Supplemental lessons to the Peak Health and Performance curriculum: Nutritional considerations for injury, energy management, and gastrointestinal issues
Authors: Tyler B. Becker12, Ronald L. Gibbs, Jr2
1Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, USA
2Michigan State University Extension, Health and Nutrition Institute, Michigan State University, East Lansing, Michigan, USA
Corresponding Author:
Tyler B. Becker, PhD, CSCS
469 Wilson Road, Room 125
East Lansing, MI 48824
517-353-3338
Tyler B. Becker, PhD, CSCS is an Associate Professor of Nutritional Sciences at Michigan State University in East Lansing, MI. His research interests focus on sports nutrition practices and strategies in youth athletes and higher education andragogy.
Ronald L. Gibbs, Jr, PhD, MCHES is currently a Program Evaluation Specialist for 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.
ABSTRACT
Youth sports injuries are quite common in sport and have several negative consequences, including healthcare costs, loss of playing time, and producing mental stress. Nutritional strategies have been suggested to improve recovery from sports-related injuries. The Peak Health and Performance (PHP) youth-sports curriculum was developed to use sport to promote healthy eating behaviors. Six additional lessons on nutrition for recovery from injury, energy management, and gastrointestinal issues have been added as addendums to PHP. Lesson A discusses the importance of key nutrients (eg., protein, complex carbohydrates, unsaturated fatty acids, water) for promoting tissue healing following an injury. Lesson B describes several micronutrients and the possible role of nitrates for aiding in injury recovery. Lesson C discusses the implications of low energy availability, including how to identify and prevent it. In Lesson D, several nutritional strategies for addressing mild traumatic brain injuries are explored. Lesson E discusses the importance of sleep for injury recovery and describes nutritional strategies for improving sleep quality. The final lesson (Lesson F) describes various gastrointestinal issues encountered in sport and how to prevent them. Future research will examine youth athlete knowledge of nutritional strategies for recovering from a sports-related injury following these lessons.
KEYWORDS: adolescent sports; sports nutrition; injury management
INTRODUCTION
Sports-related injuries are a significant concern among adolescent athletes, with prevalence rates ranging from 34.1% to 65% (2). Certain groups, including female athletes, obese athletes, and those participating in contact sports, are at particularly high risk. In the US, the rate of injuries in sports, recreation, and leisure activities is 117.1 per 1000 children and adolescents aged 12-17 years of age (57). These injuries impose substantial financial burdens; for example, over a 5-year period in Florida, inpatient care costs for pediatric sports injuries totaled $24.55 million, while emergency care expenses reached $87 million (61). Beyond the economic impact, sports-related injuries also incur both physical and mental challenges to the athlete, including lost playing time, with female athletes averaging 10 days of missed competition per injury (5). This contributes to social isolation and depressive symptoms in adolescent athletes during recovery (63). In addition, gastrointestinal (GI) problems, including diarrhea, vomiting, and abdominal injuries are common place among athletes (12,73), and can contribute to decreases in performance and a loss of playing time (39). Given these multifaceted challenges, there is a critical need to optimize injury prevention and rehabilitation strategies to support young athletes’ physical and psychological well-being.
Proper nutritional intake plays a critical role in injury prevention and rehabilitation among youth athletes (3). In addition to supporting overall health and well-being, adequate nutrition is essential during adolescence–a period marked by rapid growth and development–and contributes to athletic performance and post-workout recovery (15, 66). Despite its importance, many adolescent athletes demonstrate a lack of knowledge regarding both general and sport-specific nutritional practices (6). A recent systematic review by Hulland et al. (2023) revealed that adolescent athletes are more familiar with general than sport-specific dietary strategies (32), while Gibbs and Becker (2025) found that both male and female adolescent athletes scored below 50% on assessments covering both areas (24). These findings underscore a significant gap in nutritional literacy among youth athletes, indicating the need for targeted education to optimize their health development and athletic outcomes.
Several nutritional strategies have emerged highlighting the importance of it for injury rehabilitation primarily in adult athletes (26, 54, 65). For example, kilocaloric and protein needs often increase following injury due to a need for recovery and maintenance of lean body mass resulting from disuse (58, 65). However, the application of nutritional strategies for recovering from injury for youth athletes remains understudied. Alcock et al. (2024) offered a comprehensive overview of injury rehabilitation strategies for youth, indicating practical applications; however there remains a critical gap in understanding how adolescent athletes perceive and apply nutrition during recovery (3). To date, no research has directly examined youth athletes’ knowledge of nutrition for injury rehabilitation, but existing evidence suggests they are likely deficient in this area as well (46). Research suggests that poor food literacy and nutrition knowledge could theoretically contribute to increased injury risk (3, 15). This reinforces the urgency of developing age-appropriate interventions that address both performance and recovery nutrition, particularly in the context of injury.
The Peak Health and Performance (PHP) curriculum was designed from a collaboration 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, East Lansing, MI (25). This curriculum incorporates various sports nutrition best practices from several areas of literature providing sports nutrition recommendations (17, 66, 69). Fruit and vegetable intake significantly increased in 290 children and adolescents who completed the PHP curriculum (4). Due to the success of the program in modifying nutrition behaviors, additional lessons were created to educate youth on nutritional strategies for injury recovery, energy management, and managing GI issues. These topics include nutritional strategies for musculoskeletal and mild traumatic brain injury (mTBI) recovery, and other nutritional considerations around injury risk and recovery including sleep, low energy availability (LEA), and GI issues. This manuscript describes the rationality and creation of these addendum lessons for the PHP curriculum.
LESSON CONTENT
The original PHP curriculum consists of six lessons labeled as: Lesson 1- Nutrition Basics; Lesson 2- Athletes Performance Plates; Lesson 3- Timing of Intake; Lesson 4- Hydration, Energy Drinks, and Sugary Beverages; Lesson 5- Convenience Foods; and Lesson 6- More Than a Game (25). Further information on PHP learning objectives and topics inclusion can be found in Gibbs & Becker (25). The new additional lessons and their learning objectives can be found in Table 1. These additional lessons are meant to serve as their own lesson series, a single lesson session, or as supplemental lessons to the original PHP lessons.
| Table 1. | |
| Additional Lessons for the Peak Health and Performance Curriculum: Learning Objectives | |
| Lesson | Learning Objectives |
| A: Macronutrients for Injury Rehabilitation | • Explain the four phases of an injury • Understand the importance of consuming enough calories following an injury • Explain why protein is needed during the health process and recall amounts needed • Explain the role that carbohydrates have during the healing process • Describe what role unsaturated fatty acids, such as omega-3s, have while healing an injury. • Understand the importance of water during the healing process |
| B: Micronutrients for Injury Rehabilitation | • Explain the importance of choosing food sources of vitamins and minerals over dietary supplements • List and understand the roles that vitamins A, C, D, and E have in injury healing • Identify good food sources of vitamins A, C, D, and E • List and understand the roles that calcium, zinc, and iron have in injury healing • Identify good food sources of calcium, zine, and iron • Explain why foods high in nitrates may promote injury healing and identify good food sources of them |
| C: Low Energy Availability | • Explain what low energy availability is • Identify what causes low energy availability • Understand how low energy availability negatively impacts performance and recovery • Explain how low energy availability may lead to other negative health outcomes • Recognize the symptoms of low energy availability • Describe prevention and treatment strategies for low energy availability |
| D: Nutrition for Head Injuries | • Explain what happens during a head injury in sport • List the different phases of concussion recovery • Explain the benefits of creatine, magnesium, and flavonoids for head injury recovery • Identify good food sources of creatine, magnesium, and flavonoids • Identify other nutritional considerations to have when recovering from a head injury |
| E: Nutrition and Sleep for Injury Reduction and Recovery | • Explain why sleep is important for performance and reducing and healing injuries • Identify how much sleep an athlete should be getting each night • Explain the benefits of melatonin and serotonin rich foods for improving sleep quality • Identify other nutrients of interest that are related to sleep quality • Identify foods to avoid prior to sleep • List strategies to set up an ideal bedtime routine |
| F: Gastrointestinal Issues and Sport | • Understand how vomiting and nausea symptoms may appear during practice and sport • Provide strategies to reduce vomiting and nausea symptoms during practice and sport • Explain how diarrhea can happen during practice and sport • Identify strategies to prevent diarrhea during practice and sport • Explain how probiotics and prebiotics are important for gut health |
Each of these six lessons will be discussed in detail in the next section. These supplemental lessons were created in a manner to instruct participants to refer back to the original lessons for further information.
Lesson A: Macronutrients for Injury Prevention
This lesson begins by describing how musculoskeletal injuries heal and the importance of proper caloric intake and macronutrients during recovery from sports-related injuries. Each macronutrient is then highlighted to show its main role in providing both energy and nutritional needs to promote recovery. Macronutrient roles and responsibilities are described in detail in PHP Lesson 1 of the original curriculum (25).
Caloric Intake: The following section of the lesson describes the importance of meeting kilocalorie (kcal) needs to help heal an injury. Research on adult athletes suggest increasing kcal consumption by 10-15% during injury and recovery (58). Additionally, to offset sarcopenia in adults resulting from injury and disuse, energy intake should be between 25-40 kcal/kg of bodyweight per day (54). Independent of injury status, growth and development demands of children aged 9 and up typically require 60-65 kcal/kg of bodyweight per day (21). Taking energy needs during injury into account, coupled with normal demands for growth and development (21), an injured adolescent would need slightly more than the recommended 60-65 kcal/kg of bodyweight per day.
Protein: Following injury, protein requirements are significantly elevated to offset bodily stress incurred from the injury (65). Additionally, protein intake helps offset muscle atrophy due to disuse (47). Protein requirements for adult athletes and recreationally active adults is between 1.2 to 2.0 g/kg of bodyweight per day (69), with protein recommendations for adolescent athletes being in a similar range (15, 41). Following injury, it is suggested to increase daily intake of protein to 2.0 to 3.0 g/kg of bodyweight in athletic adults (65), which likely suffices for protein requirements for adolescent athletes.
Carbohydrates: Carbohydrates can provide a source of energy while healing through an injury (65), and aid in muscle adaptations and recovery (69). Due to a decrease in the amount of high-intensity exercise that can be performed while injured, carbohydrate needs are not as large as what is needed in an uninjured athlete (65). Thus, to meet demand while recovering from an injury, up to 60% of daily kcals should come from carbohydrates (65), with an emphasis on complex carbohydrates. Additionally, fatty acids are important in the recovery process as they synthesize several hormones and aid in the absorption of several vitamins (3, 27). Unsaturated fatty acids, such as omega-3 fatty acids may reduce inflammation, thereby making their need instrumental during the recovery process (27). It is recommended to consume good sources of omega-3 fatty acids including fatty fish, walnuts, flaxseed, and avocado, which this lessons includes as suggested food sources (27, 65).
Fluid Intake: Hydration for performance is covered in Lesson 4 of the original PHP, but in this lesson, it is explored in more detail pertaining to injury risk and recovery. Over half of US children are inadequately hydrated (37), and being in this state can increase risk of injury and prolong recovery (10). Muscles on average are 75% water with bones comprising 25% of it, suggesting that a lowered consumption of it could further exacerbate healing of injuries to these structures (27). Males aged 9 to 13 years need at least 8 cups of fluid per day, while females of the same age need at least 7 cups per day (34). Adolescent males aged 14 to 18 years of age, need at least 11 cups of fluid per day, while females of the same age need 8 cups. Thus, it could be hypothesized that an injured youth athlete should strive to meet and exceed these recommendations for fluid consumption.
Lesson B: Micronutrients for Injury Rehabilitation
Lesson B highlights the importance of specific micronutrients that provide a key role in injury rehabilitation (3, 26). Consuming adequate nutrients, including micronutrients, from whole food sources, is a major goal of the PHP curriculum (21). This lesson begins with a discussion on the concerns with the use of dietary supplements to meet micronutrient recommendations such as issues with regulation (20), and possible contamination (40). Each section of the lesson describes how the micronutrient of interest is implicated in the recovery process, how much is needed, other important functions it provides in the body, and suggested foods that are good sources for the micronutrient of interest.
Vitamin D and Calcium: As summarized in Alcock et al. (2024) micronutrients of interest for bone injury rehabilitation include vitamin D and calcium (3). Calcium is needed to increase bone mineral density and bone remodeling such as when following an injury (27). Vitamin D is needed for calcium absorption and maintenance. Children and adolescents between 9 and 18 years old, need 1,300 mg of calcium every day (23). Adolescents between 14- and 18-years old need at least 15 mcg (600 IUs) of vitamin D daily. Food sources of calcium listed in the lesson include milk, yogurt, salmon, fortified fruit juice, and collard greens (27). Good food sources of vitamin D suggested in the lesson includes salmon, fortified milk, tuna, and cashews.
Zinc and Iron: Other micronutrients of interest for muscle injury also include zinc and iron (3). Zinc and iron are both trace minerals that have several important functions in the human body (27). Zinc is involved in hundreds of functions in the body, such as involvement in DNA synthesis and wound healing, and immune system function (27). Zinc is needed for protein synthesis and iron is needed for the transport of oxygen to several tissues in the body which would increase healing (27). Youth aged 9 to 13 years, need 8 mg of zinc per day (23). Male adolescents aged 14-18 years of age need 11 mg of zinc per day, while females of the same age require 9 mg each day. Children aged 9-13 years of age need 8 mg of iron per day (23). Males aged 14-18 years of age need 11 mg of iron per day, and females of the same age need 15 mg per day. Good sources of zinc include dark meat, legumes, shrimp, and nuts (27). Good food sources of iron includes dark meat, and also spinach and cashews.
Vitamins A, C, and E: Vitamin C plays a pivotal role in the synthesis of collagen (3). Similar to vitamin C, vitamin A aids in collagen formation, specifically the laying down of new collagen (65). Vitamin E can reduce muscle breakdown and promote muscle repair (27). Each of these vitamins can reduce oxidative stress and inflammation and improve tissue healing (27). Children aged 9 to 13 years old need 1,200 mg of vitamin C every day, and adolescents aged 14 to 18 years old, need 1,800 mg per day (23). Good food sources of vitamin C include kiwis, green peppers, strawberries, and cantaloupe (27). Youth aged 9-13 years need 600 mcg of retinol activity equivalents (vitamin A) per day, while adolescents aged 14-18 years need 600 mcg of retinol activity equivalents each day (23). Youth aged 9-13 years of age need 11 mg of vitamin E per day, while adolescents over the age of 14 need 15 mg per day (23). Dietary sources of vitamin A include sweet potatoes, pumpkins, spinach, and squash, while good sources of vitamin E include sunflower seeds, apricots, avocados, and almonds (65).
Although not a micronutrient, eating foods high in nitrates, like beets, could theoretically help heal an injury (76). About 20% of the nitrates consumed in food is converted to nitrite by bacteria found in the oral cavity (76). In turn, the stomach transforms this nitrite into nitrous oxide which can cause vasodilation. Thus, more oxygen and nutrients are transported to the injured area, supporting the healing process. A recent systematic review examined nine studies and concluded that short-term consumption of beetroot may accelerate the recovery of muscle soreness and various functional markers due to its antioxidant and inflammatory properties likely exerted by its nitrate content and several phenolic compounds (60). Therefore, it could be assumed that consuming foods high in nitrates and phenolic compounds could expedite the injury healing process. Aside from beets, good food sources of nitrates include spinach, radishes, celery, and rhubarb (36).
Lesson C: Low Energy Availability
Energy availability is the amount of energy available after energy expenditure, that is used for bodily functions (9). Thus, LEA is the state of inadequate energy intake relative to energy expenditure (9) and the prevalence for LEA in athletes ranges from 22% to 58% in a given sport (44). LEA can lead to several negative impacts on performance including decreased muscular strength, decreased endurance performance, and decreased responses to training responses and adaptations (50, 70). Additionally, there is an increased injury risk with LEA (29, 56).
The next section of this lesson discusses how LEA can negatively impact the growth and development of a child or adolescent, potentially resulting in poor bone health, delayed puberty, short stature, and menstrual irregularities (15). It also highlights several signs and symptoms felt by an athlete that could indicate LEA (9, 70).
LEA, with or without the presence of an eating disorder, is a characteristic of the Female Athlete Triad, which is a condition that also includes decreased bone mineral density, and menstrual dysfunction (53, 59). The concept of Relative energy deficiency in sport (RED-S) expands upon the Female Athlete Triad by recognizing a broader range of health consequences including disruptions to the endocrine system, immune system, and cardiovascular health (9). Raising awareness of these signs and symptoms is essential, especially given that knowledge of LEA remains low among both athletes and coaches (44). The lesson concludes with evidence-based strategies to prevent LEA, as well as treatment options to address its underlying causes (9).
Lesson D: Nutrition for Head Injuries
This lesson discusses various nutritional considerations to assist in the healing process for someone who has had a concussion, or other types of mTBI (22, 62). Current concussion rates in youth sports are 4.17 cases per 10,000 athlete exposures (38). There are several nutritional aspects that may support brain health among those recovering from mTBIs (22, 62). Although several macronutrients are considered nutrients of interest during this process (22, 62), this lesson discusses other nutrients and micronutrients (aside from those discussed in previous lessons) that may have a place while recovering from a mTBI, including creatine, magnesium, and flavonoids.
Creatine: Creatine is a compound that is formed in protein metabolism and works to recycle adenosine triphosphate (ATP) for energy metabolism (42). It has been shown that creatine content in the brain is diminished after a mTBI, and increasing its intake could maintain ATP levels in the brain (1, 65). This could help offset injury sustained from the mTBI, such as decreasing protease activation that degrades axon structures (1). Good food sources of creatine listed in this lesson includes lean red meats, fatty fish, pork, and wild game (72).
Magnesium: Magnesium is a trace mineral that has several functions within the body (27). In the brain, magnesium is involved in efficient nerve signaling and maintaining the blood brain barrier (45). Following a mTBI, magnesium levels decrease in the brain (67), and low magnesium levels have been associated with neuroinflammation and neurodegeneration, including several diseases such as Alzheimer’s and Parkinson’s diseases (67). Research has revealed that magnesium supplementation can reduce concussion symptoms in adolescents following injury (67). Youth aged 9 to 13 years of age need 240 mg of magnesium per day (23). Older adolescent, males aged 14-18 years of age need 410 mg or magnesium per day while their female counterparts need 360 mg per day. Good food sources of magnesium include almonds, cashews, peanut butter, and spinach (27).
Flavonoids: Lastly, flavonoids are phytochemicals found in many fruits and vegetables, that have anti-inflammatory and antioxidant effects, which may reduce swelling after a mTBI (28). Blueberries contain high amounts of flavonoids including anthocyanins, which contribute to the blueberry’s dark color (11). Anthocyanins could lower brain inflammation and stress caused by mTBI (30). Laboratory studies have shown beneficial effects from blueberry supplementation on various cognitive performance outcomes and symptoms following a mTBI (43, 68). Therefore, consuming foods high in flavonoids, including blueberries, could offer a benefit for healing from a head injury.
This lesson concludes with additional nutritional considerations for those recovering from a mTBI. For example, it is suggested to eliminate the consumption of caffeine following a mTBI (65). Other suggestions include taking note of any foods or drinks that cause vomiting or feelings of nausea, and reducing their consumption for a period of time while mTBI symptoms decrease (72).
Lesson E: Nutrition and Sleep for Injury Reduction and Recovery
This lesson highlights the importance of sleep for performance and injury recovery (19, 49). Youth athletes not getting enough sleep are 1.7 times more likely to get injured (52). School-aged children need 9-11 hours of sleep each night, while teenagers need 8-10 hours of sleep per night (31). It is likely an injured athlete should aim for the upper amount of sleep needed per day. Currently, adolescents aged 13-18 years of age are getting on average 7.7 hours of sleep per night, slightly less than the minimum amount needed (48). Several nutrients have been identified that can naturally aid in hormone regulation associated with sleep (55).
Melatonin: Melatonin is a hormone secreted by the pineal gland that is involved in circadian rhythm and increases total sleep time and may reduce time to fall asleep (13, 55). It is found naturally in several foods including tart cherries (18, 51). In addition, tart cherries include other constituents that have anti-inflammatory and antioxidant effects, which may aid in sleep and recovery (8). Other foods with a high melatonin content include milk, pineapples, oranges, and bananas (18, 55).
Serotonin: Serotonin is another hormone involved in sleep by synthesizing hypogenic substances that influence sleep quality (7, 55). Kiwi fruits are a good source of serotonin and contain several minerals, dietary fiber, and phytochemicals that also may aid in sleep (18, 55).
This section of the lesson also includes other nutritional considerations for quality sleep. For example, some foods that contain caffeine, can make it difficult to fall asleep and the recommendation is to reduce or eliminate its intake closer to bedtime (33). This lesson concludes with tips on how to establish an effective sleep routine such as minimizing screen time before it (33).
Lesson F: Gastrointestinal Issues and Sport
This lesson addresses common GI issues encountered in sport and concludes with practical applications for maintaining gut health.
Nausea and Vomiting: Nausea and vomiting are frequent complaints among athletes across various disciplines (77). These symptoms may result from elevated levels of norepinephrine reducing splanchnic blood flow to the gut, delayed gastric emptying, or increased production of gastric bile acids (77). This lesson outlines several risk factors that may contribute to these symptoms along with simple strategies to help prevent them.
Diarrhea: Diarrhea is a common condition experienced by athletes, particularly among endurance athletes (77). Proposed mechanisms include the secretion of vasoactive intestinal peptide which relaxes smooth muscle in the digestive system (35), and changes in gut motility (77). Many of the risk factors associated with diarrhea overlap with those linked to nausea and vomiting. This section concludes with evidence-informed approaches for minimizing the risk of diarrhea during training and competition.
Heartburn: Heartburn is another GI issue sometimes encountered by athletes during exercise and sport and can be caused by increased abdominal pressure, changes in posture, and changes in exercise intensity (74). Additionally, consuming large meals prior to exercise, not being properly hydrated, and having high levels of stress or anxiety can also trigger heartburn. Chronic heartburn could be caused by gastroesophageal reflux disease or GERD (74). This section provides strategies to prevent heartburn during practice or a game, with an emphasis on taking note of such foods that sometimes cause heartburn in an individual.
This lesson concludes by discussing several strategies to maintain gut health and gut microbiota which may impact immunological function and thus injury risk and recovery from them (75). Rationale for its inclusion within this lesson is from the US Olympic & Paralympic Committee sports nutrition handout on nutrients for GI injury (71). Consuming foods high in probiotics may maintain digestion and absorption while also preventing several GI issues described in this lesson (71). Prebiotic fibers are a type of fermentable fiber that stimulates intestinal bacteria growth and activity (64). In addition, prebiotic fiber consumption is associated with several other benefits including increasing the absorption of calcium, improving cognitive health, and reducing risk of some diseases (14). Therefore, it is important to incorporate prebiotic fibers into one’s diet.
CONCLUSIONS
Nutrition is a cornerstone of health and performance for adolescent athletes not only supporting their growth and development but also their ability to train, compete, and recover effectively (15). Integrating sound nutrition practices into youth athlete development programs is essential for promoting lifelong well-being and optimal athletic potential (16). In addition to enhancing performance, proper nutrition can play a key role in preventing injuries and accelerating recovery when injuries occur (3). To emphasize these critical areas, several new lesson have been added as targeted addendums to the PHP curriculum (25). When combined with the original PHP content, these additions aim to strengthen both general and sport-specific nutrition behaviors, equipping young athletes with the knowledge and habits needed to thrive on and off the field.
Following an injury, it is important to consume adequate kcals from protein, carbohydrates, and unsaturated fatty acids, along with being properly hydrated to facilitate recovery (3). Emphasizing certain micronutrients from food may also improve recovery from injury (3). Additionally, nutritional support is needed for athletes recovering from an mTBI (65). LEA is a common problem in youth sports and understanding its consequences and how to prevent it are important for reducing injury risk (9). Getting adequate sleep is important not only for athletic performance, but also injury prevention and healing from an injury (19, 49). Although not a direct injury caused by sport, GI issues can occur during it, and can be prevented using evidence-based nutritional strategies (77). Next steps are to examine adolescent knowledge of nutritional best practices for recovering from sports-induced injuries.
APPLICATIONS IN SPORT
These supplemental lessons are to serve as adjunct lessons to the PHP curriculum and to provide youth athletes with knowledge on injury management and other sports nutrition topics not otherwise discussed in athletic circles. Additionally, the hope is to encourage further research in this understudied area and add to the growing body of literature examining nutrition practices for injury management in youth athletes.
REFERENCES
1. Ainsley Dean, P. J., Arikan, G., Opitz, B., & Sterr, A. (2017). Potential for use of creatine supplementation following mild traumatic brain injury. Concussion, 2(2), Cnc34. https://doi.org/10.2217/cnc-2016-0016
2. Al-Qahtani, M. A., Allajhar, M. A., Alzahrani, A. A., Asiri, M. A., Alsalem, A. F., Alshahrani, S. A., & Alqahtani, N. M. (2023). Sports-related injuries in adolescent athletes: A systematic review. Cureus, 15(11), e49392. https://doi.org/10.7759/cureus.49392
3. Alcock, R., Hislop, M., Vidgen, H. A., & Desbrow, B. (2024). Youth and adolescent athlete musculoskeletal health: Dietary and nutritional strategies to optimise injury prevention and support recovery. Journal of Functional Morphology and Kinesiology, 9(4). https://doi.org/10.3390/jfmk9040221
4. Becker, T. B., & Gibbs, R. L. (2024). Changes in nutrition, food safety, and physical activity behaviors: A comparison between the Peak Health and Performance and Teen Cuisine Curricula. Journal of Human Sciences and Extension, 12(3), 10.
5. Beech, J., Jones, B., Hughes, T., & Emmonds, S. (2024). Injury profile in youth female athletes: A systematic review and meta-analysis. Sports Medicine, 54(5), 1207-1230. https://doi.org/10.1007/s40279-023-01988-w
6. Bird, S. P., & Rushton, B. D. (2020). Nutritional knowledge of youth academy athletes. BMC Nutrition, 6, 35. https://doi.org/10.1186/s40795-020-00360-9
7. Cespuglio, R. (2018). Serotonin: its place today in sleep preparation, triggering or maintenance. Sleep Medicine, 49, 31-39. https://doi.org/https://doi.org/10.1016/j.sleep.2018.05.034
8. Chai, S. C., Davis, K., Zhang, Z., Zha, L., & Kirschner, K. F. (2019). Effects of tart cherry juice on biomarkers of inflammation and oxidative stress in older adults. Nutrients, 11(2). https://doi.org/10.3390/nu11020228
9. Charlton, B. T., Forsyth, S., & Clarke, D. C. (2022). Low energy availability and relative energy deficiency in sport: What coaches should know. International Journal of Sports Science & Coaching, 17(2), 445-460. https://doi.org/10.1177/17479541211054458
10. Chodkowski, J. (2024). The role of nutrition and hydration in injury prevention and recovery: A review. Journal of Educcation Health and Sport, 71, 56117.
11. Conti, F., McCue, J. J., DiTuro, P., Galpin, A. J., & Wood, T. R. (2024). Mitigating traumatic brain injury: A narrative review of supplementation and dietary protocols. Nutrients, 16(15), 2430. https://www.mdpi.com/2072-6643/16/15/2430
12. Costa, R. J. S., Snipe, R. M. J., Kitic, C. M., & Gibson, P. R. (2017). Systematic review: exercise-induced gastrointestinal syndrome-implications for health and intestinal disease. Aliment Pharmacolology and Therapeutics, 46(3), 246-265. https://doi.org/10.1111/apt.14157
13. Costello, R. B., Lentino, C. V., Boyd, C. C., O’Connell, M. L., Crawford, C. C., Sprengel, M. L., & Deuster, P. A. (2014). The effectiveness of melatonin for promoting healthy sleep: a rapid evidence assessment of the literature. Nutrition Journal, 13, 106. https://doi.org/10.1186/1475-2891-13-106
14. Davani-Davari, D., Negahdaripour, M., Karimzadeh, I., Seifan, M., Mohkam, M., Masoumi, S. J., Berenjian, A., & Ghasemi, Y. (2019). Prebiotics: Definition, types, sources, mechanisms, and clinical applications. Foods, 8(3). https://doi.org/10.3390/foods8030092
15. Desbrow, B. (2021). Youth athlete development and nutrition. Sports Medicine, 51(Suppl 1), 3-12. https://doi.org/10.1007/s40279-021-01534-6
16. Desbrow, B., Burd, N. A., Tarnopolsky, M., Moore, D. R., & Elliott-Sale, K. J. (2019). Nutrition for special populations: Young, female, and masters athletes. International Journal of Sport Nutrition and Exercise Metabolism, 29(2), 220-227. https://doi.org/10.1123/ijsnem.2018-0269
17. Desbrow, B., McCormack, J., Burke, L. M., Cox, G. R., Fallon, K., Hislop, M., Logan, R., Marino, N., Sawyer, S. M., Shaw, G., Star, A., Vidgen, H., & Leveritt, M. (2014). Sports Dietitians Australia position statement: sports nutrition for the adolescent athlete. International Journal of Sport Nutrition and Exercise Metabolism, 24(5), 570-584. https://doi.org/10.1123/ijsnem.2014-0031
18. Doherty, R., Madigan, S., Warrington, G., & Ellis, J. (2019). Sleep and nutrition interactions: Implications for athletes. Nutrients, 11(4). https://doi.org/10.3390/nu11040822
19. Dwivedi, S., Boduch, A., Gao, B., Milewski, M. D., & Cruz, A. I. J. (2019). Sleep and injury in the young athlete. The Journal of Bone and Joint Surgery Reviews, 7(9), e1. https://doi.org/10.2106/jbjs.Rvw.18.00197
20. Dwyer, J. T., Coates, P. M., & Smith, M. J. (2018). Dietary supplements: Regulatory challenges and research resources. Nutrients, 10(1). https://doi.org/10.3390/nu10010041
21. Faizan, U., & Rouster, A. S. (2024). Nutrition and hydration requirements in children and adults. In StatPearls. StatPearls Publishing. Copyright © 2024, StatPearls Publishing LLC.
22. Finnegan, E., Daly, E., Pearce, A. J., & Ryan, L. (2022). Nutritional interventions to support acute mTBI recovery. Frontiers in Nutrition, 9, 977728. https://doi.org/10.3389/fnut.2022.977728
23. Food and Nutrition Board, & Institute of Medicine. (2006). Dietary Reference Intakes: The essential guide to nutrient requirements. National Academies Press.
24. Gibbs, R. L., & Becker, T. B. (2025). General and sport-specific nutrition knowledge and behaviors of adolescent athletes. Journal of the Internation Society of Sports Nutrition, 22(1), 2477060. https://doi.org/10.1080/15502783.2025.2477060
25. Gibbs, R. L., Jr., & Becker, T. B. (2021). An evidence-based sports nutrition curriculum for youth. The Sport Journal, 24(6), 6-unpaginated. <Go to ISI>://CABI:20210342440
26. Giraldo-Vallejo, J. E., Cardona-Guzmán, M., Rodríguez-Alcivar, E. J., Kočí, J., Petro, J. L., Kreider, R. B., Cannataro, R., & Bonilla, D. A. (2023). Nutritional strategies in the rehabilitation of musculoskeletal injuries in athletes: A systematic integrative review. Nutrients, 15(4). https://doi.org/10.3390/nu15040819
27. Gropper, S. S., Smith, J. L., & Carr, T. P. (2018). Advanced nutrition and human metabolism. (7 ed.). Cengage Learning.
28. Hasan, S., Khatri, N., Rahman, Z. N., Menezes, A. A., Martini, J., Shehjar, F., Mujeeb, N., & Shah, Z. A. (2023). Neuroprotective potential of flavonoids in brain disorders. Brain Sciences, 13(9). https://doi.org/10.3390/brainsci13091258
29. Heikura, I. A., Uusitalo, A. L. T., Stellingwerff, T., Bergland, D., Mero, A. A., & Burke, L. M. (2018). Low energy availability is difficult to assess but outcomes have large impact on bone injury rates in elite distance athletes. International Journal of Sport Nutrition and Exercise Metabolism, 28(4), 403-411. https://doi.org/10.1123/ijsnem.2017-0313
30. Henriques, J. F., Serra, D., Dinis, T. C. P., & Almeida, L. M. (2020). The anti-neuroinflammatory role of anthocyanins and their metabolites for the prevention and treatment of brain disorders. International Journal of Molecular Sciences, 21(22). https://doi.org/10.3390/ijms21228653
31. Hirshkowitz, M., Whiton, K., Albert, S. M., Alessi, C., Bruni, O., DonCarlos, L., Hazen, N., Herman, J., Adams Hillard, P. J., Katz, E. S., Kheirandish-Gozal, L., Neubauer, D. N., O’Donnell, A. E., Ohayon, M., Peever, J., Rawding, R., Sachdeva, R. C., Setters, B., Vitiello, M. V., & Ware, J. C. (2015). National Sleep Foundation’s updated sleep duration recommendations: Final report. Sleep Health, 1(4), 233-243. https://doi.org/10.1016/j.sleh.2015.10.004
32. Hulland, S. C., Trakman, G. L., & Alcock, R. D. (2023). Adolescent athletes have better general than sports nutrition knowledge and lack awareness of supplement recommendations: a systematic literature review. British Journal of Nutrition, 1-15. https://doi.org/10.1017/s0007114523002799
33. Imbergamo, C. M., Patankar, A. G., & Milewski, M. D. (2021). Sleep optimization in the young athlete. Journal of the Pediatric Orthopaedic Society of North America, 3(3), 306. https://doi.org/https://doi.org/10.55275/JPOSNA-2021-306
34. Institute of Medicine of the National Academies. (2006). Dietary Reference Intakes. The essential guide to nutrient requirements. The National Academies Press.
35. Iwasaki, M., Akiba, Y., & Kaunitz, J. D. (2019). Recent advances in vasoactive intestinal peptide physiology and pathophysiology: focus on the gastrointestinal system. F1000Research, 8. https://doi.org/10.12688/f1000research.18039.1
36. Karwowska, M., & Kononiuk, A. (2020). Nitrates/nitrites in food-risk for nitrosative stress and benefits. Antioxidants (Basel), 9(3). https://doi.org/10.3390/antiox9030241
37. Kenney, E. L., Long, M. W., Cradock, A. L., & Gortmaker, S. L. (2015). Prevalence of inadequate hydration among US children and disparities by gender and race/ethnicity: National Health and Nutrition Examination Survey, 2009-2012. American Journal of Public Health, 105(8), e113-118. https://doi.org/10.2105/ajph.2015.302572
38. Kerr, Z. Y., Chandran, A., Nedimyer, A. K., Arakkal, A., Pierpoint, L. A., & Zuckerman, S. L. (2019). Concussion Incidence and Trends in 20 High School Sports. Pediatrics, 144(5). https://doi.org/10.1542/peds.2019-2180
39. Koon, G., Atay, O., & Lapsia, S. (2017). Gastrointestinal considerations related to youth sports and the young athlete. Translational Pediatrics, 6(3), 129-136. https://doi.org/10.21037/tp.2017.03.10
40. Kozhuharov, V. R., Ivanov, K., & Ivanova, S. (2022). Dietary supplements as source of unintentional doping. BioMed Research International, 2022, 8387271. https://doi.org/10.1155/2022/8387271
41. Krabak, B. J., Roberts, W. O., Tenforde, A. S., Ackerman, K. E., Adami, P. E., Baggish, A. L., Barrack, M., Cianca, J., Davis, I., D’Hemecourt, P., Fredericson, M., Goldman, J. T., Harrast, M. A., Heiderscheit, B. C., Hollander, K., Kraus, E., Luke, A., Miller, E., Moyer, M.,…Wasfy, M. M. (2021). Youth running consensus statement: minimising risk of injury and illness in youth runners. British Journal of Sports Medicine, 55(6), 305-318. https://doi.org/10.1136/bjsports-2020-102518
42. Kreider, R. B., Kalman, D. S., Antonio, J., Ziegenfuss, T. N., Wildman, R., Collins, R., Candow, D. G., Kleiner, S. M., Almada, A. L., & Lopez, H. L. (2017). International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. Journal of the International Society of Sports Nutrition, 14, 18. https://doi.org/10.1186/s12970-017-0173-z
43. Krishna, G., Ying, Z., & Gomez-Pinilla, F. (2019). Blueberry supplementation mitigates altered brain plasticity and behavior after traumatic brain injury in fats. Molecular Nutrition & Food Research, 63(15), e1801055. https://doi.org/10.1002/mnfr.201801055
44. Logue, D. M., Madigan, S. M., Melin, A., Delahunt, E., Heinen, M., Donnell, S. M., & Corish, C. A. (2020). Low energy availability in athletes 2020: An updated narrative review of prevalence, risk, within-day energy balance, knowledge, and impact on sports performance. Nutrients, 12(3). https://doi.org/10.3390/nu12030835
45. Maier, J. A. M., Locatelli, L., Fedele, G., Cazzaniga, A., & Mazur, A. (2022). Magnesium and the brain: A focus on neuroinflammation and neurodegeneration. International Journal of Molecular Sciences, 24(1). https://doi.org/10.3390/ijms24010223
46. Manore, M. M., Patton-Lopez, M. M., Meng, Y., & Wong, S. S. (2017). Sport nutrition knowledge, behaviors and beliefs of high school soccer players. Nutrients, 9(4). https://doi.org/10.3390/nu9040350
47. Marshall, R. N., Smeuninx, B., Morgan, P. T., & Breen, L. (2020). Nutritional strategies to offset disuse-induced skeletal muscle atrophy and anabolic resistance in older adults: From whole-foods to isolated ingredients. Nutrients, 12(5). https://doi.org/10.3390/nu12051533
48. Maslowsky, J., & Ozer, E. J. (2014). Developmental trends in sleep duration in adolescence and young adulthood: evidence from a national United States sample. Journal of Adolescent Health, 54(6), 691-697. https://doi.org/10.1016/j.jadohealth.2013.10.201
49. Mason, L., Connolly, J., Devenney, L. E., Lacey, K., O’Donovan, J., & Doherty, R. (2023). Sleep, nutrition, and injury risk in adolescent athletes: A narrative review. Nutrients, 15(24). https://doi.org/10.3390/nu15245101
50. Melin, A. K., Areta, J. L., Heikura, I. A., Stellingwerff, T., Torstveit, M. K., & Hackney, A. C. (2024). Direct and indirect impact of low energy availability on sports performance. Scandinavian Journal of Medicine & Science in Sports, 34(1), e14327. https://doi.org/10.1111/sms.14327
51. Meng, X., Li, Y., Li, S., Zhou, Y., Gan, R. Y., Xu, D. P., & Li, H. B. (2017). Dietary sources and bioactivities of melatonin. Nutrients, 9(4). https://doi.org/10.3390/nu9040367
52. Milewski, M. D., Skaggs, D. L., Bishop, G. A., Pace, J. L., Ibrahim, D. A., Wren, T. A., & Barzdukas, A. (2014). Chronic lack of sleep is associated with increased sports injuries in adolescent athletes. Journal of Pediatric Orthopaedics, 34(2), 129-133. https://doi.org/10.1097/bpo.0000000000000151
53. Nazem, T. G., & Ackerman, K. E. (2012). The female athlete triad. Sports Health, 4(4), 302-311. https://doi.org/10.1177/1941738112439685
54. Papadopoulou, S. K. (2020). Rehabilitation nutrition for injury recovery of athletes: The Role of macronutrient intake. Nutrients, 12(8). https://doi.org/10.3390/nu12082449
55. Pattnaik, H., Mir, M., Boike, S., Kashyap, R., Khan, S. A., & Surani, S. (2022). Nutritional elements in sleep. Cureus, 14(12), e32803. https://doi.org/10.7759/cureus.32803
56. Prus, D., Mijatovic, D., Hadzic, V., Ostojic, D., Versic, S., Zenic, N., Jezdimirovic, T., Drid, P., & Zaletel, P. (2022). (Low) energy availability and its association with injury occurrence in competitive dance: Cross-sectional analysis in female dancers. Medicina (Kaunas), 58(7). https://doi.org/10.3390/medicina58070853
57. QuickStats: Rates of injury from sports, recreation, and leisure activities among children and adolescents aged 1–17 years, by age group — National Health Interview Survey, United States, 2015–2017. (2019). Morbidity and Mortality Weekly Report, 68, 466.
58. Quintero, K. J., Resende, A. d. S., Leite, G. S. F., & Lancha Junior, A. H. (2018). An overview of nutritional strategies for recovery process in sports-related muscle injuries. Nutrire, 43(1), 27. https://doi.org/10.1186/s41110-018-0084-z
59. Raj, M., Creech, J., & Rogol, A. (2024). Female athlete triad. StatPearls Publishing. Retrieved February 3 from https://www.ncbi.nlm.nih.gov/books/NBK430787/
60. Rojano-Ortega, D., Peña Amaro, J., Berral-Aguilar, A. J., & Berral-de la Rosa, F. J. (2022). Effects of beetroot supplementation on recovery after exercise-induced muscle damage: A systematic review. Sports Health, 14(4), 556-565. https://doi.org/10.1177/19417381211036412
61. Ryan, J. L., Pracht, E. E., & Orban, B. L. (2019). Inpatient and emergency department costs from sports injuries among youth aged 5-18 years. BMJ Open Sport & Exercise Medicine, 5(1), e000491. https://doi.org/10.1136/bmjsem-2018-000491
62. Ryan, T., Nagle, S., Daly, E., Pearce, A. J., & Ryan, L. (2023). A potential role exists for nutritional interventions in the chronic phase of mild traumatic brain injury, concussion and sports-related concussion: A systematic review. Nutrients, 15(17). https://doi.org/10.3390/nu15173726
63. Sheehan, N., Summersby, R., Bleakley, C., Caulfield, B., Matthews, M., Klempel, N., & Holden, S. (2024). Adolescents’ experience with sports-related pain and injury: A systematic review of qualitative research. Physical Therapy in Sport, 68, 7-21. https://doi.org/https://doi.org/10.1016/j.ptsp.2024.05.003
64. Slavin, J. (2013). Fiber and prebiotics: mechanisms and health benefits. Nutrients, 5(4), 1417-1435. https://doi.org/10.3390/nu5041417
65. Smith-Ryan, A. E., Hirsch, K. R., Saylor, H. E., Gould, L. M., & Blue, M. N. M. (2020). Nutritional considerations and strategies to facilitate injury recovery and rehabilitation. Journal of Athletic Training, 55(9), 918-930. https://doi.org/10.4085/1062-6050-550-19
66. Smith, J. W., Holmes, M. E., & McAllister, M. J. (2015). Nutritional considerations for performance in young athletes. Journal of Sports Medicine (Hindawi Publ Corp), 2015, 734649. https://doi.org/10.1155/2015/734649
67. Standiford, L., O’Daniel, M., Hysell, M., & Trigger, C. (2021). A randomized cohort study of the efficacy of PO magnesium in the treatment of acute concussions in adolescents. The American Journal of Emergency Medicine, 44, 419-422. https://doi.org/https://doi.org/10.1016/j.ajem.2020.05.010
68. Sweeney, M. I., Kalt, W., MacKinnon, S. L., Ashby, J., & Gottschall-Pass, K. T. (2002). Feeding rats diets enriched in lowbush blueberries for six weeks decreases ischemia-induced brain damage. Nutritional Neuroscience, 5(6), 427-431. https://doi.org/10.1080/1028415021000055970
69. Thomas, D. T., Erdman, K. A., & Burke, L. M. (2016). Position of the Academy of Nutrition and Dietetics, Dietitians of Canada, and the American College of Sports Medicine: Nutrition and athletic performance. Journal of the Academy of Nutrition and Dietetics, 116(3), 501-528. https://doi.org/10.1016/j.jand.2015.12.006
70. United States Olypmic & Paralymipic Committee Sport Nutrition Team. (2020a). Low energy availability. Retrieved December 17 from chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://assets.contentstack.io/v3/assets/blt9e58afd92a18a0fc/bltaa7a0653bc475a00/6470c42af0d737510db117f0/LEA_Fact_Sheet.pdf
71. United States Olypmic & Paralymipic Committee Sport Nutrition Team. (2020b). Nutrients for GI injury. Retrieved December 17 from https://assets.contentstack.io/v3/assets/blt9e58afd92a18a0fc/bltea94cc2ce765e25a/6470c42b20efde585ba537d8/NutrientsforGIInjury2020.pdf
72. United States Olypmic & Paralymipic Committee Sport Nutrition Team. (2020c). Nutrients for head injury recovery. Retrieved December 17 from https://assets.contentstack.io/v3/assets/blt9e58afd92a18a0fc/blta749d96eff2de64b/6470c42baf1a6843564609ee/NutrientsforHeadInjury2020.pdf
73. Wardenaar, F. C., Schott, K. D., Mohr, A. E., Ortega-Santos, C. P., & Connolly, J. E. (2023). An exploratory study investigating the prevalence of gastrointestinal symptoms in collegiate division I American football athletes. International Journal of Environ Research and Public Health, 20(15). https://doi.org/10.3390/ijerph20156453
74. Waterman, J. J., & Kapur, R. (2012). Upper gastrointestinal issues in athletes. Current Sports Medicine Reports, 11(2), 99-104. https://doi.org/10.1249/JSR.0b013e318249c311
75. Wiertsema, S. P., van Bergenhenegouwen, J., Garssen, J., & Knippels, L. M. J. (2021). The interplay between the gut microbiome and the immune system in the context of infectious diseases throughout life and the role of nutrition in optimizing treatment strategies. Nutrients, 13(3). https://doi.org/10.3390/nu13030886
76. Zamani, H., de Joode, M. E. J. R., Hossein, I. J., Henckens, N. F. T., Guggeis, M. A., Berends, J. E., de Kok, T. M. C. M., & van Breda, S. G. J. (2021). The benefits and risks of beetroot juice consumption: a systematic review. Critical Reviews in Food Science and Nutrition, 61(5), 788-804. https://doi.org/10.1080/10408398.2020.1746629
77. Zaslow, T., & Mitrovich, C. (2023). Chapter 16 – Gatrointestinal and abdominal issues. In B. J. Krabak & A. Brooks (Eds.), The Youth Athlete (pp. 159-172). Academic Press. https://doi.org/https://doi.org/10.1016/B978-0-323-99992-2.00090-6




