‘ADA REPORTS Position of the American Dietetic Association, Dietitians of Canada, and the American College of Sports Medicine: Nutrition and athletic performance ABSTRACT It is the position of the American Dietetic Association, Dieti- tians of Canada, and the American College of Sports Medicine that physical activity, athletic performance, and recovery from exercise are enhanced by optiimal nutrition. These organi tions recommend appropriate selection of food and fluids, timing of intake, and supplement choices for optimal health and exercise performance. This position paper reviews the current scientific data related to the energy needs of athletes, assessinent of body composition, strategies for weight change, the nutrient and fluid needs of athletes, special nutrient needs during training, the use of supplements and nutritional ergo- sgenic aids, and the nutrition recommendations for vegetarian athletes. During times of high physical activity, energy and macronutrient needs—especially carbohydrate and protein intake—must be met in order to maintain body weight, replen- ish glycogen stores, and provide adequate protein for building, and repair of tissue. Fat intake should be adequate to provide ‘the essential fatty acids and fat-soluble vitamins, as well as to help provide adequate energy for weight maintenance. Overall, diets should provide moderate amounts of energy from fat (20% to 25% of energy); however, there appears to be 10 health or performance benefit to consuming a diet containing less than 15% of energy from fat. Body weight and composition can affect exercise performance, but should not be used as the sole criterion for sports performance; daily weigh-ins are discouraged. Consuming adequate food and fluid before, dur- ing, and after exercise can help maintain blood glucose during exercise, maximize exercise performance, and improve recov- ery time. Athletes should be well-hydrated before beginning to exercise; athletes should also drink enough fluid during and after exercise to balance fluid losses. Consumption of sport drinks containing carbohydrates and electrolytes during exer- cise will provide fuel for the muscles, help maintain blood glucose and the thirst mechanism, and decrease the risk’ of dehydration or hyponatremia, Athletes will not need vitamin and mineral supplements if adequate energy to maintain body weight is consumed from a variety of foods. However, supple- ‘ments may be required by athletes who restrict energy intake, use severe weight-loss practices, eliminate one or more food groups from their diet, or consume high-carbohydrate diets ‘with low micronutrient density. Nutritional ergogenic aids should be used with caution, and only after careful evaluation of the product for safety, efficacy, potency, and whether or not it is @ banned or illegal substance. Nutrition advice, by a {qualified nutrition expert, should only be provided after care- fully reviewing the athlete's health, diet, supplement and drug, ‘use, and energy requirements. J Am Diet Assoc. 2000;100:1 16556. beneficial effects of nutrition on exercise performance. ‘There is no doubt that what an athlete eats and drinks can affect health, body weight and composition, substrate avail- ability during exercise, recovery time after exercise, and ultimately, exercise performance. Asthe research and interest in sport nutrition has increased, so has the sale of ergogenic aids, supplements, herbal preparations, and diet aids, all aimed at improving sports performance. The manufacturers of these products frequently make unsubstantiated claimsto entice the athlete to use their products. The athlete who wants to opti- mize exercise performance needs to follow good nutrition and hydration practices, use supplements and ergogenic aids care- fully, minimize severe weight loss practices, and eat a variety of foods in adequate amounts. This position is focused on adult athletes, rather than chil- drenor adolescents, and does not focus on any particular type of athlete or athlctie event. Moreover, the position is intended to provide guidance to dietetics and health professionals work- ing with athletes, and is not directed to individual athletes themselves, POSITION STATEMENT It is the position of the American Dietetic Association, Dietitians of Canada, and the American College of Sports Medicine that physical activity, athletic performance, and recovery from exercise are enhanced by optimal nutrition. These organizations recommend appropriate selection of food and fluids, timing of intake, and supplement choices ‘Yor optimal health and exercise performance, 0 verthe past 20 years, research has clearly documented the KEY POINTS: ‘The following key points surumarize the current energy, nutei- ent, and fluid recommendations for active adults and competi- tive athletes noted in this position paper. Sport nutrition experts can further adjust these general recommendations to accommodate the unique concerns of individual athletes re- garding health, sports, nutrient. needs, food preferences, and body weight and body composition goals. = During times of high-intensity training, adequate energy needs ta be consumed to maintain body weight, maximize the training effects, and maintain health. Low-energy intakes can result in loss of muscle mass, menstrual dysfunction, loss or failure to gain bone density, and increased risk of fatigue, injury, and illness. = Body weight. and composition can affect exercise perfor- ‘mance but should not be used as the sole criterion for partici- pation in sports; daily weigh-ins are discouraged. Optimal body-fat levels vary depending upon the sex, age, and heredity of the athlete, as well as the sport itself. Body-fat assessment Journal of THE AMERICAN DIETETIC ASSOCIATION / 1543techniques have inherent variability, thus limiting the preci- sion with which they canbe interpreted. Ifweight1oss at loss) isdesired,it should start early—before the competitive season— and involve a trained health and nutrition professional 1 Carboliydrates are important to maintain blood-glucose lev- els during exercise and to replace muscle glycogen. Recom- mendations for athletes range from 6 to 10 g/kg body weight per day. The amount required depends upon the athlete's total daily energy expenditure, type of sport performed, sex of the athlete, and environmental conditions, 1 Protein requirements are slightly increased in highly active people. Protein recommendations for endurance athletes are 1.2 to 14 g/kg body weight per day, whereas those for resis- tanceand strength-trained athletes may be as highas 1.60 1.7 ‘alka body weight per day. These recommended protein intakes can generally be met through diet alone, without the use of protein or amino acid supplements, if enengy intake is ad- ‘equate to maintain body weight. 1 Fat intake should not be restricted, because there is no performance benefit in consuming. diet with less than 15% of ‘energy from fat, compared with 20% to 25% of energy from fat. Fatis important in the diets of athletes as it provides energy, fat-soluble vitamins, and essential fatty acids. Additionally, there is no scientific basis on which to recommend high-fat diets to athletes, The athlotes at greatest risk of micronutrient deficiencies are those who restrict energy intake or use severe weight-loss practices, eliminate one or more food groups from their diet, or consume high-carbohydrate diets with low micronutrient den- sity. Athletes should strive to consume diets that provide at least the RDASDRIs forall micronutrients from food. 1 Dehy:dration decreases exercise performance; ths, adequate fluid before, during, and after exercise is necessary for health and optimal performance. Athletes should drink enough fluid to balance their fluid losses. Two hours before exercise 400 to 600 mL, (14 to 22 02) of fluid should be consumed, and during exercise 150to 360m (Bto 12.02) of fluid should be consumed every 15 to 20 minutes depending on tolerance. After exercise theathlete should drink adequate fluids to replace sweat losses during exercise. The athlete needs to drink at least 450 to 675 mL (16102402) of fluid for every pound (0.5 kg) of body weight lost during exercise, ‘= Before exercise, a meal or snack should provide sulficient, ‘uid to maintain hydration, be relatively low in fat and fiber to facilitate gastric emptying and minimize gastrointestinal dis- tress, be relatively high in carbohydrate to maximize mainte nance of blood glucose, be moderate in protein, and be corn- posed of foods familiar and well tolerated by the athlete. 1» During exercise, the primary goals for nutrient consumption are to replace fluid losses and provide carbohydrate (approxi rately 30 to 60 g per hour) for the maintenance of blood glucose levels. These nutrition guidelines are especially impor- tant for endurance events lasting longer than an hour, when the athlete has not consumed adequate food or fluid before ‘exercise, ori the athlete is exercising in an extreme environ- ‘ment (heat, cold, or altitude). i After exercise, the dietary goals to provide adequate energy and carbohydrates to replace musele glycogen and to ensure rapid recovery. If an athlete is glycogen-depleted after exer- cise, a carbohydrate intake of 1.5 g/kg body weight during the first 30 minutes and again every 2 hours for 4 to 6 hours will be adequate to replace glycogen stores. Protein consumed after exercise will provide amino acids for the building and repair of 1844 December 2000 Volume 100 Nuraber 12 muscle tissue. Therefore, athletes should consume a mixed ‘meal providing carbohydrates, protein, and fat soon after a strenuous competition or training session. In general, no vitamin and mineral supplements should be required if an athlete is consuming adequate energy from a variety of foods to maintain body weight. Supplementation recommendations unrelated to exereise—such as folic acid in ‘women of childbearing potential—should be followed. If an athlete is dieting, eliminating foods or food groups, is sick or recovering from injury, or has a specific micronutrient defl- ‘ciency, a multivitamin/mineral supplement may be appropri- ate. No single nutrient supplements should be used without a ‘specific medical or nutritional reason (eg, iron supplements to reverse iron deficiency anemia). = Athletes should be counseled regarding the use of ergogenic aids, which should be used with caution and only after careful evaluation of the product for safety, efficacy, poteney, and legality. = Vegetarian athletes may be at risk for low energy, protein, and micronutrient intakes because of high intakes of low- ‘energy-dense foodsand the elimination of meat and dairy from the diet. Consultation with a registered dietitian will help to avoid these nutrition problems. ENERGY REQUIREMENTS Meeting energy needsis the first nutrition priority for athletes. Achieving encray balance is essential for the maintenance of lean tissue mass, immune and reproductive function, and optimum athletic performance. Enengy balance is defined asa State when energy intake (the sum of energy from food, fads, and supplement products) equals energy expenditure (the sum of energy expended as basal metabolism, the thermic effect of food, and any voluntary physical activity) (1), Inad- equate energy intake relative to energy expenditure compro- mises performance andthe benefits associated with training With limited energy intake, fatandleantissuemass willbe used by the body for fuel. Loss of muscle results in the loss of strength and endurance. In addition, chronically low energy intake often results in poor nutrient intake, particularly ofthe rieronutrients Inthe 1989 Recommended Dietary Allowances (RDAS) (2), mean energy requirements for women anclmenwhoare sightiy to moderately active and between 19 to 50 years of age wore established as 2,200 and 2,900 kcal per day, respectively. Expressed alternatively, normally active people are counseled to consume an energy intake of 1 to 1.7 times resting energy expenditure orat a rate of 37 to 41 kcal/kg body weight per day. (2). Energy expenditure is influenced by heredity, age, sex, body size, fatfree mass, and the intensity, frequency, and duration of exercise. For athletes, the recommendation is ‘made to evaluate the kindof exercise performed for its inten- sity, frequency, and duration, and then to add this increment to the energy needed for normal daily activity (3,4,5). For ‘example, 7 kg male runner who runs 10miles per day ata 6- ‘minute pace would require approximately 1,063keal per day to cover the energy expenditure of running (0.253 keal/mirvkg) (6), plus the energy cost of normal daily activities (70 kg x 37 to 41 kcal/kg body weight) for normal activity. Thus, this athlete would need approximately 3,653 to 3,933 kcal per day to cover the total cost of energy expenditure. Ultimately, however, numeric guidelines for energy intake, such as those cited above, can only provide a crude approximation of the average energy needs of an individual athlete. Any athleteSetting and monitoring goals 1= Sot realistic weight and body composition goals. Ask the athlete: ~ What is the maximum weight that you would find acceptable? = What was the last weight you maintained without constantly dieting? = How did you derive your goal weight? = At what weight and Dody composition do you perform best? 1= Encourage less focus on the scele and more on healtul habits such as stress management and making good food choices. f Monior progress by measuring changes in exercise performance and energy level, the prevention of nines, normal menstrual function, and general overall wel-being ‘a Hop athletes to develop lifestyle changes that maintain a healthtul weight for themselves—not for their spor, for their coach, for their friends, for their parents, oF to prove a point. ‘Suggestions for food intake = Low-energy diets will not sustain athletic training. Inctead, decreases in energy Intake of 10% lo 20% of normal intake will ead to | ‘weightloss without the athlete feeling deprived or overly hungry, Sratagies such as substituting lower-fat foods for whole-fat foods, reducing intake of energy-dense snacks, and doing activites other then eating when not hungry can be useful i= If appropriate, athletes can reduce fa intake but need to know that a lower-al dit will not guarantee weight loss if a negative energy balance (reduced energy intake and increased energy expenditure) is not achieved. Fat intake should nol be decreased [products and lean meats, fish, and poultry is suggested. Other weight management strategies should be flexible and achievable, Athletes should remem than going on a shor-term “, Going SB. Compar- on of air displacement pletnysmography with dual-energy Xray absorptiomaty and 3 "ols ‘athods lor estimating body composton In Iriddie-age men AmJ Cin Nut. 1998;68-786-733. 4. Eliskd. 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This position is in effect until December 31, 2005. The ‘American Dietetic Association, Dietitians of Canada, and the American College of Sports Medicine, authorize the publica- tion of the position, in dts entirety, provided full and proper credits given. Requests for use portions of the position, must be directed to ADA Headquarters at 800/877-1600, ext 4896, or ppapers@eatright.org, ‘= Recognition is given to the following for their contributions: Authors: American Dietetic Association; Melinda M, Manore, PhD, RD, FACSM (Arizona State University, Tempe, Ariz) Dietitians of Canada: Susan |. Barr, PhD, RDN, FACSM (Uni- versity of British Columbia, Vancouver, BC) American College of Sports Medicine: Gail E. Butterfield, PhD, RD, FACSM (Dr, Butterfield passed away on December 27, 1999. This position is dedicated to her contributions in the field of nutrition and sports medicine), Reviewers: American Dietetic Association: Nancy Clark, MS, RD, FAGSM (SportsMedicine Brookline, Brookline, Mass); Susan M. Kleiner, PD, RD (High Performance Nutrition, Mercer Island, Wash); 1856 / December 2000 Volume 100 Number 12, Suzanne Nelson, DSc (University of Washington, Seattle, WA); Stella Volpe, PhD, RD, FACSM (University of Massachusetts, Amherst, MA), ~Dietitans of Canada: Maryilyn Booth, MSc, RD (private prac- tice, Ontario, Canada); Susie Langley, MS, RD (private prac tice, Ontario, Canada); Heidi Smith, BSc, RD (University of Guelph, Ontario, Canada); HeatherSchmurr, RD (private prac- tice, Alberta, Canada), American College of Sports Medicine: Elizabeth Applegate, PhD, FACSM (University of California-Davis, Davis, Calif) Nancy Clark, MS, RD, FACSM (SportsMedicine Brookline Brookline, Mass); Linda Houtkooper, PhD, RD (University of Arizona, Tucson, Ariz); Wiliam J. Kraemer, PhD, FACSM (Ball State University, Muncie, Ind); Scott Powers, PhD, FACSM (University of Florida, Gainesville); Janice Thompson, PhD, FACSM (University of New Mexico, Albuquerque) Membersofthe Association Positions Committee Workgroup: Bthan Bergman, PRD, RD, PADA; Naney Wooldridge, MS, RD; Pauline Landhuis, MS, RD; Kristine Clark, PaD, RD, FACSM (content advisor).