Proper Nutrition and Exercise for the Adolescent

Chris&ne  Kim,  Jenna  Jackson,  Jin  Kuo,        Negin  Amanat,  Debrin  Y.  Kashani  

INTRODUCTION

Adolescence:

● Period between 10-19 years

● Divided into three stages

1. Early - rapid growth, onset of puberty

2. Middle - autonomy

3. Later - making important decisions

CONTROVERSY

•  Delicate age

•  Hormonal changes

•  Low self-esteem and

insecurities

•  Worry about bodily

changes

•  Athletic pressure

ARTICLE 1 Yager, Z., & O’Dea, J. (2014). Relationships between body image, nutritional supplement use, and attitudes towards doping in sport among adolescent boys: implications for prevention programs. Journal of the

International Society of Sports Nutrition, 11(1), 13.

Purpose: To examine the relationship between body dissatisfaction and attitudes towards drug use in sport in order to inform education and health promotion programs.

MATERIALS AND METHODS

Materials: Questionnaires Methods: 1148 male adolescents (age range 11-21

years) in Australia who completed a self-report questionnaire that measured: 1)  Weight change behaviors, supplement use, body

dissatisfaction (Male Body Attitudes Scale; MBAS) 2)  Attitudes towards doping in sport (Performance

Enhancing Attitudes Survey; PEAS)

RESULTS

Adolescent boys who reported using supplements

and dietary products (vitamins, minerals, protein

powders, sports drinks, energy drinks) were more likely

to have higher levels of body dissatisfaction and to

be more supportive of the use of drugs in sport.

Discussion, Implications, Limitations

Discussion: Body image prevention programming for adolescent boys (functional aspect aspect of their body) are different from girls (aesthetic reasons).

Implications: Preventive programs should aim effective ways to build muscle and increase sports performance without the use of doping.

Limitations: Words, concepts and lack of comfort in this questionnaire,

which might have resulted in inaccurate reporting of supplements.

ARTICLE 2 Krentz, E., & Warschburger, P. (2011). Sports-related correlates of disordered eating in

aesthetic sports. Psychology of Sports and Exercise, 12(4), 375-382. doi: 10.1016/j.psychsport.2011.03.004

Purpose: ● To examine the association between sport

variables & DE in male/females in elite aesthetic sports

METHODS AND MATERIALS Methods/Materials: ● All Participants:

o  Average 14 y/o, Controls & Athletes sex- & age-matched, 96 in each group

o  Age, wt., ht., exercise, questionnaire - Eating Attitudes Test-26 & Eating Disorder Inventory

● Athletes: o  Ice & roller-skate figure skating, diving, gymnastics & rhythmic

gymnastics, ballet o  Contour Drawing Rating Scale, ATHLETE-Scale Drive for Thinness

& Performance, Appearance-Related Social Pressure

ARTICLE 2

Results:

● Athletes & girls (p<0.001) more likely to have DE

vs. non-athletes & boys

● Girls had greater body dissatisfaction (p<0.001) vs.

boys

● Higher rates of DE in aesthetic sport athletes,

emphasis on increased risk in both genders

ARTICLE 2

Conclusion/Discussion: ●  Body dissatisfaction constant in both groups - seek out other sports-

related variables that contribute to greater rate of DE in athletes ●  Issue with sports system - athletes strive to improve performance by

stressing leanness → DE ●  Source of social pressure - evaluate in future research →

improvement within system ●  Focus on females & males, rather than just females ● Cross-sectional study ●  Participant bias in answering questionnaires

ARTICLE 3 Dwyer, J., Eisenberg, A., Prelack, K., Song, W., Sonneville, K., et al. (2012). Eating attitudes and food intakes of elite adolescent female figure skaters: A cross sectional

study. Journal of the International Society of Sports Nutrition, 9(1), 53.

Purpose: The primary purpose of this study was to

assess the eating attitudes and dietary intakes of elite adolescent female figure skaters to assess the possible nutritional risks that are generally prevalent in this competitive population.

MATERIALS AND METHODS

Participants: 36 elite adolescent female figure skaters

Methods: ●  Self administered 3-day food diary ●  Physical activity records during training

season ●  Training camp

§  EAT-40 §  Fasting blood samples §  Height/Weight measurements

MATERIALS AND METHODS

RESULTS

RESULTS

●  Moderate risk of disordered eating

●  BMIs - normal range

●  70% did not report recent weight loss

●  EAT-40 score – normal (25% - EAT-40 score >30)

●  24% high risk

●  Mean energy intake: 1491 kcal/day §  61.6% CHO, 14.6% protein, 23.7% fat

§  1/36 classified as “underweight”

RESULTS

●  38% considered themselves overweight

●  22% told by others they were overweight

●  Nutrition education necessary to inform athletes

and training staff on guidelines for athletes.

●  Focus on helping skaters learn methods to maintain

optimal weight-for-height while meeting physical

demands.

DISCUSSION AND IMPLICATIONS

Discussion: Moderate risk of disordered intake among this sample of elite adolescent female skaters but skaters should be encouraged to keep energy intakes in line to ensure adequate nutrient intake needed to growth, development, and training.

Implications: The skaters most had appropriate weights for heights but energy intake among the sampled athletes was generally low.

LIMITATIONS

●  Small sample size ●  Reliance on self-reported data and use of three-

day food records ●  2 month hiatus between data collection and

training camp ●  Data collected during training season, not

reflective of off-season food intake

ARTICLE 4 Fortes, L.de S., Kakeshita, I.S., Almeida, S.S., Gomes, A.R., & Ferreira, M. E. C.(2014). Eating

behaviour in youths: a comparison between female and male athletes and nonathletes. Scandinavian Journal of Medicine & Science in Sports. 24:e62-e68 doi: 10.1111/sms.12098

Purpose: The purpose of the study was to compare different factors associated with unhealthy eating behaviors in athletes, and nonathletes in both genders.

Sample size: 580 athletes, 362 non-athletes, 11-19 years old

 

MATERIALS AND METHODS

Instruments:

● Eating Attitudes Tests (EAT_26) ●  The items measured three subscales of diet, bulimia, and

oral self-control

● Body fat (calliper)

● Demographic aspects (age, gender, type of sports, training hours)

RESULTS

26.1% of female non-athletes 15.3% of male non-athlete 18.1% of female athletes 14.4% of male athletes

RESULTS ●  Athletes regardless of group were older and had

less body fat percentage than non-athletes.

●  The results indicate that females are more likely to develop unhealthy eating behaviors, regardless of the group.

●  Athletes were less influenced than non-athletes with regard to food intake and eating disorder symptoms.

DISCUSSION AND LIMITATION

Discussion:

● Dietary restriction seems to be more common in female nonathletes

● Inconsistency between the literature results

Limitation:

● Use of self report

● Measuring fat mass via doubly indirect method

ARTICLE 5 Ferrerira da Costa, N., Schtscherbyna, A., Soares, E.A., & Ribeiro, B.G. (2012). Disordered

eating among adolescent female swimmers: dietary, biochemical and body composition factors. Elsevier Journal of Nutrition, 29 (2013), 172-177. doi: 10.1016/j.nut.2012.06.007

Purpose: to determine relationships among food intake, biochemical parameters and body composition in adolescent female swimmers, with and without disordered eating (DE). Participants: 77 female athletes (11-19 years old), from swim clubs who had reached the 2005-2006 5th ranking position in the state championships in Rio De Janeiro.

MATERIALS AND METHODS •  Materials:

•  Three questionnaires: •  Eating Attitudes Test-26 (EAT-26), Bulimic Investigatory Test,

Edinburgh (BITE), and Body Shape Questionnaire (BSQ) •  DXA •  3-day non-consecutive dietary recall

•  Methods: •  DE was determined using questionnaires, DXA for body

composition, and recall for nutrient intake. •  Nutrients analyzed: protein, CHO, fat, calcium, iron, folic

acid, zinc, vit C, B12 •  Intake was compared to ACSM and ADA recommendations

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Eating Attitudes Test (EAT-26)©

Instructions: This is a screening measure to help you determine whether you might have an eating disorder that needsprofessional attention. This screening measure is not designed to make a diagnosis of an eating disorder or take the place ofa professional consultation. Please fill out the form below as accurately, honestly and completely as possible. There are noright or wrong answers. All of your responses are confidential.

Sample Code:

Part A: Complete the following questions:1) Birth Date Month Day Year 2) Gender: Male Female

3) Height Feet Inches

4) Current Weight (lbs.): 5) Highest Weight (excluding pregnancy):

6) Lowest Adult Weight: 7) Ideal Weight:

Part B: Check a response for each of the following statements: Always: Usually: Often: Sometimes: Rarely: Never:

1. I Am terrified about being overweight.2. I Avoid eating when I am hungry.3. I Find myself preoccupied with food.4. I Have gone on eating binges where I feel that I may not be able to stop.5. I Cut my food into small pieces.6. I Aware of the calorie content of foods that I eat.

7. I Particularly avoid food with a high carbohydrate content (i.e. bread, rice,potatoes, etc.)

8. I Feel that others would prefer if I ate more.9. I Vomit after I have eaten.

10. I Feel extremely guilty after eating.11. I Am occupied with a desire to be thinner.

12. I Think about burning up calories when I exercise.13. I Other people think that I am too thin.14. I Am preoccupied with the thought of having fat on my body.15. I Take longer than others to eat my meals.16. I Avoid foods with sugar in them.17. I Eat diet foods.18. I Feel that food controls my life.19. I Display self-control around food.20. I Feel that others pressure me to eat.21. I Give too much time and thought to food.22. I Feel uncomfortable after eating sweets.23. I Engage in dieting behavior.24. I Like my stomach to be empty.25. I Have the impulse to vomit after meals.

Eat-26

BSQ-8A © Evans & Dolan, 1993. Non-profit-making reproduction unchanged authorised, see http://www.psyctc.org/tools/bsq/

BSQ-8A We should like to know how you have been feeling about your appearance over the PAST FOUR WEEKS. Please read each question and circle the appropriate number to the right. Please answer all the questions. OVER THE PAST FOUR WEEKS:

Never | Rarely | | Sometimes | | | Often | | | | Very often | | | | | Always | | | | | | 1. Has feeling bored made you brood about your shape?........................... 1 2 3 4 5 6

2. Have you thought that your thighs, hips or bottom are too large for the rest of you?..............................................................................................

1

2

3

4

5

6

3. Have you felt so bad about your shape that you have cried?.................. 1 2 3 4 5 6

4. Have you avoided running because your flesh might wobble?............... 1 2 3 4 5 6

5. Has being with thin women made you feel self-conscious about your shape?......................................................................................................

1

2

3

4

5

6

6. Have you worried about your thighs spreading out when sitting down? 1 2 3 4 5 6

7. Has eating sweets, cakes, or other high calorie food made you feel fat? 1 2 3 4 5 6

8. Has worry about your shape made you feel you ought to exercise?....... 1 2 3 4 5 6

BSQ

RESULTS

•  44.2% were found to have some DE behavior •  24.7% were found to have tried fasting, laxatives,

diuretics, or purging as a means for weight loss

•  DE-positive participants: •  Higher percent body fat •  Decreased protein intake (11-14 y/o) •  Decreased calcium intake (15-19 y/o)

RESULTS

control weight [30]. Similarly, another study in female athletesreported that 4.5% of their sample was involved in vomitinduction to control weight [31].

The veneration of a lean body, desired for its greater agilityand better performance, may lead to dietary restrictions toachieve the desired fat percentage or body mass, causinga negative impact on the energetic balance. There is evidencethat the energetic imbalance obtained by intake restriction isassociated with a lower energetic expenditure at rest, whichmaybe related to a greater storage of body fat and low bone mineraldensity [32,33]. The athletes with DE presented a significantlyhigher percentage of body fat, fat mass, and total body masscompared with the athletes without DE in the two age strata,except for the total body mass of athletes 15 to 19 y old (Table 3).Fat mass is directly associated with earlier menarche andpuberty. This should be related to the production of sex steroidhormones [34]. In the present study, no hormone was evaluated,but DE-positive athletes presented a greater fat mass and thisprobably influenced the findings related to pubic hair. However,

because adolescence is a time of rapid hormonal changes, wehypothesize that androgen levels could have normalized inmore advanced ages or an adaptation occurred in their bodies,explaining the lack of difference in development in olderathletes.

Long-term inadequate energy consumption may result insmall stature, puberty delays, menstrual irregularity, poor bonehealth, and increased risk of injury. Adolescent female athletesmay be at a greater risk of inadequate energy intake [34]. In thisstudy, adolescents with and without DE presented a greatinadequacy in energy and carbohydrate consumption (Table 4).Studies have suggested that energy intake is more important forthe increase of bone mass than the nutrients that activelyparticipate in bone formation (calcium and vitamin D), becausethe hormonal profile resulting from energy restriction decreasesthe absorption of calcium and increases the mobilization ofcalcium in the bones [35,36].

In most cases, protein consumption is adequate if energyconsumption is observed. However, the protein requirement for

Table 3Median, maximum, and minimum values of body composition, food intake, and biochemical measurements in adolescent female swimmers, according to age strata

11–14 y 15–19 y

DE positive (n ¼ 18) DE negative (n ¼ 25) P DE positive (n ¼ 16) DE negative (n ¼ 18) P

Body compositionBody mass (kg) 53.7 (36.5–69.7) 46.6 (35.6–59.5) 0.004 57.6 (41.5–73.3) 57.2 (52.4–63.9) 0.851Fat mass (%) 27.5 (12.0–38.0) 23.4 (13.0–33.0) 0.023 30.2 (20–35) 24.1 (16–32) 0.006Fat mass (kg) 13.8 (6.0–23.7) 10.3 (4.6–16.6) 0.010 17.0 (7.9–23.8) 13.2 (8.2–18.4) 0.027Fat free mass (kg) 37.8 (27.1–48.5) 34.8 (27.6–44.0) 0.044 38.9 (31.9–46.8) 40.8 (38.5–50.9) 0.030

Energy, macronutrient, and micronutrient intakeEnergy (kcal ∙ kg"1 FFM ∙ d"1) 52.0 (30.7–137.0) 58.4 (28.5–124.2) 0.146 54.3 (21.6–115.7) 62.1 (17.5–119.2) 0.301Carbohydrate (g ∙ kg"1 ∙ d"1) 4.9 (2.8–11.8) 5.9 (2.1–11.5) 0.087 4.5 (1.7–10.3) 6.5 (1.4–12.5) 0.266Protein (g ∙ kg"1 ∙ d"1) 1.7 (0.4–3.3) 2.1 (1.2–5.1) 0.011 1.7 (0.7–3.3) 2.0 (1.0–2.9) 0.313Fat (%) 30.6 (20.4–50.6) 29.2 (22.3–46.0) 0.410 26.9 (17.9–36.3) 26.9 (20.8–38.0) 0.805Calcium (mg/d) 818.8 (92.5–1738.3) 842.8 (268.6–2304.7) 0.538 705.8 (331.7–1542.2) 908.7 (329.2–2563.4) 0.237Zinc (mg/d) 6.9 (1.3–15.7) 6.6 (1.5–17.3) 0.961 6.0 (0.7–13.5) 10.3 (2.1–120.1) 0.109Iron (mg/d) 13.4 (4.2–23.1) 13.3 (5.7–23.1) 0.828 13.2 (5.8–26.5) 15.5 (6.9–34.9) 0.281Folate (mg/d) 215.8 (23.8–515.3) 192.6 (11.6–592.3) 0.431 150.6 (0.10–546.0) 144.9 (0.0–650.5) 0.670Vitamin B12 (mg/d) 1.9 (0.4–7.7) 2.3 (0.3–7.0) 0.838 1.8 (0.0–9.2) 2.4 (0.0–7.2) 0.330Vitamin C (mg/d) 67.6 (12.1–440.1) 52.2 (6.4–374.3) 0.301 85.5 (7.0–257.1) 66.8 (7.1–592.4) 0.670

Biochemical measurementsHemoglobin (g/dL) 14.2 (12.6–15.3) 13.7 (12.3–15.2) 0.052 13.1 (10.5–14.7) 13.6 (11.6–15.7) 0.297Hematocrit (%) 42.7 (37.3–45.1) 40.9 (36.6–44.2) 0.069 38.8 (34.2–43.3) 41.0 (35.7–45.3) 0.217Serum iron (mcg/ml) 108.5 (49.0–144.0) 90.5 (42–149) 0.190 103.5 (45.0–148.0) 90.0 (43.0–151.0) 0.932Serum B12 (pg/mL) 570.5 (179–1030) 572.5 (315–1303) 0.675 541.0 (308–905) 723.0 (310–1073) 0.266Serum folate (ng/mL) 11.0 (7.1–19.3) 10.9 (7.2–18.9) 0.703 12.5 (6.1–14.1) 12.3 (6.5–19.5) 0.140TIBC (mg/mL) 312.5 (264–374) 320.0 (258–395) 0.777 300.0 (254–396) 313.0 (253–364) 0.763Transferrin saturation (%) 35.7 (14.7–44.7) 28.5 (13.8–68.5) 0.157 31.7 (13.4–50.9) 31.6 (13.6–62.1) 0.825Serum ferritin (ng/dL) 47.5 (21.0–94.0) 40.5 (12.0–79.0) 0.408 30.5 (5.0–83.0) 39.9 (14.0–80.0) 0.463

DE, disordered eating; FFM, fat-free mass; TIBC, total iron-binding capacityValues are expressed as median (minimum–maximum)

Table 4Energy consumption adequacy, macronutrients, and micronutrients of adolescent female swimmers, according to age strata

Adequacy, % (n)

11–14 y 15–19 y

DE positive (n ¼ 18) DE negative (n ¼ 25) P DE positive (n ¼ 16) DE negative (n ¼ 18) P

Energy (kcal ∙ kg"1 FFM ∙ d"1) 72.2% (13) 88.0% (22) 0.247 68.8% (11) 83.3% (15) 0.429Carbohydrate (g ∙ kg"1 ∙ d"1) 11.1% (2) 28.0% (7) 0.263 31.3% (5) 50.0% (9) 0.315Protein (g ∙ kg"1 ∙ d"1) 27.8% (5) 20.0% (5) 0.717 37.5% (6) 22.2% (4) 0.457Fat (%) 88.9% (16) 92.0% (23) 1.000 87.5% (14) 94.4% (17) 0.591Calcium (mg/d) 27.8% (5) 24.0% (6) 1.000 6.3% (1) 44.4% (8) 0.019Zinc (mg/d) 50.0% (9) 36.0% (9) 0.532 37.5% (6) 66.6% (12) 0.168Iron (mg/d) 88.9% (16) 100% (25) 0.405 68.8% (11) 88.9% (16) 0.214Folate (mg/d) 44.4% (8) 28.0% (7) 0.338 18.9% (3) 5.6% (1) 0.333Vitamin B12 (mg/d) 50.0% (9) 64.0% (16) 0.534 37.5% (6) 55.6% (10) 0.327Vitamin C (mg/d) 66.7% (12) 48.0% (12) 0.351 68.8% (11) 55.5% (10) 0.497

DE, disordered eating; FFM, fat-free mass

N. Ferreira da Costa et al. / Nutrition 29 (2013) 172–177 175

IMPLICATION AND LIMITATIONS

•  Implications: Female adolescent athletes with DE are more likely to have increased body fat, decreased protein consumption, and decreased calcium consumption compared with DE-negative adolescent athletes.

•  Limitations: Estimation errors, omittance of hormones as biochemical markers, no male participants.

REFERENCES Dwyer, J., Eisenberg, A., Prelack, K., Song, W., Sonneville, K., et al. (2012). Eating attitudes and food intakes of elite adolescent

female figure skaters: A cross sectional study. Journal of the International Society of Sports Nutrition, 9(1), 53. doi:10.1186/1550-2783-9-53

Ferrerira da Costa, N., Schtscherbyna, A., Soares, E.A., & Ribeiro, B.G. (2012). Disordered eating among adolescent female

swimmers: dietary, biochemical and body composition factors. Elsevier Journal of Nutrition, 29 (2013), 172-177. Fortes, L.de S., Kakeshita, I.S., Almeida, S.S., Gomes, A.R., & Ferreira, M. E. C.(2013). Eating behaviour in youths: a

comparison between female and male athletes and nonathletes. Scandinavian Journal of Medicine & Science in Sports,(2014) 24:e62-e68

doi: 10.1111/sms.12098 Krentz, E., & Warschburger, P. (2011). Sports-related correlates of disordered eating in aesthetic sports. Psychology of Sports and

Exercise, 12(4), 375-382. doi: 10.1016/j.psychsport.2011.03.004 Yager, Z., & O’Dea, J. (2014). Relationships between body image, nutritional supplement use, and attitudes towards doping in sport among adolescent boys: implications for prevention programs.

Journal of the International Society of Sports Nutrition, 11(1), 13. doi:10.1186/1550-2783-11-13