Hydration and bone health in young athletes -
The bone mass content BMC , bone mass density BMD , and total body less head TBLH BMD using dual-energy X-ray absorptiometry were measured in young athletes men and women aged 8.
Comparisons between the sexes and ages were performed and age-sex-smoothed reference values were constructed. Reference values, including the percentiles are presented for the bone health variables of each sex and age group. The age-, sex-, and ethnic-specific reference data for bone variables presented in this study enabled more precise reference data for young Brazilian athletes.
Osteoporosis is considered a disease of the elderly; however, researchers and clinicians agree that it has a pediatric origin 1 , 2. Therefore, ensuring maximal bone mineral content acquisition during adolescence is important to attenuate loss of bone mass associated with aging process 4.
Bone mass acquisition may be impaired by some specific disorders present during childhood, such as cystic fibrosis, type 1 diabetes mellitus, or inflammatory bowel disease 5.
Similarly, a sedentary behavior and percentage of body fat were negatively associated with bone mass density BMD 6 , 7. Conversely, physical activity during childhood may positively affect bone mass gain. Physical activity in children and adolescents has been demonstrated to result in higher bone mass content BMC and BMD than non-active youths 4.
In this context, athletes from different sports also demonstrated higher BMC and BMD than general population 8 , 9. Weight-bearing exercises, especially those characterized by high-impact loading, such as multiple high-intensity runs, sprints, turns, and jumps, have a high impact on muscles and bones, which are associated with an increase in absolute and relative bone dimensions The importance of the impact loading characteristics of physical activity can be evidenced by the higher bone mass that the tennis players present in the dominant upper limb compared to the non-dominant limb 11 or the higher bone mass that handball players high-loading impact sports presented than soccer players odd-loading impact sports 4.
Despite the unquestionable benefits of regular physical activity, there is a condition known as relative energy deficiency in sports RED-S , frequently observed among highly trained male and female athletes 12 , This situation is a consequence of inadequate energy intake relative to exercise energy expenditure associated with sports practice, triggering unfavorable health conditions, compromising bone health, and favoring the risk of bone stress injuries among other possible negative effects, such as gastrointestinal and cardiovascular dysfunction 14 , Therefore, reference values for BMC and BMD in male and female children and adolescent athletes, according to age, need to be used by healthcare providers for screening purposes 16 , Dual-energy X-ray absorptiometry DXA is widely considered the preferred method for assessing BMC and BMD in clinical and research situations because of the reliability of the results and security of the method low radiation 18 , In Brazil, sports DXA utility, especially among young people, is currently limited, owing to a lack of normal reference values for Brazilian children and adolescent athletes.
Despite the existence of normative data for other populations 20 , Brazil has particular characteristics due to continental dimensions, which are characterized by an enormous diversity of ethnicities and a highly admixed population 21 , resulting from five centuries of colonization and interbreeding among Native Americans, Europeans, and Africans Therefore, reference values for this population, which have particular characteristics, need to be established.
Therefore, this study aimed to develop normal reference values for total body BMD, BMC, and total body less head TBLH BMD, and to construct percentile curves for Brazilian children and adolescent athletes.
In addition, the study also aimed to compare bone measurements between sexes. We hypothesized that the male athletes will present higher bone measurements values than the female after the puberty. This cross-sectional study involved young athletes who were trained at the Olympic Training and Research Center São Paulo, Brazil.
Each athlete visited the laboratory once for evaluation of body composition. This study was approved by the Human Research Ethics Committee of the Federal University of São Paulo Brazil approval number: and conformed to the principles outlined in the Declaration of Helsinki.
As the study involved the analysis of the Physiology Laboratory from the Olympic Training and Research Center database, and the data were anonymous, the requirement for informed consent was waived, according to the Human Research Ethics Committee of the Federal University of São Paulo Brazil.
All data were analyzed as the principle of respect for persons, which encompasses the guarantee of privacy, confidentiality, and anonymity rights.
A total of athletes men and women from the Olympic Training and Research Center in São Paulo, Brazil participated in the study. There are several training centers in São Paulo whose athletes compete in federative championships.
Athletes who stand out in smaller training centers are sent to train at the Olympic Training and Research Center due to excellent physical structure that is composed by sportive courts, gym, soccer field, athletics track, swimming poll, exercise physiology laboratory, and medical and nutrition division.
Thus, the Olympic Training and Research Center is characterized by being frequented by well physical fitness athletes and by athletes who have a wide range of socioeconomic profiles. These reasons make the Olympic Training and Research Center a very representative place for the São Paulo population of child and adolescent athletes.
The participants were divided into 5 groups according to their age: group 1 8. Data were collected between January and December A nutritionist provided individualized guidance and food plans to meet the nutritional needs of all the athletes.
All the participants were involved in local and national sports competitions. The athletes were trained five times a week for approximately 1 or 2 h per day through 11 months of the year for at least one year.
All athletes performed at least 30 min of preventive exercises twice a week, which are exercises performed to improve muscle mass and flexibility. Evaluation of body composition was performed annually for all athletes trained at the Olympic Training and Research Center in São Paulo.
Reference values for non-athletes were obtained from a previously published study on healthy children and adolescents Age, total body mass, height, and body mass index BMI of female and male athletes are presented in Table 1.
A DXA software version All tests were performed with the participants wearing comfortable clothes, without metal pieces, centrally aligned with 10 cm between the feet, and 5 cm between the hands and trunk. The participants assumed a supine position. All the tests were performed by the same examiner.
Values are presented as means and standard deviations. Percentile values 10th, 25th, 50th, 75th, and 90th percentiles for variables related to bone mass are also presented. Statistical analysis was performed using SPSS v The BMC of the male athletes were significantly different among all age groups.
In the female group, the BMC for groups 1, 2, and 3 were significantly different from all the other groups, but the BMCs for the age groups 4 and 5 were different only in groups 1, 2, and 3, and were similar between them Table 2 and Fig.
The BMC of the male athletes was significantly higher for the male athletes than that of the female athletes for age groups 3, 4, and 5. Age- and sex-specific mean values for bone mass content. The BMD for the male athletes was significantly different among all the age groups.
In the female group, the BMDs for groups 3, 4, and 5 were significantly different from all the other groups, but the BMDs for age groups 1 and 2 were different only in groups 3, 4, and 5, and were similar between them Table 3 and Fig.
Conversely, the BMD and TBLH BMD of the male athletes were significantly higher than those of the female athletes only for age groups 4 and 5 Tables 2 , 3 , and 4. Age- and sex-specific mean values for bone mass density.
The TBLH BMD presented by the male groups 3, 4, and 5 was significantly different from all the other groups, but the age groups 1 and 2 were different only in groups 3, 4, and 5, and were similar between them. Conversely, for the female group and age groups 1 and 2 were different only from groups 3, 4, and 5, and similar between them.
Age group 3 was different from all the other age groups, and age groups 4 and 5 were different only from groups 1, 2, and 3, and similar between them Table 4 and Fig.
Female and male data for the age-smoothed percentile graph of TBLH BMD are presented in Fig. Differences in the graphical behavior of our results and reference values for non-athletes 23 can be observed. The median values 50th percentiles for TBLH BMD in female and male athletes exceeded the 90th percentile of the reference values for non-athletes.
Total body less head BMD in youth female athletes for age groups 1, 2, 3, 4 and 5; percentiles — for athletes, and reference percentiles from Lopez-Gonzalez et al. the 10th, 25th, 50th, 75th, 90th; and 50th percentiles are in bold. Total body less head BMD in youth male athletes for age groups 1, 2, 3, 4 and 5; percentiles — for athletes, and reference percentiles by Lopez-Gonzalez et al.
The main aim of the present study was to present sex- and age-specific reference values for BMD, TBLH BMD, and BMC, using a DXA scanner in Brazilian children and adolescent athletes aged 8.
Reference values were also plotted with reference values for healthy non-athletic children and adolescents. Moreover, the study aimed to compare sex and age differences, according to bone mass characteristics.
The main results were as follows: i BMC and TBLH BMD increased during growth in both sexes, but in the female group, the bone measurements tended to stabilize between group 4 According to the bone measurements comparison among different ages, the present results showed that BMD and TBLH BMD presented a significant increase after group 2 The same pattern of bone mass evolution during childhood and adolescence was shown by Lopez-Gonzalez et al.
Therefore, our results are consistent with those reported in the literature. When comparing bone mass between the male and female athletes, sex differences became evident after puberty. After 14—15 years of age group 4 , when most of the male athletes are already in puberty 27 , the male athletes presented significantly higher bone measurements than the female athletes, probably due to the influence of sex-related hormones on the bone mass, which will result in the fact that women reach lower peak bone mass than men; this has been associated with higher osteopenia and stress fracture risk in maturity 23 , 28 , 29 , Brazil has a vast territory, and the population is characterized by an enormous diversity of ethnicities, disparities in lifestyle behaviors and socioeconomic status, and conditions that have been known to contribute to differences in BMD among children and adolescents 25 , 31 , 32 ; therefore, it is necessary to establish specific reference databases for Brazilian children.
Therefore, the reference data presented in this study may contribute to the understanding of bone mass in young Brazilian athletes. The present data showed that BMD and BMC improved throughout childhood. In a visual graphical analysis of TBLH BMD, the 50th percentile curve for the athletes was higher than the 90th percentile for the non-athletes in both the female Fig.
These data are in consensus with previous literature data, which suggest that children and adolescents who play sports should reach a higher BMD and BMC at the end of the second decade of life, when the bone mass reaches its peak 10 , 14 , 34 , 35 , Therefore, young athletes should have better bone mass conditions to face the losses resulting from aging, thereby reinforcing the concept that osteoporosis, which is very common among the elderly, is a pediatric disease This osteogenic property attributed to sports practice during childhood appears to be associated with muscle mass gain.
The mechanical load over the bone produced by muscular contraction seems to be an osteogenic stimulus for bone formation In this direction, it has been considered that the weight bearing exercises, especially those presenting high-loading impacts are the most effective to bone mass gain 4 , Conversely, athletes involved with aquatic exercises, such as swimming, synchronized swimming or water polo, show similar BMD values compared to controls In the sample of the present study participated athletes of running, soccer, artistic gymnastics, handball, judo, wrestling, volleyball, and swimming.
Except for swimming, all these sports have impact loading, which is desirable for bone mass gain The swimming is not an impact loading sport, however, swimmers from this study performed terrestrial exercises with the aim of preventing sports injuries, which has been suggested by previous authors and certainly also affects bone mass positively These reference data present some limitations.
Athletes from different sports modalities were combined, and previous reports showed that bone mass gain can be affected by sports characteristics, mainly according to the impact force specificities.
For example, athletes from high-impact sports, such as handball, present higher BMD and BMC than athletes from odd-impact sports, such as soccer 4 , Maillane et al. Additionally, the participating athletes in the present study were only from São Paulo City and not from all the Brazilian regions.
Conversely, it is important to consider São Paulo as a national migratory reception pole. From the beginning of —, São Paulo received approximately thousand people from other states a year, which makes the city's population enormously mixed 40 Moreover, no previous study has demonstrated that bone mass differs among the Brazilian regions.
Even so, a broader range of participants might be needed to better represent the Brazilian population. Nevertheless, we believe that these limitations did not limit our conclusions.
Young Brazilian female athletes presented with significantly lower BMD than males after Finally, young Brazilian athletes presented with the 50th percentile above the 90th percentile for literature reference data for the non-athletes. To the best of our knowledge, this study is the first to present reference bone mass for physically active Brazilian children and adolescents, and to compare these data with literature references for healthy children.
All data generated or analysed during this study are included in this published article and its supplementary information files. Cooper, C. et al. Review: Developmental origins of osteoporotic fracture. Article Google Scholar.
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Mora, S. Establishment of peak bone mass. North Am. Fagundes, U. Adolescent female handball players present greater bone mass content than soccer players: A cross-sectional study.
Bone , Bachrach, L. Bone densitometry in children and adolescents. Pediatrics , Deng, K. Analysis of the association between fat mass distribution and bone mass in Chinese male adolescents at different stages of puberty. Nutrients 13 , Yamakita, M.
Association of objectively measured physical activity and sedentary behavior with bone stiffness in peripubertal children. Bone Miner.
Singhal, V. Bone accrual in oligo-amenorrheic athletes, eumenorrheic athletes and non-athletes. Kalabiska, I. Bone mineral reference values for athletes 11 to 20 years of age.
Public Health 17 , 1—11 Quiterio, A. Skeletal mass in adolescent male athletes and nonathletes: Relationships with high-impact sports. Strength Cond. Bass, S. The effect of mechanical loading on the size and shape of bone in pre-, peri-, and postpubertal girls: a study in tennis players.
Article CAS Google Scholar. Mountjoy, M. International Olympic Committee IOC Consensus statement on relative energy deficiency in sport red-s : update.
Sport Nutr. The IOC consensus statement: Beyond the female athlete triad-relative energy deficiency in sport RED-S. Sports Med. Bone mineral reference values for athletes 11—20 years of age.
Logue, D. Low energy availability in athletes An updated narrative review of prevalence, risk, within-day energy balance, knowledge, and impact on sports performance. Nutrients 12 , Ward, K. UK reference data for the Hologic QDR discovery dual-energy X ray absorptiometry scanner in healthy children and young adults aged 6—17 years.
Child 92 , 53—59 Elhakeem, A. Association between age at puberty and bone accrual from 10 to 25 years of age. JAMA Netw. Osteoporosis and measurement of bone mass in children and adolescents. Margulies, L. Reproducibility of pediatric whole body bone and body composition measures by dual-energy X-ray absorptiometry using the GE Lunar Prodigy.
Durso, D. Association of genetic variants with self-assessed color categories in Brazilians. PLoS One 9 , Guedes, R. Escravismo no Brasil: um convite à reflexão e ao debate. Afro-Ásia , — Lopez-Gonzalez, D.
Reference values for bone mineral density in healthy Mexican children and adolescents. Shepherd, J. Athletes in sports where there's a focus on weight — such as wrestling , swimming , dance, or gymnastics — might feel pressure to lose weight.
But drastically cutting back on calories can lead to growth problems and a higher risk of fractures and other injuries. If a coach, gym teacher, or teammate says that you need to go on a diet, talk to your doctor first or visit a dietitian who specializes in teen athletes.
If a health professional you trust agrees that it's safe to diet, they can work with you to create a healthy eating plan. When it comes to powering your game for the long haul, it's important to eat healthy, balanced meals and snacks to get the nutrients your body needs.
The MyPlate food guide can guide you on what kinds of foods and drinks to include in your diet. Besides getting the right amount of calories, teen athletes need a variety of nutrients from the foods they eat to keep performing at their best.
These include vitamins and minerals. Calcium and iron are two important minerals for athletes:. Athletes may need more protein than less-active teens, but most get plenty through a healthy diet.
It's a myth that athletes need a huge daily intake of protein to build large, strong muscles. Muscle growth comes from regular training and hard work.
Good sources of protein are fish, lean meats and poultry, eggs, dairy, nuts, soy, and peanut butter. Carbohydrates are an excellent source of fuel.
Cutting back on carbs or following low-carb diets isn't a good idea for athletes. That's because restricting carbs can make you feel tired and worn out, which can hurt your performance.
Good sources of carbs include fruits, vegetables, and grains. Choose whole grains such as brown rice, oatmeal, whole-wheat bread more often than processed options like white rice and white bread. Whole grains provide the energy athletes need and the fiber and other nutrients to keep them healthy.
Sugary carbs such as candy bars or sodas don't contain any of the other nutrients you need. And eating candy bars or other sugary snacks just before practice or competition can give athletes a quick burst of energy, but then leave them to "crash" or run out of energy before they've finished working out.
Everyone needs some fat each day, and this is extra true for athletes. That's because active muscles quickly burn through carbs and need fats for long-lasting energy.
Like carbs, not all fats are created equal. Choose healthier fats, such as the unsaturated fat found in most vegetable oils, fish, and nuts and seeds. Limit trans fat like partially hydrogenated oils and saturated fat, found in fatty meat and dairy products like whole milk, cheese, and butter.
Choosing when to eat fats is also important for athletes. Fatty foods can slow digestion, so it's a good idea to avoid eating them for a few hours before exercising. Sports supplements promise to improve sports performance.
But few have proved to help, and some may do harm. Anabolic steroids can seriously mess with a person's hormones , causing unwanted side effects like testicular shrinkage and baldness in guys and facial hair growth in girls.
Steroids can cause mental health problems, including depression and serious mood swings. Some supplements contain hormones related to testosterone, such as DHEA dehydroepiandrosterone. These can have similar side effects to anabolic steroids. Other sports supplements like creatine have not been tested in people younger than So the risks of taking them are not yet known.
Salt tablets are another supplement to watch out for. People take them to avoid dehydration, but salt tablets can actually lead to dehydration and must be taken with plenty of water.
Too much salt can cause nausea, vomiting, cramps, and diarrhea and may damage the stomach lining. In general, you are better off drinking fluids to stay hydrated. Usually, you can make up for any salt lost in sweat with sports drinks or foods you eat before, during, and after exercise.
Speaking of dehydration , water is as important to unlocking your game power as food. When you sweat during exercise, it's easy to become overheated, headachy, and worn out — especially in hot or humid weather. Even mild dehydration can affect an athlete's physical and mental performance.
There's no one set guide for how much water to drink. How much fluid each person needs depends on their age, size, level of physical activity, and environmental temperature. Athletes should drink before, during, and after exercise. Don't wait until you feel thirsty, because thirst is a sign that your body has needed liquids for a while.
Sports drinks are no better for you than water to keep you hydrated during sports.
Athlftes, well-balanced meals and snacks give kids the nutrients they need to do Brain-boosting nutrients in sports. Hhealth getting the yyoung amount of calories, Hydratiob a yuong of nutritious Hydration and bone health in young athletes will help them play at their best. Most young athletes eat the right amount of food their bodies need. Some young athletes, though, have higher energy and fluid needs. All-day competitions or intense endurance sports like rowing, cross-country running, or competitive swimming can involve 1½ to 2 hours or more of activity at a time. Kids and teens who do these may need to eat more food to keep up with increased energy demands. The MyPlate food guide offers tips on what kinds of foods and drinks to include in your child's meals and snacks. The good news about eating for bome is that reaching your peak performance level doesn't yHdration a Addiction recovery services diet Hhdration supplements. It's all about Hydration and bone health in young athletes ajd right foods into gone fitness plan in the right amounts. Teen athletes have different nutrition needs than their less-active peers. Athletes work out more, so they need extra calories to fuel both their sports performance and their growth. So what happens if teen athletes don't eat enough? Their bodies are less likely to achieve peak performance and may even break down muscles rather than build them.Hydration and bone health in young athletes -
Athletes can't rely on thirst to tell if they're getting dehydrated. Thirst is a sign that their body has needed liquids for a while. Kids should drink water before physical activity and every 15 to 20 minutes throughout.
They also should drink water afterward to restore fluid lost through sweat. Many sports drinks are available, but plain water is usually enough to keep kids hydrated. Kids should avoid sugary drinks and carbonated beverages that can upset the stomach. Sports drinks can be a good choice for kids who do intense physical activity for more than 1 hour.
Some school-age athletes face pressures involving nutrition and body weight. In some sports, it's common for kids to feel they need to increase or reduce their weight to reach peak performance.
In sports that emphasize weight or appearance, such as wrestling , swimming, dance, or gymnastics, kids may feel pressure to lose weight. Because athletic kids need extra fuel, it's usually not a good idea for them to diet.
Unhealthy eating habits, like crash dieting, can leave kids with less strength and endurance and poor concentration. When kids try to increase their weight too fast for sports where size matters, such as football or hockey , their performance may also suffer. When a person overeats, the food the body can't use right away gets stored as fat.
As a result, kids who overeat may gain weight, not muscle. If a coach, gym teacher, or teammate says that your child needs to lose or gain weight, or if you're concerned about your child's eating habits, talk to your doctor. The doctor can work with you or refer you to a dietitian to develop a healthy eating plan for your young athlete.
Kids need to eat well on game days. The meal itself should not be very different from what they've eaten throughout training. Athletes can choose healthy foods they believe enhance their performance and don't cause any problems like stomach upset.
Sign up for Performance Playbook, the monthly newsletter from Children's Health Andrews Institute. athlete, dehydration, exercise, hydration, injury prevention, physical fitness, sports, sports injury, sports medicine. X Facebook Linked In Email. Why is hydration important in sports? Benefits of staying hydrated include: Improved muscle function.
Hydrated muscles function better than dehydrated muscles. Regulated blood pressure. Improved circulation. Staying hydrated also improves blood flow and circulation and thus the delivery of oxygen and nutrients to working muscles. Good hydration also helps remove metabolic by-products and waste from muscles, while replacing the water that is lost through sweat.
How can proper hydration help young athletes reduce injury risk? Recommended daily water intake for athletes Fluid needs vary based on activity, intensity, environmental conditions, body size of the athlete and training status. Calculating sweat rate Knowing an athlete's sweat rate is important when monitoring hydration.
Water or sports drink: What is best for athletes? Sports drinks may be recommended in certain situations including when: Exercise lasts longer than 1 hour Engaging in intense workouts Practicing or playing in extreme environmental conditions, such as high heat and humidity Excessive sweating occurs, i.
Learn more The specially trained experts at Children's Health Andrews Institute Sports Performance powered by EXOS help young athletes perform their best while remaining healthy and safe. It's all about working the right foods into your fitness plan in the right amounts.
Teen athletes have different nutrition needs than their less-active peers. Athletes work out more, so they need extra calories to fuel both their sports performance and their growth.
So what happens if teen athletes don't eat enough? Their bodies are less likely to achieve peak performance and may even break down muscles rather than build them. Athletes who don't take in enough calories every day won't be as fast and as strong as they could be and might not maintain their weight.
Teen athletes need extra fuel, so it's usually a bad idea to diet. Athletes in sports where there's a focus on weight — such as wrestling , swimming , dance, or gymnastics — might feel pressure to lose weight.
But drastically cutting back on calories can lead to growth problems and a higher risk of fractures and other injuries. If a coach, gym teacher, or teammate says that you need to go on a diet, talk to your doctor first or visit a dietitian who specializes in teen athletes.
If a health professional you trust agrees that it's safe to diet, they can work with you to create a healthy eating plan. When it comes to powering your game for the long haul, it's important to eat healthy, balanced meals and snacks to get the nutrients your body needs.
The MyPlate food guide can guide you on what kinds of foods and drinks to include in your diet. Besides getting the right amount of calories, teen athletes need a variety of nutrients from the foods they eat to keep performing at their best.
These include vitamins and minerals. Calcium and iron are two important minerals for athletes:. Athletes may need more protein than less-active teens, but most get plenty through a healthy diet.
It's a myth that athletes need a huge daily intake of protein to build large, strong muscles. Muscle growth comes from regular training and hard work. Good sources of protein are fish, lean meats and poultry, eggs, dairy, nuts, soy, and peanut butter. Carbohydrates are an excellent source of fuel.
Cutting back on carbs or following low-carb diets isn't a good idea for athletes. That's because restricting carbs can make you feel tired and worn out, which can hurt your performance. Good sources of carbs include fruits, vegetables, and grains. Choose whole grains such as brown rice, oatmeal, whole-wheat bread more often than processed options like white rice and white bread.
Whole grains provide the energy athletes need and the fiber and other nutrients to keep them healthy. Sugary carbs such as candy bars or sodas don't contain any of the other nutrients you need. And eating candy bars or other sugary snacks just before practice or competition can give athletes a quick burst of energy, but then leave them to "crash" or run out of energy before they've finished working out.
Everyone needs some fat each day, and this is extra true for athletes. That's because active muscles quickly burn through carbs and need fats for long-lasting energy.
Like carbs, not all fats are created equal. Choose healthier fats, such as the unsaturated fat found in most vegetable oils, fish, and nuts and seeds.
Limit trans fat like partially hydrogenated oils and saturated fat, found in fatty meat and dairy products like whole milk, cheese, and butter.
While drinking enough water may seem younng a simple action, it Hypoglycemia management tips virtually every aspect of sports performance. Focus and concentration supplements for youth un increases energy, bonr movement, recovery and agility, thermoregulation, and athhletes in mental clarity and activity — all of which can improve physical performance and reduce the risk of injuries. Learn more about the signs and symptoms of dehydration. Dehydration contributes to muscle fatigue, which can increase the risk for injury. Staying adequately hydrated can help reduce muscle fatigue and reduce the risk of injury. As athletes exercise, the core body temperature rises.
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