Authors: Ronald L. Gibbs Jr.1, Tyler B. Becker1,2
1MSU Extension, Health and Nutrition Institute, Michigan State University, East Lansing, MI, USA
2Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, USA
Ronald L. Gibbs Jr PhD, MCHES
446 W. Circle Drive, Justin S. Morrill Hall of Agriculture, Rm: 250
East Lansing, MI 48828
Ronald L. Gibbs Jr. PhD, MCHES is an academic specialist in Extension at Michigan State University in East Lansing, MI. His research interests focus on coach and athlete education, long-term athlete development (LTAD), psychosocial aspects of sports and physical activity, adolescent nutrition and physical activity behavior change through sport participation, sports performance, and reducing childhood obesity.
Tyler B. Becker, PhD, CSCS is an Assistant Professor of Nutritional Sciences at Michigan State University in East Lansing, MI. His research areas include rural health, sports nutrition, and youth health education programs.
An evidence-based sports nutrition curriculum for youth
Most youth do not meet national nutrition recommendations and overconsume high-calorie, low nutrient-dense foods. A large portion of youth in the US participate in organized sports, which provides an alternative means for delivering nutrition-based education. Peak Health and Performance (PHP) is a youth-focused curriculum that uses sport to promote healthy eating behaviors. PHP uses evidenced-based sports nutrition guidelines and recommendations from the Dietary Guidelines for Americans. Lesson 1 provides an introductory overview of the three macronutrients including basic classifications and recommendations. Lesson 2, describes how athletes should change the portions of foods they are consuming based on activity levels for a particular day. Lesson 3 describes recommendations for timing of intake, and lesson 4 emphasizes best hydration practices. Lesson 5 is an application-based lesson on how athletes can use information from the previous four lessons to practice a healthy eating pattern that will also improve sports performance. The final lesson promotes and encourages sport as a vehicle for physical, mental, and emotional wellness. Future research will examine the effects of PHP in changing nutrition-related behaviors among a diverse population of children and adolescent athletes.
Keywords: sports nutrition, youth, sports, curriculum, instructional design
Youth sport participation has grown rapidly over the last several decades with estimates of nearly 45 million children and adolescents participating in organized sport (15). Youth sports can play a major role in shaping and developing physical, mental, and emotional behaviors in young athletes and has been used successfully in promoting such life skills as leadership, goal setting, and academic success (8). One area of focus that has been overlooked among young athletes is in the area of nutrition education and nutrition recommendations. Nutrition can play a substantial role in athletic performance and athletes should be aware of the guidelines and recommendations for general and sport-specific nutrition practices (34). An important skillset for an athlete to develop includes understanding nutrition’s important role in athletic performance, knowing recommendations for adequate consumption of each of the food groups, recognizing the importance of pre-and post-competition meals and snacks, knowing the pitfalls of sport supplementation, and understanding the role of hydration for athletic performance (34). Given that healthy nutrition behaviors are important to promote growth and development during adolescence, and that nutrition can play a role in improving performance and promoting recovery in sport participation, attention should be given to this area (9).
A Need for Improvement
Proper dietary intake during adolescence is crucial for growth and development and a reduction in chronic disease risk during adulthood (4). Furthermore, dietary behaviors often track from childhood to adulthood (5). Most youth do not meet national dietary recommendations for fruit and vegetable consumption and overconsume “empty calorie” foods such as sweets and sugary beverages (19, 24, 30). Further, 18.5% of children and adolescents are considered obese (17). It is estimated that 33% of children aged 6-11 years, and 50% of adolescents aged 12-19 years of age, will be overweight or obese by 2030 (39). This increased prevalence in obesity is due to numerous factors including less nutrient-dense nutrition behaviors such as dietary patterns low in fruit and vegetables, and high in added sugars and saturated fats (7, 14).
Bridging the Gap
Many school and community programs exist to promote healthy nutrition behaviors to a youth audience, though they have been met with mixed results (22). Few sport nutrition curriculum programs have been designed and implemented in youth athletes and very few have undergone extensive evaluation, resulting in limited published studies in this area (20, 33, 40). Lee and Lim (2019), applied the Performance Nutrition Curriculum, originally designed for collegiate athletes (26), with the 5 A’s behavior change model and motivational interviewing among Korean middle and high school athletes. Another program, the WAVE~Ripples for Change: Obesity Prevention in Active Youth curriculum, utilizes adolescent’s interests in sports to adopt eating patterns for improving sports performance and overall health (40). Both curricula utilize existing programming for non-adolescent audiences and adapt programming to meet the needs of the intended audience. Overall, there is a consistent need for nutrition education programs for young athletes as they have the potential to significantly impact knowledge, behavior, and ultimately athletic performance (35).
Peak Health and Performance (PHP) is a nutrition education program developed by faculty and staff at Michigan State University, Division of Sports and Cardiovascular Nutrition, College of Osteopathic Medicine, East Lansing, MI and Spartan Performance Training Center, East Lansing, MI. The goal of the program is to instruct adolescent athletes about the importance of nutrition for health and sports performance and to provide suggestions and recommendations for adopting these healthy behaviors. Recommendations for dietary intake are based on the US Department of Agriculture’s (USDA) Dietary Guidelines for Americans (36). Sport-specific macronutrient recommendations and behaviors, such as timing of intake and hydration practices, are based on the Academy of Nutrition and Dietetics, Dietitians of Canada, and the American College of Sports Medicine: Nutrition and Athletic Performance position statement (34) and the Sports Dietitians of Australia Position Statement: Sports Nutrition for the Adolescent Athlete (9, 32). It should be noted that these sport-specific practices and recommendations are intended to provide guidance and a general understanding as they are based on recommendations for an adult population. It has been recommended that in the absence of adolescent-specific nutrition recommendations to use adult-specific recommendations as guidance (9, 32). It should also be noted that these recommendations are not intended for individualized diet plans or prescriptions. Specific dietary recommendations should come from the consultation of a Registered Dietician or a family care practitioner.
Table 1 provides an overview of the learning objectives associated with each lesson of Peak Health and Performance. Lesson topics include functions of macronutrients on health and performance, USDA MyPlate recommended servings of each food group, energy balance, timing of meal and snack intake, hydration practices and consumption recommendations, and healthy meal and snack options for fast food and restaurants.
TABLE 1: Lesson Learning Objectives
|1: Nutrition Basics||Explain the importance of proper nutrition for performance and healthUnderstand the concept of energy balance and how it relates to health and performanceUnderstand that eating from all the groups of MyPlate is a health way for athletes to eatList the three macronutrients: carbohydrates, protein and fat, and their main function in an athlete’s dietDistinguish which of the five food groups are the main contributors of carbohydrates, protein, and fatSet a goal to examine his/her plate and look for a variety of foods that contain protein, carbohydrates, and health fat|
|2. Athletes Performance Plates||Construct on paper, orally or using food models a meal that contains all the food groups contained in MyPlateDescribe specifically how athletes’ energy needs change on easy vs. moderate vs. harder training daysCite examples of healthy choices to add to a meal or snack on days when energy needs increaseIdentify servings per package, serving size, calories per serving and the three macronutrients on nutrition labelsKnow how to identify significant sources of fiber and protein as well as added sugar quantities using nutrition labelsSet a goal to make his/her plate look like MyPlate, and to adjust food intake based on intensity and type of training or competition|
|3: Time of Intake||List behaviors that athletes should engage in to maximize timing of intake, energy levels, and athletic performanceState that in order to maximize athletic performance athletes should eat something every 2-4 hoursProvide examples of pre- and post-workout “Power Hour” snacks that contain both carbohydrates and proteinRecognize the importance of food safety practices when packing meals and snacks|
|4: Hydration, Energy Drinks, and Sugary Beverages||List at least three signs/symptoms of dehydrationExplain how to assess hydration statusList three ways to stay hydratedIdentify strategies to stay hydrated throughout the dayCalculate the amount of water needed to replace fluids lost by weighing himself/herself before and after practice|
|5: Convenience Foods||Identify techniques for planning health meals and snacksExplain the benefits of using a grocery list when shoppingIdentify ways to make healthy meal and snack choices when eating at a restaurant or fast food restaurantIdentify healthy snack options at convenience stores|
|6: More Than a Game||Identify ways that sports can impact physical and emotional health and well-beingRecall ways in which sport participation has had a positive impact in their livesIdentify ways to be continually physically active after “competitive” sports participation|
Lesson 1: Nutrition 101
The purpose of this first lesson is to provide an overview of general nutrition and sports nutrition-related components and to introduce the “Four Pillars of Peak Performance”. These include energy balance, portion size, timing of intake, and hydration. This lesson sets out to teach the young athlete that food is more than just something we eat when we are hungry, but rather has many different functions in the body. For instance, the lesson beings by identifying the many benefits of healthy nutrition behaviors including improvements in recovery and performance (1), a healthy body composition (34), reduction in illness (28) and injuries (3), and overall long-term health (34).
Aside from many health benefits, food also acts as “fuel” for the athlete to train, perform, and recover from exercise and competition. An analogy of the body as an automobile is emphasized to describe the relationship of food as fuel for the body to enhance the connection of good sports nutrition practices with health and performance. It is also emphasized that an athlete should strive to match their energy intake with their energy expenditure, a concept called energy balance. Energy balance refers to the amount of total energy consumed via kilocalories (kcals) compared to the amount of energy expended (16). When an individual consumes more energy than they are expending they are in a positive energy balance, and if one expends more energy than they are consuming, they are in a negative energy balance. Generally, youth athletes should strive to maintain energy balance during the competitive season to meet the needs of growth and maturation, and also to meet the needs of one’s sport (9, 32). This can be achieved by eating the correct portion sizes from each of the five food groups, a concept that will be further explained in Lesson 2.
Macronutrients are also discussed in this lesson, including function, food source, and recommended amounts. Carbohydrates offer the athlete numerous benefits including serving as a major fuel source during moderate to intense exercise and decreasing recovery times between activities (32). For simplicity of the targeted audience, carbohydrates are classified into two different types: simple and complex (16). Simple carbohydrates are those mostly coming from sources higher in mono- and di-saccharides including sweets, candy, and soda. Complex carbohydrates are those coming from foods higher in starches (polysaccharides) and oligosaccharides. Complex carbohydrates are emphasized primarily over simple carbohydrates as the former contains more dietary fiber and micronutrients. The USDA Dietary Guidelines for Americans recommends 45-65% of total daily caloric intake to come from carbohydrate-based foods (36), which is in line with recommendations for athletes which recommends consuming over 50% of daily kcals from carbohydrates, or approximately 3-8 g/kg/day (32). The daily amount needed is dependent on numerous factors including, type of activity and intensity of it, sex differences, and environmental influences.
Protein is important for numerous bodily functions including muscle and other tissue rebuilding, which is very beneficial to those in athletics (16, 34). Good sources of complete protein include lean meats such as beef and pork, poultry, fish, eggs, soy, beans/legumes, nuts/seeds, and dairy products. For youth, the USDA Dietary Guidelines for Americans recommends that 10-35% of kcals should come from protein for adolescents, or about 0.8-1.2g/kg/day (32).
Lastly, dietary fats are described related to their ability to serve as fuel to the athlete (34). Additionally, fats are important components of cell membranes, provide protection to internal organs, and aid in reducing heat loss (16). Similar to carbohydrates, fats can be classified into two types for simplicity: saturated and unsaturated (16). Sources of saturated fatty acids include butter, lard, and cheese, while good sources of unsaturated fatty acids include olive oil, nuts, and peanut butter. To promote short- and long-term health, unsaturated fatty acids should be emphasized over saturated fatty acids (32). The USDA Dietary Guidelines for Americans recommends daily caloric intake to range between 20-35% for dietary fat, with <10% coming from saturated fats (36).
Lesson 2: Performance Plates
Energy demands may increase or decrease as training intensity and/or volume changes (34). Lesson 2 expands upon the concept of energy balance and provides a visual representation of how to increase or decrease portion sizes of each of the five good groups to meet the energy demands of their sport. This lesson also instructs athletes how to identify the relevant information on a Nutrition Facts Label to make healthy food choices.
Individual energy needs are dependent on a number of other factors including age, weight, sex, and physical activity levels (34, 36). Further, the composition of these energy needs will differ depending on the length, type, and duration of activity for a particular day (27). According to the USDA Dietary Guidelines for Americans, energy requirements for adolescent males and females (ages 14-18 years) range from 1,800 for sedentary females and 2,000-2,400 for sedentary males, to 2,400 for active females and 2,800-3,200 for active males (36). A simple way to address these issues with the young athlete is to provide them a visual aid in determining portion sizes of each of the food groups based on their level of activity. Athlete’s plates included in this curriculum were modified from the Athlete’s Plate Models developed by Dr. Nanna Meyer in collaboration with the Sport Nutrition Graduate Program at the University of Colorado, Colorado Springs and the United States Olympic Committee (31). The Athlete’s Plate models are methods to visually show how an individual’s plate should look depending on training for a particular day (34), similar to MyPlate (38). They are broken down into three basic illustrations: an easy training day, a moderate training day, and a hard training day. The curriculum versions were modified in a manner to illustrate similar food proportions but make it easier to understand for a younger audience.
Easy Training. An easy training day could be defined as a light workout or walkthrough practice, or a day that may not have a practice or competition scheduled (34). A performance plate on these days should follow the MyPlate guidelines for food group consumption as these guidelines meet recommendations for normal daily activity for most youth. Sedentary adolescent males, need approximately 2000-2400 kcals daily, while their female counterparts require 1600-1800 kcals (36). Assuming 4 meals a day (3 meals plus a snack), each easy training meal could consist of ~450-550 kcals each.
Moderation Training. A moderate training day is considered a “typical” practice or competition for the young athlete in terms of the length and intensity of the activity. Since energy needs are greater, the recommendation is to increase the amount of energy consumed, primarily from the fruit, vegetable, and grain groups as these are the most carbohydrate-rich food groups. Moderately active adolescent males need approximately 2200-2800 kcals daily, while female adolescents with the same activity level need about 2000 kcals daily (36). Therefore, a typical training meal recommendation (assuming 3 meals and a snack) for moderate training days could be 550-650 kcals.
Hard Training. Lastly, a hard training day would be equivalent to high intensity training, practice, or a competition lasting longer than 90 minutes. This could also include situations in which an athlete is practicing twice per day or have an all-day tournament. Similar to the moderate training day, recommendations for a hard training day consists of increased portion sizes of carbohydrate-rich foods, mostly from whole grains which make up about half of the hard training day performance plate.
The last portion of this lesson explains the importance of reading Nutrition Facts labels. The goal of this section is to equip the athlete with the knowledge and skills necessary to make healthy food choices. Specifically, a few sections of the Nutrition Facts label are emphasized. Saturated fats are found under Total Fats, and the recommendation is to limit their intake (13). Dietary Fiber is another Nutrition Facts label requirement, and its increased consumption is associated with a reduction in risk for cardiovascular disease and type II diabetes mellitus, and for maintaining overall gastrointestinal health (16). Good sources of dietary fiber include whole grain bread, whole fruit, vegetables, beans and legumes. Adolescent females need around 25 grams of fiber per day, while adolescent males need about 31 grams per day (18).
Lesson 3: Timing of Intake
The overall emphasis of lesson 3 builds on the importance energy balance and portion size by providing young athletes with a meal pattern that promotes optimal performance and recovery. The main idea is that following a pattern of smaller, more frequent meals helps to promote energy balance, and timing meals around practice and competition helps to fuel performance and promote muscle repair and energy replenishment (34). The recommendation is to eat at regular intervals throughout the day to maintain energy levels.
Along with eating smaller and more frequent meals and snacks, this lesson emphasizes the importance of meal timing, particularly regarding eating breakfast, and eating before and after activity. Eating breakfast among children and adolescents is associated with increased cognitive performance and academic achievement, and higher quality of life (21). Additionally, skipping breakfast is associated with a lower dietary quality compared to those who do not and chronically skipping breakfast is associated with greater obesity and waist circumference in children and adolescents (10, 29). The recommendation it to consume breakfast within 30-60 minutes of waking. This section concludes with recommendations for breakfast food options.
Along with breakfast consumption, consuming meals or snacks before and after practice or competition, often called the “power hour” are important for improving performance in a variety of sports (32, 34). The purpose of consuming a light meal or snack before activity is to maximize blood glucose levels and glycogen stores, and prepare an athlete for activity (34). General recommendations for pre-workout meals include those that are higher in carbohydrates (~40 grams), moderate in protein (~10 grams), and low in fat (32). Foods higher in fat often lead to stomach discomfort which could increase risk of nausea and vomiting, and decreased performance. The lesson recommends athletes experiment with smaller portions prior to practice or competition to gauge their tolerance and build towards recommended portion sizes. Example food items are provided matching the suggested recommendations (see Table 2). Following a practice or competition, athletes should consume a meal or snack containing both protein and carbohydrate to replenish glycogen stores, and facilitate protein synthesis and recovery (34). The recommendation is to consume a meal higher in carbohydrates (~75 grams) and protein (~20 grams) within an hour after activity. Table 2 provides a summary of both pre- and post-workout food combination options.
TABLE 2: Power Hour Food Combinations
|Pre-Workout Snacks||Post-Workout Snacks|
|Each snack contains approximately 250-300 calories, 40-50 grams of carbohydrates, and 10-15 grams of protein||Each snack contains approximately 500 calories, 75 grams of carb, and 20 grams of protein.|
|¼ cup dry roasted peanuts, ¼ cup raisins||2 cups low-fat chocolate milk, 1 large banana|
|1 cheese stick, 1 small bag pretzels, one small apple||1 cup cooked oatmeal, 1 cup skim milk, 1 pear, ¼ cup trail mix|
|8 oz. skim milk, 1 crunchy granola bar||2 boiled eggs, 1 slice toast, 1 orange, 1 banana, ¾ cups low-fat cottage cheese|
|1.5 oz. bag baked chips, ¼ cup hummus, 10 baby carrots||1 whole grain tortilla, ¼ cup refried beans, 2 tbs. salsa, 1 banana, 1 stick string cheese|
|1 banana, 1 ½ T peanut butter||1 whole wheat bagel, 2 T hummus, 1 slice cheese, 2 tomato slices, 8 oz skim milk|
This lesson concludes with a summary of the importance of food safety and practical recommendations for the youth athlete. The goal with this section is to educate the athlete on basic food safety practices, such as hand washing, keeping foods at appropriate temperatures (e.g. cooking foods to appropriate temperatures, maintaining cold foods), and maintaining clean surfaces to avoid the risk of foodborne illnesses (37). Examples include using a clean and insulated lunch bag or box and throwing away perishable leftovers if they cannot be kept cold. This section concludes with the importance of washing one’s hands for 20 seconds with soap and water or using hand sanitizer.
Lesson 4: Hydration
While the first three lessons primarily focus on the consumption of healthy foods, lesson 4 reminds the athlete that beverage choices can also impact health and athletic performance. The main theme in this lesson is that of improving or maintaining adequate hydration before, during, and after activity. Water typically constitutes over 50% of the body and is important in regulating body temperature, maintaining fluid balance, and aiding in food digestion (16). This first section identifies healthy beverage choices for hydration including water, low-fat or fat-free milk, watered down 100% fruit juice, and sports drinks. Energy drinks, soda, and other sugary beverages are not recommended to aid in hydration of the body.
The second section explains the causes, risks, and negative impacts of dehydration to performance and potential health outcomes, such as a headache, muscle cramps, and impaired concentration (34). If left unaddressed, dehydration can lead to more serious health outcomes such as a heat stroke. The lesson describes methods to monitor hydration status using one’s body weight, urine color, and thirst sensation (2). Body weight can be used as a method to monitor hydration such as weighing oneself before and after activity (2). A decrease in weight following activity may indicate hypohydration. The recommendation would be to consume 1.25 to 1.5L of fluid for every kg of bodyweight lost, or ~24 ounces of fluid for every pound of bodyweight lost (34). Urine color is a practical way in which one could monitor hydration status. A lighter urine color is indicative of a more hydrated state, while a darker urine color could indicate possible dehydration. This section notes that consumption of some vitamins may change one’s urine color that could appear to suggest an individual is in a hypohydrated state (12). Lastly, using thirst is an easy method to identify is someone is possibly hypohydrated (2). If you have one of them, you may likely be dehydrated; if you have two of them you are likely dehydrated; and if you have all three you are very likely dehydrated.
The next two sections discuss sports drinks and hydration recommendations. Sports drinks are highly marketed for use during activity as they often contain electrolytes and carbohydrates which may improve performance by optimizing water absorption and maintaining metabolism (25). However, if exercise is less than an hour or an hour and fifteen minutes (and the intensity is low along with normal temperatures and humidity), a sports drink is likely not needed (9). Most of the time, consuming water before, during, and after activity will suffice the typical youth athlete. About 4 hours prior to activity, 2-3 cups of fluid are recommended to maintain hydration. About 2 hours before activity, 1-2 cups of fluid is recommended (11). To maintain or improve hydration during activity, .4 to .8 L (14-27 ounces) of fluid should be consumed per hour. As previously stated, after activity, the recommendation is to consume 1.25 to 1.5L of fluid for every kg of bodyweight lost, or 24 ounces of fluid to replace every pound lost (34).
The last section discusses energy drinks and their potential detriments to health and performance. It is estimated that nearly 2/3 of adolescents have reporting using energy drinks, with 41% reporting having done so in the previous 3 months (23). However, they are often full of stimulates such as caffeine and other ingredients that may not be beneficial to youth athletes, and could potentially be harmful (6). The recommendation is to stay hydrated using other beverage types as previously listed.
Lesson 5: Convenience Foods
This lesson aims to provide practical applications of the previous nutritional concepts described in lessons 1-4 with respect to meal and snack planning and preparation. The overall goal is to prime the young athlete to make healthy decisions when: 1) food is available at home; and 2) when choosing foods at a restaurant, fast food, or convenience store.
The first section discusses the importance of planning and preparing meals and snacks at home. This includes making sure that the correct ingredients are available to create healthy recipes and provides suggestions, including keeping fruits and vegetables available as an easy snack, planning meals around schools and practice, and using a grocery list when shopping. The remainder of this lesson provides some basic tips for eating out and for choosing healthier options at convenience stores (see Table 3).
TABLE 3: Tips for Eating out at Restaurants and Convenience Stores
|Tips for Eating Out- Restaurants and Fast Food||Tips for Eating Out- Convenience Stores|
|Choose grilled or baked options over deep-fried foods||Choose healthy snacks such as fresh or dried fruit|
|When choosing side dishes, choose fresh fruit, side salad, or mixed vegetables||Try trail mix or mixed nuts with no salt added|
|Choose a made-to-order fast-food restaurant as they may offer healthier options||Choose low-fat beef or turkey jerky|
|Go easy on adding sauces and dressing to a meal||Choose bottled water over fountain pop and frozen drinks|
|Choose water as your main beverage||If there are little healthier snack options, choose those that are lower in saturated fat and sodium|
|Order of the children’s menu to help with portion control||Limit the number of snacks high in simple sugars|
Lesson 6: More Than a Game
The final lesson in PHP serves as an opportunity to showcase the many benefits of maintaining a physically active lifestyle and to identify the many ways sport participation can add value to the young athlete’s life. The main theme of this lesson is that sports are a vehicle for life and can impact a young athlete physically, mentally, and emotionally (8, 15).
The first section explains how sports participation and other physical activities contribute to the recommendation of being physically active for 60 minutes or more every day, and the short- and long-term benefits of regular physical activity. This lesson also encourages young athletes to find other modalities of physical activity, such as recreational sports or strength training, that are both enjoyable and available after their current competitive days are over. The remainder of the lesson emphasizes some of the other important aspects of sports participation. This includes the fun aspects of participating in sports such as connecting with peers, being part of a team, and working towards self-improvement. These characteristics have been associated with increased participation in youth sports and can lead to highly satisfied, highly motivated athletes (8). Athletes are also asked to reflect on different life skills or lessons they may have learned through sport participation and how they can use these in other areas, such as using goal setting strategies or time management skills to aid in academic success.
The PHP curriculum aims to bring nutrition education to the young athlete in a fun, efficient, and practical manner. The lessons included in this program offer an evidence-based approach to educating young athletes on general and sport-specific nutrition behaviors that can have a positive impact on their health and athletic performance. The lessons are designed in way that youth sport coaches can lead the program facilitation and play a key role shaping the health and well-being of their athletes. Future plans for PHP include testing the program in a variety of settings (e.g. urban versus rural) and disseminating to communities outside of Michigan to measure the overall effectiveness of the program at improving general and sport-specific related knowledge and behaviors.
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