Sports and PKU A Balancing Act - Presented by: Abby Hall, RD CD Department of Medical Molecular Genetics at Riley Hospital for Children Personal ...
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Sports and PKU
A Balancing Act
Presented by: Abby Hall, RD CD
Department of Medical Molecular Genetics
at Riley Hospital for Children
Personal Experience by: Brady and Curt
Disclosure Statement
I have no relevant financial or nonfinancial
relationship(s) within the products or services
described, reviewed, evaluated or compared in
this presentation.
Content appropriate for presentation at NPKUA
meeting.
Overview O Importance of nutrition in sports O Who this affects? O Macronutrient needs: Calories, CHO, Protein O Fluids O Pre and Post workout O Vitamin and Minerals O How this looks with PKU O Personal experience
Importance of Nutrition
in Sports
O Nutrition plays a huge role in sports
performance.
O Well nourished athlete performs optimally,
has decreased risk for injury, and focuses
better.
O Important to know what to do and WHY?
Bonci, MPH, RD, CSSD, LDN, Leslie. "Sports Nutrition for Young Athletes."
Pediatric Annals 39.5 (2010): 300-06. Print.
Who This Affects?
O Any and all children, adolescents and teens
participating in athletic programs.
O Depending on competition level, skill levels of
participants, length of season, etc. this will
affect the nutrition required
O Studies show that 7.6 million athletes
participated in organized high school sports in
2010. Largest group to date with 44 million
children and youth also participating in athletic
programs.
O Nutrition should play a role in each of these
participants diet regimen.
ADA Nutrition Care Manual. Chicago: American Dietetic Association (ADA),
2005. Child Athletes. Web. 8 June 2016Sports Nutrition
Macronutrient Needs: Calories
O What are calories: fuel for the body
O Body burns calories at rest and
calories during exercise
O Weight is based on total calories in
vs. total calories out each day.
Maintain: calories in = calories out
Weight Gain: calories in > calories out
Weight Loss: calories in < calories out
Macronutrient Needs: Calories
O Estimated Energy Requirements (EER)
Sex Age Range EER in kcal/day (weight in kg)
Males
3-8 yo 88.5 - (61.9 x age [y] )+ PA x (26.7 x weight [kg] + 903 x Ht [m]) + 20
9-18 yo 88.5 - (61.9 x age [y]) + PA x (26.7 x weight [kg] + 903 x Ht [m]) +25
Female
3-8 yo 135.3 - (30.8 x age [y]) + PA x (10.0 x weight [kg]) + (934 x height [m]) + 20
9-18 yo 135.3 - (30.8 x age [y]) + PA x (10.0 x weight [kg]) + (934 x height [m]) + 25
*Note: 1 lb = 2.2kg
McAuley, PharmD., David. "Institute of Medicine - Estimated Energy Requirement (EER). Dieting and
Nutrition Tool. Energy Requirements Included in MyPyramid." Institute of Medicine - Estimated Energy
Requirement (EER). Dieting and Nutrition Tool. Energy Requirements Included in MyPyramid. Institute
of Medicine, 16 Mar. 2016. Web. 08 June 2016.
Macronutrient Needs: Calories
O EER x Activity level = Total caloric needs/day
Age Range Activity Level
Boys ages Activity Level based on:
3-18 yo Sedentary PAL is rare in children
Sedentary: 1.0 Low Active PAL = Less than 1 hour/day of physical activity
Active PAL = Approximately 1 hour/day of physical activity
Low Active: 1.13
Very Active PAL = More than 1 hour/day of physical activity
Active: 1.26
Very Active: 1.42
Girls ages
3-18 yo
Sedentary: 1.0
Low Active: 1.16
Active: 1.31
Very Active: 1.56 McAuley, PharmD., David. "Metabolic Equivalents - METS, Energy
Expenditure Various Activities, PAL." Metabolic Equivalents - METS,
Energy Expenditure Various Activities, PAL. Clinicians Ultimate Reference,
16 Mar. 2016. Web. 08 June 2016.Macronutrient Needs: CHO
O Main source of fuel during sports performance.
O Energy released 3 times faster than from protein or fat.
O Carbohydrates are broken down to glucose in the body
to be either used immediately as energy or stored at
glycogen.
O During short burst of activity (sprints, sports with
intermittent aerobic activity like basketball, soccer,
volleyball, tennis, etc) the body converts glycogen to
glucose in the muscles for energy.
O During endurance sports (long distant running, cycling,
long distant swimming) the body begins to convert fat
for energy to spare the glycogen needed for quick
energy.
ADA Nutrition Care Manual. Chicago: American Dietetic Association (ADA),
2005. Child Athletes. Web. 8 June 2016Sports NutritionMacronutrient Needs: CHO
O Carbohydrates should make up 55-60% of
total daily intake.
O Estimate per activity level on how much
recommended
Intensity of Activity Carbohydrate (g/kg/day)
None/light training (2-3 x week) 3-5 g/kg/day
Moderate/heavy training (3-5 x week) 5-8 g/kg/day
Pre-event (24-48 hrs) 8-9 g/kg/day
Post-event (within 2-4 hrs) 0.8-1 g/kg/hour for 4 hours after glycogen-depleting exercise
*Note: 1 lb = 2.2kg ADA Nutrition Care Manual. Chicago: American Dietetic Association (ADA),
2005. Child Athletes. Web. 8 June 2016Sports NutritionMacronutrient Needs: Protein
O Vital to muscle and bone health, especially
in athletes.
O Recommended intake different for all
depending on size and what they are
looking to get out of training.
O Increasing muscle size or losing weight:
need increased protein
Bonci, MPH, RD, CSSD, LDN, Leslie. "Sports Nutrition for Young Athletes."
Pediatric Annals 39.5 (2010): 300-06. Print.Macronutrient Needs: Protein
O Average adolescent/teenager needs about
0.9-1.0g/kg body weight of protein per day.
O Total protein should make up 12-15% of
total daily intake.
Training level Protein (g/kg/day)
Training 1.0-1.5
Endruance 1.2-1.4
Calorie resticting athletes 1.7
*Note: 1 lb = 2.2kg
ADA Nutrition Care Manual. Chicago: American Dietetic Association (ADA),
2005. Child Athletes. Web. 8 June 2016Sports NutritionMacronutrient Needs: Protein
O Research shows that additional amino acid
supplementation will not increase
strength/endurance, reduce fat or increase
size of muscles
O Fluids are very important when increasing
total protein over the basic needs of 0.9-
1.0g/kg to prevent damage to kidney and
liver and to prevent dehydration.
ADA Nutrition Care Manual. Chicago: American Dietetic Association (ADA),
2005. Child Athletes. Web. 8 June 2016Sports NutritionFluid Needs
O Extremely important and overlooked
in many training programs.
O Purpose to cool the body.
O Prepubertal children should be monitored more
closely as they are at higher risk for dehydration.
O Hydration needed for optimal performance
Age/Sex Daily Fluid Needs O Goal to have pale yellow
Boys
4-6 yo. boys & girls 5 cups (1.2 L)
urine throughout the day.
9-13 yo. 8 cups (1.8 L)
14-18 yo. 11 cups (2.6 L)
Girls ADA Nutrition Care Manual. Chicago: American Dietetic Association (ADA),
9-13 yo. 7 cups (1.6 L) 2005. Child Athletes. Web. 8 June 2016Sports Nutrition
Bonci, MPH, RD, CSSD, LDN, Leslie. "Sports Nutrition for Young Athletes."
14-18 yo. 8 cups (1.8 L) Pediatric Annals 39.5 (2010): 300-06. Print.Fluid Needs
O Most accurate way to replace fluids is to weigh pre and
post workout
O 1-2% decrease in total body weight in fluids can
decrease endurance.
O Replace every pound of body weight lost with 16-24 oz
fluids.
O Accurate replacement fluids is most crucial in hot and
humid environments.
ADA Nutrition Care Manual. Chicago: American Dietetic Association (ADA),
2005. Child Athletes. Web. 8 June 2016Sports NutritionFluid Needs
O Water is all that is needed for exercise up to 60 minutes
O Fluids with sodium and electrolytes (sports drinks) are
recommended when sweating for longer than 60
minutes or in very hot and humid weather.
O Sugary (soda, juice) Timing Rehydration Amounts
and caffeinated drinks 1 to 2 hours before event 12-22 oz of cool water
are not recommended 10 to 15 min. before event 10-20 oz of cool water
as they increase During physical activity
4-6 oz cool water
Every 15-20 min.
dehydration.
2-3 cups (16-24 oz) cool fluids
After physical activity
for every pound of weight lost
ADA Nutrition Care Manual. Chicago: American Dietetic Association (ADA),
2005. Child Athletes. Web. 8 June 2016Sports NutritionPre and Post Workout
O The body is performing from glycogen stores 24-
48 hours prior to event, making CHO important
before and event and to ensure athlete is not
hungry.
O Post exercise the body is most receptive to
storing glycogen in the first 2 hours. Fueling the
body with moderate CHO snack or beverage right
after exercise and then eating a well balanced
moderate CHO meal 2 hours after is the best
way to replenish your stores.
ADA Nutrition Care Manual. Chicago: American Dietetic Association (ADA),
2005. Child Athletes. Web. 8 June 2016Sports NutritionVitamins and Minerals
O Most PKU formula is adequate in
vitamins and minerals
O Have your Dietitian check to make sure!
O May need to be on Multi Vitamin depending
on how much medical food you take and
which one
Age Calcium/day (mg)
1-3 yo. 500
O Calcium 4-8 yo. 800
9-18 yo. 1300
19-50 yo 1000What does this look like?
PKU Case Study
O 12 yo male
O Weight: 41.2kg
O Height: 151.6cm
O Sport: cross country & is in season
currently
O Phe Tolerance: 400mg Phe (8 g protein)
O Metabolic Food: Lophlex LQ – 3 x day (60g
Protein, 360kcal, 12.5 oz fluid)What does this look like?
PKU Case Study
O Normal routine the day of a cross country meet:
O Eats a good dinner, usually low protein pasta and
1 Lophlex LQ
O Has breakfast in am with 1 Lophlex LQ
O Lunch at school – hot lunch + 1 Lophlex LQ
O May drink water from fountain in between class
periods.
O Meet right after school – no time
for snack!
O Dinner + 1 Lophlex LQWhat does this look like?
PKU Case Study
O Does his diet look adequate?
O What is missing/insufficient in?
O How can we make this diet better?What does this look like?
PKU Case Study
O Calories:
O 88.5 - (61.9 x 12 [y]) + 1.42 x (26.7 x 41.6[kg] +
903 x 1.516 [m]) +25 = 2,892kcal/day
O 1.42 = very active activity level
O CHO: 5-8g/day during season
O 208-333g CHO/day = 832-1332 kcal/d
O Pre-event (24-48 hr prior):
O 333-374g CHO = 1332-1500 kcal CHO
O Post-event (1-2 hour after):
O 33-42g CHO = 132-168 kcal CHOWhat does this look like?
PKU Case Study
O Protein: 1.2-1.4g/kg/day = 50-58g
O Phe tolerance = 400mg (8g)
O 50g – 8g (PHE) = 42g needed in metabolic food
O 2 Lophlex LQ = 40g protein, 240kcal, 8.3oz
O 2 Cambrooke Restore = 20g protein, 340kcal, 33oz
O TOTAL: 60g protein, 580kcal, 42oz fulids
vs.
60g protein, 360kcal, 12.5oz fluidsWhat does this look like?
PKU Case Study
O Fluids: 8 cups (1.8 L)
O 12-22oz during day of/before event
O 10-20oz 60-30 min before event
O 4-6oz q 15 minutes during event
O 16-24oz after event
O TOTAL NEEDS: 46-74oz
O New formula of Lophlex LQ and Restore
almost meets fluid needs for day!What does this look like?
PKU Case Study
O What day looks like NOW!
O Eats a good dinner, usually low protein pasta and 1 Lophlex LQ
O Has breakfast in am with 1 Lophlex LQ + 4-6oz water
O PLUS: 500 mg Calcium supplement + Complete MV
O Lunch at school – hot lunch + 1 Lophlex LQ
O Has water bottle during school to drink 10-20oz water throughout
day
O Drinks 1 Restore 60-30 minutes before meet
O Drinks 1 Restore + within 2 hours after meet
O Normal dinner with 8-10oz water
O On days without meets, may go back to 3 Loplex LQ
O Taken breakfast, lunch, after school/practice + CalciumPersonal Experience
Open Discussion
Summary O Nutrition plays a huge role in sports performance. O CHO are the main source of fuel during sports performance. O Protein (medical foods) are essential to build muscle. O Fluids are THE most important factor in exercise and performance.
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