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 0021-7557/00/76-Supl.3/S349 Jornal de Pediatria - Vol. 76, Supl.3, 2000 S349
Jornal de Pediatria
Copyright © 2000 by Sociedade Brasileira de Pediatria

REVIEW ARTICLE

Nutrition and physical activity

Claudia Ridel Juzwiak1, Valéria C.P. Paschoal2, Fábio Ancona Lopez3

Abstract
Objective: to review data about the nutrition of physically active children and adolescents.
Method: review of literature using MEDLINE and LILACS data base and the keywords sport or
physical activity and nutrition and children or adolescents.
Results and Conclusion: involvement of children and adolescents in sports activities is important for
their growth and development process, which should be regularly assessed. Na adequate diet should
provide enough energy and nutrients so that young athletes can meet their requirements. The diet should
suit the different stages of training, before, during and after competition. Hydration should be planned
carefully as children present a less efficient thermoregulation than adults and can dehydrate more quickly,
specially during sports practice. Female athletes can present menstrual alterations and inadequate bone
growth due to excessive training associated with inadequate energy intake. Eating disorders are found
among some groups of athletes. Physical activity should be encouraged as part of the treatment of
overweight children.
J. pediatr. (Rio J.). 2000; 76 (Supl.3): S349-S358: exercise, adolescent nutrition.

Introduction
Participation of children in sports is an essential part of
the growth and development process. Physical exercises
helps prevent several diseases such as obesity, diabetes, and
hypertension, and offers children an opportunity for leisure,
social integration and development of their aptitude, leading
to enhanced self-esteem and confidence.1
It is important that physically active children and
adolescents consume enough energy and nutrients to meet
their needs in terms of growth, tissue maintenance, and
performance of their intellectual and physical activities. 1-6
Nowadays, early participation of young people in
competitions and their involvement in intensive training
programs calls for health professionals’ attention to the
1. Associate professor of Neurology, FAMED, PUCRS.
2. Student, Graduation Program in Neurosciences, PUCRS.
3. Municipal Health Secretariat, Porto Alegre, RS.
adoption of eating behaviors that could be deleterious to
health such as dehydration, inadequate weight control
practices, nutritional disorders and uncontrolled use of
substances seen as ergogenic.
Growth and development
Height, weight and body composition
One of the major concerns during childhood and
adolescence is to ensure the achievement of expected growth
and development. Regular physical training, or even the
involvement in every-day relatively moderate physical
activities, together with other environmental variables,
influence the establishment of a genetically-determined
growth pattern.7-8 Their action on muscles and bones is an
important factor for the increase in bone mass peak during
adolescence and, consequently, for the prevention of

S349
S350 Jornal de Pediatria - Vol. 76, Supl.3, 2000
osteoporosis in adulthood. However, their effects do not
seem to increase or reduce final height values.9-11
To verify whether growth is adequate, weight and height
should be measured regularly and assessed in terms of
weight/height ratio, according to reference standards and
body mass index (BMI).3-4,12
Regular physical activity is important for controlling
ponderal index and has been associated with the reduction
of fat mass and increase in lean mass. However, it is difficult
to distinguish between the effects of training and the expected
effects of an increase in lean mass caused by growth and
maturation.11
Several aspects such as bone density, body water content
and composition of tissues that form lean mass are different
in adults and children. Although methods for body
composition assessment have been developed in
consideration to these differences,13-14 body fat content
and weight should not be used as a criterion for the
participation of young people in sports or for determining
weight requirements, as they could cause impairment to
normal growth and development.3-5,13
Among the existing body composition assessment
methods, the most practical ones are skinfold and
circumference measurements.15 Slaughter and col. 16
developed an equation by using the measurements obtained
from a sampling of young people, which may be used for
adolescents at large. The measurements of several other
skinfolds, without conveerting them into fat content, can
also be used to check changes in body fat composition of
these adolescents.13-14
Slaughter et al.16 propose an equation for children and
adolescents that is formulated as follows:
a) For children whose addition of triceps and
subscapular skinfolds is < 35 mm
Boys:
Fat content (%) = 1.21 x (addition of skinfolds) – 0.008
x (addition of skinfolds)2 - constant
Girls:
Fat content (%) = 1.33 x (addition of skinfolds) – 0.013
x (addition of skinfolds)2 - constant
Prepubertal Pubertal Postpubertal
Constants for boys
White 1.7 3.4 5.5
Non-white 3.2 5.2 6.8
Constants for girls
White 2.0
Non-white 3.0
Nutrition and physical activity - Juzwiak CR et alii
b) For children whose addition of triceps and
subscapular skinfolds is > 35 mm
Boys:
Fat content (%) = 0.783 x (addition of skinfolds) + 1.6
Girls:
Fat content (%) = 0.546 x (addition of skinfolds) + 9.7
When estimating body fat content, the errors associated
with the method being used should be considered. We
should not forget that skinfold increases with normal growth
in non-athletes while the opposite may occur in athletes.14
Changes in body composition should be monitored by
qualified personnel in order to assess its effects on health
and performance.3-4,13
During the pubertal period, primary and secondary
sexual characteristics are developed, at the same time that
physical growth process continues, culminating in the second
growth enhancement stage. At this stage, the assessment of
nutritional status is more complex, as criteria are not so
clearly-defined as in childhood.17 In general, participation
in sports activities is defined according to chronological
age. In the case of adolescents, an individual with late
sexual maturation usually competes with a peer with early
sexual maturation, that is, someone who is taller and
stronger.11
Boys and girls increase their body fat content during the
pubertal period.13 Individuals with early sexual maturation
are usually fatter, especially girls , staying fatter, taller and
presenting reduced aerobic capacity when they reach
adulthood.18,19 Kemper and col.,19 in a longitudinal study
with 200 young people (13 to 22 years old, during 9 years),
concluded that individuals with late sexual maturation had
greater energy intake and an activity pattern slightly higher
than those adolescents with early sexual maturation, resulting
in a lower body fat content than the first group. 19
A negative energy balance, caused by inadequate energy
intake or energy restrictions associated with certain sports,
may inhibit the production of growth factors typical of
normal growth and development. It was observed that 6
days of energy restricition (35 kcal/kg/day) in children
between eight and 11 years old, resulted in a negative
nitrogen balance and reduction in IGF-I and IFGBP3
circulating levels. The authors suggest that these hormonal
changes may indicate a resistant growth hormone status,
which could impair normal growth and development on the
long run.
Components of physical aptitude
The components of physical aptitude are related to
growth and sexual maturation. Physical exercise ability
increases throughout the pubertal period due to an increase
in strength, ability and resistance. These changes involve
linear growth and alterations in body and physiological
composition, for example, a greater control over body
temperature, which improves peformance.
Nutrition and physical activity - Juzwiak CR et alii Jornal de Pediatria - Vol. 76, Supl.3, 2000 S351

Boys increase their aerobic capacity (VO2max) during
adolescence, reaching their peak between the ages of 18 and
20. In postpubertal adolescent girls, VO2max per unit of
body weight decreases, while body fat increases, hemoglobin
tends to decrease and so does voluntary activity. Aerobic
capacity (in ml of O2/kg/min), measured through an
endurance test in male and female adolescents, from different
countries, is approximately 45 to 55 in boys and 36 to 46 in
girls. Age and aerobic capacity have an inverse relation.
The chances for improving aerobic capacity through training
are greater in adolescents than in children, and its peak
occurs at the growth enhancement stage.18
There is higher efficiency of movements after the pubertal
period. Even with declining aerobic capacity, performance
in sports activities may reach its peak a few years after the
pubertal period due to better motor coordination, movement
saving and better strategies. Aerobic threshold is greater
after the pubertal period and is a linear function of lean body
mass.18
Several studies have attempted to document the energy
and nutrient intake of young athletes and demonstrated that
these individuals’ food intake analysis indicates a lower
energy intake in relation to their age, according to RDA
(Recommended Dietary Allowances).24 Thompson,6 in a
review on energy balance of young athletes, reports that
such results were based on these athletes’ own diet records,
which means that the accuracy of reported values depend on
the athletes’ capacity of registering their food intake
correctly, their tendency to report lower energy intakes and
on the use of restrictive diets among athletes in certain
modalities (gym, dancing, figure skating, fighters).6
RDA 24 may be used to estimate calorie requirements
for normal growth and development (Table 1 and 2),
although recent findings, through the double labeled water
(DLW) method used in young people, suggest that RDA
might be overestimating requirements for this age group.6

Nutritional aspects
General considerations
There are a variety of factors that influence the quality Table 1 - Prediction equations for energy expenditure at rest,
of a diet. In the case of schoolars and mainly adolescents, we according to weight
should take into consideration that there is a quest for
Sex/Age Equations to derive kcal/day
greater independence at this age, and food selection is one
of the areas in which adolescents can show their Men
determination and express their preferences. Peer influence, 0-3 years (60.9 x W*) - 54
training time, and other daily activities are factors that may 3-10 years (22.7 x W*) + 495
cause young athletes to choose foods, which despite being 10-18 years (17.5 x W*) + 651
their favorite one, are not very nutritious, resulting in a
Women
suboptimal energy and nutrient intake.5,6,20 0-3 years (61.0 x W*) - 51
Snack intake is very common in this age group and 3-10 years (22.5 x W*) + 499
corresponds to approximately 20% of daily total energy 10-18 years (12.2 x W*) + 746
intake.18,21-22 Soares et al.23 reported a snack intake of 25 * W = weight in kg
- 28% between major meals, when they assessed the food Source: Nrc, Food & Nutrition Board, Nas, 1989
intake of 67 competitive swimmers from Rio de Janeiro and
São Paulo, aged between 15 and 25 years. It is important to
evaluate the frequency and quality of these snacks in order
to improve their nutritional quality and their energetic
contribution to the diet.23

Energy Table 2 - Calorie and protein needs for normal growth and
development
Maintenance of energy balance should a constant worry.
Young athletes are commonly affected by energy imbalance, Age Calories (kcal/kg) Protein (g/kg)
which, if maintained for a long period, may cause serious
effects on health such as low height, delayed pubertal 1-3 102 1.2
period, nutrient deficiency, dehydration, irregular menstrual 4-6 90 1.1
periods, bone changes, higher incidence of lesions, and 7 - 10 70 1.0
higher risk for the development of nutritional disorders.6 11 - 14 (women) 55 1.0
11 - 14 (men) 47 1.0
Although accurate energy requirements of young athletes
15 - 18 (women) 40 0.9
is not well-established yet, their energy requirements may
15 - 18 (men) 45 0.9
be estimated by current food intake analysis, growth rate,
gender, age and intensity of physical activity.1,6 Recomended Dietary Allowances, NRC, 1989
S352 Jornal de Pediatria - Vol. 76, Supl.3, 2000 Nutrition and physical activity - Juzwiak CR et alii

Henry et al.25 proposed equations to calculate basal Macronutrients

energy requirements by means of variables such as skinfolds,
circumferences, fat mass, fat-free mass, in addition to
Tanner stages, and observed that weight was the variable
which had the best correlation with basal metabolism rate.
For boys, the most accurate equation was that which used
skinfold data (suprailliac, triceps and subscapular), and for
girls, the most accurate equation was the one that used
weight, height, fat-free mass and age (Tables 3 and 4).25
To calculate energy spending during exercise, we should
consider the kind of sport practiced, frequency, duration,
participation or not in competitions. Equivalence tables on
energy spending in exercise may be used to calculate extra
calories necessary for the day, as the one proposed by Bar-
or26 (Table 5).
Inadequate energy intake is also associated with marginal
intake of macronutrients and micronutrients, especially
carbohydrates, pyrodoxin, calcium, folate, zinc and
magnesium. Such association has deleterious consequences
on growth such as increased risk for the development of
diseases, reduction of metabolic rate, exacerbating the need
for more restrictive diets as to obtain the desired weight
loss, which is totally contraindicated.5,6
Food restrictions are common among athletes who
compete in sports where body composition and esthetics are
determining factors for success.3-4,6 As an example, young
greco-roman wrestlers, who repeatedly restrict their diet
drastically and regain weight later, present a 14% reduction
in basal metabolic rate per unit of lean mass.18
It is recommended that a diet for young athletes should
provide between 55 and 60% of total energy in the form of
carbohydrates, 12-15% of proteins and 25-30 % of lipids.2-4
These carbohydrates should preferably be complex (40-
45% of calories) and in a smaller proportion, simple (10-
15%).2 Inadequate intake of carbohydrates may result in
insufficient muscle glycogen stores and early fatigue, in
addition to the use of protein stores for energy production.6,27
Protein requirements are greater in young people than in
sedentary adults.6 RDA (24) serve as a guide for a protein
intake that ensures normal growth. There are no studies that
specify protein allowances for young athletes; however,
Ortega2 suggests that protein intake in adolescents who
practice sports should be 2 g/kg/day, which is double the
recommendation for sedentary adolescents.2 In general,
protein allowances are easily achieved since there is a
validation of protein intake, not only through food ingestion,
but also via nutritional supplements, which results from the
existing association between the intake of this nutrient,
muscle mass gain and strength.18
Young people have higher levels of glycerol in their
blood, increased use of free fatty acids and lower breathing
exchange ratio during exercises, indicating an increased use
of fats. Despite this increased use of fat during exercises, it
is not recommended that the dietary ingestion of this nutrient
be higher than 30% of total calorie value, and saturated fatty
acids should contribute with less than 10% of this value. 6,28
A low energy intake due to reduced fat ingestion is very
common among athletes who follow restrictive diets.5

Table 3 - Regression equations to estimate TMB (kj/day) in children aged between 10 and 15 years old

Gender Equations according to gender R2 PR

Boys
W x 66.9 + 2876 0.61 575
FFM (kg) x 105.4 + 2230 0.62 567
W x 54.6 + H x 18.8 + 576 0.62 563
FFM (kg) x 91.1 + FM (kg) x 29.4 + 2422 0.63 558
W x 78.5 + SI (mm) x 45.3 - TR (mm) x 54.99 - SB (mm) x 38.3 + 294 0.67 527

Girls
W x 47,9 + 3230 0.52 519
W x 21 - H x 11 + FFM (kg) x 8007 - A x 154.6 + 5319 0.57 480
FFM (kg) x 96.7 - gender x 383.9 + FM (kg) x 21.4 - A x 136 + 3949 0.60 522

R2 = concordance level between TMB measured and estimated values; RSD = residual standard deviation (kg); W = weight
(kg); H= height (cm); A = age (years) ; FFM = fat-free mass; SI = suprailliac skinfold; TRI= triceps skinfold; SB = subscapular
skinfold; gender = female (equivalent to 0).
Source: Henry et al., 1999
Nutrition and physical activity - Juzwiak CR et alii Jornal de Pediatria - Vol. 76, Supl.3, 2000 S353

Table 4 - Regression equations to estimate TMB (kj/day) in children according to their pubertal stage

Pubertal stage Equations according to gender R2 PR

Boys
PU W x 60 - A x 194 + WC (mm) x 50.7 + 2892 0.61 471
DG3 AMC (cm) x 270 + log soma 5 folds (mm) x 1450 - 1803 0.69 519

Girls
MD1 W x 69.9 - 5230 0.52 416
10-15 years W x 50.6 - ME x 170.9 + 3161 0.52 416
Premenarche W x 53.6 + 3031 0.57 485
Premenarche W x 97.07 - FM x 74.6 - A x 121.2 + 3452 0.61 462

R2 = concordance level between TMB measured and estimated values; RSD = residual standard deviation (kj); W = weight
(kg); A = age (years) ; PU = pubic hair; GD3= genital development stage 3 (Tanner|); MD1 = mammary development stage
1 (Tanner); WC = wrist circumference; AMC = arm muscle circumference; ME = Menarche (premenarche = 0 and
postmenarche = 1); FM = fat mass.
Source: Henry et al., 1999

Micronutrients cell counts results in higher iron requirement for myoglobulin

There are no specific nutrient recommendations for
young athletes. RDA 24 and DRI29,31 are used as standards
to check adequation, although they have little specificity.
In addition to low energy intake, calcium intake should
be controlled. An adequate intake of this nutrient is extremely
important for these athletes who are at growth stage so that
they reduce stress fractures and later risk for developing
osteoporosis. This factor is especially important among
female athletes who present primary amenorrhea, which is
associated to a lower bone density. Among athletes, gymnasts
are the ones who have a higher frequency of bone damage.6,18
A calcium intake less than 500 mg results in lower
retention of this nutrient in adolescents, which is a common
intake for this group. For better bone development and
reduction in stress fracture, Bernadot32 suggests that levels
higher than those preconized by RDA 24 should be ingested,
especially by elite gymnasts. The new calcium DRI29
suggests higher intake rates for this nutrient by adolescents,
considering the dramatic increment of bone mineral content
during this period, however it does not take into account
requirements in terms of sports practice.
Calcium intake may be insufficient, especially among
young people who reduce the intake of dairy products and
present a high intake of proteins and foods that provide a
large amount of phosphorus (ex. carbonated drinks).2
Special attention should be paid to iron intake during
adolescence. Quick increase in lean mass, blood and red
and hemoglobin, with higher probability for the occurrence
of anemia at the growth enhancement stage. Higher iron
reserves due to greater lean mass and menstrual losses in
girls justify the need for higher iron intake at this age. 18
Insufficient iron intake may hinder oxygen transport
capacity, thus reducing performance and interfering with
training if iron deficiency progresses into anemia. 6
Female adolescent athletes are at greater risk for iron
deficiency due to their greater physiological needs, low
energy intake (in relation to sports that require weight
control), inadequate iron intake, and iron loss due to the
practice of sports (hemolysis by impact). Even when the
analysis of daily intake shows adequate ingestion and the
blood test indicates a normal hemoglobin count, it is
necessary to monitor body iron stores (ferritin) due to low
iron bioavailability.6,18
Intake of vitamin A, vitamin C and magnesium may be
below recommended levels in children who are not in the
habit of eating fruits and vegeatbles. Diets that present
severe caloric restriction may be deficient in pyrodoxin,
calcium, folate and zinc.1,18
Hydration
Hydration is essential to maintain health and physical
performance. Due to increased loss of water and electrolytes
S354 Jornal de Pediatria - Vol. 76, Supl.3, 2000 Nutrition and physical activity - Juzwiak CR et alii

Table 5 - Calorie equivalent in children, representing kcal per 10 minutes of activity

Weight (kg)
Activity 20 25 30 35 40 45 50 55 60 65

Basketball (game) 34 43 51 60 68 77 85 94 102 110

Gym 13 17 20 23 26 30 33 36 40 43
Cross-country skiing 24 30 36 42 48 54 60 66 72 78
Cycling
10 km/h 15 17 20 23 26 29 33 36 39 42
15 km/h 22 27 32 36 41 46 50 55 60 65
Field hockey 27 34 40 47 54 60 67 74 80 87
Figure skating 40 50 60 70 80 90 100 110 120 130
Horseback-riding
Walking 8 11 13 15 17 19 21 23 25 27
Trotting 22 28 33 39 44 50 55 61 66 72
Galloping 28 35 41 48 50 62 69 76 83 90
Ice hockey 52 65 78 91 104 117 130 143 156 168
Judo 39 49 59 69 78 88 98 108 118 127
Jogging
8 km/h 37 45 52 60 66 72 78 84 90 95
10 km/h 48 55 64 73 79 85 92 100 107 113
12 km/h - - 76 88 91 99 107 115 123 130
14 km/h - - - - - 113 121 130 140 148
Sitting, playing calmly 11 12 14 15 15 16 17 18 19 20
Soccer (game) 36 45 54 63 72 81 90 99 108 117
Squash - - 64 74 85 95 106 117 127 138
Swimming (30 m/min)
Breaststroke 19 24 29 34 38 43 48 53 58 62
Crawl 25 31 37 48 49 56 62 68 74 80
Backstroke 17 21 25 30 34 38 42 47 51 55
Table tennis 14 17 20 24 28 31 34 37 41 44
Tennis 22 28 33 39 44 50 55 64 66 72
Volleyball (game) 20 25 30 35 40 45 50 55 60 65
Walking
4 km/h 17 19 21 23 26 28 30 32 34 36
6 km/h 24 26 28 30 32 34 37 40 43 48

Source: BAR-OR, 1983.

through sudoresis, sportspersons should ingest fluids before,
during and after training and competition periods.3-5
Water and electrolyte requirements for adults are well-
studied in the literature, but there is little information about
these needs in children.33 During dehydration, young athletes
have a faster increase in their internal temperature if
compared to adults. This indicates that children have a less
efficient thermoregulation than adults, which is possibly
due to their reduced rate of sudoresis, higher surface area/
body mass ratio (which leads to enhanced heat exchange
with the environment) and higher production of metabolic
heat. These findings emphasize the necessity to guarantee
fluid intake by children and adolescents during physical
exercise.6,32
Children usually lose less than 350 - 400 ml/hr/m2 of
body surface area. This low rate of sudoresis is the result of
reduced sweat production by the gland rather than by the
number of heat-activated sweat glands. The transition of
sweat patterns from childhood to adulthood occurs at the
beginning and middle of the pubertal period. Some studies
show that fluid intake by children and also by adults during
long-lasting exercises was not enough to repor the losses,
even when drinks were offered ad libitum. Although, for
ethical reasons, dehydration levels have not exceeded 2 -
Nutrition and physical activity - Juzwiak CR et alii
3% of body weight, voluntary hydration rate among
adolescents and adults was similar.33
Children may avoid dehydration during long-lasting
and intermittent exercises by ingesting fluids every 15 - 20
minutes.28
For long-lasting sports activities, especially those over
90 minutes, hydroelectrolytic drinks with adequate
carbohydrate concentration (6 - 8%) and osmolarity, may
be used, having as advantage pleasant flavor and the
enhanced fluid intake by young people.2,27 In a study that
assessed children’s fluid flavor preference during physical
exercise, Meyer et al.33 found that male and female Canadian
children aged nine through 13 preferred grape beverages to
plain water and orange or apple drinks. This preference was
consistent at rest, after an oxygen uptake test and a
progressively provoked mild dehydration process. Grape
was the flavor that led to highest rehydration levels.
Dehydration can also the result of insufficient energy
intake in association with low fluid intake. It can also be
intentionally caused with the aim of quickly reducing
ponderal weight (sports requiring weight control), through
increased sudoresis, fluid restriction and use of diuretics,
with possible harmful effects on kidneys when performed
on a regular basis. Body water loss through sweating higher
than 5% of body weight is associated with fatigue and puts
athletes at risk for heatstroke and even death. 6,18,35
Water homeostasis is more efficient after the pubertal
period, but the importance of water for thermoregulation
should not be underestimated. Children should be instructed
on the consequences of dehydration and encouraged to get
into the habit of drinking water regularly during the practice
of sports. The use of an unshareable bottle should be
encouraged.
Specific nutrition pautas for competition sports
It is important to guarantee adequate energy reserves for
children and adolescents involved in competitions. It is not
recommended that children use the classic technique of
carbohydrate overcompensation, which comprises a
glycogen reserve depletion phase and a carbohydrate-free
diet (replaced with a diet high in proteins and fat) followed
by a high intake phase, due to the side effects caused in the
first phase such as fatigue and irritability. It is suggested that
3 - 4 days before competition, special attention should be
paid to the intake of carbohydrate-rich food.28
On the day of competition, athletes should be told to eat
carbohydrate-rich and low-fat foods. Easily digestible and
low-fiber foods should be chosen. Unknown foods (e.g.:
regional) should not be selected at this time.
The last meal should occur 3 - 4 hours before the event
to guarantee gastric emptying. Selected foods should be
easily digestible, preferably high in carbohydrates, with
either high or low glycemic index.
Jornal de Pediatria - Vol. 76, Supl.3, 2000 S355
Up to two hours before competition, a snack high in low
glycemic index carbohydrates may be ingested.1,35
Hendelman et al. 37 did not observe any effect on
physiological response to submaximal exercise (75 minutes
of bicycle) when carbohydrate-rich foods were offered 10
minutes before competition to untrained adolescents aged
on average 14. 5 years. Respiratory quotient, heartbeat rate,
glycemia and lactate concentration.
Water may and should be ingested before the event. A
fluid intake pattern should be established before competition
so that the adolescents start the exercises with an optimal
hydration level.
Children’s preferences should be respected provided
that the selected food has adequate characteristics.
Nervousness and anxiety may affect children’s acceptance
of the food.2
It is of fundamental importance that hydration be
maintained during the event. Carbohydrate-rich foods or
beverages may be ingested during long-lasting activities.
Temperature and beverage flavor contribute to higher
intake.33
Fluids and foods, especially those high in carbohydrates,
should be offered in order to replenish water and restore
muscle glycogen reserves, especially during the first hours
after the event, taking advantage of glycogen synthetase
activation. High glycemic index foods allow more efficient
muscle glycogen restoration.37
Specific nutritional aspects of female athletes
Menstrual alterations such as delayed menarche, primary
amenorrhea, inadequate bone growth and fracture proneness
are very common among female athletes, and are a
consequence of insufficient nutrition and excessive training,
mainly in the case of sports in which esthetics, strength and
weight are determining factors. 5-6 The existing
interrelationship between nutritional, menstrual and bone
disorders is known as the female athlete triad.39
Menstrual dysfunctions include subclinical ovulatory
disorders such as luteal phase deficiency and anovulation,
in addition to clinical disorders such as oligomenorrhea and
amenorrhea.6
The etiology of these menstrual anomalies is
multifactorial. Some factors associated with menstrual
irregularities include stress (related to lifestyle and athletic
performance), inadequate energy intake, low body fat content
and strict training program.1,39
Physically active and amenorrheic adolescents may not
be worried about the long-term risk for osteoporosis, but
may be persuaded to change their food intake and load of
exercise training when warned against the risks of stress
fracture and problems with hypothermia during exercise in
cold climates.13
S356 Jornal de Pediatria - Vol. 76, Supl.3, 2000
Although some athletes and coaches believe that
menstrual cycle suspension indicates optimal body fat
content or optimal level of training, this situation is actually
deleterious to bone health and may lead to infertility and
other reproductive problems, immunofucntional changes
and a greater risk for cardiovascular diseases. 6
Nutritional disorders
Anorexia and bulimia
The high incidence of nutritional disorders, menstrual
dysfunctions and use of inadequate weight control practices
reported by young athletes suggests that many of them do
not meet their daily energy and diet requirements. The
practice of sports such as gymnastics, ballet, figure skating,
body-building and wrestling were identified as a stimulus
for borderline energy intake, aimed at keeping body weight
low, and compatible with the criterion for body image
related to these activities.6
The presence of a modified eating behavior, frequently
associated with other symptoms such as vomiting, use of
laxatives, extreme weight loss, amenorrhea and other
physiological and psychological symptoms, may
characterize a real nutritional disorder.6,18 The prevalence
of these disorders is significantly higher among athletes
than in the population at large, and especially among female
athletes, corresponding to 32 - 63%.3,4,6,38,39
Bulimia is characterized by binge-eating behavior
followed by lack of control and excessively quick food
intake within a short period of time, alternating with purge
behavior or use of laxatives and diuretics. This kind of
behavior is difficult to diagnose as patients present secretive
behavior and normal weight, especially at the beginning.
Anorexia nervosa is a more severe syndrome and has more
harmful effects on health. The classic clinical status involves
changes in body image, and constant and compulsive food
restriction or even fasting, resulting, in many cases, in
death.18
These nutritional disorders may manifest themselves in
their hardly diagnosable clinical or subclinical form and
should be a concern to professionals who deal with these
athletes.38,39
Obesity
There are multiple interactions between physical activity
and obesity. Physical activity reduces the risk for obesity by
acting on energy balance regulation; influences body weight
distribution, conserving or maintaining lean mass, in addition
to its effects on weight loss.41
Participation in sports and increase in physical activity
are often recommended for the treatment of childhood
Nutrition and physical activity - Juzwiak CR et alii
obesity, followed by nutritional guidance and education.
Psychosocial factors and low physical aptitude may
discourage obese children from physical activity. Physical
hypoactivity creates a vicious cycle: inactivity - positive
calorie balance - obesity - reduced physical activity -
greater inactivity.9,41
Children should be encouraged to have a more active
life when they are still very young. The practice of early
exercise during growth process prevents the formation of
new adipose cells.41,42
Children following an antiobesity treatment should
associate calorie intake and low intensity and long-lasting
physical activity, also considering the recreational aspect. 44
Weight loss and positive cardiovascular and respiratory
effects resulting from physical conditioning in obese children
cause a reduction in physiological effort during exercise. As
to the psychosocial aspect, it improves self-image, self-
confidence, sociability, and also provides reduced effort
perception.
Final considerations
Several adolescents use food supplements and,
sometimes, drugs, in order to achieve better performance,
build up their muscles and reduce body fat content, thinking
that if these substances are “natural”, they cannot cause any
harm and that “if a small amount works well, a larger
amount will work even better”. Health professionals who
deal with these young athletes are supposed to warn them
against the risks associated with the use of such substances
and show them the importance of a balanced diet.45,46
Adolescents, family members and coaches should be
well-informed so that adequate eating habits can be adopted,
thus maintaining health and providing positive effects on
intellectual and sports performance.
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