La Nutrizione Di Genere BARI 22 SETTEMBRE 2018

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1 La Nutrizione Di Genere BARI 22 SETTEMBRE 2018 Beatrice Molinari BIOLOGA NUTRIZIONISTA SPECIALISTA IN SCIENZA DELL ALIMENTAZIONE

2 In the 80s, in the literature no differences were reported in physiological responses to exercise, between men and women Today again most nutritional recommendations related to the exercise they are based on data studied for the male and extrapolated for the females The most recent research highlighted gender differences

3 FOLLICULAR PHASE OVULATION LUTEAL PHASE MENSTRUATION Female Hormonal Cycle 1 9 DAY Estrogen low Progesterone low DAY Estrogen high Progesterone low DAY 28 DAY Estrogen high Progesterone high Estrogen low Progesterone low

4 GENDER DIFFERENCE Società Italiana Nutrizione Sport e Benessere - Females reach physiological and skeletal maturity and achieve peak height velocity before males - Women have more body fat and less lean body mass than males - Females have less upper body strength, - Females are at greater risk of anemia Between the two sexes there are anatomical and biomechanical differences that predispose women more to injury - Men also have higher red blood cell counts and hemoglobin levels than women - Men have more fat-free mass Ireland ML, Ott SM. Special concerns of the female athlete. Clin Sports Med Apr;23(2):281-98

5 ENERGY NEED 45% of recreational female athletes were classified as at risk for low EA female dancers consume less than 70% of recommended daily energy needs injury menstrual dysfunction decreased performance Kelly A. Rossi - Nutritional Aspects of the Female Athlete 2017

6 EA = Energy Intake (EI) Energy Expenditure (EE) per kg FFM amount of energy available for the metabolic processes of the body after energy is used for exercise, and normalized for fat free mass (FFM) LOW EA < 30 kcal/kg FFM/d American College of Sports Medicine Joint Position Statement. Nutrition and Athletic Performance 2016 Optimal EA 45 kcal/kg FFM/d IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update. Disordered eating Intentional efforts to decrease body weight Unintentional failure to meet energy requirements Time management Food availability Lack of nutritional knowledge Increase energy needs (environement factors, stress) Low Energy density diet

7 The Female Athlete Triad 1 - Low energy availability with or without disordered eating 2 - Menstrual dysfunction 3 - Low bone mineral density 2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad

8 The Female Athlete Triad Società Italiana Nutrizione Sport e Benessere 2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad

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10 Mountjoy M, Sundgot-Borgen J, Burke L, et al. Br J Sports Med 2014;48:

11 Carbohydrate Availability g / kg BW Società Italiana Nutrizione Sport e Benessere

12 Carbohydrate Needs based on training Società Italiana Nutrizione Sport e Benessere FOLLICULAR PHASE late surge of estrogen suppressed progesterone INCREASE IN GLYCOGEN UTILIZATION attention on carbohydrate loading LUTEAL PHASE increased circulating estrogen and progesteron HIGHER GLYCOGEN STORAGE, LOWER CARBOHYDRATE OXIDATION lipid oxidation females may perform better in longer distance events (>66 km)

13 Carbohydrate Replacement during exercise intestinal absorption of glucose rate g/min it is possible to ingest approximately g/min of carbohydrate consuming multiple transportable carbohydrate (glucose or maltodextrin plus fructose) De Oliveira EP Curr Opin Gastroenterol 2017 Jan;33(1):41-46.

14 Recovery DOPO: recupero of training Burke LM, Hawley JA, Wwong SH, Jeukendrup AE Carbohydrates for training and Competition J Sports Sci 2011;29 Suppl 1:S17-27.

15 consuming protein after exercise promote muscle protein synthesis, protein also may promote higher glycogen storage in the early stages of recovery if carbohydrate intake is low (<1 g/kg)

16 Training Low Increase lipid oxidation Increase mitochondrial enzyme Enhance exercise capacity Spare glycogen Reduced training intensities Inability to oxidize endogenous carbohydrate Muscle protein breakdown Risk of infection and illness Optimal protein intake Recommended for prolonged and low intensity workouts Periodic use Kelly A. Rossi Nutritional Aspects of the Female Athlete 2017

17 Fat / lipids - lower respiratory exchange ratio (RER) - greater lipolytic activity during prolonged moderate exercise higher intramuscular triglycerides (IMTG) stores higher percentage of type I muscle fiber - post-exercise mobilization of fatty acids is lower in females

18 Protein Società Italiana Nutrizione Sport e Benessere Daily recommended ranges male = female 1,2 2,0 g / kg BW / d Assessing the protein requirements Carbohydrate Energy Availability Needs individualized and periodizedbased on training American College of Sports Medicine Joint Position Statement. Nutrition and Athletic Performance Kelly A. Rossi Nutritional Aspects of the Female Athlete 2017

19 Use of proteins during the exercise females use less protein than males both at rest and during exercise FOLLICULAR PHASE late surge of estrogen suppressed progesterone lower protein catabolism LUTEAL PHASE increased circulating estrogen and progesteron higher protein catabolism Non-significant hormonal effects when carbohydrates are available during exercise Kelly A. Rossi Nutritional Aspects of the Female Athlete 2017

20 Recovery muscle protein synthesis (MPS) is similar in men and women RECOVERY MPS STRENGTH 10g EAA (<2h post-exercise) 15 to 25 g protein high biological value 0.25 to 0.3 g/kg BW Kelly A. Rossi Nutritional Aspects of the Female Athlete 2017

21 Iron deficiency (ID) is the most prevalent nutrient deficiency in the world female > male > active > sedentary CAUSES IRON DEFICIENCY Hemolysis (foot strike and impact) increased Fe losses (gastrointestinal tract, hematuria, and sweat) Poor dietary Fe intake Altered intestinal Fe absorption, including the effects of inflammation due to training Psuedoanemia Menstrual losses Iron Iron Deficiency with anemia (IDA): 3% - 5% Iron Deficiency without anemia (IDNA): 16% of premenopausal women (United States) Della Valle.Iron Supplementation for Female Athletes: Effects on Iron Status and Performance Outcomes 2013

22 FACTORS THAT INFLUENCE THE ABSORPTION OF THE IRON Società Italiana Nutrizione Sport e Benessere

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24 Iron Requirements adeguate intake for female athletes? Società Italiana Nutrizione Sport e Benessere

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26 maintenance of iron status -Intensive physical activity or/and inadequate iron intake? - Monitoring Iron status - Nutritional Counseling ironrich diet or/and haem iron-based diet - Supplements if necessary

27 Calcio structural bone health blood clotting muscle contractions nerve transmission cellular communication 72% to 90% of all females fail to meet the 1997 Adequate Intake (AI) Females with delayed menarche and menstrual dysfunction are at increased risk for low bone mineral density (BMD) Frequent deficiency in female athletes due to eating disorders, caloric restriction, exclusion of dairy products

28 For athletes with eating disorders, amenorrhea and premature risk of osteoporosis 1500 mg/d Prefer food sources (possible adverse cardiovascular and renal effects with supplements) exercise-induced rise in markers of bone resorption is decreased with a highcalcium (1350 mg) meal consumed approximately 90 minutes before prolonged, high-intensity cycling

29 Hydration Sweat, liquid losses 2% of BW: impaired cognitive function and aerobic performance 3-5% of BW: impaired anaerobic or skill performance 6-10% of BW: decreased exercise tolerance, decreased cardiac output, sweat production and blood supply to muscles and skin Numerous studies have found that many athletes (>30%) begin exercise in a dehydrated state Hyponatremia blood sodium levels < 135 mmol/l Katherine A. Beals Nutrition and the Female Athlete: From Research to Practice 2013

30 Gender difference in regulation of fluid-electrolyte balance Società Italiana Nutrizione Sport e Benessere Women have lower sweat rates, lower plasma volumes, and lower potassium and sodium sweat concentrations Women have smaller body size and greater body surface area to-bw ratio and produce 18% to 34% less sweat per hour than men during exercise female athletes maintain their core temperature and have a thermoregulatory advantage over man Quese fluttuazioni non sembrano influenzare la performance L adattameno all esercizio diminuisce queste differenze tra uomo e donna Kelly A.RossiMS, RD, CSSD Nutritional Aspects of the Female Athlete Clinics in Sports Medicine Volume 36, Issue 4, October 2017, Pages

31 Gender difference in regulation of fluid-electrolyte balance Società Italiana Nutrizione Sport e Benessere FOLLICULAR PHASE LUTEAL PHASE Increase body water plasma volume expansion Lower thermoregulatory threshold faster sweating increase risk for dehydration Kelly A. Rossi - Nutritional Aspects of the Female Athlete 2017

32 Guidelines for hydration needs surrounding exercise. Società Italiana Nutrizione Sport e Benessere

33 Gastrointestinal disorders in athletes Nausea, vomiting, diarrhea, bloody stools, and abdominal angina may affect the athlete s performance Both upper and lower GI problems occur in athletes with 25% to 50% of recreational athletes and up to 70% of elite athletes IBS and celiac disease are more prevalent in women. Splanchnic hypoperfusion Decreased blood flow to the gut GI ischemia and reperfusion increased permeability Bacterial translocation Endotoxemia Kent Diduch.Gastrointestinal Conditions in the Female Athlete, 2017

34 Gastrointestinal disorders in athletes Società Italiana Nutrizione Sport e Benessere Avoid high protein, fiber, and fat intake within 2 to 3 hours of activity due to slow digestibility Adequate hydration is also essential to prevent systemic hypovolemia and maintain splanchnic perfusion during exercise Carbohydrate concentrations 8% in beverages are best to reduce the occurrence of diarrhea associated with high osmolar fluids After exercise, consuming lipids may decrease intestinal inflammation Precursors of NO (glutamine, Citrulline, Arginine) to promote vasodilatation caffeine and FANS may infer risk to the GI system low FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet Probiotics: prevention of respiratory tract infections, control of immunosuppression, absorption of nutrients

35 GRAZIE A TUTTI Società Italiana Nutrizione Sport e Benessere