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Joseph M. Kindler, Hannah L. Ross, Emma M. Laing, Christopher M. Modlesky, Norman K. Pollock, Clifton A. Baile and Richard D. Lewis

Assessment of physical activity in clinical bone studies is essential. Two bone-specific physical activity scoring methods, the Bone Loading History Questionnaire (BLHQ) and Bone-Specific Physical Activity Questionnaire (BPAQ), have shown correlations with bone density and geometry, but not architecture. The purpose of this study was to determine relationships between physical activity scoring methods and bone architecture in non-Hispanic white adolescent females (N = 24; 18-19 years of age). Bone loading scores (BLHQ [hip and spine] and past BPAQ) and energy expenditure (7-day physical activity recall) were determined from respective questionnaires. Estimates of trabecular and cortical bone architecture at the nondominant radius and tibia were assessed via magnetic resonance imaging. Total body and regional areal bone mineral density (aBMD), as well as total body fat mass and fat-free soft tissue (FFST) mass were assessed via dual energy X-ray absorptiometry. Pearson’s correlations and partial correlations adjusting for height, total body fat mass, and FFST were performed. Hip BLHQ scores were correlated with midtibia cortical volume (r = .43; p = .03). Adjusted hip and spine BLHQ scores were correlated with all midtibia cortical measures (r = .50-0.58; p < .05) and distal radius apparent trabecular number (r = .46-0.53; p < .05). BPAQ scores were correlated with all midtibia cortical (r = .41-0.51; p < .05) and most aBMD (r = .47-0.53; p < .05) measures. Energy expenditure was inversely associated with femoral neck aBMD only after statistical adjustment (r = .49, p < .05). These data show that greater load-specific physical activity scores, but not energy expenditure, are indicative of greater midtibia cortical bone quality, thus supporting the utility of these instruments in musculoskeletal research.

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Deborah Fearnley, Louise Sutton, John O’Hara, Amy Brightmore, Roderick King and Carlton Cooke

The Vendée Globe is a solo round-the-world sailing race without stopovers or assistance, a physically demanding challenge for which appropriate nutrition should maintain energy balance and ensure optimum performance. This is an account of prerace nutritional preparation with a professional and experienced female racer and assessment of daily nutritional intake (NI) during the race using a multimethod approach. A daily energy intake (EI) of 15.1 MJ/day was recommended for the race and negotiated down by the racer to 12.7 MJ/day, with carbohydrate and fluid intake goals of 480 g/day and 3,020 ml/day, respectively. Throughout the 99-day voyage, daily NI was recorded using electronic food diaries and inventories piloted during training races. NI was assessed and a postrace interview and questionnaire were used to evaluate the intervention. Fat mass (FM) and fat-free mass (FFM) were assessed pre- (37 days) and postrace (11 days) using dual-energy X-ray absorptiometry, and body mass was measured before the racer stepped on the yacht and immediately postrace. Mean EI was 9.2 MJ/day (2.4–14.3 MJ/day), representing a negative energy balance of 3.5 MJ/day under the negotiated EI goal, evidenced by a 7.9-kg loss of body mass (FM –7.5 kg, FFM –0.4 kg) during the voyage, with consequent underconsumption of carbohydrate by ~130 g/day. According to the postrace yacht food inventory, self-reported EI was underreported by 7%. This intervention demonstrates the practicality of the NI approach and assessment, but the racer’s nutrition strategy can be further improved to facilitate meeting more optimal NI goals for performance and health. It also shows that evaluation of NI is possible in this environment over prolonged periods, which can provide important information for optimizing nutritional strategies for ocean racing.

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Robyn S. Mehlenbeck, Kenneth D. Ward, Robert C. Klesges and Christopher M. Vukadinovich

Calcium intake in adolescent and young adult female athletes often is inadequate to optimize peak bone mass, an important determinant of osteoporosis risk. The purpose of this study was to determine if calcium supplementation in eumenorrheic female collegiate athletes increases intake to recommended levels and promotes increases in bone mineral density (BMD). Forty-eight eumenorrheic female athletes from several college teams (15 soccer, 7 crosscountry, 8 indoor track, and 18 basketball) were randomized at the beginning of a competitive season to receive either an oral calcium supplement (1000 mg calcium citrate/400 I.U. Vitamin D) or placebo daily throughout the training season (16 weeks). Self-reported daily pill intake was obtained every 2 weeks to assess adherence. Calcium intake was evaluated using the Rapid Assessment Method, and total body and leg BMD was measured at pre-, mid-, and postseason using dual energy x-ray absorptiometry (DEXA; Hologic QDR-2000). Pre-season calcium intake was lower than national recommendations for this age group (12), averaging 842 mg/d (SD = 719) and was lower in the placebo group compared to the supplemented group (649 ± 268 vs. 1071 ± 986 mg/d, respectively; p = .064). Adherence to supplementation was good, averaging 70% across the training season. Supplementation boosted total calcium intake to a mean of 1397 ± 411 mg/d, which is consistent with recommended levels for this group (37). Supplementation did not influence BMD change during this 16-week intervention. Across teams, a small increase of 0.8% was observed in leg BMD. Change in total body BMD was modified by team, with a significant increase of 1.5% observed in basketball players. These results indicate that providing calcium supplements of 1000 mg/d is adequate to boost total intake to recommended levels during athletic training. Longer intervention trials are required to determine whether calcium supplementation has a positive effect on BMD.

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Krissy D. Weisgarber, Darren G. Candow and Emelie S. M. Vogt

Purpose:

To determine the effects of whey protein before and during resistance exercise (RE) on body composition and strength in young adults.

Methods:

Participants were randomized to ingest whey protein (PRO; 0.3 g/kg protein; n = 9, 24.58 ± 1.8 yr, 88.3 ± 17.1 kg, 172.5 ± 8.0 cm) or placebo (PLA; 0.2 g/kg cornstarch maltodextrin + 0.1 g/kg sucrose; n = 8, 23.6 ± 4.4 yr, 82.6 ± 16.1 kg, 169.4 ± 9.2 cm) during RE (3 sets of 6–10 repetitions for 9 whole-body exercises), which was performed 4 d/wk for 8 wk. PRO and PLA were mixed with water (600 ml); 50% of the solution containing 0.15 g/kg of PRO or PLA was consumed immediately before the start of exercise, and ~1.9% of the remaining solution containing ~0.006 g/kg of PRO or PLA was consumed immediately after each training set. Before and after the study, measures were taken for leantissue mass (dual-energy X-ray absorptiometry), muscle size of the elbow and knee flexors and extensors and ankle dorsiflexors and plantar flexors (ultrasound), and muscle strength (1-repetition-maximum chest press).

Results:

There was a significant increase (p < .05) in muscle size of the knee extensors (PRO 0.6 ± 0.4 cm, PLA 0.1 ± 0.5 cm), knee flexors (PRO 0.4 ± 0.6 cm, PLA 0.5 ± 0.7 cm) and ankle plantar flexors (PRO 0.6 ± 0.7 cm, PLA 0.8 ± 1.4 cm) and chest-press strength (PRO 16.6 ± 11.1 kg, PLA 9.1 ± 14.6 kg) over time, with no differences between groups.

Conclusion:

The ingestion of whey protein immediately before the start of exercise and again after each training set has no effect on muscle mass and strength in untrained young adults.

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Claudia Ridel Juzwiak, Olga Maria Silverio Amancio, Maria Sylvia Souza Vitalle, Vera Lúcia Szejnfeld and Marcelo Medeiros Pinheiro

In this prospective, cross-sectional study male adolescent tennis players (44) and nonathletic controls (32) were evaluated to determine the effects of physical activity, dietary nutrient intakes, sexual maturation, and body composition on bone-mineral density (BMD). Dietary nutrient intakes and physical activity expenditure were estimated by 4-d diaries. Total body composition, bone-mineral content (BMC), and BMD (L1–L4, femur, and nondominant forearm) were assessed by dual-energy X-ray absorptiometry. Tennis players had significantly greater lean body mass (mean [SEM] 50.6 [1.6] kg vs. 45.1 [1.7] kg, p = .022), trochanter BMD (1.0 [0.02] g/cm2 vs. 0.9 [0.03] g/cm2, p = .032), and dominant forearm BMC (173.7 [7.4] g vs. 146.5 [9.3] g) but lower BMD in the nondominant forearm (0.7 [0.02] g/cm2 vs. 0.8 [0.03] g/cm2, p = .028). Daily average calcium intake was below the recommendation in both groups. No correlation was found between BMD and calcium intake and exercise. Lean body mass was the best predictor of BMD and BMC for both tennis players and controls (R 2 = .825, .628, and .693 for L1–L4, total femur, and nondominant forearm, respectively). Based on these results the authors conclude that lean body mass is the best predictor of BMD and BMC for both tennis players and others. Tennis exerts a site-specific effect, and training should focus on ways minimize this effect. Although calcium intake showed no effect on BMD, nutrition education for young athletes should focus on promoting a balanced diet, providing energy and nutrients in adequate amounts.

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Laurel Wentz, Pei-Yang Liu, Jasminka Z. Ilich and Emily M. Haymes

Purpose:

To compare female runners with and without a history of stress fractures to determine possible predictors of such fractures.

Methods:

27 female runners (age 18–40 yr) who had had at least 1 stress fracture were matched to a control sample of 32 female runners without a history of stress fractures. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry (iDXA). Subjects answered questionnaires on stress-fracture history, training, menstrual status, and diet.

Results:

No significant differences were found in menstrual characteristics, diet and dairy intake, or bone measurements. Weekly servings of milk during middle school significantly predicted BMD at the femur (p = .010), femoral neck (p = .002), Ward’s triangle (p = .014), and femoral shaft (p = .005). Number of menstrual cycles in the previous year predicted femoral-neck BMD (p = .004). Caffeine intake was negatively associated with BMD of the femur (p = .010), femoral neck (p = .003), trochanter (p = .038), and femoral shaft (p = .035). Weekly hours of training were negatively associated with total-body BMD (p = .021), total-body bone mineral content (p = .028), and lumbar-spine BMD (p = .011). Predictors for stress fractures included the number of years running, predominantly running on hard ground, irregular menstrual history, low total-body BMD, and low current dietary calcium intake when controlling for body-mass index (Nagelkerke R 2 = .364).

Conclusions:

Servings of milk during middle-school years were positively correlated with hip BMD, although current calcium intake, low BMD, irregular menstrual history, hard training surface, and long history of training duration were the most important predictors of stress fractures.

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Kathryn L. Beck, Sarah Mitchell, Andrew Foskett, Cathryn A Conlon and Pamela R. Von Hurst

Ballet dancing is a multifaceted activity requiring muscular power, strength, endurance, flexibility, and agility; necessitating demanding training schedules. Furthermore dancers may be under aesthetic pressure to maintain a lean physique, and adolescent dancers require extra nutrients for growth and development. This cross-sectional study investigated the nutritional status of 47 female adolescent ballet dancers (13–18 years) living in Auckland, New Zealand. Participants who danced at least 1 hr per day 5 days per week completed a 4-day estimated food record, anthropometric measurements (Dual-energy X-ray Absorptiometry) and hematological analysis (iron and vitamin D). Mean BMI was 19.7 ± 2.4kg/m2 and percentage body fat, 23.5 ± 4.1%. The majority (89.4%) of dancers had a healthy weight (5th-85th percentile) using BMI-for-age growth charts. Food records showed a mean energy intake of 8097.3 ± 2155.6kJ/day (48.9% carbohydrate, 16.9% protein, 33.8% fat, 14.0% saturated fat). Mean carbohydrate and protein intakes were 4.8 ± 1.4 and 1.6 ± 0.5g/kg/day respectively. Over half (54.8%) of dancers consumed less than 5g carbohydrate/kg/day, and 10 (23.8%) less than 1.2 g protein/kg/day. Over 60% consumed less than the estimated average requirement for calcium, folate, magnesium and selenium. Thirteen (28.3%) dancers had suboptimal iron status (serum ferritin (SF) <20μg/L). Of these, four had iron deficiency (SF < 12μg/L, hemoglobin (Hb) ≥ 120g/L) and one iron deficiency anemia (SF < 12μg/L, Hb < 120g/L). Mean serum 25-hydroxy vitamin D was 75.1 ± 18.6nmol/L, 41 (91.1%) had concentrations above 50nmol/L. Female adolescent ballet dancers are at risk for iron deficiency, and possibly inadequate nutrient intakes.

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Paul J. Cribb, Andrew D. Williams, Michael F. Carey and Alan Hayes

Different dietary proteins affect whole body protein anabolism and accretion and therefore, have the potential to influence results obtained from resistance training. This study examined the effects of supplementation with two proteins, hydrolyzed whey isolate (WI) and casein (C), on strength, body composition, and plasma glutamine levels during a 10 wk, supervised resistance training program. In a double-blind protocol, 13 male, recreational bodybuilders supplemented their normal diet with either WI or C (1.5 gm/kg body wt/d) for the duration of the program. Strength was assessed by 1-RM in three exercises (barbell bench press, squat, and cable pull-down). Body composition was assessed by dual energy X-ray absorptiometry. Plasma glutamine levels were determined by the enzymatic method with spectrophotometric detection. All assessments occurred in the week before and the week following 10 wk of training. Plasma glutamine levels did not change in either supplement group following the intervention. The WI group achieved a significantly greater gain (P < 0.01) in lean mass than the C group (5.0 ± 0.3 vs. 0.8 ± 0.4 kg for WI and C, respectively) and a significant (P < 0.05) change in fat mass (−1.5 ± 0.5 kg) compared to the C group (+0.2 ± 0.3 kg). The WI group also achieved significantly greater (P < 0.05) improvements in strength compared to the C group in each assessment of strength. When the strength changes were expressed relative to body weight, the WI group still achieved significantly greater (P < 0.05) improvements in strength compared to the C group.

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Darren G. Burke, Philip D. Chilibeck, K. Shawn Davison, Darren C. Candow, Jon Farthing and Truis Smith-Palmer

Our purpose was to assess muscular adaptations during 6 weeks of resistance training in 36 males randomly assigned to supplementation with whey protein (W; 1.2 g/kg/day), whey protein and creatine monohydrate (WC; 0.1 g/kg/day), or placebo (P; 1.2 g/kg/day maltodextrin). Measures included lean tissue mass by dual energy x-ray absorptiometry, bench press and squat strength (1-repetition maximum), and knee extension/flexion peak torque. Lean tissue mass increased to a greater extent with training in WC compared to the other groups, and in the W compared to the P group (p < .05). Bench press strength increased to a greater extent for WC compared to W and P (p < .05). Knee extension peak torque increased with training for WC and W (p < .05), but not for P. All other measures increased to a similar extent across groups. Continued training without supplementation for an additional 6 weeks resulted in maintenance of strength and lean tissue mass in all groups. Males that supplemented with whey protein while resistance training demonstrated greater improvement in knee extension peak torque and lean tissue mass than males engaged in training alone. Males that supplemented with a combination of whey protein and creatine had greater increases in lean tissue mass and bench press than those who supplemented with only whey protein or placebo. However, not all strength measures were improved with supplementation, since subjects who supplemented with creatine and/or whey protein had similar increases in squat strength and knee flexion peak torque compared to subjects who received placebo.

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Nuno M. Pimenta, Helena Santa-Clara, Xavier Melo, Helena Cortez-Pinto, José Silva-Nunes and Luís B. Sardinha

Central accumulation and distribution of body fat (BF) is an important cardiometabolic risk factor. Waist-to-hip ratio (WHR), commonly elevated in nonalcoholic fatty liver disease (NAFLD) patients, has been endorsed as a risk related marker of central BF content and distribution, but no standardized waist circumference measurement protocol (WCmp) has been proposed. We aimed to investigate whether using different WCmp affects the strength of association between WHR and BF content and distribution in NAFLD patients. BF was assessed with dual energy X-ray absorptiometry (DXA) in 28 NAFLD patients (19 males, 51 ± 13 years, and 9 females, 47 ± 13 years). Waist circumference (WC) was measured using four different WCmp (WC1: minimal waist; WC2: iliac crest; WC3: mid-distance between iliac crest and lowest rib; WC4: at the umbilicus) and WHR was calculated accordingly (WHR1, WHR2, WHR3 and WHR4, respectively). High WHR was found in up to 84.6% of subjects, depending on the WHR considered. With the exception of WHR1, all WHR correlated well with abdominal BF (r = .47 for WHR1; r = .59 for WHR2 and WHR3; r = .58 for WHR4) and BF distribution (r = .45 for WHR1; r = .56 for WHR2 and WHR3; r = .51 for WHR4), controlling for age, sex and body mass index (BMI). WHR2 and WHR3 diagnosed exactly the same prevalence of high WHR (76.9%). The present study confirms the strong relation between WHR and central BF, regardless of WCmp used, in NAFLD patients. WHR2 and WHR3 seemed preferable for use in clinical practice, interchangeably, for the diagnosis of high WHR in NAFLD patients.