1. 1 Jennifer Sacheck, PhD Tufts University Friedman School of Nutrition Science & Policy John Hancock Center on Physical Activity, Nutrition, and Obesity Prevention Youth Exercise & Sport – Relevance of “Sports” Nutrition?

2. The National Crisis 2 ~32% Kids 2-19 yrs ~69% Adults APOP, IOM, 2012

3. Energy In vs. Energy Out Dietary Intake Physical Activity

4. Food Advertising/ Marketing Aimed at Children Plethora of Low Cost/Energy Dense Foods Physical Education and Recess Cuts Development of Childhood Obesity Multi Media Saturation Increased Portion Sizes Energy IN Energy OUT Sugar Sweetened Beverage Consumption Frequent Eating Away from Home Declines in Physical Activity Changing Built Environment Less Sleep

5. Caloric Difference: 525 calories 1,025 calories 2 cups of pasta w/ sauce 3 large meatballs 20 Years AgoToday 500 calories 1 cup pasta w/ sauce 3 small meatballs SPAGHETTI & MEATBALLS We Eat Too Much….

6. Estimated Calorie Requirements by Age and Activity Level GenderAgeSedentary Activity Moderate Activity Active Young child 2-31,0001,000-1,400 Female 4-8 9-13 14-18 1,200 1,600 2,000 1,400-1,600 1,600-2,000 2,000 1,400-1,800 1,800-2,200 2,400 Male 4-8 9-13 14-18 1,400 1,800 2,200 1,400-1,600 1,800-2,200 2,400-2,800 1,600-2,000 2,000-2,600 2,800-3,200 (Institute of Medicine Dietary Reference Intakes, 2002)

8. W E E AT “D EAD F OOD ”

9. A ND M ORE “D EAD F OOD ”

10. Contribution of Solid Fats and Added Sugars to Energy Intake Among Children and Adolescents in the United States Reedy J, et al. J Am Diet Assoc; 2010; Volume 110 (Oct).

11. Food Sources and Mean Intake of Empty Calories for Male Children and Adolescents, Relative to Discretionary Calorie Allowance Males (by age) Discretionary calorie allowance 165 171 195 290 Data Source: NHANES 2003-04 Whole milk Soda

12. AND WHAT ABOUT SUGAR?..... WHITE, CANE, BEET, FRUIT, TABLE, BROWN, & HFCS….& HONEY, MAPLE SYRUP, & AGAVE

13. Sources of Dietary Added Sugars: Americans Ages 2+, NHANES 2005-2006

15. Total Television Food Advertising Exposure, by Age Rudd Report TRENDS IN TELEVISION FOOD ADVERTISING. Data Used from Nielsen Report (2008) Teens see 14 ads/day

16. 16 Lack of Physical Activity Can Johnny Come Out and Eat?

17. Physical Activity Guidelines for Children Children and adolescents should do 60 minutes or more of physical activity daily. Aerobic: Most of the 60 or more minutes a day should be either moderate- or vigorous-intensity aerobic physical activity, and should include vigorous-intensity physical activity at least 3 days a week. Muscle-strengthening: As part of their 60 or more minutes of daily physical activity, children and adolescents should include muscle- strengthening physical activity on at least 3 days of the week. Bone-strengthening: As part of their 60 or more minutes of daily physical activity, children and adolescents should include bone- strengthening physical activity on at least 3 days of the week.

18. Youth Meeting Physical Activity Guidelines Troiano R, et al. Medicine & Science in Sports & Exercise, 2008. Massachusetts Youth Risk Behavior Survey, 2011

19. Youth Cardiorespiratory Fitness 12-19 yrs (NHANES 1999-2002) ~65% of males and females met the standard Males Females Pate et al 2006 19

20. Built Environment & Free Play 20

21. Physical Education 21 150 min/week for elementary and 225 min/week of PE for middle and high school students APOP, IOM, 2012

22. Media Blitz 22 APOP, IOM, 2012

23. Contribution of Organized Sports to Physical Activity Recommendations Physical Activity During Youth Sports Practices Leek, D. et al. Arch Pediatr Adolesc Med 2010;0:archpediatrics.2010.252v1-6.

24. Moderate to Vigorous Physical Activity (MVPA) during Practice and Participants Meeting PA Guidelines by Sex

25. Contribution of Organized Sports to Physical Activity Recommendations: Physical Activity During Youth Indoor Soccer Games Sacheck, et al. Pediatric Exercise Science, 2010

26. Out of School Time – Organized Sports Time spent at various intensities of physical activity during a 50-min soccer match Values are means (SD). Moderate-to-vigorous activity (MVPA). * P < 0.05, ** P < 0.01, vs. females Sacheck et al, Ped Exer Sci, 2010

27. % Time spent in different intensities of physical activity during a 50-min soccer match by BMI category Values are means  SE. Different than normal weight individuals **P<0.01 N N Normal Weight Overweight/Obese N N Normal Weight Overweight/Obese

28. Estimated kcals for BMR, AEE, and TEE during a 50-min soccer match by BMI category BMR = basal metabolic rate; AEE = activity energy expenditure; TEE = total energy expenditure (BMR + AEE). Values are means  SE. Different than normal weight individuals *P<0.05, **P<0.01 N N Normal Weight Overweight/Obese N N Normal Weight Overweight/Obese

29. 29 Consequences

30. Poor Health Outcomes 30 WHO estimates that 1.9 million deaths worldwide are attributable to physical inactivity APOP, IOM, 2012

31. The Somerville FIT Study **P<0.001 BMIFitness <85th %tile>85th %tileFitUnfit (n=236)(n=194)(n=192)(n=206) Cholesterol (mg/dL)155.1 (24.4)158.8 (26.1)157.1 (26.0)156.2 (24.7) Triglycerides (mg/dL)73.3 (26.1)106.8 (61.4)**76.0 (25.9)100.5 (62.2)** HDL (mg/dL)56.1 (11.4)49.6 (10.6)**55.7 (10.7)50.9 (11.6)** LDL (mg/dL)84.4 (20.1)87.8 (22.7)86.3 (22.3)85.3 (20.6)

32. Combined Impact of Fitness & Fatness on Metabolic Risk Factors in Children 32 Black Bars = unfit

33. Mean Number of Fitness Tests Passed by BMI Percentile 33 Kim et al Obes Res 2005 End run, ab strength, flexibility, upper body strength and agility

34. What is happening? Obese children may: –have a more difficult time moving their body against gravity –Be more likely to have physical complications/pain during PA –perform less PA so that they also have less opportunity to practice and develop proficiency –have fewer opportunities for and have less enjoyment in PA 34

35. Adult Fitness, BMI and CVD Mortality in Men Fitness trumps “fatness” (Aerobics Center Longitudinal Study) 35 Lee et al Circulation 2011

36. Student Academic Achievement 36

37. Likelihood of Passing Academic Tests For Each Fitness Test Passed by Massachusetts Students in Grades 4 to 8 Chomitz V, et al. Journal of School Health, 2009. Odds of passing increased by 24% per test passed Odds of passing increased by 38% per test passed

38. Kids: Sports Nutrition Issues Consuming adequate calories Eating consistent meals Getting a good balance of foods/nutrients (carbohydrate, protein, & fat) Refueling after exercise Drinking enough fluids –Most appropriate fluids Inappropriate use of sports drinks, bars and supplements

39. Estimated Calorie Requirements by Age and Activity Level GenderAgeSedentary Activity Moderate Activity Active Young child 2-31,0001,000-1,400 Female 4-8 9-13 14-18 1,200 1,600 2,000 1,400-1,600 1,600-2,000 2,000 1,400-1,800 1,800-2,200 2,400 Male 4-8 9-13 14-18 1,400 1,800 2,200 1,400-1,600 1,800-2,200 2,400-2,800 1,600-2,000 2,000-2,600 2,800-3,200 (Institute of Medicine Dietary Reference Intakes, 2002)

40. Macronutrient Needs Protein: 10-30% calories Carbohydrate: 45 to 65% calories Fat: 25-35% calories –5 to 10% as linoleic acid –0.6 to 1.2% as linolenic acid RDAMalesFemales Protein (g/day) 9-13 yr34 14-18 yr5246 Carbohydrate (g/day) 9-13 yr130 14-18 yr130

41. Protein Needs: 0.8-1.2 g/kg/day Recommended Dietary Allowance for Protein Grams of protein needed each day Children ages 1 – 313 Children ages 4 – 819 Children ages 9 – 1334 Girls ages 14 – 1846 Boys ages 14 – 1852 Women ages 19 – 70+46 Men ages 19 – 70+56 Here are examples of amounts of protein in food: 1 cup of milk has 8 grams of protein A 3-ounce piece of meat has about 21 grams of protein 1 cup of dry beans has about 16 grams of protein An 8-ounce container of yogurt has about 11 grams of protein

42. WHAT TO EAT? –2/3 carbohydrates: 1/3 bread, bagels, cereal, rice, pasta, crackers, pretzels 1/3 vegetables, beverages –1/3 protein OR LESS: Meat, poultry, fish, dairy foods, nuts, seeds, soy foods, dried beans, eggs

43. Nutrient Needs: Critical Minerals Calcium –Most important for obtaining peak bone mass at this age Iron –Increased need related to rapid rate of linear growth, increase in blood volume, and in females, onset of menarche Zinc –Required for sexual maturation, important co- factor in enzymes MalesFemales Calcium (mg/day), AI 9-181300 (700-1150 actual intake) 1300 (550-800 actual intake ) Iron (mg/day), RDA 9-1388 14-181115 Zinc (mg/day), RDA 9-1388 14-18119

44. Thermal Stress and Children Children rely more on convection and radiation, which are enhanced through greater peripheral vasodilation Evaporative heat loss is lower because of reduced sweat rates Children have greater ratios of surface area to mass Acclimatization to heat is slower in boys than in adult men (no data available for girls)

45. Water is critical for endurance performance!

46. And What About All Those Drinks???

47. Sport Drinks Uniquely designed to meet both energy and fluid needs of athletes Composition influences gastric emptying Carbohydrate solutions empty more slowly Most sports drinks contain: –6-8% CHO in the form of glucose and glucose polymers –20-60 mmol/L sodium Adding glucose stimulates sodium and water absorption Sodium increases thirst

48. Who Really Needs Sports Drinks? American Academy of Pediatrics: –“If children are participating in prolonged vigorous physical activity in hot, humid conditions for more than one hour, small amounts of sports drinks may be appropriate” 2010 National Youth PA & Nutrition Study –16% drank at least one serving/day –9% drank at least two servings/day Participation in varsity sports: 33% (girls) 37% (boys) Johnston LD, et al. Am J Prev Med 2007; Volume 33 (Oct).

49. Hydration BEFORE – Water! 1-2 hours before: 2-1/2 cups (20 oz.) 15-30 min before: 1-1/2 cups (12 oz.) DURING – Water! 8 oz every 15-20 min diluted fruit juice, sports drinks (6-8%) IF exercise is >60 min AFTER – Water! Drink 2 cups for each pound lost Weigh yourself before and after exercise Don’t trust thirst Avoid caffeine

50. Caffeine Benefits Increases: Mental alertness Concentration Catecholamine release Use of fats by muscles Decreases fatigue & lowers perception of effort Improves endurance performance –May improve sprint/strength performance Potential side-effects Increased urination Gastrointestinal distress Tremors Decreased sleep Nervousness/Anxiety symptoms Irregular heart rate/rhythm

51. Ergogenic Aids Ergogenic = “work-producing” Performance enhancers Many product claims –Energy, enhance performance, change body composition This includes ergogenic aids that are: –Pharmacological – amphetamines, caffeine, diuretics –Hormonal – anabolic steroids, oral contraceptives –Physiological –Nutritional –Psychological –Biomechanical

52. Four Important Questions Effective? –Advertisements –Popular press –Anecdotal evidence –Personal experience –Research and science Safe? –Toxicity and knowledge Legal? –Determined by governing body of the sport Ethical? –Moral, guiding principles

53. Sports Supplements Natural and safe are NOT the same Supplements can interfere with medications More is NOT BETTER Tell someone what you take, or are planning to take Be informed, and be cautious with supplements, as what you don’t know may hurt you!

54. And What About Those Bars???

55. Nutrition Facts We eat FOOD, NOT nutrients Athletes need carbohydrate, protein and fat- containing foods daily We can be selective about the types of foods we choose to eat: Fish instead of a hot dog Kashi instead of Fruit Loops Peanut butter instead of bacon

56. Bottom Line!! Food, fluid, and rest are essential for peak mind and body performance Food choices, timing, and amounts matter Foster POSITIVE environments

57. Healthy Kids Out of School Unite out-of-school organizations around nutrition and physical activity principles and providing the resources to help them become effective venues for childhood obesity prevention.

59. Three Guiding Principles Drink Right: Choose water instead of sugar-sweetened beverages. Move More: Boost movement and physical activity in all programs. Snack Smart: Fuel up on fruits and vegetables.

60. Healthy Kids Hub website