. In general, strategies
body weights and avoiding use of media that idolizes thinness and an that promote positive and empowering
supplements and ergogenic aids, a 2008 ideal body image—one that is far messages that encourage adolescents to
consensus statement for team physicians different from the average adolescent take responsibility for feeding
made a clear recommendation to athlete’s body size or shape. This is not themselves and to focus on foods to
emphasize health and performance over only an issue for female athletes who include to maximize nutrition, rather
weight goals and to understand the perceive the need to diet, but also for than focusing on foods to restrict or
impact of pathological weight behaviors male athletes who are faced with the avoid, are recommended.
on adolescent growth and development.13 challenge of developing “abs of steel.”
Three major concerns are iron Adolescents do not necessarily have Fill your plate with fresh food:
deficiency anemia, compromised bone the nutrition knowledge to practice Reflect on your food choices and
health, and disordered eating/eating sports nutrition, nor do coaches who consider how many of the things
disorders. A well-described combination most typically coach at the middle you eat come from packages that
of risk factors known as the female school or high school level. Taken you simply tear open and eat, or
athlete triad consists of inadequate food together, there is tremendous potential heat and eat. For good health
intake, amenorrhea, and reduced bone for misinformation and pressure for and sports performance, it is time
21,22
mineral density. This triad poses a dieting behavior or supplement use. to shift the balance to include
specific threat to athletes in both the The risk for disordered eating and real foods like fresh fruits, fresh
short and long term because the eating disorders is high in the vegetables, nuts, beans, dairy,
opportunity to reach peak bone mass 25,26
adolescent athlete population. lean meats, chicken and fish, and
can be negatively affected by poor minimally processed whole grain
nutrition during adolescence. In an Role of Physicians foods in your daily diet. Fuel
updated definition acknowledging that and Other Health your body with food, not with
male athletes are similarly affected, the Professionals supplements and energy drinks
triad was described as one piece of a or other sports products that
more comprehensive syndrome called For nutrition advice to be adopted and masquerade as food.
RED-S (Relative Energy Deficiency in sustained by adolescents, it must be food Eat to compete: Athletes need to eat
Sport). RED-S consists of “impaired based, practical, achievable, and breakfast, lunch, and dinner with
physiological function including, but not personally relevant. Yet sports nutrition snacks in between to be properly
limited to, metabolic rate, menstrual guidelines are oftentimes nutrient based, fueled for performance. Skipping
function (in females), bone health, framed in technical terms involving meals is not a strategy for success.
immunity, protein synthesis, and mathematical equations, and highly sport Break your overnight fast
cardiovascular health caused by relative specific, leaving athletes confused and (“breakfast”) with a balanced
energy deficiency” (p. 491) where an misinformed, unable to translate the meal. Follow this simple meal-
imbalance occurs between dietary advice to their own personal needs and building strategy to create
energy intake and energy expenditure vulnerable to adverse outcomes. The role balanced meals including these
required to sustain homeostasis, health of the nutrition professional in sport is to key components:
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vol. 9 • no. 6 American Journal of Lifestyle Medicine
maintaining weight in a healthy
Protein Carbohydrate Fruit/Vegetable range, seek help from a physician,
qualified health professional, and/
Peanut butter Whole grain bread Banana or registered dietitian. AJLM
Greek yogurt Granola Fresh berries
Scrambled eggs Tortilla or pita Diced peppers and onions References
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