Synchronized swimming enjoys worldwide popularity and has been part of the formal Olympic program since 1984. Despite this, relatively little research has been conducted on participant nutrition practices and requirements, and there are significant gaps in the knowledge base despite the numerous areas in which nutrition could affect performance and safety. This review aimed to summarize current findings and identify areas requiring further research. Uniform physique in team or duet events may be more important than absolute values for muscularity or body fat, but a lean and athletic appearance remains key. Synchronized swimmers appear to have an increased risk of developing eating disorders, and there is evidence of delayed menarche, menstrual dysfunction, and lower bone density relative to population norms. Dietary practices remain relatively unknown, but micronutrient status for iron and magnesium may be compromised. More research is required across all aspects of nutrition status, anthropometry, and physiology, and both sports nutrition and sports medicine support may be required to reduce risks for participants.
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Bronwen Lundy, Helen O’Connor, Fiona Pelly, and Ian Caterson
This study aimed to describe the physique characteristics and competition nutrient intake of professional Rugby League players and to assess use of a statistical technique for evaluating validity of dietary reporting. Players (n = 74) were endomorphic mesomorphs and had a mean weight, height, and BMI of 93.4 ± 10.9 kg, 179.9 ± 7.3 cm, and 28.5 ± 2.1 kg/m2 respectively. Mean sum of eight skinfolds was 78.9 ± 2.2 mm (12.4 ± 2.9% fat). Players (n = 34) reported a mean daily energy intake of 17,708 ± 3,688 kJ (carbohydrate 51%, protein 18%, fat 25%, alcohol 4%) with 6 and 2.0 g · kg−1 · d−1 from carbohydrate and protein respectively. Micronutrient intake was adequate but alcohol consumption was high relative to health standards. The dietary records provided a plausible estimate of energy intake however further research is required to evaluate statistical techniques for assessing dietary validity in athlete groups.
Louise M. Burke, Bronwen Lundy, Ida L. Fahrenholtz, and Anna K. Melin
The human body requires energy for numerous functions including, growth, thermogenesis, reproduction, cellular maintenance, and movement. In sports nutrition, energy availability (EA) is defined as the energy available to support these basic physiological functions and good health once the energy cost of exercise is deducted from energy intake (EI), relative to an athlete’s fat-free mass (FFM). Low EA provides a unifying theory to link numerous disorders seen in both female and male athletes, described by the syndrome Relative Energy Deficiency in Sport, and related to restricted energy intake, excessive exercise or a combination of both. These outcomes are incurred in different dose–response patterns relative to the reduction in EA below a “healthy” level of ∼45 kcal·kg FFM−1·day−1. Although EA estimates are being used to guide and monitor athletic practices, as well as support a diagnosis of Relative Energy Deficiency in Sport, problems associated with the measurement and interpretation of EA in the field should be explored. These include the lack of a universal protocol for the calculation of EA, the resources needed to achieve estimates of each of the components of the equation, and the residual errors in these estimates. The lack of a clear definition of the value for EA that is considered “low” reflects problems around its measurement, as well as differences between individuals and individual components of “normal”/“healthy” function. Finally, further investigation of nutrition and exercise behavior including within- and between-day energy spread and dietary characteristics is warranted since it may directly contribute to low EA or its secondary problems.
Louise M. Burke, Graeme L. Close, Bronwen Lundy, Martin Mooses, James P. Morton, and Adam S. Tenforde
Low energy availability (LEA) is a key element of the Female Athlete Triad. Causes of LEA include failure to match high exercise energy expenditure (unintentional) or pathological behaviors of disordered eating (compulsive) and overzealous weight control programs (misguided but intentional). Recognition of such scenarios in male athletes contributed to the pronouncement of the more inclusive Relative Energy Deficiency in Sport (RED-S) syndrome. This commentary describes the insights and experience of the current group of authors around the apparently heightened risk of LEA in some populations of male athletes: road cyclists, rowers (lightweight and open weight), athletes in combat sports, distance runners, and jockeys. The frequency, duration, and magnitude of the LEA state appear to vary between populations. Common risk factors include cyclical management of challenging body mass and composition targets (including “making weight”) and the high energy cost of some training programs or events that is not easily matched by energy intake. However, additional factors such as food insecurity and lack of finances may also contribute to impaired nutrition in some populations. Collectively, these insights substantiate the concept of RED-S in male athletes and suggest that a specific understanding of a sport, subpopulation, or culture may identify a complex series of factors that can contribute to LEA and the type and severity of its outcomes. This commentary provides a perspective on the range of risk factors that should be addressed in future surveys of RED-S in athletic populations and targeted for specific investigation and modification.
Margot A. Rogers, Michael K. Drew, Renee Appaneal, Greg Lovell, Bronwen Lundy, David Hughes, Nicole Vlahovich, Gordon Waddington, and Louise M. Burke
The Low Energy Availability in Females Questionnaire (LEAF-Q) was validated to identify risk of the female athlete triad (triad) in female endurance athletes. This study explored the ability of the LEAF-Q to detect conditions related to low energy availability (LEA) in a mixed sport cohort of female athletes. Data included the LEAF-Q, SCOFF Questionnaire for disordered eating, dual-energy X-ray absorptiometry-derived body composition and bone mineral density, Mini International Neuropsychiatric Interview, blood pressure, and blood metabolic and reproductive hormones. Participants were grouped according to LEAF-Q score (≥8 or <8), and a comparison of means was undertaken. Sensitivity, specificity, and predictive values of the overall score and subscale scores were calculated in relation to the triad and biomarkers relevant to LEA. Fisher’s exact test explored differences in prevalence of these conditions between groups. Seventy-five athletes (18–32 years) participated. Mean LEAF-Q score was 8.0 ± 4.2 (55% scored ≥8). Injury and menstrual function subscale scores identified low bone mineral density (100% sensitivity, 95% confidence interval [15.8%, 100%]) and menstrual dysfunction (80.0% sensitivity, 95% confidence interval [28.4%, 99.5%]), respectively. The gastrointestinal subscale did not detect surrogate markers of LEA. LEAF-Q score cannot be used to classify athletes as “high risk” of conditions related to LEA, nor can it be used as a surrogate diagnostic tool for LEA given the low specificity identified. Our study supports its use as a screening tool to rule out risk of LEA-related conditions or to create selective low-risk groups that do not need management as there were generally high negative predictive values (range 76.5–100%) for conditions related to LEA.
Nikita C. Fensham, Alannah K.A. McKay, Nicolin Tee, Bronwen Lundy, Bryce Anderson, Aimee Morabito, Megan L.R. Ross, and Louise M. Burke
Previous research investigating single bouts of exercise have identified baseline iron status and circulating concentrations of interleukin-6 (IL-6) as contributors to the magnitude of postexercise hepcidin increase. The current study examined the effects of repeated training bouts in close succession on IL-6 and hepcidin responses. In a randomized, crossover design, 16 elite male rowers completed two trials, a week apart, with either high (1,000 mg) or low (<50 mg) calcium pre-exercise meals. Each trial involved two, submaximal 90-min rowing ergometer sessions, 2.5 hr apart, with venous blood sampled at baseline; pre-exercise; and 0, 1, 2, and 3 hr after each session. Peak elevations in IL-6 (approximately 7.5-fold, p < .0001) and hepcidin (approximately threefold, p < .0001) concentrations relative to baseline were seen at 2 and 3 hr after the first session, respectively. Following the second session, concentrations of both IL-6 and hepcidin remained elevated above baseline, exhibiting a plateau rather than an additive increase (2 hr post first session vs. 2 hr post second session, p = 1.00). Pre-exercise calcium resulted in a slightly greater elevation in hepcidin across all time points compared with control (p = .0005); however, no effect on IL-6 was evident (p = .27). Performing multiple submaximal training sessions in close succession with adequate nutritional support does not result in an amplified increase in IL-6 or hepcidin concentrations following the second session in male elite rowers. Although effects of calcium intake require further investigation, athletes should continue to prioritize iron consumption around morning exercise prior to exercise-induced hepcidin elevations to maximize absorption.
Matthew W. Hoon, Andrew M. Jones, Nathan A. Johnson, Jamie R. Blackwell, Elizabeth M. Broad, Bronwen Lundy, Anthony J. Rice, and Louise M. Burke
Beetroot juice is a naturally rich source of inorganic nitrate (NO3 −), a compound hypothesized to enhance endurance performance by improving exercise efficiency.
To investigate the effect of different doses of beetroot juice on 2000-m ergometer-rowing performance in highly trained athletes.
Ten highly trained male rowers volunteered to participate in a placebo-controlled, double-blinded crossover study. Two hours before undertaking a 2000-m rowing-ergometer test, subjects consumed beetroot juice containing 0 mmol (placebo), 4.2 mmol (SINGLE), or 8.4 mmol (DOUBLE) NO3 −. Blood samples were taken before supplement ingestion and immediately before the rowing test for analysis of plasma [NO3 −] and [nitrite (NO2 −)].
The SINGLE dose demonstrated a trivial effect on time to complete 2000 m compared with placebo (mean difference: 0.2 ± 2.5 s). A possibly beneficial effect was found with DOUBLE compared with SINGLE (mean difference –1.8 ± 2.1 s) and with placebo (–1.6 ± 1.6 s). Plasma [NO2 −] and [NO3 −] demonstrated a dose-response effect, with greater amounts of ingested nitrate leading to substantially higher concentrations (DOUBLE > SINGLE > placebo). There was a moderate but insignificant correlation (r = –.593, P = .055) between change in plasma [NO2 −] and performance time.
Compared with nitratedepleted beetroot juice, a high (8.4 mmol NO3 −) but not moderate (4.2 mmol NO3 −) dose of NO3 − in beetroot juice, consumed 2 h before exercise, may improve 2000-m rowing performance in highly trained athletes.